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All year, Susan Mason has gone long stretches during which she barely opens her eyes.
“She understands what is happening to her,” her daughter Mary Mason says.
Mason moved her mother, now 74, to The Washington Home eight years ago after she suffered a catastrophic stroke. Last September, the nursing home on the edge of Tenleytown announced that it would close in order to sell its property to Sidwell Friends School, the private Quaker school around the corner.
Eleven months later, the elder Mason is among 35 residents who remain, most of whom have nowhere to go because they are the hardest to relocate. That’s fewer than a third of the total who were living at the nursing home last fall.
Some of them say they don’t know what will happen to them come Dec. 15, when the deed transfers to Sidwell. The Washington Home has told the residents to leave—or have specific plans in place to do so—by Oct. 2, so that it has time to clear out the facility by December.
In the aftermath of the deal, the relationship between the remaining residents and the nursing home’s leadership has grown acrimonious, culminating in a lawsuit. Tension has simmered in the Sidwell community as well. An administration baffled at its portrayal as uncaring faces criticism from alumni who intend to hold accountable the school that ingrained in them as children the Quaker values of service and kindness.
Sidwell Friends School was founded in 1883 in a Friends Meeting House on I Street NW. No mere relic, the Quaker tradition remains core to its identity today. Community members sign their messages to each other, “In friendship.” A recent renovation of the campus meeting house won national architecture awards that cited the Quaker aesthetic of simplicity and light.
The spirit of Quakerism is also what sparked Larry Ottinger, Sidwell class of 1978, to show up on Wisconsin Avenue NW on a rainy Thursday afternoon in April to protest the $32.5 million purchase of The Washington Home. In front of Sidwell’s campus, a group of about 20 people alternated chants of “save our seniors” and “shame on Sidwell.”
“Sidwell teaches a lot about social justice,” Ottinger says. “It’s so much part of the brand and the mission and the philosophy.” He believes the purchase damaged the school’s reputation and that the school’s leaders have failed to live up to its own standards.
To this day, Sidwell’s administration maintains that it acted in accordance with its values.
“During the negotiations, the Home leadership indicated that they were developing individualized transition plans for all residents,” says Ellis Turner, Sidwell’s associate head of school. “We just had no reason for concern, based on the longstanding reputation of The Washington Home.”
He adds, “There was nothing that would have led us to have predicted these concerns, and thus far we’ve not been able to determine that there are reasons for concern.”
But for the alumni who have criticized the deal, that isn’t good enough coming from a Quaker school with ample resources.
They wish Sidwell had explored the consequences of closing a nursing home in the District, instead of deferring to an organization that, by its own account, was struggling financially and needed to complete a sale so it could survive as an organization.
Even the New York Times Ethicist column weighed in last October, saying that Sidwell should be held to a higher standard: “An educational nonprofit that is explicitly committed to Quaker values might be expected to think about this question within the framework of its distinctive ideals. And those surely include recognizing the worth of doing more than you are obliged to do.”
But Turner says it wouldn’t have mattered. Sidwell couldn’t have altered the Home’s destiny anyway. “There’s an assumption that if Sidwell Friends had walked away from the sale, the Home would’ve remained open, but that’s not the case,” he says.
Neither side wants credit for the idea of selling the nursing home to Sidwell. The school wanted to move its lower school campus from Bethesda, unifying its campuses. It hired a broker to ask about a post office site at Wisconsin Avenue and Upton Street NW, owned by The Washington Home. It wasn’t for sale.
The neighboring nonprofits, both founded in the 1880s, disagree on what happened next.
Sidwell says The Washington Home offered to sell its nursing home property. The Washington Home says Sidwell’s offer to buy was unsolicited. Worried about its financial future, The Washington Home had already been considering the idea of selling its property and continuing its mission by providing care to people in their own homes.
Nobody knows what would’ve happened if The Washington Home had posted a for-sale sign, instead of agreeing to a sale in secret, but they can speculate.
Judith Ingram, one of Ottinger’s classmates who has also criticized Sidwell, can imagine a better outcome for the residents. “Maybe some other nursing home operator could have come in,” she says. “I think that was a lost opportunity.”
Any nursing home operator would have faced the same reality of high operating costs and relatively low Medicaid reimbursement rates. But it’s conceivable that a different nonprofit—one with a stronger source of funding from an endowment, donations, or other revenue—could have absorbed the losses permanently.
And no matter the buyer, the residents would have had a chance to speak up had they known the nursing home was for sale before it was sold. They could have also gotten onto waiting lists at other facilities months earlier.
