Between September 29th, 2009 and October 2 of the same year (yes, four days), the Tribune published 8 investigative reports on the dangerous conditions of nursing homes in which mentally ill patients are housed (each is briefly summarized below with a link). The final article reports the formation of a task force by the governor’s office to assess the problems the Tribune has highlighted and offer recommendations for fixing the problem. This final article implies that the Tribune’s investigative series itself played a crucial role in initiating the formation of the task force. However, the Tribune has investigated and reported this problem before (in 1998, as they note). The critical question, surely, must be why the problem continues to exist over 10 years after their last investigative series? Although the answer to this question is undoubtedly complex, I would argue that the quality of the Tribune’s reporting itself contributes significantly to this failure. Specifically, their shallow and sensationalist journalism shifts focus away from the root problem allowing superficial ‘fixes’ which, in the end, do not fix the real problem but rather enable the state to successfully weasel out of responsibility for the mentally ill in Illinois by shifting responsibility and blame to others. Exactly as they are doing now. Two key points need to be made about this series.
First, after the initial report, only one of the subsequent articles provides concrete information (ie., as opposed to insinuation) relevant to understanding the problem. In A Failure to Protect, they provide some details as to the actual process by which residents are screened through background checks. Specifically, facilities are required to perform a background check within days of a resident’s admission. If a criminal background is discovered, then the state is notified and state contractors conduct an assessment to determine whether the resident is at low, moderate or high risk of violence. The Tribune comments that an extremely low percentage are assessed to be high risk and most are identified as low risk, implying that these evaluations are not legitimate and/or accurate assessments of resident risk. The writers report that the evaluations are contracted by the state to a company called VIP, which won a no-bid contract in 2006 to perform these evaluations despite having only two employees.
The problem with this report is simply its inadequacy and lack of follow-up. Crack investigative reporters might ask ‘why did such an enormous task get contracted out to a company with only two employees?’ And equally, ‘who made this decision?’ Moreover, one might ask ‘in what way did the state monitor and evaluate the performance of this company and who would be responsible for such monitoring?’ A good reporter might ask experts to evaluate the assessment tools used: are these evaluations legitimate or not? For example, they specifically cite a resident, Lola Thomas (her name is published, so I use it here), as having been deemed moderate risk. They note that she had been arrested 70 times and convicted 19 times for prostitution, battery and drug possession. In addition, they cite incidents she had in the facility during her first 6 months, including striking another resident and suspected drug use. They imply, based on these facts, that designating her moderate risk is inappropriate. But do they provide any evidence of an inappropriate evaluation or simply allow insinuation to substitute for actual journalism? Taken in the context of the psychiatric acuity of the majority of residents at Somerset, she is not actually that unusual
More remarkably, the Tribune failed to discuss the disposition of those residents who are, in fact, deemed high risk. As they are implying more people should be deemed high risk, the obvious question is how those so designated will be managed. Are they put in prison? Locked in a state hospital indefinitely? No, nursing facilities are, in fact, the primary mode of care the state has adopted for the chronically and severely mentally ill, many of whom do in fact get arrested, use drugs and hit people. The Tribune implies these difficult residents should be sorted out, but sorted out to where?
Finally, it is surprising that the writers didn’t question the entire system more critically. Why, for example, are nursing homes required to do the background checks themselves after a resident has been admitted? Would it not make more sense for the state to do the background check and risk evaluation prior to placement? Could there not be a central registry of this sort of information? Perhaps with the initial screening and placement into the system, a background check could be completed and then through cooperative arrangement with law enforcement, the records of those in the registry kept up to date? They criticize facilities for being slow to do background checks without asking what obstacles facilities encounter. For example, they do not report that the required background checks only check criminal records within the state of Illinois. A murder arrest and/or conviction in Arkansas might go undetected. Certainly, this might merit examination. But again, the Tribune opts for sensationalism, dropping in tidbits of the real story but failing to ask the important questions or fully analyze the problem.
The second key point is that in this entire series, Somerset is actually only mentioned once. Specifically, in the article discussed above, two residents are singled out and mentioned by name with the implication that they were inappropriately assessed as moderate rather than high risk. What is interesting is that Somerset does not, in fact, accept everyone. I know from personal observation that administration rejects scores of potential residents, with significant financial consequences. Residents are rejected if they have any known history of arson, history of unsafe smoking, history of unpredictable, uncontrolled violence, history of sexual aggression. But often these decisions are not black and white. Psychiatric patients sometimes, perhaps frequently, do bad things. The nice, safe, docile mentally ill patients are generally not looking for placement in an institution. They are living with family, living in community based housing and treatment programs or, sometimes, living independently. Institutional placement is the destination for difficult and low-functioning patients. If the Tribune does not feel these patients, like Lola, should be treated at Somerset, where should they be placed? Conversely, what population of chronically mentally ill patients does the Tribune envision living in such institutions? Where, exactly, did all those rejected by Somerset get placed? Of the two Somerset residents the Tribune mentioned, one, Lola, is in my estimation, appropriate for placement and can be provided needed care and treatment. The other, Clifton Pickett, was not and was, in fact, discharged.
