OK, So I was Wrong

I have left so many things unfinished; topics merely introduced, follow ups promised, to do lists not done, sequels languishing somewhere that can’t be found. It’s awful. So let me follow up on something.

On the 27th of November, around Thanksgiving and just before my road trip to Florida, I wrote about an ICG-MI (intermediate care facility for the mentally ill) in which a friend of mine was placed. Winter was just underway. It proved to be a very long winter for my friend. So much heartache, but so much change.

I didn’t like the facility. Here’s what I said back then.

As I walked to the entrance a back hoe was digging under the foundation near the front door. Once inside, after signing in, I saw a man on a ladder shining a light up into the suspended ceiling where a tile was pushed aside seeking a source for the water that dripped into buckets below. Five corridors leading to a big day room with coin vending machines, one TV, a Wii play station. Little printed material. Lines of patients at the nurse’s office, the dietician’s office. Their doors are closed. The room is filled with folding banquet tables. At the tables some people play a dice game, others do jigsaw puzzles, while some sleep, foreheads on the fake wood finish or cheeks pressed flat, mouths agape. At the same time the TV blares, yet only a few watch.

You can no longer see where the backhoe was digging that day. The day room is the same, chaotic, but now, after visiting several times, it strikes me as a place full of life as well as woe. I see familiar faces.

The five corridors, long and narrow linoleum tiled halls, with doors to two person patient rooms, floors covered in the same brown tile, on them old hospital beds with hand cranks at the foot that no one uses, metal night stands and dressers, closets built into the wall. In some the plastic brackets that hold the rod are broken, so clothes are simply laid in the bottom of the large compartment. One nondescript picture of an unnamed seascape adorns one of four beige/peach walls. The bathroom is shared with the room next door. Shower down the hall. Hasps on the night stands, added later and attached with metal screws, yawn open with no locks.

I visit my friend in the same room. Nothing has changed in the room, same single nondescript picture, same old bed, the rod in the closet still broken. But the room is changed by my friend’s new found presence. She smiles broadly, animated, putting down the book she is reading, and jumps up to greet me. The first day I visited she was sleeping, curled under a blanket and woke with a start. She looked scared. Through groggy eyes she looked at me and said,

“Did you come to take me out of here?”

It broke my heart.

“No, I can’t. You have to stay till you’re better.”

She’s better. Four months later she’s amazingly better. When I came home from my first visit I researched the place.

The owners of that facility own ten such places. Private company. Perhaps this was their oldest, the facility in the worst condition. No way to tell. Maybe it was their best. The internet offered little information. They maintain no independent web page, the owners, so their online presence is controlled by others. I found an ambitious list of ICF facilities in Illinois that appears to have been designed so that a wealth of information, provided by the facility, could be shared with consumers. Little data existed. Staffing patterns were outlined, few nurses, surprisingly low ratio of mental health professionals. 11% of a full time psychiatrist for 115 patients. Sliver of a dietician. I could imagine the requirements behind their staffing pattern. People you pay for because you have to have them.

My friend saw that psychiatrist exactly twice, each time for five minutes. When she came in she refused to take her pills, refused to leave the room, didn’t want to eat, hated going to the day room. Gradually it changed. They were patient, and gradually she developed relationships. The owners didn’t matter, or the dietician, the psychiatrist in the end hardly at all. It was the low paid staff that mattered, the people in the kitchen, the housekeepers, the people she saw everyday, who shared details of their life with her. After hearing nothing of other people for so long she began to mention the names of staff, and other residents, and the social worker. She grew to like the social worker. He persuaded her to attend group counseling.

She introduced me to the social worker, a man about her age, put her arm around him and told me he was stingy with the cigarettes but a nice guy all the same. Coordinates the color of his canvas Chuck Taylor s basketball shoes with his outfit. Later when he was helping me carry her stuff to the car he confided in me

“She finally came out of it in group. By the end she could have been running it. It took a long time but she made great progress. She’s doing really well. She just has to take her meds. As long as she does that I think she’ll be fine.”

The facility was called a nursing home though there were very few nurses there. It’s intermediate care. Physical disability and poor health is not the main concern inside those walls, but rather mental illness. Were the people inside not mentally ill they would live in the community. This is a private facility housing poor publicly funded patients. I would guess 100% of the people inside are funded by Medicaid. When you are poor you qualify for Medicaid and when you are mentally ill and unable to live on your own a facility such as this accepts you and provides care (think housing) collecting a daily fee for you based on those Medicaid rates. The condition of the patients earns the owners of the home a lower rate than what we think of as a nursing home. The rates are set by the state and reflect the money legislators budget for Medicaid reimbursement to private facilities. If you are the owners of this nursing home you put ten such place together and run it on a business model. Hey, someone has to do it.

My friend never knew anything about the owners, the Medicaid rates, the failure of the Illinois legislature. Those were my issues. She knew that the people she lived with, and who worked there, were kind and wanted her to get better. She came to trust the social worker, and the social worker helped her. That was the key I think.

As we walked through the day room for the last time it was slow going. My friend was something of a rock star. She had gotten better. She was going home. Everyone wanted a hug. There were tears, mine included.

Some societies have much less. America and Illinois at least has a system to care for the mentally ill. Should we be thankful for that system? OK. Can we do better? God, I hope so. Will we in the future? I see little indication we will do so.

Four months ago I was very critical of the system I encountered for serving the adult mentally ill. Today I’m less so. We can still do much, much better. I forgot something in my critique four months ago. It’s not the facility that matters, the light in the day room, the condition of the closets, the roof. It’s the staff. It’s the people we trust our loved ones to that matter. At the very least we should not cut them or their system one dime more. Look closely at what happens to your state’s mental health system in the months to come as Illinois negotiates a budget. People depend on that system. We cannot let them down.

P.S.-I’m leaving in a few hours for Peru, not the town on the other side of LaSalle. I’m going to Peru, Peru” as the young man put it in the phone store the other day. I’m going on an eye care mission to Lima and parts beyond. I’ll be back at the very end of March. Don’t expect a Dave in the Shack blog post till I get back. If you get one it’s not from me.