Ottinger and Ingram both decided to get involved personally, simply as Sidwell alumni who still live nearby, despite having no ties to the residents. Each has met with residents to hear their concerns, something Sidwell brass haven’t done.
They’re also frustrated by the school’s excuses. Soon after the sale was announced, Sidwell released a statement noting that the school “lacks expertise in long-term elder or hospice care.” But Sidwell did have an expert on its board of trustees: Katie Smith Sloan. At the time, she was executive director of the International Association of Homes and Services for the Ageing. (Sloan declined to comment for this story, noting that her board term has since ended.)
Sidwell eventually tapped Sloan for a position on a committee it formed in February to monitor the nursing home’s closure process.
Some alumni say they simply feel a basic sense of injustice. Nursing home residents are losing the place they’ve called home for years, even decades. Meanwhile the school, which charges $39,000 in annual tuition to families of privilege, including the Obamas, stands to gain.
“They definitely are operating from a position of power,” Ingram says. “They’ve got the money, apparently, to make the purchase.”
To its credit, Sidwell did agree to a provision in the deal that would let The Washington Home lease back the property for six months after Dec. 15, for a nominal charge of $1, if the Home chooses to exercise it. Sidwell has also offered to help residents move their belongings, once they find somewhere to go. And the 15-month notice goes well beyond any legal requirement.
The Washington Home hasn’t needed to take Sidwell up on its offer for moving vans. It also hasn’t appreciated the Sidwell alumni who have criticized the deal.
In May, a Washington Home attorney sent a cease-and-desist letter to Ingram on behalf of CEO Tim Cox, stating that Ingram had made inaccurate and defamatory comments to Sidwell about his organization.
“That was the first and the last I heard from Tim Cox,” Ingram says.
After suffering a stroke during hip surgery at age 66, Susan Mason lost her ability to speak and walk. She can’t move her wheelchair, read, or write. She needs a feeding tube to eat. Her daughter Mary, a 51-year-old Mount Pleasant resident, brought her to The Washington Home eight years ago.
“She can slightly communicate yes and no. She has this default no, so you really have to work it with her to get her to say yes,” Mary Mason says. “She has certain eye cues that I can read.”
An attorney for the Justice Department who visits her mother every day after work, Mason added her mother’s name to waiting lists at several nursing homes shortly after the closure was announced. A co-chair of the nursing home’s family council, Mason says she knows other residents who applied later to the same homes and already moved, leapfrogging her mother on the waiting lists.
Nursing homes do not have to admit applicants in the order they apply. They prefer applicants with enough money or assets to afford the full cost, because they can only charge the government-approved rate to residents who need Medicaid to help cover their costs.
Susan Mason, impoverished by her healthcare needs, now needs Medicaid to make up the difference between her Social Security check and the cost of nursing care. But when she first moved to The Washington Home, she paid the full rate. She was a middle-class homeowner before her stroke, before she became collateral damage in a property deal. Her family sold her house and used the money to pay for her care at The Washington Home.
“I could’ve used that money, potentially, to up-front pay to get her in somewhere else,” Mary Mason says. Now, it’s gone.
On the second floor of The Washington Home, the sounds of a cheering audience, contestants pushing buzzers, bells ringing, and Steve Harvey’s voice fill a 265-square-foot room as Family Feud plays on the TV.
Mary Mayfield watches from her wheelchair. Pictures of her grown children hang on the wall. Clothes are neatly folded in her closet. Mayfield suffers from dementia and has lived at The Washington Home since 2009. She’s silent while her daughter Ivan recounts how she got here.
The earliest detail won’t ever be known for sure.
“She’s got two ages,” Ivan Mayfield says. Her mother’s birth certificate lists a date three years and a day earlier than the one she always went by. “Back when my mother was born in Mississippi 80-plus years ago, they weren’t born in hospitals. They were born in houses,” her daughter says.
Mayfield came to the District in the mid-1950s and got married soon after. She and her husband will celebrate their 60th anniversary next year. Ivan says her parents lived on Euclid Street NW in Columbia Heights as far back as she can remember, and her father still lives in the neighborhood. At age 87, he still works and drives.
Before retiring, Mary Mayfield was a nanny for three families who were “high up the political chain” in the administrations of Gerald Ford, Ronald Reagan, and George H. W. Bush, Ivan says. She declines to name them, but all three families remain involved in her mother’s life, and one has tried to assist Mayfield in finding a new nursing home.
