(click headline for Chgo SunTimes)
Patients brace for Oak Forest Hospital’s likely closure
By Carla K. Johnson Apr 15, 2011
The stopped clocks in the corridors of Oak Forest Hospital fuel Michael Yanul’s anxiety.
For 17 years, the facility that serves the poor in Chicago’s south suburbs has been his home, but later this year, Cook County plans to end hospital services there in an effort to cut the rising costs pressuring Oak Forest and other “safety-net” hospitals across the country. That means Yanul and six other long-term patients will have to find nursing homes or other places to live, leaving them little assurance they’ll get the same level of care.
Yanul, who has muscular dystrophy, says he’s “devastated.”
“The nurses turn me and clean me and give me a bath every day. I’ve never had one pressure sore,” said Yanul, 58, speaking slowly as his ventilator kept him breathing. “That’s the great worry I have about going to a nursing home. They don’t have the staff to turn the patients.”
The fate of the seven long-term patients is among many considerations to be addressed Monday at a public hearing before the state’s Health Facilities and Services Review Board, which is scheduled to decide on the closure plan May 10. The board postponed the decision last month after protesters interrupted a previous meeting.
Cook County is the largest provider of health care to Illinois’ poor and uninsured, but is struggling under rising medical costs, declining federal help, dependence on Illinois’ Medicaid system and patients who can’t pay their bills.
The county already has eliminated nearly 80 nursing jobs at Oak Forest, moving most of those nurses to Stroger Hospital.
While hospital officials say they have plans to upgrade the stopped, “antiquated” clocks, for the residents they are a worrisome sign that the hospital is slowing to a halt.
County officials promise to convert Oak Forest into a large primary care center with no major surgeries, intensive care unit or overnight patients that will increase access to care, including medical specialists. Outpatient clinics already operating at the hospital would continue without a pause and the emergency department would immediately become an urgent care clinic. By 2015, the county estimates outpatient visits in the south suburbs would quadruple to 150,000 visits.
Other cities’ health systems have already shifted resources from hospital care toward primary care, county officials say. The 213-bed Oak Forest Hospital has seen its patient census dwindle to about 40 patients a day. The county hopes to save $25 million with the change, mostly by reducing staff.
The cost of caring for a long-term care patient is $1,320 per day, while the rate they are reimbursed for those costs through Medicaid is $133 per day, hospital officials said.
“We understand that some people will have to make changes, but we think that a plan that will bring in four times as many patients is the right one for the community,” said Lucio Guerrero, spokesman for the Cook County Health and Hospitals System.
Yet outpatient care won’t help patients like Yanul.
He and other long-term patients fear they’ll have to move to nursing homes where they may face neglect. Research shows the amount of time nurses spend with patients is the key to preventing potentially deadly problems, and Illinois’ for-profit nursing homes have the lowest average staffing level in the nation, according to an analysis of federal data by the Chicago Reporter, an investigative magazine focused on equality issues.
Yanul can blink, talk and weakly grasp a hand for a greeting, but otherwise he can’t move. Without a machine’s help, he can’t breathe. There’s no cure for muscular dystrophy, the disease that’s confined him to the same hospital bed for nearly two decades.
Tacked to the ceiling above his bed is a Beatles poster, glow-in-the-dark stars and a photo of a friend, Juanita Gibbs, who has visited or called Yanul every day for seven years since they met when she visited her hospitalized brother-in-law. Gibbs also has testified at public hearings on the closing, concerned about the quality of care he will get if he is moved.
Others have similar anxieties. Oak Forest once included a large nursing home, but hasn’t admitted new residents to it since 2007. Five of those residents are left, in addition to Yanul and another long-term patient in another unit.
Cynthia Phillips, 55, has lived at the hospital nearly 10 years. Her legs and one arm are paralyzed. She once worked in a nursing home where she saw patients who’d wet themselves left for hours without anyone coming to change their bedding.
Across the hall is Glenn Wise, 50, who has lived at the hospital 22 years after a gunshot wound left him paralyzed. “It’s a matter of life and death,” he said. “They’re putting us in a position that could cause people to die.”
Yanul said hospital officials gave him a list of nursing homes but no other help. He wasn’t given a formal assessment of his needs or matched with a facility that can take long-term ventilator patients, he said.
Deborah Kennedy of Chicago-based advocacy group Equip for Equality said that’s not enough. Illinois requires hospitals to do detailed discharge plans, she said.
Diane Soltis-Velilla, director of social services at Oak Forest Hospital, said hospital social workers are meeting with patients and their families and, besides medical needs, must also consider what will be covered by the patients’ insurance, if they have insurance.
Some patients have refused to participate in the process, opting to wait until the state board determines whether Oak Forest will indeed close.
“We are walking a thin line in this effort,” Soltis-Velilla said. Social workers want to be accessible, “yet at the same time, we don’t want to appear pushy and/or aggressive in our approach.”
Without money to solve Cook County’s problems, the state board may not have much choice but to allow the hospital to finally die.
“I try to be realistic,” Yanul said. “I know that the chances are slim that I could be allowed to stay, but I’m hopeful.”
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