The ghost in the shell: Part 2, Render unto Scituate

March 1, 2017 | Churches, Development, F.X. Cabrini, Housing, Land value, Nonprofits, Real estate taxes, Redevelopment, Scituate | No comments 35 views


By: David A. Smith


[Continued from yesterday’s Part 1.]


As we saw yesterday, my morbid fascination with the deconsecration, closure, occupancy-vigil, and litigation of St. Frances X. Cabrini Catholic Church in Scituate has caused me to track it past the media’s loss-of-interest point (the vigilers’ peaceful departure) and to the question, is there redevelopment after closure? 


Sources used in this post


Quincy Patriot-Ledger (December 20, 2011; midnight blue font)

Forbes (January 8, 2012; emerald font)

AHI: Houses sacred and profane (February 27, 2013), 3 parts, churches into housing

Quincy Patriot-Ledger (January 11, 2017)


While for some churches, like St. James the Great in Wellesley, the answer is rubble to dust – it was sold to the Town of Wellesley with an anti-resurrection deed restriction (no churches allowed in the future) and will be turned into public recreation space – for Frances X. Cabrini redevelopment or reuse is highly likely – not least because the Archdiocese will want to recoup its unexpected cost of closure – a hefty real estate tax bill caused by the vigil.


Parishioner and vigiler Nancy Shilts before the final service at F. X. Cabrini


Churches are so used to being exempt from real estate taxes that it must have come as a shock to the Archdiocese to find themselves being assessed by the Town of Scituate – but really there was no alternative:



As wryly explained by Peter J. Reilly, a tax accountant and regular Forbes contributor:


So here is the problem.  You are an assessor for the Town of Scituate and there is this building.  The Archbishop, who should know, says that is not a church anymore.  On the other hand it is being occupied by a group of people, who have organized a not-for-profit, and are certainly acting like it is a church.


It is actually not that hard a problem for an assessor.  When in doubt, tax it.  So the problem then goes to the Massachusetts Appellate Tax Board to rule in the case of the Roman Catholic Archbishop of Boston (RCAB), a Corporation Sole v the Board of Assessors of the Town of Scituate.


Reilly commenting on the Archdiocese’s predicament


A ‘corporation sole’, Mr. Reilly explains, is a unique legal status:


As is common for Catholic churches, title is in the name of the Roman Catholic Archbishop of Boston, a Corporation Sole.  Corporation sole is a logical way for title to Catholic church property to be held given the hierarchical nature of the Church.  Don’t try it yourself, unless you want serious IRS trouble.


Without bothering to research it, I speculate that the corporation sole possessed by churches by virtue of their existing long before there were income taxes or even a United States to create its tax code, and as one of the awkward axioms necessary to square the government’s duty not to interfere with the establishment or exercise of religion with the tax exemption that has been a staple of Western practice since before there were nations, much less Federal income tax laws.


Does that mean you’re a Corporation Sole?


Still, having lost possession of the church and having deconsecrated it so that masses could no longer be held there, the Archdiocese could protest its new tax status only by paying the tax and then filing a claim for refund. 


The archdiocese was seeking a refund of up to $141,403 in taxes paid to Scituate between fiscal years 2008 and 2011.


This is one of several ways in which tax law inverts the normal rules of US jurisprudence. 


In Scituate, the property taxes in question are sitting in an escrow account and cannot be used by the town until the appeals process is complete.


In tax law, you are guilty until proven innocent, and whereas in civil or criminal cases you can get out on bail pending the trial, the IRS doesn’t take credit risk: you can’t plead until you pay the full disputed amount. 


I see right through your form-over-substance argument


In this case neither party wanted to take credit risk on the other – understandable in each respect –


In my business you don’t last long if you take credit risk


The archdiocese argued that the closed St. Frances X. Cabrini Church and its surrounding parcels are exempt from taxation because of the religious and charitable activities performed by a group of former parishioners who have been occupying the church since 2004.  In a decision handed down Friday, the Massachusetts Appellate Tax Board ruled in favor of Scituate’s board of assessors, concluding that the archdiocese forfeited its exempt status once it closed the church in October 2004.


I would not have enjoyed being the Archdiocese attorney who brought forward that argument, as it requires not logic but illogical faith:


In trying to make an argument for continued exemption, the archdiocese ended up being hoist on its own petard:


In case you’ve ever wondered, that’s a petard and he’s about to be hoisted by it


In the present appeals, the Board found that RCAB terminated all official religious activity on the subject properties as of October, 2004. … RCAB effectively ceased occupying and using the subject properties for religious worship and instruction as of that time.