When the last of the children in her care was grown, Mayfield retired in March 2009. Eight months later, she was in The Washington Home. Doctors told the family that the dementia probably began unnoticed before she retired, and the structure and routine of her work kept it at bay.
The Washington Home is not in a convenient location for Ivan, who says she visits every evening before driving 25 miles home to Maryland. But she wants her mother to live at a nursing home that’s close enough to Columbia Heights. “It’s extremely important for me, if my dad wants to get in his car and come and see his wife, he can do that,” she says.
Last week, she found herself working on an application to a nursing home far from the District. The facility is in Anne Arundel County, too far for her father to drive. Despite applying to facilities in D.C. shortly after The Washington Home announced its sale, the family has had no luck with admission to those places. Mayfield can’t take her D.C. Medicaid dollars to the Anne Arundel facility, so her daughter first has to pull together a mountain of paperwork to sign her up for Medicaid in Maryland.
Other than The Washington Home, the District has 18 nursing homes, all privately owned. Eight of them have no private rooms available at all and no shared rooms designated for women, according to the D.C. Health Care Association’s latest bed availability count. Only two have private rooms and shared women’s rooms currently open.
And while the city’s population has shot up in recent years, D.C. hasn’t had a new nursing home open since the United Medical Nursing Center came to Southern Avenue SE in January 2009.
With limited space in their own communities, 428 people currently take their D.C. Medicaid dollars to 12 approved facilities in Maryland and Virginia.
Mason and Mayfield are holding out for private rooms. In part, it’s a matter of safety if their mothers are forced to share a small room with a stranger and that person’s visitors. Their chronic conditions prevent both women from speaking up if something happens to them. Mayfield says that as she plans for her mother’s future, that’s an issue “that weighs on me very heavily.”
They also say privacy is a matter of dignity in the final years of their mothers’ lives. They don’t want those intimate times together to include a stranger and visitors in a small room.
Wanda Fisher thought she could leave her hometown D.C. for good—at least, that was her plan.
Fisher’s family has been in the District since Abraham Lincoln was president. “We come from the guts and roots of D.C.,” she says. “We even had a house on Logan Circle, our family, which is unheard of for black people.”
Her mother, Carrollyn Fisher, has spent all of her life in the District, where she worked for decades as a federal employee. For the past two years, she’s lived at The Washington Home, where she moved when her dementia worsened.
Wanda Fisher had a different idea. After college, she left the District with no intention of moving back. Fisher is a business consultant who works for herself, and her career has taken her to places as far-flung as Miami, New York, and, most recently, the San Francisco area. Her only child, a grown son, lives in Miami.
In March, she flew from her California home to the District, hoping to attend a D.C. Council roundtable on the closure of The Washington Home. It ended up being canceled. “I came over with a suitcase, to go back the next day,” she says. She hasn’t been back to California in the nearly five months since then.
She had flown in from California on short notice before, to meet with nursing homes and see rooms when they became available. “I came one time through a snowstorm,” she says. “They couldn’t even figure out how I got there, but I said: This is important. I’ve got to see this home.” Realizing how hard it would be to move her mother, she decided she couldn’t afford to keep flying back and forth.
Fisher doesn’t plan to go back west until her mother’s situation is resolved. “I had to make a conscious decision to give up my life,” she says.
In the meantime, she is depleting her savings. Her consulting work requires commitments to her clients, but she can’t say how long she’ll be in any one place. She stays with the few people she still knows in the area—a cousin, a childhood friend she reconnected with—and borrows a car when she can. She spends some time in New York, where she has a reliable place to stay but a longer trek when she needs to be in D.C.
The distance and uncertainty put a strain on her fiance in California. “He’s trying, but he’s like, ‘This has gone too far,’” she says.
Fisher isn’t holding out in the hopes of finding her mother a private room. But she has toured nursing homes that are dirty or where the beds are so close together, the patients would land on top of each other if they both fell out of bed, she says. “In some conditions, you just know.”
During a City Paper visit to Unique Residential Care Center, a nursing home on First Street NW, around 3 p.m. on a Monday in July, the smell of feces in the hallway was apparent, and what seemed to be a urine-soaked garment was on the hallway floor. Down the hall, an elderly woman in a wheelchair sat alone. Seeing a visitor passing by whom she had never met, she reached out a cupped hand and asked, “You got something to eat?”
Maybe the staff were in the middle of cleaning up a mess. Maybe the woman with the outstretched hand was confused, not hungry. The next afternoon, the hallway smelled clean, and a wheelchair-bound man with an easy smile made small talk as a visitor passed by.
