History of problems at OP Healthcare

Complaints have been a regular occurrence at nursing home over the past dozen years. New

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By BILL DWYER

Oak Park Healthcare Center, 625 N. Harlem Ave., has been called by several names since it first opened in 1978 - Metropolitan Nursing Center of Oak Park, Oak Park Convalescent and Geriatric, and The Fairmont of Oak Park. Yet over the course of ownership and administrative changes, the facility has forged a troubled reputation for lapses in patient care that continues to this day. Depending on whom one speaks with, that bad reputation is either bound to continue, or is in the process of genuine, substantive change.

According to Illinois Department of Public Health records, Oak Park Healthcare had at least 55 formal complaints lodged with the IDPH between Jan. 1, 2001 and the end of 2004. At least 12 of those incidents were determined by investigators to be founded. In that time Oak Park Healthcare Center has been fined a total of $40,000 four serious violations of state and federal regulations, including a patient who suffered seizures for some 75 minutes before finally receiving treatment from responding paramedics, an unattended smoker who suffered serious burns to both legs, and a resident who was raped by another, intoxicated resident. In the most recent incident, the state fined the facility $10,000 for inadequate care of a resident's infected leg wounds that were allowed to become so badly infested with maggots that both his legs required amputation.

When a complaint is filed against a nursing facility, state inspectors show up, unannounced, to see if they're valid, according to an expert on nursing home inspection and accreditation who asked to remain anonymous. The expert cautioned that some complaints filed are unfounded.

However, Wendy Meltzer, executive director of Illinois Citizens for Better Care, questioned whether the state has enough inspectors, called "surveyors," to keep adequate tabs on Illinois' nursing homes.

"The state tends to react to things, rather than prevent bad things from happening," said  Meltzer. "They just don't have the staff."

While acknowledging Oak Park Healthcare Center's troubled history, current  administrator Jeffrey Kalkowski said Friday that the facility's owner, Careplus Management, has committed itself to "transforming" the facility into one more appropriate to its Oak Park location.

"Part of what I had to do on arrival was to change the population from a young, psychiatric (profile) and make the transition to a geriatric facility."

"The population we're targeting now is the geriatric segment," said Kalkowski, who defined that population as "generally over the age of 55."

As part of that change, Kalkowski said the facility will attempt to place restrictions on admitting individuals with drug and alcohol problems. Along with altering the characteristics of the resident population, he said, the facility will be undergoing a thorough renovation soon, including redoing the furnishings and decor of the entire first floor, which is presently closed. Kalkowski expects that work to be finished sometime in mid-July.

As for the two fines assessed against OPHC during his tenure, Kalkowski said both will be appealed. While not disputing the general facts in the state's charges, Kalkowski said that the reports present a distorted picture of what actually happened. In the latest case that resulted in the amputation of a resident's legs, he said that a doctor had in fact visited the man and seen his condition.

"Our treatment of him was not the cause of the amputation," said Kalkowski.

Oak Park Healthcare Center's track record compares unfavorably with the other three nursing facilities located in Oak Park?#34;though up to now any comparison has been something of an apple to oranges process in terms of both the numbers and types of patients with which they deal. While the other facilities have numerous restrictions on accepting patients with mental illness, drug addiction, alcoholism or aggressive, anti-social behavior, Oak Park Healthcare Center, with well over twice the number of beds, had previously accepted all types of patients, with the exception of drug addicts and chronic alcoholics.

Oak Park's other for profit nursing facility, The Woodbine Nursing Home, which had a reported 53 patients in 2002, 47 of them 65 years or older, incorporated around the same time as Oak Park Healthcare. It had just two of five complaints founded between 2001 and 2005, though both incidents, both in 2003, were deemed serious enough by the IDPH to result in $10,000 fines by the department. One incident involved alleged abuse and insensitivity by staff. The other involved inadequate medical treatment of a foot wound that resulted in gangrene and the amputation of a woman's leg above the knee.

Kalkowski said proof of his ownership's commitment to real change is reflected in their willingness to hold the population, or "census" of the home below previous population levels as they manage that transition. Licensed for 204 Medicare and/or Medicaid beds, with 126 filled during the 2002 fiscal year, the facility currently has just 110 filled beds.

There is skepticism by some regarding the ability or willingness of current Oak Park Healthcare ownership to effect and manage meaningful change at the facility, however. While changes in ownership and administration of nursing homes is rather routine, those changes don't necessarily mean a change in the people making the decisions.

Back in 1987, then-Illinois Citizens for Better Care (ICBC) executive director Malcolm Rich told the Tribune that nursing home ownership changed "on a regular basis."

