Protecting Ethnic Elders In Nursing Homes

ST. LOUIS - Sheryl Wilson always thought the large house on Florissant Avenue was a place only rich people could go. It must be a country club, thought Wilson, a nurse who has lived her whole life in the largely African-American community of North St. Louis.

The perfect irony is: The grand old house is actually the Little Sisters of the Poor, a home for impoverished elders. Catholic nuns live there. Elders who fall below the poverty line live there, as they have since 1869 – elders of other denominations. You don’t have to be Catholic to find a home there.

Now, 36 years later, Wilson is the staff development coordinator at Little Sisters. She has innumerable stories about the sisters’ compassion and kindness. She has learned that Little Sisters sets the standard for long-term elder care, a field rife with harsh or neglectful treatment of seniors, especially those with low incomes. (See Part 1 of this series.)

In fact, Little Sisters in North St. Louis has a five-star rating on the Medicare.gov website.

With its apartments, independent living, 67-bed nursing home for very frail seniors and community center, the facility soars above many other nursing homes in the ratings for positive health-inspection reports and low staff-patient ratios showing the facility has enough nurses and aides on hand to take good care of residents.

Help for Ethnic Seniors

But as most seniors and their family members know, ideal places to grow old are few and far between in the United States, particularly for lower-income ethnic elders, who rely largely on Medicaid to cover their care.

For most families, finding a decent nursing home placement is a nightmare -- an emotional rollercoaster -- a process most people know nothing about until it smacks them in the face.

With the right resources and information, though, the in-depth process of finding a nursing home for oneself or a frail parent – often a unexpected need following a medical episode -- can lead to suitable living situations for residents. But, without knowing their rights, elders can get taken advantage of.

One important public resource is the local long-term care (LTC) ombudsman program. These consumer advocacy offices are mandated and funded under the federal Older Americans Act in every U.S. community.

Cheryl Wilson, director of the Long-Term Care Ombudsman Program in St. Louis (unrelated to Sheryl), noted that a majority of her calls come from white elders, because fewer African-American or other ethnic seniors or their families seek advocates or know the program exists.

Wilson encourages more ethnic families to contact offices such as hers, if a problem emerges with their nursing home care.

State Inspection Reports

By visiting http://www.medicare.gov/NHCompare/home.asp, one can look through state inspection reports for each nursing home. The rating system looks at health inspections, nursing home staffing and quality measures. One can also compare a few different nursing homes’ ratings on the Medicare.gov website.

That’s a good place to start, Wilson said, but Medicare typically takes three to six months to post new inspection results.

“Too many things change in a long-term care facility. If it was a five-star facility in January, that doesn’t mean in March it’s a five-star facility,” she said.

Families should take a tour of the facility and ask for the statement of deficiencies survey, which all nursing homes are required to display. This survey is more up-to-date than the state inspection reports.

On the tour, the family should take a non-family member, who isn’t as emotionally attached to the situation, Wilson said. And if possible, take the potential resident.

In addition, the family should visit the home three times at different times of the day, if they can.

Warning signs and advocacy

In St. Louis, one of the most heart-breaking calls Wilson gets is what she calls the empty-promise scenario: A man or woman enters a nursing home, using their life savings to pay for the costs. The administrators promise the elder the facility will provide him or her with a Medicaid bed once his or her life savings are all dried up.

But without a written agreement, when that time comes around, the facility says no beds are available.

“The resident lived there for years,” Wilson contended. “The facility could choose to get a bed for the resident, if they wanted.” But now the resident has to find another place to live. The person’s choices are limited because, with no private funds, he or she is at the whim of whichever facility has an opening.

When she receives such complaints, she or another ombudsman will investigate the case. If they can’t come to a solution between the patient and the home, then they turn it over to the state Department of Health and Human Services.

Still, Wilson warns seniors and their family members to make sure everything is in writing before the patient moves in.

Little Sisters in North St. Louis offers prospective residents a weeklong stay to get a feel for living there. That’s how Oralynn Allen, a home resident, first got introduced.

“I’d been in the hospital for three months,” Allen said. “They were fixing to discharge me, but my house has steps. I couldn't do the steps anymore.”

Allen said she is an independent person. Adjusting to having some things that she could no longer do was difficult at first.

“But everybody worked with me and helped me,” she said.