A former case-manager shares his thoughts. . .

I fully believe that Somerset should have been shut down. As a PRSC in that facility my job was nearly impossible. It was very unorganized and suffered from a severe lack of communication between co-workers, various departments, and from administration down. Even when I started, the training I received was invalid by the end of the first month. Almost every day there was a new policy change without explanation. Add to this that the state was visiting regularly and constantly putting everyone on edge. I can say that, when it came down to it, the resident’s health and safety always came first. They always received any treatment we could provide. I blame everything else on politics and decisions made by people who weren’t there. That makes things hard real quick.

In the beginning state visits went very well and we received all kinds of praise, but something changed. All the sudden the state started visiting and citing us for things we didn’t even know we were supposed to be doing. How can you say a facility isn’t providing enough treatment and referrals to programs, while cutting the budget for treatment and day programs? Who was I supposed to refer a resident to if all the day programs in the city were cutting their hours and the number of residents admitted to their programs? What tools does the state think are appropriate when dealing with residents who are actively abusing substances? I had a “piss cup” and that was it. I knew all kinds of residents with substance abuse problems but I didn’t have any resources to help them. Sure, refer them to MISA and require them to go. Well, if they don’t want to go then they won’t. I couldn’t drag them. I couldn’t bribe them. I could counsel them and help them see the benefits of the MISA program, if I had time to sit. If I put them on restriction, ok great, leads me to my next point. Psychotic residents mixing with residents looking for their next fix…at least it was contained within the facility. It was all very frustrating. I have to give credit where it’s due, though. Some residents really made an effort to sober up. Most of them really understood and complied with what we were trying to do for them, and it helped.

My problem with Somerset closing is how and why they are doing it. The neighborhood complained that the residents were bringing everything down and people didn’t feel safe. I live in Uptown. If I had a problem with a resident while in the community then it was directed specifically toward me for something that happened within the facility. Most of the time, my run-ins with Somerset residents involved them working in the little food stores and helping the local businesses stock their shelves and what not. Others were just trying to go about their business like any other person in the city. The most complaints I ever received involving my residents were for panhandling and it was all just bitching. I’ve asked and been asked for cigarettes and change. You say no and you move on. I’m more afraid of the gangs in Uptown and the random drug deals going on. Seriously, almost every day I walked to work, at 7:45am, I would literally walk in between several drug deals on Argyle. I’ve clocked out of Somerset, crossed the street, and had to grab a resident and force them inside Quick-Stop because some kids were chasing each other and throwing glass bottles in the middle of the street. Local blogs informed me when I got home that those same kids shot somebody right down the street. How many out-right, in the middle of the street, middle of the day gang shootings were there last summer? You can find the answer by watching them on Youtube. I was happy to be in Somerset, safe. A Somerset resident did not murder Ms. Walker. She was killed by a member of the community. Residents did not grow weed and make crack in their rooms. They bought it from the community.

Somerset residents had a stigma attached to them that they could not escape from. It’s obvious that most members of the community are scared of the mentally ill. The infamous Alderwoman wants to get reelected and she’s not doing anything else. Why not take part in something easy, that she really has no control over, and take some credit for “making it better?” What she and everyone else who sit around and bitch do not seem to realize, nothing that is currently being done is going to make anything better. These residents are going to be lacking treatment everywhere you ship them. Those who’ve got a record will still have a record when they go to their new placement. They don’t just disappear because Somerset did. The neighborhood violence will continue. Somerset will probably become the next public urinal (Wilson/Broadway).

Somerset was a huge facility, governed by the state. Because of its size it was the easiest target. It should be considered the largest, most obvious example of what happens when politics govern treatment of the mentally ill. If Somerset needed to be closed, then so does every other psychiatric nursing facility everywhere.

Also, I feel like I do not understand something. Why does the Alderwoman think she has control of what happens to the building next? Why does the neighborhood think the same? No one came to my door and asked me what I thought? Isn’t that up to the person who owns it? How does all this work, really?

