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Aggressive/Antisocial, Drug Addiction, Mental Illness


Have you at any time in the past been diagnosed with one or more forms of mental illness as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)? How about an antisocial personality disorder? Aggressiveness, for example? Do you now exhibit, or have you ever exhibited, a recurring and even systematic disregard for the rights and well-being of others? Do you tend to resort to the threat or use of force to get what you want from others, whenever you want it?

Addictions, too. Let us not forget addictions. Americans make such wonderful addicts. Whether to legal or illicit substances, or to other chronic patterns of consumption. Because by this stage, Americans must comprise the most chronically-addicted population on the face of the earth. So. Yet another question demands an answer: Are you now, or have you ever been at any time in the past, engaged in addictive behavior?

Don’t know about the rest of you. But I for one am more than a little curious about how we all might answer these questions. Particularly now that a very peculiar ordinance was adopted on July 18 by the Mayor and the Board of Trustees of the Village of Evergreen Park (at least this is how they refer to the joint), E.P. being a suburb of some 20,000 people within the greater metropolitan Chicago area, located just southwest of the major city.

(Click here to see an image of Evergreen Park as photographed by one of the Apollo space craft. E.P. can be found just off the southwestern tip of Lake Michigan—that deep-blue finger jutting downwards from the center of the North American land mass. Please note that you first might have to enlarge the image, and scroll around a bit to find the lake. Also remember to squint real hard.)

Ordinance No. 19 – 2005, in fact: An Ordinance Deleting Article VI, Special Uses, Planned Developments, and Adding Section 25 – 95, Nursing and Personal Care Facility, to the Evergreen Park Zoning Code. Since an electronically-accessible copy of Ordinance No. 19 isn’t available right now—and may never be—permit me to transcribe the crucial paragraphs for you here.

As the title of the ordinance instructs, it deletes Article VI, “Special Uses, Planned Developments,” from the Evergreen Park Zoning Code. Also, it adds a new section numbered 25 – 94, “Nursing and Personal Care Facility,” to the same Zoning Code. (Personally, I have never seen the E.P. Zoning Code or its previous Article VI. Nor for that matter do I believe that an electronically-accessible copy of the Zoning Code exists as of this time.—Though if you manage to find one, please pass along the link.)

What the ordinance states in Section 1 about the now-deleted Article VI sounds pretty sweeping. It reads:

There shall be no special uses of planned developments within the Village. All uses which are not affirmatively set forth as permitted uses in a zoning district are prohibited uses and may be allowed only upon application for a variation.

Then, in the meatier Section 2, “Nursing and Personal Care Facility,” the ordinance adds the following paragraphs to the Zoning Code:

Any nursing and personal care facility which lawfully existed on the date of the passage of this ordinance shall be a legal non-conforming use subject to the provisions of Article IX, Nonconformities. In order to be lawfully existing, the nursing and personal care facility must have a current valid license from the State of Illinois under the Nursing Home Care Act.

Because of the effect that such facilities have shown upon neighboring residential areas, the continuation of any legal non-conforming use is subject to the following limitations:

A. There shall be no increase in the number of beds for which the facility is permitted by the Illinois Department of Public Health.
B. There shall be no increase in the number of beds in any category (such as skilled beds, intermediate beds, etc.) for which the facility is permitted by the Illinois Department of Public Health.
C. No new patients shall be admitted under the categories of Aggressive/Anti-Social, Drug Addiction, and Mental Illness. Any existing patients in such categories may remain, but upon their removal from the facility, no new patient may replace the same if admitted under the above categories or with a diagnosis of mental illness.
D. On-site parking requirements shall be not less than one parking place for each three beds for which the facility is permitted by the Illinois Department of Public Health plus one parking space for each member of the staff as determined by taking the most recent total staff (including full-time and part-time) as reported by the Illinois Department of Public Aid and divided by three. To the extent that a facility does not meet this on-site parking requirement, no new patients shall be admitted, even if replacing existing patients who are removed from the facility.

Now. Ordinance No. 19 did not come out of nowhere. Indeed. Ordinance No. 19 happens to be the ill-begotten spawn of two aspects of E.P. life in particular: The state of nursing and personal care facilities there, and the state of E.P.’s by now monumentally hysterical reaction to them.

Until recent months, at least two long-term care facilities used to be in operation in E.P.:

Emerald Park Healthcare Center
Evergreen Healthcare Center

But this was it. Just two. The Chicago-area suburb which always has billed itself as the “Village of Churches” never once billed itself as the Village of Nursing Homes, as far as I’m aware. Why then take the trouble to amend E.P.’s Zoning Code to prevent the development of new nursing homes? To prevent any increase in the number of beds in the currently existing homes? And above all, to prevent the admission of any new residents to the homes under categories that include the “aggressive,” the “anti-social,” “drug addiction” and, last but not least, the all-encompassing category “mental illness”? And why now?