In addition to their aforesaid dominant use of the Church, the Vigilers or The Friends conduct a 45-minute lay-lead service at the Church on Sundays.  … RCAB and/or the Vigilers’ former Parish priest have labeled the Vigilers’ or The Friends’ actions as being, among other things, “illegal, immoral, sinful, and heresy.” The testimony also describes the lay-lead services and any other uses as ‘minuscule’ compared to the Vigilers’ and The Friends’ dominant use.


So it is hard for the archbishop to argue that this illegal, immoral, sinful and heretical stuff going on qualifies the property for tax exemption.  They can’t ride on the 501(c)(3) status of the occupiers, because occupying is not a valid exempt use.


That’s basically what the appellate tax board said:


The Friends of St. Frances X. Cabrini, the group that has held a sit-in vigil at the former church for the past seven years, has occupied the building for the sole purpose of advocating for the church’s re-opening, the board said. Because the parishioners’ prayer services and charitable work is not sanctioned by the archdiocese, the property owner is not eligible for an exemption, the board determined.


“The Friends’ dominant use of the church is as unauthorized occupiers and guards,” the ruling states.


Thus an irony: When the Archdiocese used the property as a church, it was exempt from real estate taxation.  When it stopped using the property as a church – when, in fact, it didn’t merely suspend religious use but renounced it entirely, it reverted to the normal state of American property:


I’m telling you, nothing holy is going on


It was taxable.  Render unto Scituate


Jay Talerman, Scituate’s attorney in the case, said the decision is a major victory for the town.


“I think this sets a precedent,” Talerman said. “This is not the only municipality in Massachusetts looking at the issue of the use of closed churches.”


An attorney often at the intersection of religion and local land use


It certainly seems to me a definitive precedent.


Several cities and towns around the state are levying property taxes on closed churches. One of those is Star of the Sea in Quincy. Since last July, the city has been charging the archdiocese $7,829 each quarter for taxes on the church building itself and $2,709 on the rectory.


Reanimation as condo’s, or demolition in favor of homestead homes?


In 2015, the property was sold for $600,000 (30% of assessed value) to a residential developer that specializes in converting non-residential buildings like churches into other uses, but who later decided to demolish it to clear the site for greenfield development of four homes after local residents squashed his plan to make it affordable condominiums. 


Brian Sullivan, chairman of Scituate’s board of assessors –


A few months later, Mr. Sullivan would be disbarred as an attorney after “repeatedly engaged in serial, temporary misappropriation of trust funds on deposit in by using the funds of succeeding clients to cover obligations owed to prior clients,” and left the Board of Assessors in June, 2012.


– said his town was the first to tax the archdiocese after the religious entity decided in 2004 to shut down more than 80 churches.


“I feel bad because I am a Catholic, and I was baptized at St. Frances. I don’t relish sending the archdiocese a tax bill,” Sullivan said. “But rules are rules, and they are not exempt.”


I had no idea those rules would apply to me


Indeed they are not tax-exempt, a thought that five years ago gave Jon Rogers his own bit of schadenfreude:


One group that is not as sympathetic to the archdiocese is the Friends of St. Frances Cabrini. The parishioners said the archdiocese is disingenuous by first condemning the sit-in vigil, then trying to use it to get a tax break.


As we just saw above, five years hiatus softened Mr. Rogers’ views.


“There is a sense of justice here,” said Jon Rogers. “This can all go away instantly: Just open us up as a fully-functioning church, and they can take their religious exemption. Until then, they’ve got to pay taxes.”


Maryellen and Jon Rogers, late in their dozen-year campaign


In the event the Archdiocese never reversed course, and with Cabrini’s closure Mr. Rogers’ perspective has changed:


Now Mr. Rogers hopes the town “can turn our spiritual home into something beneficial to the people of Scituate,” he said.


What will my future be?

The ghost in the shell: Part 1, I am the redevelopment and reuse

February 28, 2017 | Churches, Development, F.X. Cabrini, Housing, Land value, Nonprofits, Real estate taxes, Redevelopment, Scituate | 1 comment 53 views


By: David A. Smith


What comes after death?


What worth the body when the spirit has fled?


For human beings, any affirmative answer rests on faith, because we know what happens to the shell of our selves; it goes into the earth or into the fire.  But what happened to a building, when its animating spirit is gone and what remains is a deconsecrated, empty and locked, a building that once was a church?


