Closed For Good
How the Court Restored Dignity To the Residents of D.C. Village
By Harriet A. Fields
Sunday, June 22, 1997; Page C01
The Washington Post
There is a plaque in the entryway of D.C. Village, the now boarded up nursing home once operated by the District of Columbia. It is engraved with a quote from President John F. Kennedy: "A society's quality and durability can best be measured by the respect and care given its elder citizens."
What an inspiring statement, I thought when I first visited the facility in August 1995. But by the time I had helped the last resident of D.C. Village move out a year later, I had come to see Kennedy's words as mere wall dressing. If we as a society were to measure the District government's "quality and durability" by how it treated the people under its care at D.C. Village, we would have no choice but to say that the government had failed miserably in its duties.
The story of D.C. Village is one of appalling and avoidable wrongs. Those are strong words, but there is no other way to describe what I saw there during my time as court monitor. Within its walls, 269 of the District's most vulnerable and defenseless residents -- some elderly, some with mental illness, some with mental retardation, all poor -- lived in such conditions of filth and abuse that even basic needs were often neglected. U.S. District Judge Thomas F. Hogan actually had to issue a formal court order at one point to make sure that each resident had water, and cups to drink it, in their rooms. He had to put in writing that D.C. Village officials must provide "adequate supplies of soap."
But the story of D.C. Village's closure is also one of extraordinary accomplishment. Lives once discarded by a bureaucracy have been reclaimed. The residents have been placed in new homes. Many are enjoying the little pleasures of life -- reading, walking, listening to music -- after spending years sitting listlessly in hallways or strapped to their beds or medicated to the point of stupor.
Unlike so many lawsuits against failed public institutions, this one was concluded less than two years after the Justice Department alleged that the civil rights of D.C. Village's residents had been violated. In contrast, the District's mental health system has been under a federal judge's supervision for 22 years and it took 13 years to shut down Forest Haven, the city's troubled home for people with mental retardation.
As the court monitor, I never lost sight of my duty: to protect the rights of the residents at D.C. Village. Monitors and receivers must not be lulled into functioning as if their positions are permanent. Otherwise, they become just another arm of the bureaucracy they are supposed to be observing. On the other hand, monitoring must not cease until the court can be assured that the rights and dignity of the individuals who need protection are, indeed, protected.
Judge Hogan never wavered from his determination to protect the residents' rights. He refused to tolerate the adversarial and uncooperative attitude shown by District officials. He demanded they come to court for regular meetings. He threatened them with jail if they refused to adhere to his orders. Twice he held them in contempt of court for their failure to comply. In short, he held the District accountable. For too many years, that message was not being heard by top officials at the District building. It is a message that needs to be delivered loud and clear, over and over, so that this kind of abuse does not ever happen again.
The history of the legal battle is worth retelling. On May 19, 1995, Richard J. Farano of the U.S. Department of Justice, Civil Rights Division, filed a lawsuit that named not only the District government, but also the individuals with ultimate responsibility for the care of the residents at D.C. Village: Mayor Marion Barry Jr.; Vernon Hawkins, then the director of the Department of Human Services; Frances Bowie, the head of the Mental Retardation/Development Disabilities Administration, and the executive director of D.C. Village.
The lawsuit should not have surprised anyone in District government because the Long-Term Care Ombudsman had issued reports for years about neglect, abuse and poor care at D.C. Village. Yet the conditions persisted.
On July 6, 1995, District officials signed a consent decree agreeing to properly nourish the residents, to treat their bedsores, to not leave them incontinent, to pay vendors so that needed supplies and services would not continue to be interrupted or terminated. The consent decree also provided for a court monitor.
On Aug. 1, 1995, I was appointed by Judge Hogan. I came to the position with 25 years' experience in the field of long-term care, both as a consultant and as a nurse educator. As the court monitor, it was my responsibility to be objective and neutral, to oversee the District's compliance and to advise the administration, the staff and District officials on how to comply with federal law and regulations. I would serve as the eyes and ears of the court.
Two weeks after my appointment, Mayor Barry and the D.C. Council unexpectedly and callously announced the closure of D.C. Village under the guise of fiscal responsibility. This unilateral decision was made without informing the residents, many of whom had lived at D.C. Village for decades, and without considering the possible life-threatening consequences of a sudden, mass transfer. I soon discovered that D.C. officials did not have an appropriate plan for a shut down and did not have new placements lined up. Judge Hogan halted the transfers -- he later called the District's effort "a disaster" -- and expanded my duties to include oversight of the outplacement process.
When I first entered D.C. Village at the end of August 1995, astoundingly I found that every abuse cited in the lawsuit, and every violation that was supposed to be remedied by the July decree, still boldly existed. As far I could tell, nothing had been done to improve the lives of the residents.
The residents included 15 individuals with mental retardation who had been dumped at D.C. Village after Forest Haven closed. There were about 70 people who came to D.C. Village in 1991 from St. Elizabeth's Hospital, and were classified as having mental illness -- although some had been slapped with that label as adolescents and had never been reevaluated.
By going to each resident's bedside, I saw for myself what the Justice Department had alleged. The odor of urine was everywhere. There were residents who had not been turned in their beds regularly and had developed decubitus ulcers -- a kind of bedsore -- so deep that bone was visible amid the oozing tissue. There were residents being fed through a gastric tube because it was easier than trying to feed them by mouth. There were also some residents languishing at D.C. Village who no longer needed nursing-home care and who could have been living in a more independent setting if only someone had taken the initiative to arrange it. The residents rarely if ever smiled, and had bewildered and even pained expressions in their eyes and on their faces. Many residents had lost their spirit entirely, and had passively accepted their own neglect.
