Home run: The five people who still live here have until Aug. 10 to move out (photo by: Michael Persico).

Living on the Edge

Loose oversight of personal care homes jeopardizes the most vulnerable.

by Liz Spikol

It’s been a rough week or so for residents of Ivy Ridge personal care home. Ivy Ridge’s owner Rosalind Lavin agreed to a settlement that banned her from owning and operating such facilities. While Lavin luxuriated on her Villanova estate, the people in her homes—Ivy Ridge and three others—lived in squalor.

U.S. attorney Patrick Meehan said the conditions were “grossly inadequate” and “appalling.” There wasn’t enough food. Medications weren’t distributed. The sheets were dirty. The Daily News reported, “Lavin or her managers allow[ed] residents to lie in vomit or feces for days, unattended.”

So it was good to see Lavin get her walking papers. But practically speaking, things quickly got dicey. On June 12 the five remaining residents of Ivy Ridge received a letter from the city’s Department of Licenses and Inspections (L&I) telling them to vacate within 24 hours.

The abrupt action sent Lisa Faulkner of the We CARE advocacy project into overdrive. She called L&I to explain these people could be out on the street unless they had more time. L&I backed down, saying the letter had been sent in error, and that in fact residents have until Aug. 10 to relocate.

So now the appalling and illegal conditions are apparently good enough for another month or so.

They’re poor. They’re old. They’re disabled. They live in neighborhoods with abandoned buildings and crack vials on the sidewalks. We picture sad faces and broken spirits.

But the truth isn’t that simple. The people who live in Pennsylvania’s 1,500 personal care homes (PCH) are a mixed group—young and old, white and black, disabled and able-bodied. Many of them do have mental illnesses or physical restrictions, but they also have senses of humor, favorite books, ideas about politics and the desire to make their lives better.

I knew a woman who lived in a PCH who had a very rich sense of her sexuality. I knew another who was most delighted when someone did her hair. I knew another who was a college grad. What they had in common was simply being vulnerable at a certain time in their lives.

In the 1990s I was receiving disability benefits and needed assistance with meals and medications. Lucky for me, when the bottom totally dropped, I ended up living with my parents. But not everyone has a family member willing or able to take them in. Sometimes a PCH is the only option.

And that’s where the problems come in.

Most PCH residents get just $60 a month allowance for medication, transportation and anything else not provided by the PCH. This amount hasn’t changed since 1993.

In theory, the homes provide three meals a day, laundry service and other basic necessities. But it doesn’t always happen. I’ve seen people become overjoyed at the prospect of getting a new toothbrush for free. They can’t afford to buy their own hygiene products, and they’re not getting them from the PCH.

There’s also the food. Meals of hot dog and beans, or chicken strips or bologna and mayonnaise. Dietary restrictions? Metabolic issues? You’re out of luck.

One home in West Philadelphia was cited for 18 violations a few months ago. These included not having medication evaluations for residents, having undated medication bottles, and stopping a resident’s medication without any written evidence from a prescribing doctor.

The home has no second exit on one floor, and no plans to build one. Yet it continues to operate, having received another provisional license from the Department of Public Welfare (DPW).

DPW spokesperson Anne Bale says, “We don’t issue provisional licenses lightly. It means we have serious health and safety concerns for residents of a particular facility.”

At the same time, she says, “The licenses don’t necessarily have massive repercussions. But it means we’re going to monitor [the facilities that receive them] more closely. Some violations are very little—while still important—like there aren’t enough paper towels. At the same time a lot of little violations can add up to really big problems.”

Bale says family members need to do research before they place a relative. But what about people without family? “It’s a tough situation, no doubt,” she says.

Why? Because there’s nowhere else for him to go.

Rosalind Lavin and Ivy Ridge landed on the cover of the Daily News last week. There are plenty of other PCHs with violations—perhaps not as large as Lavin’s—that compromise quality of life significantly.

The DPW’s Anne Bale says, “We hear it both ways. Some people say we’re not strict enough. Some people say we’re too strict. We follow the law.” One has to question the efficacy and merit of laws that would let thousands of people live in such poor conditions.