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Tables Reserved for the Healthiest 2012-02-13
By PAULA SPAN



Residents at Harbor’s Edge, an upscale retirement community in downtown Norfolk, Va., appreciate their gracious dining room, called the River Terrace. They like the country club cuisine, the socializing, the view of ships passing on the Elizabeth River.

Until recently, William Hodges had dinner there every evening with his wife, Betty. Dorothy and Thomas Evans hosted out-of-town guests and celebrated Thanksgiving and Christmas there with their son. Lindsay Bilisoly regularly shared meals there with his parents, Frank and Indie.

For years after Harbor’s Edge, a nonprofit facility, opened in 2006, nobody seemed to care that some of these diners occupied independent living units in the high-rise building while others, in need of greater care, lived in assisted living apartments or in the facility’s nursing unit.

But last spring, managers declared the River Terrace and two other dining facilities at the community off limits to anyone but independent living residents. Assisted living residents were told to use their own small dining room; nursing residents were restricted to theirs.

Family members were instructed to join them there. But longtime friends — and several married couples — who lived in separate parts of the facility could no longer share meals in the main dining room. Those in assisted living or nursing care also were also barred from community events like the Fourth of July celebration.

Charges of discrimination quickly followed the new edict. “We’ve been excommunicated,” said Judith Schapiro, 83, an assisted living resident. “I thought segregation ended in 1954.”

Harbor’s Edge is not the first retirement facility to enact policies separating sicker or more disabled residents from healthier ones. Questions about how much access and autonomy residents have in such complexes, and who gets to decide, have arisen around the country, said Susan Silverstein, an AARP senior attorney.

An assisted living facility in Colorado attempted to keep walkers and wheelchairs out of a communal dining room; in 1996 a state appeals court ruled that action discriminatory. In San Francisco, an assisted living resident who used a walker sued in 2008 when administrators decreed that she couldn’t use the dining room buffet but instead had to be seated for table service. That suit was settled.

In 2006, a woman in an independent living apartment in Palo Alto, Calif., sued administrators at her continuing care retirement community, or C.C.R.C., who insisted she move to assisted living. Her case was settled, as well, as was a similar one in a South Carolina C.C.R.C. the same year.

The growing popularity of this type of retirement village poses particular challenges. In a C.C.R.C., residents are able to graduate to increasingly higher levels of care without the trauma and disruption of moving to a different facility. But that also means these communities serve a population with unusually broad ranges of health and function.

About 1,880 C.C.R.C.’s now house an estimated half a million residents nationwide, said Stephen Maag of LeadingAge, an association of nonprofit elder care providers. About 130 new communities opened across the country from 2002 to 2010, and construction is likely to increase as the economy and the housing market improve, he said.

C.C.R.C.’s occupy a unusual regulatory niche, according to Joani Latimer, Virginia’s long-term care ombudsman. The hybrid facilities provide care overseen by different governmental authorities: The nursing home sections are federally regulated, but assisted living units fall under state laws. Independent living units often are regarded simply as local housing.

At Harbor’s Edge, the new policy initially stemmed from overcrowding, said Neil Volder, a former real estate developer who built the complex and is its executive director.

Early on, the River Terrace had room for everyone. But by last spring, independent living occupancy hit 95 percent and residents with reservations were sometimes turned away. “People were saying to me, ‘You’ve got to do something,’” he said.

Moreover, managers believed that the policy of letting residents of various degrees of disability dine together violated Virginia state regulations, Mr. Volder said, and left Harbor’s Edge vulnerable to lawsuits or revoked licenses.

But Ms. Latimer, the state ombudsman, said in an interview that she could find no statutes setting forth several of the requirements Mr. Volder had mentioned. And other Virginia C.C.R.C.’s have avoided such prohibitions.

“We have no restrictions on where residents or their family members can dine,” said Daniel Nimon, vice president at Westminster-Canterbury on Chesapeake Bay, in nearby Virginia Beach, which is also near capacity.
Lindsay BilisolyJudith Schapiro, a resident of Harbor’s Edge in assisted living, said, “I thought segregation ended in 1954.”