On one Sunday evening, while I was touring the residents' units, there came from one room the unforgettable stench of urine and dead skin. I found James B. lying in bed, soaked with urine and feces. Three years before, he had walked into the facility on his own. Now his body was so contracted that his knees were touching his chest and sores were developing on his knuckles, which were nearly stuck under his chin.
It is inconceivable to me that the staff at D.C. Village had allowed this to happen. I immediately brought the nurses and aides on duty to his bedside and oversaw them as they turned him, cleaned him and cared for him. I then notified the D.C. Village administration and Judge Hogan of his suffering, and through the ongoing vigilance of the court, never again was James B. left unturned. Never again did he lie in urine and feces. Never again did the odor of death emanate from his bed.
The sad thing was that James B.'s pain was so preventable -- and so senseless. Many of the caregivers at D.C. Village did not have the training and education they needed to do their jobs. Many did not seem to know the minimum standards of care required by the Nursing Home Reform Act of 1987. I provided them with copies of the federal laws and regulations, as well as Judge Hogan's court orders. Experts were made available to train the staff, many of whom wanted to improve their caregiving. Indeed, on one of my last nights at D.C. Village, a nurse hugged me and said, "We are now giving the type of care the residents deserve."
The District's financial situation was not the cause of the deplorable conditions at D.C. Village. The fact is that the federal government was reimbursing D.C. Village at one of the highest rates of any nursing home in the country, nearly $240 a day for each resident or $87,000 a year -- a total of $24 million annually. Nor can the problems be attributed to a staff shortage: D.C. Village had six medical doctors, 18 therapeutic recreation staff, five pharmacists, and a full complement of nurses' aides, even on the night shift. Neither the federal Health Care Financing Administration, nor its D.C. counterpart, ever demanded true accountability for this generous funding.
No, money was not the cause. The problems were far deeper than that. There was a bankruptcy, but it was of the moral kind. Individuals within a government bureaucracy became blinded to their mission as public servants. If we want to prevent this kind of abuse again, we must not hesitate to punish those who neglect and trample the civil rights of others. Both the Health Care Financing Administration and the District sent surveyors to D.C. Village for years, but they were unable to enforce recommendations for improving conditions at the nursing home. They came, they saw, they went away.
Now, the residents have left D.C. Village for good, too. The last one, Curmet Forte, left nearly a year ago, on June 24, 1996. He is living in the community in his own apartment, which is handicapped accessible. He has limited use of his hands, so he has an aide who comes four hours a day, five days a week, to help him with meals. He has a computer, which he uses to work on nursing-home reform issues -- and he is travels on public transportation.
The lawsuit is over, too. Judge Hogan signed his final order last month, taking care of one last indignity: For years the District had deposited the residents' personal needs allowances into the D.C. treasury, and retained the interest. The District must pay the interest owed, plus compensatory damages of $100 to each resident.
Most of the other residents are in private nursing facilities. In a new spirit of cooperation, representatives of the Corporation's Counsel's office and the U.S. government accompanied me on some of my visits to the residents in their new homes so that we could assure Judge Hogan that their needs were being met.
The residents finally received the "respect and care" that President Kennedy was talking about when he uttered the words enshrined on that plaque. It's a shame it took a lawsuit and the federal court to compel a government to perform its most basic duties and to accomplish what should be a simple act of kindness.
Harriet Fields served as court monitor in the case against the District government for civil rights violations at the D.C. Village nursing home.
WORDS TO LIVE BY
Conditions at the nursing home operated by the District of Columbia drew harsh words and threats of legal action all too soon after it opened as the Home for the Aged and Infirm in 1906.
Today, there seems to be no one in the District government who can provide a history of D.C. Village's nobler days. What does exist is a record of outrage at intervals when officials surveyed the level of care, as first lady Eleanor Roosevelt was asked to do in 1940.
Here are excerpts of reports and Washington Post editorials up until the time when D.C. Village stopped admitting new residents in 1993:
After her 1940 tour of the Blue Plains facility, a "shocked and depressed" Eleanor Roosevelt says it is being operated like an old-type prison, and that the service it offers is "far below the standards of decency." Later that year, physicians from Gallinger Hospital find that conditions are "more closely approaching those described in the writing of Charles Dickens than the standards which should be applied to such a home in the Nation's Capital." The Post reports: "The home is a dumping ground for human derelicts of all types . . . having also opened its doors to the feeble-minded, epileptic, insane, deaf-mute, blind and  incurable patients of all ages."
In 1941, Senate District Committee counsel R.F. Camalier calls the facility "indescribably filthy and insanitary;" City Commissioner Guy Mason says the aged and infirm there are "treated worse than criminals."
In 1951, The Post reports that "if the District wins its demand for home rule and acquires the right to issue bonds to finance the improvement of its run-down social institutions, additional buildings at Blue Plains are likely to have a high place on the priority list." Three years later, the facility is renamed D.C. Village and gets its long-awaited infirmary for 350 patients.
In 1976, the U.S. Department of Health, Education and Welfare threatens to cut off Medicare payments because of inadequate staffing and poor care of D.C. Village residents, and the home responds by halting admissions to bring the staff-patient ratio to acceptable level. Five years later, it voluntarily withdraws from Medicaid to avoid a federal inspection that city officials conclude it could not pass because of severe understaffing.
After a 1985 review of the facility, consultants find "residents were neglected and had few activities," and that residents of all ages and disabilities were mixed together," along with "no security system for exterior doors" and "air and water temperatures poorly regulated." A year later, city officials find staff "procedures were too unclear to place blame" for the 1985 freezing and scalding deaths of two elderly D.C. Village residents.
In 1989, the U.S. Health Care Financing Administration cites "poor conditions, including asbestos, cockroaches and mistakes in giving residents medication," and threatens to stop $9 million in Medicaid-Medicare payments.
© 1997 The Washington Post Company