Now an empty shell


Sources used in this post


Quincy Patriot-Ledger (December 20, 2011; midnight blue font)

Forbes (January 8, 2012; emerald font)

AHI: Houses sacred and profane (February 27, 2013), 3 parts, churches into housing

Quincy Patriot-Ledger (January 11, 2017)



As I chronicled at length (March 7, 2013: Cannot we consecrate?) and then at even greater length (October 19, 2016: Catechism of a closure), the Archdiocese of Boston closed 85 churches throughout the archdiocese, for reasons about which the Archdiocese maintained a lordly silence:


The archbishop of Boston, Cardinal Sean O’Malley, said the closings had nothing to do with the tens of millions the church was paying out to victims of priestly sex abuse.


Actually, the Archdiocese paid over a hundred million dollars, and while there had been several decades of steadily declining parishes, a shortage of priests, and expensive drafty real estate, the payouts are widely believed to have been the precipitating event because the Archdiocese clearly needed to recapitalize and improve its solvency.  But this motive the Archdiocese steadfastly refused to acknowledge.


Terrence Donlion: Effective at not saying what the Archdiocese wants not said


While some parishioners protested their church’s closing, only one – the Friends of St. Frances X. Cabrini in Scituate – not only protested but also took advantage of a lapse in security to occupy the building to occupy it (though they were careful to avoid that phrasing, preferring to say they were ‘in vigil’).


Though the church was initially closed by the archdiocese in 2004, parishioners found an open door to the building and held an 11-year, seven-month and four-day vigil on the site to allow the congregation to continue worshipping there.


[Note to Archdiocese: Next time you deconsecrate a church, lock all the doors and post a round-the-clock guard for a solid week. – Ed.]


Nearly twelve years in the making


They finally left the church in May 2016 after the U.S. Supreme Court declined to hear their appeal of a lower-court ruling that found they were trespassing.


Having finally secured vacant adverse possession – a canonical foreclosure, as it were – the Archdiocese


The Archdiocese of Boston is trying to sell the former St. Frances X. Cabrini Catholic Church and has approached town officials about the property.


In an interview, archdiocese spokesman Terrence Donilon said that no asking price has been set yet.  “When we begin to market, we don’t set a price,” he said. “We do a full evaluation and an appraisal.” 


Donilon also said that it’s not unusual for the archdiocese first to approach a town when looking to sell one of its properties.


Are you trying to buying a re-animatable structure?


As the Archdiocese does nothing without a strategy and a view to the precedents it sets, much can be deduced from these innocuous statements:


1. The Archdiocese thinks it’s good relations to give the locals a chance to buy first.  Not precisely a right of first refusal, but rather an ‘open to view’ pre-auction.  Political and public-relations insurance against later being accused of having “sold the property out from under us.”


2. This is a prelude to listing the property with brokers, based among other things on a highest-and-best use appraisal.


The 16.3-acre parcel near Egypt Beach is valued at $2.2 million, town property records show.


[Technically, it’s assessed at that value; probably it’s worth a fair bit more, which will make the second half of this post even more piquant. – Ed.]


3. The Archdiocese intends to maximize proceeds; whatever the market most wants is what will be developed.


Previous AHI posts on the closure of F. X. Cabrini Church in Scituate


March 7, 2013: Cannot we consecrate?, 2 parts

October 19, 2016: Catechism of a closure, 9 parts



Once the property passes out of the Archdiocese’s hands, who knows what the future will bring?


In the most diplomatic and decorous way possible, the Archdiocese is methodically washing its hands of the site.


It’s not a church any more, so it’s not my problem any more


Likely it will bring rezoning, quite probably with an override of local zoning and put a high-density Chapter 40B affordable housing property onto it, since Scituate has only 4.3% affordable housing (310 out of 7,163 dwelling units), putting it in a par with sinner Milton and eco-exclusionary Belmont. 


In an interview Tuesday, Maryellen and Jon Rogers, co-founders of the non-profit Friends of St. Frances Cabrini, said they would support a town purchase of the property.


This is a change of heart for the Rogerses, who previously said they intended to raise funds to buy the church. 


Jon Rogers said he does not expect that his congregation, which now worships as an independent Catholic church in a temporary home at the Satuit Masonic Lodge, would be able to buy the building back.


He pointed to the sale of St. James the Great Catholic Church to the town of Wellesley 


Kelly Tolman’s first communion at St. James the Great, Wellesley


– where the archdiocese placed deed restrictions on the property that prevent it from being turned into a new church.