Unique may be a high-quality facility, a poor one, or something in between. But these glimpses during visits are sometimes the best information that families have when they decide whether to send their loved ones to a facility, perhaps for the rest of their lives.
Aster Bailey, 76, moved to Unique from The Washington Home a few months after the sale to Sidwell was announced. He needs a wheelchair to get around, and arthritis makes it difficult for him to use his hands. A North Carolina native, he says he moved to D.C. more than 50 years ago, worked in construction, and never married or had children.
Bailey lives in a narrow room that he shares with another man. They have one bathroom, and each has a curtain to wrap around his bed.
“I prefer to have a room by myself, like anybody would. But it ain’t like that,” Bailey says.
Carrollyn Fisher, Susan Mason, and Mary Mayfield represent some of the most difficult Washington Home residents to relocate. None of them can pay as much as residents who have private resources that far exceed the Medicaid rate, so the most in-demand facilities won’t accept them. Their inability to communicate and walk means they’ll need substantial resources from the facilities that care for them.
All three have devoted daughters, bearing the responsibility for their futures, who want to give them a decent place.
Tim Cox, who’s 31 years into his career in elder care, says he has always had an affinity for older people.
“I just really like the experiences they have. I like the aging part—that people still can thrive and be a participant in living,” he says during an interview in his office, on the ground floor of The Washington Home.
Cox, who joined The Washington Home as CEO in 2011, also has to protect the organization he runs so it can continue to serve older people, as it has for more than 125 years. Just not the ones who live at its nursing home now.
“It’s upsetting. People get angry. I get it. You think you’ve placed your loved one here, and you think they can stay until they die. But as an organization, we have to change before we become a dinosaur and cease to exist as well,” he says.
Cox says fewer and fewer people who can afford assisted-living residences or in-home care choose to live in nursing homes. The Washington Home reached a point where nearly 90 percent of its residents were on Medicaid. (Medicare does cover short-term stays at nursing homes at a higher rate than Medicaid, but it stops paying after 100 days.)
The Medicaid rate for a nursing home in the District varies by facility. Currently, The Washington Home can charge $306.42 per day to Medicaid recipients. That comes out to more than $111,000 annually per resident.
Nursing homes charge more to people paying privately, and since Medicare pays more than Medicaid, nursing homes bring in more money from residents who only need a short-term stay.
“Medicaid [patients], from a financial perspective, are the least desirable patients for these nursing homes,” says David Grabowski, a healthcare policy professor at Harvard Medical School whose research focuses on long-term care. “It’s very challenging to run a high-Medicaid nursing home, and indeed in a lot of these markets, we’re seeing closures of nursing homes that predominantly care for Medicaid.”
“In many ways you can think about these as safety-net nursing homes, because they’re really caring for a frail, vulnerable part of the population without a lot of other options out there,” Grabowski says.
Cox says The Washington Home looked into converting its rooms to shared rooms, to stretch the Medicaid dollars. But they are too small to be adjusted to fit two people.
To cover its expenses, the Home relies on its endowment, fundraising, grants, and the post office lease that alone brings in more than $3 million annually. But even with all that added revenue, it says its nursing home is not financially sustainable.
The relatively low Medicaid rates are one part of the financial equation. The considerable regulatory burden that nursing homes must deal with is another big one.
A saying has caught on among nursing home experts that, true or not, makes the point: The nursing home industry is the second-most regulated industry in the country, right after nuclear power.
Even if the closure was inevitable, some residents and family members resent the way it was handled and what has happened since.
Mason and Mayfield, who co-chair the Home’s family council, say that Cox lied when they confronted him about whether it was contemplating a sale. They began inquiring last spring after hearing about a possible sale to Sidwell, months before the announcement.
Rumors spread from staff to residents: one saying that a proposed sale came in over the fax machine, another that the head of Sidwell had come by to meet with Cox.
One pillar of the lawsuit filed in July by four residents against The Washington Home accuses Cox of fraud for denying that the nursing home was for sale. The complaint also accuses the nonprofit of deteriorating care and a failure to offer the residents a chance to buy the building under D.C. law.
According to the lawsuit, Cox said during a June 2015 meeting with Mason and Mayfield that there was no planned sale and refused their request to see the nonprofit’s board minutes. Later that month at a family council meeting, with dozens of people in attendance, Cox repeated that there was no sale, the lawsuit says. Meanwhile, the negotiations with Sidwell had begun months before.