"It's very much a club of owners."

Current ICBC executive director Wendy Meltzer, who started with the organization in 1988, said she thinks the "club" analogy is a good one, then offered one of her own.

"It's like an interlocking directorate, to use an old term," she said last Thursday. "Except it is ownership."

That contention is bolstered by the circumstances in which current Oak Park Healthcare owners Sherwin Ray and Jakob Bakst took over the facility?#34;in the wake of a $1 million libel and slander lawsuit against  Fairmount Oak Park owners Eric Rothner and Bryan G. Barrish in 1998, (which was settled in October, 2001). Ray and Bakst took over as owners of the subsequently renamed Oak Park Healthcare Center on Aug. 24, 1999. State records show that both Ray and Bakst have co-ownership arrangements with Rothner in numerous other nursing homes.

Ray and Bakst have a history of resident care concerns and legal problems at numerous nursing homes throughout Illinois. In December, 2001, Ray's Careplus Management and Bakst were sued in federal court by a former senior female employee of one of their facilities. The case, which charged sexual harassment, unlawful retaliation, and assault and battery, was dismissed by mutual agreement of both parties in October, 2002.

Sherwin Ray is partners with Rothner in at least four nursing homes, and with Bakst in at least 10 other long term care facilities around the state, including four nursing homes currently on the Consumer Reports.org's Nursing HomeWatch List. Oak Park Healthcare is not one of those four facilities.

Back in 1987, the state attempted to revoke the license of one Ray/Rothner facility, Boulevard Care, 3405 S. Michigan Ave., according to a Chicago Tribune article. Revocation attempts against the home's previous legal entity, Michigan Terrace, had ended when the then owners, including Rothner, apparently sold it. However, the Trib article quotes IDPH records as stating that Rothner owned 33 percent of the new business name. Rothner disputed those contentions at the time, saying he owned only 16 percent. Current state records show Ray and Rothner each with 50 percent stakes in the facility.

More recently, in November, 2002 the Tribune disclosed that Boulevard Care had taken in more ex-cons in the prior three years than any other Illinois nursing home - nine of whom were registered sex offenders.

Administrators also get moved around among Ray and Bakst owned facilities. Oak Park Healthcare Center's former administrator Samuel Biber is now administrator of another Ray owned facility, Avenue Care Center on Chicago's  South Side. Biber worked at Oak Park Healthcare in 2002 when it faced one of the most serious challenges to its financial viability from the Illinois Department of Public Health. In a March 12, 2002 letter, IDPH officials informed Biber that the facility had not "achieved and maintained 'substantial compliance' with all certification requirements."

As a result of that failure, the letter continued, the IDPH intended to recommend that the facility be barred from participating in Medicare/Medicaid if it did not come into compliance by June 20, 2002. Such action by the state is effectively the kiss of death for facilities that rely almost solely on those types of payments. Despite subsequent founded complaint investigations in September, 2002 and October 2002, the facility remained in the Medicaid/Medicare program, though a new administrator, Gloria L. Green, had replaced Biber.

And Kalkowski, prior to taking over at Oak Park Healthcare early last year, worked at two other Ray/Bakst facilities in Joliet that have troubled records concerning patient care, according to state records.

Paul Waterhouse, communications director for the Service Employees International Union Local 4 believes that one primary cause of problems at nursing facilities like Oak Park Healthcare Center is staff turnover among certain types of  employees. Among those  employees are certified nursing assistants (CNAs).

"Those CNAs perform the bulk of the direct care of residents," said Waterhouse, adding that the national average for turnover at nursing homes is "around 75 per cent annually." That, Waterhouse said, is primarily a result of low pay and benefits, in addition to the physically demanding nature of the work.

"Thirty-two of the 70 to 75 (registered nurse and LPN) staff (at Oak Park Healthcare) have been there less than a year," said Waterhouse, citing the most recent figures available. "And 39 less than two years."

SEIU Local 4 is currently in the fourth month of negotiating a contract on behalf of Oak Park Healthcare CNAs, kitchen and housekeeping employees. The previous contract expired at the end of 2004.

Those working at facilities less than one year, said Waterhouse, are likely making the minimum rate of $8 per hour. The industry average, for more experienced workers is around $8.80 to $9 an hour.

"Studies have shown that as salaries rise, rates of complaints tend to drop," said Waterhouse.

Kalkowski dismisses that assessment, though.

"It all involves how you run the facility," said Kalkowski. "You could have the best paid staff, and you wouldn't necessarily have a happy staff."

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