In real estate terms the church’s deed restriction makes no sense, so the explanation must be in canonical terms, and once that is framed, the reason is obvious – the Archdiocese wants to maintain its monopoly over Catholic places of worship. 


Do not take church-delivered communion, do not receive salvation?


In the event, Saint James the Great was demolished and will be turned into public recreational space, which Wellesley undoubtedly believes it needs, and for which Community Preservation Act funds are a natural source.


The leaders of the vigil said they hope the property can be used in a ‘positive’ way by the town.

“Being a lifelong resident of Scituate, and St. Frances being my lifelong parish, if the town can do something to benefit the community, that would be great,” Maryellen Rogers said.


That’s a welcome development, though Ms. Rogers could not resist adding a little rhetorical stinger:


We just couldn’t resist


She added that by occupying the building for so long, “we generated years of revenue for the town of Scituate.”


Ms. Rogers’ comment is both true and incredibly cynical, for reasons that make us take a left turn into the past:


Since 2006, the Archdiocese has paid more than $310,000 in property taxes to the town, after town property assessors argued the property had lost its tax-exempt status when it stopped operating as a church.


Time to shift gears! 


Have them reintegrated by tomorrow, please!

In a decision that could alter how cities and towns classify closed churches, the state’s Appellate Tax Board has denied the Catholic Archdiocese of Boston’s bid to get back four years’ worth of property taxes on a closed Scituate parish.


[Continued tomorrow in Part 2.]

The room closing in: Part 5, An economic kiss of death

February 27, 2017 | Adulthood, Aging, Apartments, Assisted living, charity, Elderly, Housing, independence, Innovation, Nursing homes, Regulation, Technology, US News | No comments 52 views

[Continued from the preceding Part 1, Part 2, Part 3, and Part 4.]


By: David A. Smith


He started to rise, then sank, back in the chair again. It was no dice. Just talking to someone or looking in on the place wasn’t being there.

– Clifford D. Simak, Huddling Place, 1952


Ever since I was a little boy, I’ve had a fear of nursing homes. 


Calling it a ‘convalescent hospital’ doesn’t really change what it is


Evolution has wired us to delight in and protect the young and to fear and shun the extremely old:


Sacramento Bee (June 13, 2015), pickle font

Sources used in this post


Marblehead Messenger, January 10, 2013 (brown font)

Boston Globe, May 19, 2014 (Forest green font)

Sacramento Bee, June 13, 2015, (midnight font)

New York Times, January 27, 2017

The history of nursing homes, Foundation Aiding the Elderly, pdf, brick red font)


While hospitals were certainly a place to avoid, a boy goes to the hospital to get fixed, either from illness or injury, and he expects to emerge from it good as new.  In Marblehead, that was the Mary Alley Hospital, which on nostalgic impulse I have just looked up, discovering that like our previously profiled General Sternberg, Mary Alley was a Reconstruction/ Gilded Age progressive:


During the Civil War, Mary Alley formed a Soldiers Aid Society with Mary Graves. Their object was to perform work for the comfort of the soldiers, and to collect clothing, medicine and ‘delicacies’ for use in Union hospitals. They raised $500 in the first week, a large sum of money in 1862. Additional money came from Marblehead teachers, who pledged 6% of their annual salaries.


Town benefactress. Mary A. Alley


[When Mary Alley died in 1904], in her will she donated her land and house at 6 Franklin Street to the Town, along with a $30,000 endowment, to be converted int4o a hospital when her family members no longer needed it.  That happened in 1920, the same year the 19th Amendment gave women the vote, and in 1922 the hospital opened.  This was the first and only hospital in Marblehead.  The building was remodeled in 1953 [The year I was born – Ed.] and finally closed in the mid-1960s.


Whereas one left a hospital healthy again, and that was always a happy day, a nursing home was a place that one’s elderly relative entered and never left – and we who were younger would go to visit, be at loose ends, and leave saddened.  These complicated and in many ways unworthy feelings arise even in good nursing homes – what about bad ones?


We need redress – but can we get it?



5. Redress


A valuable right back when postage was ten cents


Even before the updated regulations, regulators always have a nuclear option – they can shut down a facility entirely, or cut off all its Medicare/ Medicaid funding:


Between October and January, three of Shlomo Rechnitz’s facilities, including South Pasadena, were decertified by the federal government, an economic kiss of death that is extremely rare. The punishment strips a nursing home of its crucial Medicare funding until it can demonstrate improvement, or is closed or sold.