There is no next step though. There’s no plan. Actually providing the means for quality treatment of the mentally ill seems to be too much to ask. So, here’s to the next set of policies and propaganda that will serve to set up the next horrible failure. To those who actually cared and worked their asses into the ground, got hit and abused, cried to their families, were too tired for a social life, but loved their job anyway…all we can do is try again so that eventually someone in control sees the effort and does what needs to be done.

Ryan, former case-manager

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14 Comments

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14 responses to “A former case-manager shares his thoughts. . .

  1. David

    As someone who works in long-term care I can say I agree with some of your points. Working with a dual diagnosis population is very challenging work. Treatment team members need to be qualified and skilled at setting limits and aware of what the best practices are for working with this population. Frankly, the owner/administrator needs to be comfortable discharging anyone who does not value the structure that you are trying to provide. But clearly profits were of more importance than providing quality treatment. You can’t treat a population of users when people are still actively seeking drugs in their company.

    All nursing home facilities had to cope with the same cuts to outside programs last fall due to changes with Medicaid funding. Some owners made the choice to hire more staff and provide more treatment groups in the facility. Many in long term care have been aware for years that the owner/owners of Somerset, and the number of other long term care facilities that they manage, do not value the important treatment the residents are in need of. It appears they do the least possible to keep IDPH off their backs and profits high. But as you mentioned IDPH responded to the political pressure put on by recent media reports. You owners did not! I am sorry that you had to work in such a setting. It is no way to be successful with this type of population. I hope you find a more supportive and successful place to work. Not everyone working in long-term care has such a difficult employment situation.

  2. Hi David—

    Thank you for your comments. They provide valuable discussion points. I would like to comment on a couple.

    1. You suggest the best way to treat dually-diagnosed substance abusers who do not cooperate with treatment is to discharge them. There are two problems with this view. (a) Residents have a right to not participate in treatment (whether this is good or not is another question). A facility can give a resident a 30-day discharge notice, but that resident can file a complaint with the state and appeal. If the only basis for the discharge notice is failure to participate in programming, the facility will be found to have violated the resident’s rights and the discharge disallowed. Somerset residents have appealed 30-day discharge notices. (b) More importantly, discharging uncooperative residents is great for a single facility’s success rate, but it leaves open the larger question of who will provide services for those patients? If every facility adopted the same policy, this would be equivalent to saying that normal, non-mentally ill substance abusers who do not engage in treatment should be forced out of their homes to live on the street. Given the relapse rate prevalent in substance abuse generally and dually-diagnosed patients specifically, such a policy, if widespread, would be disastrous and result in a dramatic increase in untreated, dangerous mentally ill substance abusers living on the streets and in shelters. Rather than admirable policy, I would suggest that it is merely self-serving on the part of your administrators: dump the problem on someone else. Though I appreciate your perspective, I believe it is myopic.
    2. You suggest that when the state cut funding for day programs, more altruistic owners bit the bullet and spent money to provide these services themselves, and imply that Somerset greedily did not do this. Several comments are in order.
    a. You incorrectly assume Somerset made no efforts to provide services. Somerset already had 1.5 FTE CADC to coordinate and run MISA services. In addition, Somerset has a full-time art therapist and a significant in-house work program. During last year, Somerset hired someone to develop in-house psycho-educational programming, which they were in the process of doing. The owners were in negotiations with a hospital to establish a partial hospitalization/day program within the facility. To do this, a very large sum had to be spent to renovate and change the structure of the facility, which would not be recouped for many many years (the only revenue from this venture being rent to the contracted hospital). The purpose was to provide on-site, intensive services closely integrated with facility services. In addition, Somerset contracted with outside providers to come in and provide further services. Finally, the owners funded an incentive program in which every resident could earn $5.00 per week for appropriate engagement with facility activities and programs. This constitutes 65% of what the state allows each resident each month ($30.00) and could potentially cost the owners over $100,000 per year. Somerset was in the process of dramatically increasing programming services.
    b. You assert that many owners chose to hire more staff and provide services. I have worked in mental health in Illinois across a variety of settings for many years. In my experience, IMDs are all fairly comparable and owners, though some more or less greedy, all nonetheless are running businesses and guard their bottom line closely. Unless you provide some evidence (what facility? How many staff with what clinical background? What was their clinical staffing beforehand?), I will assume that this is either an unsupportable assertion or an isolated case. You’re implication that the owners of Somerset are just greedy and the rest of the industry altruistic is, in my mind, completely unsubstantiated and bordering on absurd.
    c. The most important observation is that the state cut community based services without providing alternatives. Whether some facilities voluntarily increased services (as Somerset was, in fact, trying to do) is beside the point. That would be dumping responsibility on these facilities without any reimbursement: great for the state budget, bad for the businesses they are dumping on. But worse, they did not actually make any provisions for facilities to make up for the lost services, neither with funding, with regulation or even with suggestions. The state merely cut them, apparently wholly indifferent to the needs of the mentally ill population. Given the recent task force has decided it would be much better to shift more psychiatric patients to community based care, it seems the state is either conflicted or confused. There is an answer: they are shifting more patients to community care in order to obtain federal matching dollars. If you want to understand state policy, follow the money.
    3. You state that IDPH responded to political pressure (with the implication that Somerset, in contrast, did not respond). IDPH, as you can see on this blog, has placed identified offenders in the community (not, I think, what the Tribune was suggesting), they managed to lose a resident, they are treating residents and families poorly, and all they are doing is putting on a show and transferring residents to other facilities that are really not any better. IDPH is trying to avoid being placed under consent decree as a result of the ACLU lawsuit and trying to get federal money through matching available with community based treatment. Though the task-force made several reasonable sounding recommendations, we have gone through this before. If the way in which the state is handling Somerset is indicative of how the task force recommendations will be implemented, then their response is quite poor and should, I believe, be carefully scrutinized.

