Jewish Home: Not just zoning - also a failure of mission

Jewish Home’s plan to build a 22 story nursing home in a congested area of 100^th Street is as bad for residents of the nursing home as it is for residents of Park West Village. JH has a poor track record in treating residents in all three of its nursing homes despite significant resources and clout and despite all that is known about how to improve. A move would delay the need to transform how it operates, administers and supervises, deferring substantial change in how it serves older New Yorkers. A new building, no matter how impressive, is not as important as transforming the institutional culture.

Jewish Home’s ratings are poor. Medicare.gov publishes evaluations of all nursing homes in the country on a scale from much above average, to above average, to average, to below average, to much below average. [Click on "Find and Compare nursing homes" and then enter the name of the nursing home and location. Then scroll down.]

• As of June, 2009, the overall rating of JH on 106^th Street was the lowest possible category: “much below average,” while the unrelated Amsterdam Nursing Home, six blocks to the north, achieved an overall rating of “much above average.”
• JH’s Westchester Division, Sarah Neuman, despite amenities like serving fine wines was also accorded the lowest possible rating: “much below average.”
• JH’s 816-bed nursing home in the Bronx received an overall rating of: “average.” But in the recent New York State survey, the Bronx Division narrowly averted the designation of: “immediate jeopardy.” To protect itself from fiscal calamity were that rating applied, the Bronx Division imposed more institutional policies. Its reputation for clinical excellence is eroding as it replaces RNs with LPNs despite multiple medical challenges residents face. As clinical competence decreases, the facility assumes more of an institutional culture.

JH’s downward trajectory on all three campuses shows deep systemic failure, while top management, flanked by high priced lawyers and lobbyists, pursues logos, PR and branding.

This poor performance is rewarded with lavish pay and perks for their top executives. It’s CEO, Audrey Weiner, in the latest available 990 tax form of 2007, earned $800,000 which is double the salary of the President of the United States. Judith Nicholson, Administrator, earned $410,500. Amy Horowitz, researcher, earned $334, 545. Thomas Gilmartin, Chief Administrative Officer was paid $462, 387 and Thomas Ruggiero, Senior Vice President of Finance, was paid $632,102. Below them sit multiple layers of overpaid executive staff. Lobbyist, Ethan Geto, received $280,000 so far over a 2 ½ year period for “targeting the Community Board and City Council” to promote JH’s accelerated corporate interests which compete with fulfilling its mission to residents.

Meanwhile, Certified Nursing Assistants, who provide most of the personal care to the residents earn in the $25,000 range, not a living wage in NYC. As of June 2009, the federal government, in its evaluation of JH rated its staffing: “below average.” Historic poor treatment of C.N.A.s leads to absenteeism, low morale and poor care. Yet hiring too few direct care staff and keeping their salaries low makes it possible for executive compensation to exceed that of any other nursing home in New York.

But our tax dollars are paying for this, In 2007, for example, Medicare and Medicaid reimbursed Jewish Home $85 million. Jewish Home’s total income from client services was $95 million in that year. Taxpayers expect that a greater percentage of public money would be applied to good care for elders and is becoming aware of inadequate transparency and oversight.

Although nursing homes think of themselves as private corporations, each nursing home is a public trust, a legal concept that predates the Magna Carta, and is as old as Deuteronomy urging “Justice, justice shall you pursue.” When a nursing home veers so far from its mission as JH has, as evidenced by its “much below average” ratings, the community must press it to improve.

The good news is that it is more expensive to operate a nursing home as poorly as JH does while it is cheaper and more humane to do it right. JH has convinced some folks that if only they could swap their 50 year old building for a modern one, they could render better care. What they really need to change is their 19^th century institutional culture which is toxic to residents, families and staff. The human environment, JH’s legendary difficulty relating honestly not only to the community but to its own residents, staff and families is far more injurious to quality of life than the architecture.

JH must seriously address what’s wrong with how it administers and supervises and what’s wrong with how residents are regarded and treated. It needs to promote professional growth and competence throughout the organization, until bottom up and top down initiatives meet somewhere in the middle.

All over the United States, fresh winds are coursing through nursing homes, replacing an entrenched institutional culture with one where rampant normalcy prevails, where each resident becomes known and unconditionally affirmed, where professional growth, clinical competence and honest relationships are the coin of the realm.

JH needs to become an ethical, responsible steward of Americans’ generosity and spend money wisely to benefit residents and to pay staff a living wage. It needs to replace its military culture towards staff and its corrections culture towards residents with an unconditional commitment to growth, affirming the dignity and worth of each person. And they must prune the creeping corporate culture that has crowded out better judgment and convinced them to mistreat and disregard whole communities in the same way that they disregard the voices and common human needs of their own residents, families and staff.

The voices of residents of Jewish Home join those of nursing home residents all over this country that “resound loud as the roaring sea”: “Do not forsake me when I am old.”

Catherine Unsino, LCSW

Psychotherapist

Consultant in Aging and Alzheimer’s

Advocate in Nursing Home Reform

September 8, 2009