Since 2010, the federal Centers for Medicare and Medicaid Services has decertified only six out of more than 1,200 nursing homes in California.


Short of the nuclear option, the Federal government does little except have each facility rated and publish the ratings:


Overall, those aren’t good scores


Yet ratings, helpful though they are, merely guide the choice before one moves in.  After the loved one is admitted, what can you do about neglect or abuse?  This being America, you can sue … or can you?


One major change, a ban on the binding arbitration agreements that nursing homes frequently require at admission — before any dispute arises — has already stalled.


Giving residents and families the right to take nursing homes to court could bring far-reaching results, Ms. Grant said.   Arbitration proceedings typically remain confidential, and monetary awards can be modest.


True enough, but if litigation can be filed, that can lead to class-action litigation, which creates its own potential for abuse:


The American Health Care Association, which represents most for-profit nursing homes — 70% of nursing homes in the United States are for-profit — filed suit to stop the change. In November, a federal court in Mississippi granted a preliminary injunction.


Even without the nuclear option, fines and charges can easily drive a nursing home operator out of business, whether that operator is private or a public agency, and when a nursing home closes entirely, that’s a loss of inventory:


Mr. Rechnitz, looking pensive and sad at the thought of being unfairly driven out of business


Shlomo Rechnitz explained that his business model is to rescue failing facilities and turn them around. Of his 81 nursing homes, he said, 59 were considered “distressed” when he acquired them, meaning that they were insolvent or on the verge of decertification or closure for poor performance.


Is Mr. Rechnitz a double-bottom-line social entrepreneur?


Officials in San Mateo County, for instance, credit Rechnitz with preserving nearly 300 needed beds and dozens of jobs when he took over management of the Burlingame Long Term Care facility in 2012.  Formerly operated by the county, the facility had been headed for closure because of financial problems and concerns about the building’s age and safety.


Likewise, Mr. Rechnitz has improved another private nursing home:


A Rechnitz success story: Fullerton


When Rechnitz took over the Fullerton facility, it was in deep trouble – only one of California’s roughly 1,200 nursing homes had more serious violations in 2013. Under EmpRes’ control, a survey in October 2013 resulted in 52 health-related deficiencies, eight of them so serious that residents were harmed or deemed in immediate jeopardy.


When inspectors visited the facility for a survey again in December 2014, after Rechnitz had taken over, they found 17 health violations, none of them serious.


“It was a horrible facility,” said Rechnitz. “That thing was going to be shut down. We met with the health department and (they) said, ‘Shlomo, go in and do what you can do. Try to fix it.’ And we went in and, in fact, we did fix it.”


Social entrepreneur, or a smooth-talking mediagenic serial acquisition-predator?  Though the Sacramento Bee (June 13, 2015, midnight font) published a long and well-researched article on the subject, the writers could come to no conclusion, and nor could I.


Sacramento Bee series on nursing homes in California


Shlomo Rechnitz vs. California: Key documents

Nine stories from Rechnitz’s California nursing homes

Help for consumers: How to research California nursing homes

Unmasked: See who owns every California nursing home and how those homes stack up

Part 1: How California’s largest nursing home chains perform

Part 2: Who owns California’s nursing homes?

Part 3: California falls short in disclosing nursing-home ownership


The end game: what supplants the nursing home?


AHI multi-part posts on unusual emerging housing tenures


April 16, 2007: Mobile homes: how they got here (5 parts)

May 18, 2009: Outlaw in-laws (accessory dwelling units, 2 parts)

July 22, 2011: Campus of the university of independence (veterans housing’, 2 parts)

June 27, 2013: NORCs like us (mobile home parks as elderly housing; 6 parts)

January 6, 2016: Sprouting innovation (co-living; 3 parts)

February 9, 2016: The hipster’s mobile home (tiny houses; 6 parts)

September 28, 2016: Ask after me tomorrow (funeral homes; 8 parts)



Wars stimulate housing innovation because they displace vast numbers of people: soldiers fighting far from home, and civilians whose homes are disrupted or destroyed by the war’s passage. 


Surgical kit, Civil War


When the war ends, as thankfully they eventually do, those displaced by the call to arms or the effect of arms return to what they remembered as home, only to find that both it and they have changed:


Union hospital, Civil War


1.     The Civil War gave us the hospital; its ending brought the funeral home.

2.     World War I’s end saw the rise of urban social-reformer public housing.

3.     After World War II came the mobile home and the convalescent home that became the nursing home.

4.     The wars in Kuwait and Iraq are bringing us new supportive housing and veterans’ housing.


Each type of housing is specialized, and most of the innovations are most sophisticated, more technological, and more able to extend our lifespan and expand our mental frontiers even as they cater to our extended frailty. 