Under Article I, Short Title and Definitions, of the State of Illinois’ Nursing Home Care Act, a long-term care facility means (Sec. 1?113):

a private home, institution, building, residence, or any other place, whether operated for profit or not, or a county home for the infirm and chronically ill…or any similar institution operated by a political subdivision of the State of Illinois, which provides, through its ownership or management, personal care, sheltered care or nursing for 3 or more persons, not related to the applicant or owner by blood or marriage. It includes skilled nursing facilities and intermediate care facilities as those terms are defined in Title XVIII and Title XIX of the Federal Social Security Act. It also includes homes, institutions, or other places operated by or under the authority of the Illinois Department of Veterans’ Affairs.

(As for what a long-term care facility does not include……..Well. You can always check it for yourselves on the website (Sec. 1?113).)

The Illinois Department of Public Health (IDPH) makes available aggregate data about the residents from all of the State’s long-term care facilities—of which there are some 1200, the State reports (Nursing Homes in Illinois).

Unfortunately, the data currently available is more than 18 months old, having been collected during a reporting period that ended on December 31, 2003.

Nevertheless. It’s still worth taking a look at. As of December 31, 2003:

Emerald Park Healthcare Center (“Residents by Primary Diagnosis“) had 239 residents. Of these, 140 had “mental illness” listed as their primary diagnosis, 11 “Alzheimer disease,” and 0 “developmental disability.”

Evergreen Healthcare Center (“Residents by Primary Diagnosis“) had 194 residents. Of these, zero had “mental illness” listed as their primary diagnosis, 23 “Alzheimer disease,” and 5 “developmental disability.”

So. Immediately we see that as of December 31, 2003, there were a lot more residents at the Emerald Park Healthcare Center whose primary diagnosis was “mental illness” (140, in fact) than there were at the Evergreen Healthcare Center (zero), some two-and-a-half miles away. At Emerald Park, that is, six-out-of-ten residents (59%) became residents under a “mental health” diagnosis.

IDPH provides other kinds of data about the residents of the State’s nursing homes too. For example, as of December 31, 2003:

Of Emerald Park Healthcare Center’s 239 residents (“Residents by Age, Gender, and Level of Care“), all 239 were receiving “nursing care.” Among these, 134 were males aged 18 – 64—pretty young guys, at least in years, for a nursing home. Only 23 male residents were aged 65 and over. A total of 82 females were residents. Fifty-five were aged 18 – 64; only 27 females were aged 65 and over.

Of Evergreen Healthcare Center 194 residents (“Residents by Age, Gender, and Level of Care“), all 194 were receiving “nursing care.” But unlike Emerald Park’s younger-than-65 set, here, at Evergreen Healthcare, only 14 male residents were aged 18 – 64. Fifty-six were aged 65 and over. Of the 124 female residents, 17 were aged 18 – 64. The other 107 were aged 65 and over.

In other words, 79% of Emerald Park’s residents were 64 years of age or younger—a collection of relatively young individuals for a nursing home. Particularly when compared to Evergreen Healthcare’s residents, where 84% were aged 65 and over.

Still other resident data jump out at us:

At the Emerald Park Healthcare Center (“Residents by Racial/Ethnic Groups“), 166 residents were black, and 67 white. (Another 6 were Hispanic.)

At the Evergreen Healthcare Center (“Residents by Racial/Ethnic Groups“), 132 residents were white, and 59 were black. (With 2 Hispanics and 1 American Indian, according to the State’s data).

Thus in percentage terms, the racial breakdowns of Emerald Park Healthcare and Evergreen Healthcare were virtually the inverse of each other. Whereas Emerald Park was 69% black and 28% white, Evergreen Healthcare was 68% white and 30% black.

Last, in terms of who paid the bills for the residents at these two long-term care facilities:

At the Emerald Park Healthcare Center (“Residents by Age Group and Payment Source“), the government (Medicare, Medicaid, and “public”) was the source of payment for all but one of its 239 residents.

At the Evergreen Healthcare Center (“Residents by Age Group and Payment Source“), the government (Medicare, Medicaid, and “public”) paid the bills for 139 residents; the source of payment for the other 55 residents was private (i.e., whether privately funded insurance policies or other private, out-of-pocket sources). In fact, the bills for 43 of the residents (22%) at the Evergreen Healthcare Center were covered by strictly private, out-of-pocket sources.

To sum it up: Here are four categories of resident-data that strike me as significant and that contrast pretty sharply—some pretty dramatically—between E.P.’s Emerald Park Healthcare Center and its Evergreen Healthcare Center: (1) Primary diagnosis (or the justification for placing a person within a long-term care facility); (2) resident age; (3) racial breakdown; and (4) source of payments.

At Emerald Park, more than half (59%) of the residents entered under a “mental health” diagnosis; 79% of all residents were 64 years of age or younger, and 56% males; 69% were black; and 99% of the residents’ bills were paid by government programs.