    Thanks again for your comments.

  3. Maria

    I have contacts in other Chicago nursing homes and IMD’s and I can truly say that compared to some of these facilities, Somerset had more staff, systems and programs in place, hands down. One Nursing Home which I had contact with had almost 100 identified offenders. This facility has skilled residents, not all MI as we did. So they are a mixed population. Upon sharing information with them it was evident that they did not have a fraction of the systems we had in place to care for such individuals, along with the lack of programming and systems to address safety and supervision issues.

    Somerset staff did the best possible job they could caring for the residents and meeting their needs. Supervision was a priority along with the managment of symptomatic residents to ensure a safe environment. During 2009 no resident had a significant negative outcome or serious injury related to any incident that could be attributed to lack of care. That in itself is a tribute to the dedicated staff who worked with these residents to ensure a good outcome for them and did everything they could to keep them safe along with managing their chronic illness on a daily basis. The facility was bombarded with regulatory agencies to the tune of about 15 surveys in 2009, which hindered our progress. This was very disruptive and detrimental with negative outcomes for the facility. The facility had a formal plan in place from the beginning of 2009 which was being implemented accordingly, but was not successful in the timely implementation due to the constant interference of the regulatory agencies imposing their own agenda. To the contrary, the facility did not ignore any concerns related to resident services and for anyone to insinuate otherwise is absurd.

  4. Buzz

    I have lived in Uptown since 1998, first on Argyle, now on Marine. And I’m one of the people who is just tired of dealing with Somerset. While you can write me off and ignore me, what about the business in the area, or perhaps other homeowners, or even the teachers at nearby schools? We “bitched” (see below) for YEARS for someone to do something about this blight, and not till the Trib identified and documented the ticking bomb on the corner, did anyone move at all.

    This blog discounts the Trib’s coverage. But I doubt if the owner of this blog watched them seal off the motel parking lot and carry the decomposing remains of a Somerset resident out after 3 days in a closet. The resident who turned tricks on our corners for drugs, murdered by a John. And had I known about the violant offenders housed there, I would have been on the phone to the state myself.

    I would love to trade clinic-speak with you about how hard life is in the current situation, and what you perceive the problems to be. And if they are true, I’m sorry to hear that. But to the world at large, and the community in specific, we’re just sick and tired of dealing with it.

    This is not to say that the community as a group is a posse of insensitive peasants. We live on a daily basis with several SROs, community housing, the Uplift school, not to mention a veritable ponderosa of Section 8. It makes life in Uptown “challenging.”