The change at Harbor’s Edge caught many residents by surprise, particularly married couples. The Hodgeses had been eating together nightly, though he lived in the nursing unit and she was in independent living. Lindsay Bilisoly sometimes escorted his 90-year-old father, Frank, to dinner with his wife, Indie, 85, who remained in the independent living unit they’d originally moved into together.

“We were a happy community,” said Ms. Schapiro, who liked to invite her grown grandchildren for dinner. “We all intermingled. Nobody thought anything about it.”

Angry residents and their children called board members to protest the new rules. They sought help from the local ombudsman. They signed and circulated letters. When all that failed, several pooled their resources and hired an elder attorney.

That lawyer, Andrew Hook, believes the new policy violates the federal Fair Housing Act and the Americans With Disabilities Act, as well as Virginia law. “The federal statutes are clear,” he said. “You can’t discriminate, and the law requires reasonable accommodation” for people with disabilities.

“You don’t bar people simply because they have a physical or mental impairment that doesn’t interfere with other users or require additional services,” said Ms. Silverstein of the AARP Foundation.

Some residents support the new policy, however, including Martha Haycox, 80, past president of the Resident Advisory Council, who took pains to point out that three independent living residents with health problems are also excluded from the dining room, while many who do use it require wheelchairs or walkers.

“It happened to me twice in one week that somebody at the next table threw up,” requiring hasty clean-up by the maintenance staff, she said. Another time, she said, someone’s wheelchair got tangled in a tablecloth at Sunday brunch and nearly pulled all the food off the buffet table.

“I should be able to have what we call quiet enjoyment,” she said.

“It’s a very upscale community,” said Mr. Volder. “When someone comes in wearing a coat and tie, with guests, they want an ambience of fine dining.”

Disgruntled residents acknowledge that their more disabled neighbors might pose safety problems in the dining room or sometimes behave inappropriately. But they want decisions about access to be made on an individual basis.

In December, the Harbor’s Edge management offered a compromise. Assisted living residents who originally entered independent living and then transitioned may now seek an assessment determining whether they will be allowed to continue to use the dining room.

The test assigns points in various categories. If a resident is diabetic, can he make “wise menu choices”? Avoid adding salt if he’s on a low-salt diet? Residents with nine or fewer points, plus a written physician’s order, will be admitted to the dining room (though they will pay an additional fee), but must be reassessed monthly or even weekly.

They still can’t use the community’s other restaurants, however, and “direct admits” to assisted living or nursing care, like Ms. Schapiro, are out of luck. Nursing care residents remain excluded, period.

So the Bilisoly, Hodges and Evans families still can’t meet in the River Terrace for meals. Mrs. Evans herself could seek an assessment, but “I’m not going to play that game,” she said. “It’s the principle of the thing.” The uneasiness some older adults experience when they coexist with those more impaired may be at work here, the protesters believe.

“We’ve run into this bigotry,” said Mike Evans, son of Dorothy and Thomas Evans. “I was told that people were saying, ‘We didn’t pay all this money to be in the same place with people who are crippled.’”

They also suspect management marketing concerns. “They think it will appeal to newcomers more if they have the impression that the residents here are in better condition than they probably are,” said Mr. Hodges, a retired appellate court judge who uses an electric wheelchair.

Mr. Volder denied that and said that dissenters could always move elsewhere: “I’ll make it so they get 100 percent of their money back if they’re that unhappy,” he said.

Lindsay Bilisoly said his father, a retired internist, doesn’t want to move. “We love Harbor’s Edge,” the younger Mr. Bilisoly said. “It’s beautiful. The people who take care of my father are awesome.”

But the exclusion rankles.

“Ninety-five percent of the time he’s perfectly capable of eating dinner,” Mr. Bilisoly said. “I can take him to any restaurant in Norfolk or in the state of Virginia, except the one in the building he paid $600,000 to move into.”

Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”
 


 
 
 
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