At Evergreen Healthcare, on the other hand, none of the residents entered under a “mental health” diagnosis; 84% of all residents were aged 65 or over; 68% were white; and 72% of the residents’ bills were paid by government programs.

Of these four categories, only the fourth, source of payments, showed even a rough symmetry among the resident populations of E.P.’s two nursing and personal care facilities. But as far as the other three were concerned—primary diagnosis, resident age, and racial breakdown—the contrasts were fairly sharp-to-dramatic, and asymmetries abounded. The Emerald Park Healthcare Center simply had a lot more “mental illness” residents, a lot more younger residents, and a lot more black residents than did the Evergreen Healthcare Center.

Don’t forget: That was as of December 31, 2003. But between then and now, a concerted effort by Evergreen Park officials, State representatives and senators, the Illinois Department of Public Health, and the State’s Attorney General has managed to shut-down the Emerald Park Healthcare Center as part of a negotiated deal with its owners, citing “multiple deficiencies” and an impressively horrific track record—though a track record that I do not believe is at all atypical for long-term care facilities in the United States whose residents rely solely on the largesse of Medicare and Medicaid to survive. (See, e.g., “Emerald Park Owners Agree to Suspension and Surrender of License” (News Release), Illinois Department of Public Health, July 15; also see “‘Horror story’ finished,” Stephanie Gehring, Daily Southtown, July 13; “Owners banned from new business,” Stephanie Gehring, Daily Southtown, July 16; and “Troubled nursing home’s owners settle, give up license,” Lori Rackl, Chicago Sun-Times, July 17.)

Meanwhile, E.P.’s other long-term care facility, the Evergreen Healthcare Center, remains open.

Still. What I would like to know is exactly where the Village of Evergreen Park’s Ordinance 19 came from. Presuming that it wasn’t outer space. And given the fact that the Emerald Park Healthcare Center has been closed since June 3. All of it residents relocated—its registered sex offenders included. And the license of its former owners suspended (July 15). Including a penalty that prohibits them operating a long-term care facility at the same location for the next 50 years.

About which: More another time.

Village of Evergreen Park (Homepage)

U.S. Department of Health and Human Services (Homepage)
Center for Medicare and Medicaid Services (HHS)
Nursing Home Compare (national database maintained by the Center for Medicare and Medicaid Services)

Illinois Department of Public Health (Homepage)
Nursing Homes in Illinois (IDPH)
Nursing Home Care Act, Illinois General Assembly

Emerald Park Healthcare Center, 9125 S. Pulaski (analytic data provided by the Illinois Department of Public Health)
Evergreen Healthcare Center, 10124 S. Kedzie (analytic data provided by the Illinois Department of Public Health)

Letter to Yosef Meystel, Administrator, Emerald Park Health Care Center, from Maryann Ream, Chief, Division of Long-Term Care Quality Assurance, Illinois Department of Public Health, April 25, 2005

Illinois Attorney General (Homepage)

Madigan, IDPH, Lawmakers, Local Officials Applaud Signing of New Law That Will Further Protect Residents of State-Licensed Nursing Homes from Parolees and Sex Offenders” (Press Release), Illinois Attorney General, July 12, 2005
Emerald Park Owners Agree to Suspension and Surrender of License” (Press Release), Illinois Department of Public Health, July 15, 2005

‘Horror story’ finished. Problems at Evergreen Park nursing home spur change in state law,” Stephanie Gehring, Daily Southtown, July 13, 2005
Owners banned from new business. Emerald Park Health Care group can’t open new homes for up to three years,” Stephanie Gehring, Daily Southtown, July 16, 2005
Troubled nursing home’s owners settle, give up license,” Lori Rackl, Chicago Sun-Times, July 17, 2005
Nursing home ban expanded. Evergreen Park bars admission of mentally ill, addicts,” Stephanie Gehring, Daily Southtown, July 20, 2005
Nursing home ban illegal, experts say. Evergreen Park bars addicts, mentally ill from village facilities,” Gregg Sherrard Blesch, Daily Southtown, July 24, 2005
Mental illness, addiction law under fire in Evergreen Park,” Gregg Sherrard Blesch, Chicago Sun-Times, July 25, 2005
Nursing home rules go too far in Evergreen Park,” Editorial, Daily Southtown, July 28, 2005
Advocates rally against nursing home,” Kate McCann, Daily Southtown, July 30, 2005
Family lost in rush to close Emerald Park,” Gregg Sherrard Blesch, Daily Southtown, July 31, 2005
Nursing home rules come with heavy price,” Gregg Sherrard Blesch, Daily Southtown, August 11, 2005

Gestapo Journalism, ZNet, April 24, 2005
In the Penal Colony, ZNet, May 4, 2005
Aggressive/Antisocial, Drug Addiction, Mental Illness, ZNet, August 15, 2005

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