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Chapter 5 The Jane Dent Home: The Rise and Fall of Homes for the Aged in Low-Income Communities Susan C. Reed Nancy Davis When the Jane Dent Home opened its doors in 1893 as a home for the aged in Chicago’s African American community, other ethnic communities in the city were establishing similar institutions to protect their elders from neglect, loneliness, and, ultimately, the poorhouse. When the doors of the Jane Dent Home were closed for good in 1975, many other ethnically based homes for the aged had also closed their doors, but there were some that had moved into new neighborhoods of the city or out to the suburbs. Over the course of the intervening century, the neighborhoods that were once served by not-for-profit homes for the aged increasingly housed for-profit nursing homes. In the process, care for the elderly and disabled shifted from a community endeavor to a business. Scholars have debated for 40 years whether quality of care suffered with changing ownership of longterm care facilities. The story of the Jane Dent Home is told as a case study of (1) the effect of economic segregation on the location of not-for-profit homes for the aged in Chicago and elsewhere; (2) how the passage of Medicaid inadvertently encouraged the displacement of not-for-profit homes for the aged by for-profit nursing homes; and (3) how these important changes in the nursing home market affect access to long-term care for the poor today. Crucial to the story of the Jane Dent Home are the racial and economic changes that occurred over the course of the century within the African American community that housed and supported the home. Early in the twentieth century, the neighborhood of Grand Boulevard, where the Jane Dent Home was located, was racially segregated but relatively diverse economically. Working adults contributed to the Home financially and gave of their time whenever needed. But by the 1960s the community became economically as well as racially segregated, as a high per capita poverty rate settled in. Similar demographic changes have challenged communities of color in cities throughout the country. In addition to the effects of the demographic changes in communities like Grand Boulevard, the passage of federal legislation creating Medicaid in 1965 Susan C. Reed, PhD, is an associate dean of curriculum instruction and assessment and an associate professor in the School for New Learning at DePaul University, Chicago. Nancy Davis, PhD, is an associate professor in the School for New Learning at DePaul University. The Jane Dent Home 51 required participating facilities to meet new standards of care. Both Medicaid, which covered nursing home care for the indigent, and Medicare, which covered only a limited number of days of skilled nursing care, established new criteria for eligibility. Many homes for the aged, both proprietary and nonprofit, were forced to close because they were unable to comply with the stricter requlations. On the other hand, the passage of Medicaid encouraged the growth of long-term care beds by covering construction and investment costs for new facilities. Much of this new construction was of for-profit facilities located in poor communities of Chicago so the owners could profit from Medicaid-reimbursed care for the poor. After 1965, not-for-profit homes for the aged, once established to serve an immigrant population, became the preference of middle-class elders, leading to class differences between the residents of nursing homes by ownership type. Nationally, research suggests that residents of not-for-profit nursing homes have higher incomes than residents of for-profit nursing homes. The most recent study of patient sorting found that those with the greatest need (as measured by disability, diagnosis , and age) and those with the greatest range of long-term care options (as measured by family income and college education) reside in not-for-profit nursing homes. This study confirms previous research that has found that not-for-profit residents have higher incomes and are more likely to pay privately, rather than with Medicaid, than residents of for-profit nursing homes.– (Some studies have found no such relationship between ownership and source of payment.) Class differences between the residents of for-profit and not-for-profit homes is a health policy concern if the care that the poor receive in for-profit homes is of a lower quality. In fact, more than 30 years of research comparing the quality of for-profit and not-for-profit homes has...

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