He shut his eyes and fought down the chill that crept across his body. He couldn’t let it get him now, he told himself. He had to stick it out.

– Clifford D. Simak, Huddling Place, 1952


Today’s nursing homes are a business model designed in the 1950s and obsolete by the 1980s, yet kept on financial life support by $155 billion annually in Medicare/ Medicaid payments. 


Who’s going to be in charge of my future?


Though the new regulations are a major improvement, the industry needs not better regulation but a comprehensive reinvention.


The younger you feel, the longer you live

The room closing in: Part 4, Close down rather than face violations

February 24, 2017 | Adulthood, Aging, Apartments, Assisted living, charity, Elderly, Homes, Housing, independence, Innovation, Nursing homes, Regulation, Technology, US News | No comments 49 views

By: David A. Smith

[Continued from the preceding Part 1, Part 2, and Part 3.]

So far in this post looking at the first update to nursing home regulations in a quarter of a century I’ve covered three of the five big principles of consumer protection – freedom, choice, and security.

Here was another huddling place. Not a huddling place for one’s body, but one’s mind. A psychological campfire that still held a man within the circle of its light.

– Clifford D. Simak, Huddling Place, 1952

That leaves two more: quality and redress.

Is anybody home?


4. Quality


Markets are premised that we can get quality for our money when we have choice and the mental capacity to use it, and markets work for Lockean independent adults.


“All mankind being all equal and independent, no one ought to harm another in his life, health, liberty, or possessions.”


Markets don’t work for impaired consumers: children (who lack judgment), the cognitively impaired (whether by misfortune, booze, or drugs), and the elderly, who lose faculties slowly and randomly.  All of these groups are expected to be sheltered from predation:


·         Children are to be protected by their parents, and by lockout laws like the age of consent, drinking, or smoking.

·         The cognitively impaired are to be protected by trustees or custodianship.

·         The elderly are to be protected by their families (before 1946) or the government (increasingly, after 1946).


Importantly, protection of the weak or vulnerable works best when the guardian is both personally close to the vulnerable one and emotionally connected to him or her.  A government guardian is emotionally distant and cognitively schizophrenic (Alan Turing was unable to demonstrate that bureaucracies think, though his theorem that their simulated thinking could halt).


For ‘program’ read ‘bureaucracy’ and you will see why a general halting law is impossible


As our mental capacity wanes, we may be unable to complain – about either the nursing home or the government – which means that relying on the tenderness and mercy of the government is asking to be exploited.


Sources used in this post


Boston Globe, May 19, 2014 (Forest green font)

New York Times, January 27, 2017

The history of nursing homes, Foundation Aiding the Elderly, pdf, brick red font)


Elderly advocates understand this; they don’t trust the operator to do the right thing over the profitable thing, and they don’t trust the government to oversee with the attentiveness and concern one expects from loved ones (because the government doesn’t love anybody).


You’re really important to the government … aren’t you?


Hence the natural desire of advocates to mandate proxies for service, such as staffing levels.


[The new regulations] also declined:


1. To incorporate specific staff ratios or minimum hours of care in the new regulations, or

2. To require nursing homes to have registered nurses on site around the clock. (Current rules require RNs only for eight hours.)


Both such steps may improve service, but they certainly would decrease nursing home owner flexibility.


Instead, homes must develop assessments of their resources and residents’ needs and hire accordingly. 


And they would increase costs:


Federal regulators feared that some homes, particularly in rural areas, might find higher staff requirements unnecessary and impossible to reach, and close down rather than face violations and fines.


Seems entirely reasonable – especially as America’s urbanization is mainly mobility of the young, leaving behind the older and elderly, who have less ability to move and little if any desire to do so.


Advocates are fuming, however, because better staffing has been shown to improve quality of care. 


Obviously there will be a correlation between having more staff and having better care, but will it be cost-effective? 


Without standards, “it’s completely left to the nursing homes, and they’re not going to change because there’s no incentive to,” said Charlene Harrington, a longtime nursing home researcher at the University of California, San Francisco.


Harrington wants standards


“They can cut staff, keep their wages low and pocket the profits,” she said.


“From our perspective, it’s a mixed bag,” said Robyn Grant, public policy director at the National Consumer Voice for Quality Long-Term Care.