    But Somerset is the worst of the worst. You mention you daily walks to the el, and panhandling vs. drug deals. “The most complaints I ever received involving my residents were for panhandling and it was all just bitching” Seriously? Are either of them acceptable? Is there a social ruler where either of them is ok? How about we rid our streets of both?

    My now 14yo daughter won’t walk past that place to get the 151 CTA bus, or the CTA Red line, because of the number of times men, intoxicated or otherwise, made lewd remarks, or wose, towards her. At the age of 10 she knew exactly what an adult man’s penis looked like, having seen residents urinating outside the facility on more than one occasion. The parents of her friends from church won’t let their kids come here to see her, unless we take them to the park, because they are afraid of that big scary building on the corner. Chalk it up to prejudice or what you will, but perception is reality.

    Are the homeowners, taxpayers, parents, and businesses in this areas supposed to be punished because, as you say, the failing is not at the facility, but at the state? That would be nice, but when you follow the money, it all leads back to the facility owners, not the state or staff. While you might indicate that the state failed the residents, they clearly did not fail the owners, who have reaped profits years after year, since they took ownership of this property. This is a failed instution, and has been for a while. They took the money…because they could.

    If I never have to step over a resident, passed-out, face down, in a pool of their own vomit on my way to the El, so be it. If I don’t have to worry about a resident crossing diagionaly across the Sheridan/Argyle interscetion, regardless of the lights, in front of my car, it can’t happed a day too soon. One less resident screaming for Jesus or “directing traffic” at Sheridan and Foster would be a welcome relief.

    You’re loyality to the ‘idea” of Somerset is admirable, but the reality of Somerset does not deserve your noble efforts.

  5. Tom

    Our family has lived around the corner from Somerset (on Carmen) for ten years. This was our polling place, so we were inside a few times. Speaking as a homeowner and health care professional, I can say that Somerset provided a much more positive impact on the community than all these “holier than thou” alleged community members would have us believe – as well as a valuable service to their residents. You will find more agressive panhandling on Michigan Avenue than on Argyle and Sheridan. The place actually does a pretty good job of monitoring residents and keeping things under control. Their clientele is the most difficult, and there are not now nor will their ever be adequate “community placements” for these clients.

  6. Maria

    Last time I looked Somerset residents did not wear the facility logo on their outerwear. So how does one tell they are Somerset residents, unless they are seen around the building. I too pass foster and Sheridan where a man stands yelling on the corner..not a Somerset resident. I walk down argyle to get lunch and come across people sitting on the sidewalk and others panhandling..not Somerset residents. Just the other day a man and a woman were smoking crack by the Somerset dumpsters in the alley, I chased them away..not Somerset residents. I am not saying that Somerset residents have not engaged in any socially inappropriate behavior, but I know who the Somerset residents are and can identify them in the streets…The reality is that most of the crime and socially inappropriate behavior in the community can be attributed to people not living at Somerset. I myself lived in uptown in a condo building on Winthrop off of argyle in the 90’s..The gang violence, drug dealing and prostitution on my block and in the area was outrageous.. The promise from the Alderman back then was things were going to change fast..Well 16 years later and I still see the same level of crime in the community. So much for the Aldermans promise. I moved after living there for 4 years because of the continued threat to myself and my family, not the socially inappropriate behavior of the residents of Somerset. I’m just saying, lets keep things in perspective. To think that by getting rid of the Somerset residents the community is going to be much safer is ludicrous. The community used a perfect political climate to get rid of that building on the corner. That’s all that was accomplished, but the real problems of the community will not go away due to the concentrated criminal activity in the area… along with the continued neglect of the entire mental health system and the needs of the chronically mentally ill.