The Tribune is implicitly creating a fantasy world in which, if properly assessed, risk can be eliminated and the horrible stories they describe avoided. It is undoubtedly true that the assessment of risk could be better conducted, risk better managed and horrible stories greatly reduced. But they grossly underestimate the amount of risk in the severely, chronically mentally ill population and entirely evade the more fundamental problem of how we, as a society, and specifically our government—the state—manage that risk. Instead, again, they opt to create simple villains in a simple world. “If we just screen and evaluate people correctly all will be well.” It will not. In fact, if anything, this would only serve to highlight the inadequacy of Illinois in providing appropriate services for this population. The State of Illinois has dumped its responsibility for managing this difficult segment of our society onto nursing homes, where it can conveniently shift blame. And cost. And the Tribune, ultimately, is complicit, enabling this shirking of state responsibility by failing to critically analyze and identify the root of the problem it is reporting.
And we are still left with the question, how did Somerset become the center of this storm?
The articles, in sequece:
Nursing Home Death: One victim’s story at Burnham Healthcare. Chronicles the events surrounding the death of a resident at Burnham Healthcare. Other than recognizing the tragedy of the events reported, I have no knowledge or insight regarding this story.
A Failure to Protect: discussed above at length. Perhaps, with better reporting, it should have been entitled ‘A Failure to Provide.’
Nursing Home Attack: One victim’ story. Another chronicle of a specific horror story. These stories are, indeed, horrible. Exploiting these stories to bring attention to the plight of vulnerable people in nursing homes is understandable. It is too bad, though, that this exploitation is not accompanied by insightful analysis that might actually prevent future suffering.
Nursing Homes a Risky Business. This article, though it exploits another horror story, really focuses on implying that two individuals, Bryan Barrish and Michael Giannini, are schmucks. It implicates SIR management, a company ‘consulting’, ie., indirectly running, multiple facilities as also being schmucky. I cannot comment on the integrity of the two individuals nor SIR management as I have no experience with them or their facilities. Whether the Tribune is right to single them out or not, I cannot say. What I can say, at risk of being repetitive, is that the state of Illinois is responsible for the oversight, regulation and discipline of all facilities in Illinois and the state is ultimately culpable. Moreover, the policies and funding system in the state are precisely what allow, even cultivate, these individuals and companies. The question is not ‘are these bad guys’ but rather, ‘how has the state of Illinois ensured that ‘bad guys’ do not own and operate large facilities providing care and treatment to vulnerable populations in the Illinois?’
Owners but not in charge. This articles continues, from the last one, to cast aspersions on Bryan Barrish and Michael Giannini. Again, I don’t know these two. But if the Tribune thinks they are doing something wrong, can they just spit it out? I am not certain how insinuation constitutes journalism. If they have done something wrong, spell it out and provide facts. If not, isn’t it irresponsible to merely imply they are crooks? The problem is that what these two are doing is, undoubtedly, legal. If it is less than admirable, then the real problem is how it is that something socially problematic is not only allowed, but funded by the state. This insinuate-but-miss-the-real-point journalism is reprehensible.
A deadly mix. This article, curiously, highlights the fact that in 1998 the Tribune reported on these very same problems and yet, they muse, the problems still continue. I can only assume that in 1998 their reporting also failed to clearly identify the real problem, thus contributing significantly to a ‘false fix’ and, well, not surprisingly, the problem remaining some 10 years later
Nursing Home Safety: Gov Pat Quinn forms a task force. This somewhat self-congratulatory article reports the formation of a task force to address safety in nursing homes. At the time of this writing, the task force has still not made recommendations. One can only hope, optimistically, that the task force will see beyond the confused haze of the Tribune and clearly and accurately assess the real problems and offer real solutions. Time will tell. Unfortunately, the task force, unless the Tribune only partially reported its composition, is made up entirely of state officials. This is somewhat like asking the fox to evaluate safety in the henhouse. Why was no one from the nursing home industry, the target of the task force, included? No experts in mental health policy? Illinois has no shortage of excellent academic institutions riddled with experts. Why was no one from patient advocacy groups, such as The National Alliance for the Mentally Ill, included? For that matter, why were no representative ‘community’ members included? And maybe, even, they might have considered including a representative patient or two in the task force? And finally, why was this Tribune article filled mostly with self-promotion rather than a critical analysis of the composition of the task force, its articulated objective and its plan for approaching its task?