Translation of ‘mixed bag’: We didn’t get everything we wanted.


The regulations disappointed nursing associations and many advocates by declining to set minimum staffing standards.


I can see why advocates would want specified ratios – it’s a safe harbor against obvious operator neglect – but to lock a number into regulations is to freeze the standard of service to a current-technology model, and to substitute a proxy (people at the property) for the desired goal (quality service and resident self-actualization). 


AHI multi-part posts on unusual emerging housing tenures


April 16, 2007: Mobile homes: how they got here (5 parts)

May 18, 2009: Outlaw in-laws (accessory dwelling units, 2 parts)

June 27, 2013: NORCs like us (mobile home parks as elderly housing; 6 parts)

January 6, 2016: Sprouting innovation (co-living; 3 parts)

February 9, 2016: The hipster’s mobile home (tiny houses; 6 parts)

September 28, 2016: Ask after me tomorrow (funeral homes; 8 parts)


I can also see why others would object – it’s an irreversible increase in cost without compelling evidence of benefit.  Lacking evidence of domain knowledge myself, I can’t say for sure, but as the law of bureaucratic entropy states that regulation expands without limit and well beyond the point of cost-benefit utility, I am very much inclined not to regulate the process but only to regulate the outcome.


Good thing OSHA can’t see this


[Continued tomorrow in Part 5.]


The room closing in: Part 3, Once they’re out the door

February 23, 2017 | Adulthood, Aging, Apartments, Assisted living, charity, Elderly, Housing, independence, Innovation, Nursing homes, Regulation, Technology, US News | No comments 84 views


By: David A. Smith


[Continued from yesterday’s Part 2 and the preceding Part 1.]


A society of robots for humanity’s physical needs, dogs for our emotional ones


He stayed close to the wall to keep out of people’s way, headed for a chair in one corner. He sat down and huddled back, forcing his body deep into the cushions, watching the milling humanity.  Strangers-every one of them. Not a face he knew. People going places. Heading out. Anxious to be off. Worried about last details. Rushing here and there.

– Clifford D. Simak, Huddling Place, 1952


As we’ve seen in the preceding two parts, the older one gets, the less one wants to travel physically, and the more one wants to remain alert and active mentally, but safe and secure and in a familiar environment – a place, in fact, envisioned at least in spirit by Clifford D. Simak, whose haunting novel City imagines a future in which humanity has ceded control over its physical environment to perfectly protective robots, and of its emotional environment to the faithful dogs.


The doctor’s simulacrum will see you now


As technology revolutionizes how we age and how we live the extra decades technology is giving us, it is time to reinvent what we mistakenly call the nursing home around five core elements that arise as themes within these updated regulations: freedom, choice, security, quality, and redress. 

Sources used in this post


New York Times, January 27, 2017

The history of nursing homes, Foundation Aiding the Elderly, pdf, brick red font)



1. Freedom


Even if a person is impaired, dependency in one aspect of daily living shouldn’t invalidate the resident’s right to freedom and independence in other things, such as who she sees:


1.A. Residents deserve freedom to host whom they want, when they want


Those of us who live independently take for granted that we can admit into our home anyone we choose, at any time of day or night, for any purpose that doesn’t violate the law or ruin the neighbors’ quiet enjoyment.  In a hospital, that notion of privacy is one of the first rights we lose, as people come and go at all hours, with lights and sounds and traffic in the corridor.


It’s out there, it’s loud, and I’m afraid of it


The regulations strengthen residents’ control over certain decisions important to their daily lives. For example, the rules allow people to receive any visitor they choose (not just relatives) whenever they choose, without restricted hours, as long as visitors don’t disturb other residents.


That change is also important because twenty-first century relationships come in many more varieties than they did a quarter-century ago.  Even as gay relationships have normalized, the nuclear family has undergone household fission.


Nuclear era, nuclear family


Just having family members around in the evening, when homes have fewer staff members, might improve attention and care, Dr. Castle pointed out.


We’re all so cool our kids fold their arms to show their self-satisfaction


Likewise, with ubiquitous cell phones, broadband, and increasingly cheap and high-quality videoconferencing, strong and meaningful friendships can be formed between people who live far away from each other – and with Facebook and similar social-media networks, people can find good friends they lost decades earlier. 


2. Choice


A toast to the choice of power relationships


Choice is an illusion, created between those with power and those without.