  7. from someone who wishes to remain anonymous:

    In response to Buzz, I’d just like to know why it’s assumed the incidents were caused by residents of Somerset? It’s all too easy to blame community problems on the ‘big scary building’ on the corner. Having worked at Somerset for many years, I know our residents, past and present. I looked out the window one afternoon last summer into the alley behind Somerset, and saw a man urinating against the side of the building next door. I drove down the Lawrence Ave. exit not too long ago and had a man bang on my windshield for money. I’ve seen the “traffic director” at Sheridan and Foster. I parked on Argyle, nearly at Marine, last fall and was accosted for money while walking to work. Last Wednesday, while driving down Argyle, at Winthrop I had to slam on my brakes to avoid hitting the man running across the street. None of these incidents were caused by Somerset residents. Ms. Walker wasn’t murdered while in the facility and it wasn’t a resident of Somerset that murdered her. Her murder occurred in the community, and it could have happened to any one of us. I am not going to say that Somerset is or ever has been perfect, or that our residents are. But getting rid of Somerset is ultimately not going to get rid of the issues Buzz listed- SROs, other psychiatric facilities, Section 8 housing, and so on are all still going to be there next week. The reality of Somerset DOES deserve our efforts to defend it. The treatment residents receive while at Somerset is superior, and that fact is well-recognized within the psychiatric community. And the residents who call Somerset “home” and have been forced to leave, crying, also deserve our efforts to defend them. As Buzz so aptly demonstrates- no one else will.

    • Buzz

      I just love the bleeding hearts on here. You would have us believe that absolutely none of the behavior I have mentioned happened? Ok then

      I knew who lived there, I saw them walk in and out of the building to smoke etc. I walked right past the dining room windows 2-3 times a day. I saw the same bunch sitting against the building, drinking out of bags and smoking in the warm weather.

      You would further indicate that Somerset residents were blameless for any of the social misconduct there? Seriously? Wow.

      The state, as opposed to you, documented the trouble at Somerset, which amazingly runs counter to your protestations. And, unlike yourselves, they don’t own their daily bread to the owners of that package of misery.

      If closing Somerset is what it takes to get these people the help they need, so be it. If it hits the owners in the pocket, that’s the way it should be.

      Nobody on hear is trashing the staff, that I have seen. They are trashing the facility and the owners. The owners backed up the money truck to this place and went at it. Why do you continue to defend an owner who was taking money to provide the quality cae that these people were not getting?

      And why on earth would anyone defend a facility where violent felons were let lose to roam the halls, sexually assault defenseless elderly, rob, beat and intimidate other residents as well as use narcotics on the premises?

      Ask yourselves a single question: if Somerset had been better run, better funded, better maintained and better policed, do you think the state would be in the process of shutting it down?

      • Thank you for your impassioned comments. Couple of thoughts:

        1. No point in arguing about how much crime/trouble can/cannot be attributed to Somerset residents. In 6 months we can simply look at the crime statistics in uptown and see if they significantly improve. I doubt it, you think otherwise, we’ll see. I prefer to set aside angry arguments and wait for the facts to tell the story.

        2. The first sentence of this particular post starts “I fully believe that Somerset should have been shut down.” Throughout my writing here, I am critical of the industry. The point of this blog is not to ‘defend’ anyone. . . that’s entirely academic. Somerset is closing, end of story, move on. I’m not interested in arguing whether the owners were good guys or bad. Who cares. What is important is to assess the degree to which the state created the mess you complain of and, more importantly, what are they doing now?

        3. Those ‘violent felons let loose to wander the halls’? The state has placed at least one, with a history of double murder and medication non-compliance in your neighborhood in his own apartment. Perhaps you should pay more attention to what the state is doing rather than pointlessly continuing to bash the owners of a facility that is closed anyway. This blog is designed to help you do that, not to defend anyone.

        4. About your question: the answer is quite clearly, yes. In fact, it was only a few months ago the state said everything was fine at Somerset and the federal monitor was removed. Because then it served their purposes. The facility didn’t plunge back into chaos. They were in fact working to continue to improve. The state closed Somerset, I believe, out of political considerations. Did it deserve to be closed? At the end of the day, who cares. . . it doesn’t matter now. By closing it, the state is putting on a big show: “see, look how we’re fixing everything.” You seem to want to buy into their show. Great, good for you. I wonder if that ex-murderer was placed next door to you? Call the state and ask.

        5. You seem to have great faith in the state of Illinois. Have you lived here very long? Just wondering.

  8. Buzz

    Wow, that was an “owie.”

    I don’t mind taking the heat on this, but I feel like we’re talking about apples & bricks.