If residents had known about the possible sale, they would have had more time to add their names to waiting lists, and they could have voiced their concerns about a closure. “Upper management here, members of the board … it personally affects none of them,” Mayfield says.
The Washington Home would have violated the confidentiality agreement that it entered into with Sidwell if it had told residents about the sale talks.
Its attorneys argued in court that the facility didn’t want to alarm the residents unnecessarily when it was still unclear whether the sale would proceed. The confidentiality persisted during the 60 days after the deal was signed, a due-diligence period for Sidwell to make sure the building was suitable.
In the aftermath of the sale, residents insist that the quality of care has declined, a charge that the nursing home has firmly denied. Residents attribute the alleged deterioration in care to the staff turnover that has taken place since the closure was announced, despite retention bonuses.
In April, Josephine Redman, a 91-year-old with dementia, was found on the floor, having apparently slipped from her wheelchair. Staff determined that she was not seriously hurt and returned her to her bed, according to her son, Clarence Seegars. The next day, Redman’s niece visited and found her in pain.
It turned out she had a fractured femur. After a three-week hospital stay, Redman moved to a nursing home in Chevy Chase, Maryland. She passed away about a week later, one month to the day of her fall. Seegars says the cause of death on her death certificate was the fall.
Seegars knew the staff at The Washington Home well. His mother had lived there since 2009. His father, aunt, and uncle had all lived there too, and Seegars visited often.
“As a family, we knew them by name, they knew us, they knew my mother,” he writes in an email. Following the sale, there were many unfamiliar faces on staff, he says, who didn’t know Redman as well.
Seegars filed a complaint with the District Department of Health, whose investigation could not substantiate the allegations of reduction in care or deficiencies in staffing.
The accusations of fraud and poor care could win the plaintiffs damages, but only one part of the lawsuit would block the sale.
The residents say they ought to have had a chance to buy the nursing facility under D.C.’s Tenant Opportunity to Purchase Act. But the first hearing in the case, held July 13, did not bode well for that strategy. “This is not a very close case,” Judge Henry Greene said then.
TOPA does not specifically exclude nursing homes. But the judge said, “I can’t find any basis to conclude that a nursing home is a residential accommodation in the District of Columbia.”
The plaintiffs face another barrier to success. Unable to afford a lawyer, the residents are being represented by law students from the University of the District of Columbia who are learning as they go as part of the school’s housing clinic.
Mary Mason tried unsuccessfully to obtain pro bono representation from numerous law firms. Mason knows people at many of the firms from her decades working as an attorney in the District. Several were willing to be frank about the rejection. The firms had partners with kids at Sidwell or other ties to the school, and they expected that to be the case at any large firm in town. Sidwell is not a target of the lawsuit, but the firms preferred not to get involved.
Suffice it to say, the effort to block the sale is a long shot.
“Nobody ought to be operating on the theory that The Washington Home is going to remain open,” the judge said.
The Washington Home has argued in its defense that “the public interest will actually be served to a greater degree with the sale of this property,” since it will free up money to serve people in their homes, and at a lower cost.
It also voiced frustrations of its own with the remaining residents. “There has been some lack of cooperation from these plaintiffs” regarding efforts to move, one attorney said.
Cox won’t say what will happen if residents don’t leave in time.
“They won’t be here in December, because we’ll start having one-on-one meetings with families that haven’t put in an application to a place that has an opening,” he said in June, by which point he’d already had a couple such meetings. “They’ve been productive.”
When Sidwell’s campuses are unified, rising fifth graders will have a smoother transition to middle school. They’ll be able to maintain relationships with their former teachers from the lower school, and parents with children in different age groups will be able to pick up and drop off their kids at the same place.
Sidwell students will lose the chance to perform community service at The Washington Home, which many students have done over the decades. “There’s something magical between kids and older folks,” says Larry Ottinger. His daughter’s music teacher at Sidwell has held recitals for the residents.
Ellis Turner says decisions about how to honor the site’s past are under discussion. Many people have purchased bricks engraved in memory of loved ones who died at The Washington Home, which used to promote the bricks as “timeless tributes” placed in the garden.
The wider community has lost a place for its residents to go when they age. Judith Ingram decided to speak out about the sale not just as a Sidwell alumna, but also as someone who lives just a mile away.
“None of us really wants to end our days in a nursing home,” Ingram says. “But many of us will, and it’s pretty short-sighted of the community to accept that there’s no place in our neighborhood for this kind of facility.”