Closing “The Home”

 The last nursing home resident left Pleasant Hill Village in Girard last week, almost 112 years after the first ones arrived at “The Home for the Homeless,” a beautiful large brick facility with 50 rooms and great halls, built by a small German-originated denomination, the Church of the Brethren. At the dedication on Thanksgiving Day, 1906, speakers vowed that “over the hill to the poor house” would never again be a threat to the homeless who would live out their days at “The Home.” The Brethren believed in practical Christian living as described in the book of James, which called on the church to gather alms for the support of “widows and orphans.” By 1910 some 30 to 40 orphans had come to live with the old folks, to give the children “a taste of heaven’s sweetness.”

The children returned the favor, entertaining the elderly by spitting watermelon seeds at picnics, by putting to use surplus equipment for wheelchair races, and by their prayers. A worker at the home in the 1920s recalled that little Hazel was saying her prayers as her older sister, Edna, was tickling her feet. Hazel said, “Wait a minute Lord while I knock the devil out of Edna.” In 1924 a youngster, George, supposed to be on his way to school, decided to go swimming in a pond west of Girard. He drowned. Soon after, the state stepped in and shipped the children to an orphanage in Bloomington. “It took the heart out of us all,” a worker wrote. “It was family breakup for all once again. The Home was never the same.”

The careful Christians who set out to do God’s work knew an institution of this size needed rules. From the beginning, the use of opiates and tobacco was banned. The superintendent was expected to “show a proper disposition in temperament and due courtesy toward each inmate of The Home,” and he was to “prohibit all disorder or disquietude, such as whistling and boisterous laughing.” For their part, the residents “are expected to conduct themselves in a becoming Christian manner, endeavoring to add to each other’s happiness by kindness and a forbearing spirit.” Finances were to be provided by the churches, and carefully watched over. “The number of inmates shall be regulated by the capacity of the building, or amount of funds on hand.”  And the rules made clear the responsibility of the individual churches, which had to recommend somebody for admission and come get her if she misbehaved.

Over the years things changed in the field of elder care, with the state getting more involved and churches less. Still when it came time for a new building the in the 1970s, churches and the local community pitched in to raise $210,000 of the $779,000 cost of the modern 98-bed nursing home, the balance financed by the Federal Housing Administration. (Estimates are it would cost $17 million to replace the facility today.) When the new nursing home opened in March 1976, most of the 32 residents walked from the old home to the new. Only one required a wheelchair. At first there was one nurse aide working nights, then, as the census grew, more were needed. “It was not hard to attract aides then,” recalls one longtime nurse, “as many mothers took their children to school and then came to work.”

Operating an old folks home was never an easy financial proposition. The Girard Gazette of Sept. 28, 1933, reported, “After spending practically 10 days studying the situation and considering ways and means, the management of The Home, at Girard, decided to continue to operate the place. . . .” By the late 1980s crisis meetings were so common they no longer made the papers. The state took over paying for most of the residents through the Medicaid program, but the “reimbursement rate” never reflected the full cost of care. And the less the state paid, the more it would regulate, sending in inspectors and occasionally dinging the home with pesky fines.

By the time I joined the Pleasant Hill board in the 1990s, Illinois governors had learned the trick of helping to balance state books by delaying payments to nursing homes, so not only were reimbursements low they were slow. We would protest this wasn’t fair to the elderly, but only nursing homes serving the poor elderly were affected. Many wealthier nursing homes simply refused to admit residents who depended on Medicaid.

In recent years governors and bureaucrats have refined their methods for slowing down Medicaid payments. Now the delay is supposedly no longer deliberate, but an unavoidable computer backlog in approving applications for Medicaid coverage. In fact, Gov. Bruce Rauner earlier this month signed legislation he says will speed up the process by allowing banks to share financial information with the state. “We want to do everything possible in easing the bureaucratic burden on seniors and their loved ones as they enroll in Medicaid long-term care,” Rauner said. “It is not fair to residents that it can take up to a year to get approved for essential services. Our families deserve better.” Yeah, right.

When Pleasant Hill announced in June it would close its nursing home by September, the state was paying $128.48 per resident day, when the cost of quality care was $160 per day. The state owed the facility more than $2 million. Some 60 residents were relocated to other facilities and 60 employees were laid off. The number of faith-based, nonprofit senior living providers in Illinois is steadily shrinking. In the days of hedge-fund style government squeezing every last dime from health-care costs, this is too tough an arena for churches without political clout and motivated solely by compassion.

Now Pleasant Hill will serve seniors by concentrating its efforts on the 48 independent and assisted living apartments it built 15 years ago. Still there is a deep sense of loss, which will be recognized in a public gathering at 3 p.m. Sept. 9. The announcement reads, “We will gather on our front lawn to give God thanks for the many days of loving care we have been able to provide for the least among us.”

Fletcher Farrar, editor and CEO, is a former Pleasant Hill Village board member and a member of the Church of the Brethren.