    I’m reminded of the famous saying in politics: there’s lies, damn lies, and statistics.

    Measuring crime stats is a flawed way to address the idea of the impact of closing Somerset. How about we ask the people who live and work in the area about how they feel their quality of life has changed +/-

    On the one hand, you say that things were getting better. Does that not imply that previously they were bad? Exactly how bad? What defines anyone’s acceptable level of bad. It’s like the age old question “how long is a ball of string.”

    Unlike you, I do blame the owners. The cost to run this facility was less than better equipped and staffed facilities, but the funding from the state is the same per patient no matter where they are housed. It’s called economy of scale. So when you warehouse the poorest of the poor in a box like Somerset, your costs per pt are even lower and your margins higher. They raked in the money every year they owned it, never a deficit. The state outsourced the care, and the care they got was not good. The profits however were enough to keep the owners in the black.

    I would further ask you, what was the turnover in staff like? Was employment a revolving door? What were the reasons people left? Did the owners of Somerset invest in a professional level of training for new staff, or just toss them on the floors knowing there was more where that came from? Is it your opinion that this situation was greater or lesser than similar facilities?

    As for the boogie man of the ax murderer, it’s the Willie Horton of arguments. The state puts bad guys back on the street every day for all kinds of reasons. It’s like this everywhere in the US, who would think that Chicago would be any different than anywhere else? And why should it be?

    I have lived in Chicago since 1995, Uptown since 1998, minus 1 year in a different location. And I am a student of the history of Uptown, are you?

    Uptown became a dumping ground for misery starting in the 60’s with the Great Society programs of LBJ. The working white people had moved out, the aldermen were weak and the mayor took the money and dumped the problems in these 2 wards. Old residential hotels like Somerset were sold to anyone who could pay the back taxes. They made ideal, you guessed it, nursing homes. Somerset was just a cash cow.

    You would know better than I, but were it not for the most minimal of state intervention, do you think the owners would have wrung every last dime out of that place to the detriment of the patients? Considering the coverage of what happened there, my guess would yes.

    Is the end of this incarnation of Somerset permanent? I doubt it. I fully believe the facility will house another facility just like it again.

    Did the Trib do anyone any good with their sensational stories? I believe yes. Any other meek “help me help me” sounds from mental health professionals fell on completely deaf ears for years and years.

    Will closing Somerset benefit the patients? That’s a total crap shoot, depending on their new placements. The question I would ask is, are they getting placed in settings better, worse or similar to Somerset?

    How the placements are being done is not pretty. Involving the state in this process however was avoidable. If the owners had served the patients better, it would not fall to the state.

    And you don’t hear the owners begging and pleading for their patients, their argument has never been about quality of care, they are just pissed because someone finally turned off the money faucet.

  9. Thank you again for your follow-up post. Though we disagree on several points, I will not respond but let readers read and think for themselves.

    In the meantime, I will continue to scrutinize the actions of the state as that is where I see the cause for the greatest concern.

  10. Resident Winthrop/Argyle

    I’m scared of the gangs and drug deals too. Who do you think is out there making those purchases? Sure some come from other neighborhoods, but a lot of the deals were from residents at Somerset and other facilities in the area. The gangs and drugs follow the demand, just like any other business. I’ve already seen a decrease in gang activity.

  11. Really? You believe that Somerset is supporting the criminal activity in uptown? That without Somerset residents, those gangs of 16/17 year-olds will go somewhere else? And that they’ve already started to pack up and go elsewhere? You believe that the residents of Somerset, only a percentage of which were involved with drugs, and who by and large have exceptionally small amounts of money (they get 30.00 a month), provided substantial demand to sustain a drug trade?

    Really? Interesting.

    • Ryan

      I just have to add that the day after Somerset was officially closed I was on Argyle and saw about 5 cop cars flying down the street sirens blaring heading toward Sheridan. Can’t blame that on Somerset.

      Also, all the drug deals I walked by when working at Somerset occurred before 8am. Somerset didn’t allow it’s residents out of the building until 8am. It simply didn’t happen. They may have had people sneak out, but I can assure you, no one got out before 8.

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