The Merovingian, The Matrix Reloaded


When you take away my choice, I lose some of my humanity, so as long as I can choose, I should be able to choose – and among the most fundamental rights of being at home is choosing with whom one is at home.


2.A Choice of roommate


The requirements also allow residents to choose their roommates when both parties agree, making it easier for friends, siblings or same-sex couples to share living quarters.


It’s a measure of my naivete that I didn’t know nursing home residents could have a roommate foisted upon them without their consent.  Thank goodness this was added.



2.B Choice of schedule


I choose to like olives … what do you choose?


Adults choose when and what they eat; those whose meals are chosen for them, we call children.


You’re violating my autonomy!


The regulations require facilities to make meals and snacks available when residents want to eat, not only at predetermined mealtimes.


Again my ignorance is showing; I’d never given thought to when and how residents in a nursing home should be able to eat, but certainly few thing are more frustrating, even humiliating, than being hungry or thirsty while unable to provide for oneself. 


3. Security


Among the core benefits of home (whether ownership or rental) is physical security, for ourselves, our possessions, and our loved ones.  Patients don’t have such rights; residents do.

AHI multi-part posts on unusual emerging housing tenures


April 16, 2007: Mobile homes: how they got here (5 parts)

May 18, 2009: Outlaw in-laws (accessory dwelling units, 2 parts)

June 27, 2013: NORCs like us (mobile home parks as elderly housing; 6 parts)

January 6, 2016: Sprouting innovation (co-living; 3 parts)

February 9, 2016: The hipster’s mobile home (tiny houses; 6 parts)

September 28, 2016: Ask after me tomorrow (funeral homes; 8 parts)


Indeed, unless the regulatory changes merely codify what has already become standard in the industry, then nursing homes must be dismal places where residents have little security over the most basic decencies of life.


3.A. Security from contagion through carelessness


The rule requires a nursing home to designate an infection-control officer and to establish a system to monitor antibiotic use.


3.B. Security of personal possessions


For the first time, nursing homes must take “reasonable care” of residents’ personal belongings and can’t shrug off responsibility for theft or loss by requiring residents to sign waivers. “That’s been a big complaint,” Ms. Grant said.


That such basics of proper accommodation weren’t required is further evidence nursing home regulations were horribly out of date.


I mean, horribly out of date


Times author Mr. Span adds this poignant note:


Moving into a nursing home already requires giving up so many possessions that “losing something can be devastating” — especially when eyeglasses, hearing aids or dentures go missing.


While some people in a nursing home will have all their faculties intact, some – perhaps many – will not, and I’ve experienced at first hand that when someone’s mind goes, he or she can no longer distinguish one door from another, one pair of glasses, one hearing aid. 


3.C. Security from abuse


Worse, demented patients are emotionally fragile, and for those who take care of them, few things are more upsetting than being shrieked at by an incoherent, undersized, and yet furiously aggressive oldster. 


The regulations call for expanded staff training in preventing elder abuse and in caring for patients with dementia. Dr. Phillips calls the latter critically important; most residents have moderate or severe dementia, Medicare statistics show.


Just as parents lose patience with their children, it’s easy enough to understand staff losing patients with their residents – but it’s still wrong, and it’s still elder abuse.


There’s one more bit of insecurity:


I mean, the worst


3.D. Security of tenure


This last element of insecurity is the worst:


Long-term-care ombudsmen report frequent complaints of “dumping”.


Too bad about Mildred, but somebody’s got to go


The existing regulations provide a lot of protection against being bounced from nursing homes.


But there is a loophole:


A nursing home sends a resident, often someone whose dementia causes problematic behavior, to a hospital. 


The ‘health care system’ (a misnomer as triply wrong as the Holy Roman Empire) functions as an assembly line operating in the dark, staffed by workers with attention deficit disorder and neuromuscular decay, and overseen by an addled bureaucracy.


After she is discharged, the home won’t readmit her.


Yes, you’re located somewhere in the system


“Once they’re out the door, it’s a lot easier to just evict someone,” Ms. Grant said.


It certainly is, and it has all the earmarks of corner-cutting shenanigans.


The new rule extends those protections to someone who’s been hospitalized but intends to return.


“That resident has all the rights that go with discharge and can appeal the decision.”  Nor can the facility transfer the resident while she is appealing.


Thank goodness – though of course, residents whose faculties are dimming will need their relatives to defend them as energetically as if in a case of mistaken identity, grandma had been taken into protective custody by the inept constabulary of Information Retrieval.


Whoever she is, she’s never getting out


[Continued tomorrow in Part 4.]