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A Volatile Mix?By Georgina Gustin, New York Times March
16, 2003
The fire at the Greenwood Health Center, a 150-bed nursing home near Hartford's downtown, that killed 13 people and injured 20 on Feb. 26 was the most lethal fire in an American nursing home in more than a decade and the worst in a Connecticut health care facility since a fire at Hartford Hospital killed 16 in 1963. The primary suspect in the fire is Lesley Andino, a 23-year-old Hartford woman who has multiple sclerosis and a history of drug abuse. Her possible role in starting the fire has fueled the debate over who should and who shouldn't be allowed to live in the state's nursing homes. "Putting people with psychiatric problems in homes when they're a danger to themselves or to others just can't continue," said State Senator Edith G. Prague, chairwoman of the General Assembly's Select Committee on Aging. "People suffering from psychiatric illnesses who behave erratically, there's no way they should be interspersed with the frail elderly." Some state officials and advocates for the elderly are wondering why Ms. Andino, who has a history of emotional problems, was placed in a room with Lois Morin, a partly paralyzed 72-year-old woman, who died in the fire. Less than a week after the fire, Ms. Prague presided over a public hearing to discuss a bill she proposed earlier this year that would separate the mentally ill from the elderly in nursing homes. At the hearing, Ms. Morin's son, William, said he was not pleased about his mother's roommate. "That mix shouldn't have happened," he said. "My mother was put into a situation she couldn't get out of. My mother was incapacitated." Mr. Morin said he was never told about Ms. Andino's problems, but in hindsight said he saw trouble coming. "There were situations that led to this," he said, saying she had behaved erratically when he visited his mother the night before the fire. Dianne Casey, whose mother has lived at Greenwood for two years, said the mentally ill should not be paired with the elderly. "Did she do it on purpose? That's not the issue," Ms. Casey said, referring to Ms. Andino. "It was established she was mentally ill. She never should have been there." The problem, some said, is that there is often no place else to put the mentally ill and they end up in nursing homes. "People are being put into nursing homes as a substitute for care," said Janet Wells, the director of public policy for the National Coalition for Nursing Home Reform, adding, "There is clearly a need to address the problem." People in the mental health community said that there is indeed a problem, but mentally ill patients should not be made the scapegoats. Mental health workers stressed that the legislation will stigmatize the mentally ill and questioned how the bill would define mental illness, a term that encompasses everything from schizophrenia to depression. Most people who end up in nursing homes come from hospitals after being treated for serious illnesses or injuries, conditions that often lead to depression "In general, people who have serious physical illnesses sometimes become despondent over their illness," said Wayne Dailey, a spokesman for the State Department of Mental Health and Addiction Services. "It's common." That means, Mr. Dailey said, that depression, which is considered a mental illness, could hypothetically be a reason for many people to be singled out. Where, mental health advocates wonder, will the law draw the line? "It's really a misrepresentation of facts to suggest that risky behavior in nursing homes is the exclusive province of people with mental illnesses," Mr. Dailey said. "This is far from the case. Most people with mental illnesses in nursing homes are very stable and indistinguishable from other patients." Citing a study by the Connecticut group, the Violence in Nursing Homes Study Group, mental health advocates said the mentally ill are no more or less dangerous to residents than other nursing home residents with Alzheimer's or dementia, who do not fall under the federal definition of mental illness but are potentially as dangerous. "It feeds into the stereotype that people with mental illness are more violent," said Jan Van Tassel, the executive director of the Connecticut Legal Rights Project, referring to the legislation. "There seems to be an immediate knee-jerk reaction to associate this with mental illness, and in this instance it doesn't appear to me this person had a major psychiatric diagnosis. Certainly there was physical illness and addiction." Ms. Van Tassel noted that the 21st amendment of the state's Constitution identified people with physical and psychiatric disorders as protected classes. "I believe this is unconstitutional," she said. Others agreed. "The citizens treated and cared for by my agency on behalf of the State of Connecticut must have the same legal, ethical and basic rights to the full range of health care services and settings as does any other citizen, and that included access to care provided at a nursing home,'' said the state's mental health commissioner, Thomas Kirk, addressing the public hearing. "The Department of Mental Health and Addiction Services cannot support any legislation that restricts that right." In 1996, Gov. John G. Rowland closed the state's two large state-run psychiatric hospitals as part of a broad effort to de-institutionalize the mentally ill and instead deliver psychiatric services in community-based settings. But in the last several years, critics of the approach said those community-based services haven't been adequate, and many of the state's mentally ill have no place to go. The situation has only gotten worse as state budget constraints have cut funding to social service programs. "One of the things that startled me is the fact that you closed the state hospitals and the state made an effort to give community services without addressing the housing piece," Ms. Van Tassel said. "The major barrier that people have to stable community living is a lack of housing and a lot of people end up in nursing homes, not because they need that level of care, but because we don't have adequate housing in the state." According to the mental health department, about 8 percent, or roughly 2,500 people, of the state's 30,000 nursing home residents are mentally ill, and of those, 190 are mental health department clients. In 2002 , only 13 of the 1,886 people it discharged from its facilities went to nursing homes for care. "These statistics are clear evidence that, in contrast to what some believe is occurring, D.M.H.A.S. is not 'dumping' people into nursing homes," Mr. Kirk said. Teresa Cusano, the state's long-term care ombudsman, said Mr. Kirk is right. "They do an adequate job with the resources they have," she said. "The number of residents who suffer from mental illnesses that come from D.M.H.A.S. is small. There are more people with mental illnesses that aren't D.M.H.A.S. clients. That's our concern." Ms. Cusano said the most frequent complaint her office receives comes from the families of people with behavioral health problems, including mental illnesses, who have been discharged or evicted from nursing homes. In many cases, Ms. Cusano said, the homes discharge patients to either general or psychiatric hospitals because they can't take care of them, and then refuse to take them back. Federal law requires that every nursing home receiving federal funds - most in Connecticut, including Greenwood, do - have a two-phase screening process in order to determine whether a person can fit into a nursing home setting or needs psychiatric care. But according to a report written by the state's Office of Legislative Research last year, that process "suffers from several flaws." The report said there was little evidence that first-phase screenings were being performed, and, when second-phase screenings were being done, there was no process to make sure the person was getting the recommended treatment. "It's pretty obvious, from what we're hearing, that people aren't being screened," Ms. Wells said. The report also said nursing homes that accept nonelderly residents "with serious mental illness are not required to have additional staff or specially trained staff to care for them." The state's public health code says there should be one nurse and two nurses aides for every 16 residents, and at Greenwood, staffing levels were adequate, according to the most recent state inspection. "That's not enough," Ms. Cusano said. "We need to change the public health code in regard to the staffing levels." Even though Mr. Morin used to visit his mother at Greenwood almost every day, he couldn't be on the lookout all the time. He said he believed that improving screening procedures and staffing levels might have made the difference. "At the beginning she seemed to be very normal," he said, referring to Ms. Andino. But on Tuesday, there was "a total change of person." Mr. Morin said he wished he had been told about his mother's roommate. "I didn't know, so I wasn't on alert," he said. Copyright
© 2002 Global Action on Aging |
