For James Thompson, life at D.C. Village has meant suffering a series of indignities, some great and some small.
The 48-year-old stroke victim said nurses at the city-run nursing home make him go to bed right after supper, even though he wants to stay up. He says his belongings have been stolen, and he claims a nurse has called him names.
"One night I took the top off his water pitcher, because the water was hot," said his sister, Annie Thompson. "There was a bunch of roach eggs in it. They had just been putting water and ice in it and not cleaning it. I asked James if he had been drinking from it, and he said yes."
D.C. Village is the city's public nursing home, and as such, cares for elderly indigents. It has drawn new attention from city officials because of two unusual deaths there this year -- a woman got outside in her wheelchair and froze to death, and a man suffered fatal burns in a bathtub of scalding water.
But persons who are regularly involved with D.C. Village say they are as concerned about day-to-day conditions and care as they are about the bizarre deaths.
Interviews with residents, members of their families, community advocates and some staff members indicate that complaints of thefts, missing clothes and roach infestation are common and that residents' days are often filled with numbing inactivity.
"Generally, [D.C. Village residents] are not treated with the best quality of care," said the Rev. Alvin Hathaway, executive director of the Southeast Cluster, a church-affiliated group that takes complaints from residents. "The staff has the attitude that they are overworked and understaffed . . . . There needs to be greater scrutiny and monitoring."
City officials said that serious problems cited in official inspection reports over the years have been cleared up as they became known and that they are doing a broad review of the operation to see where more improvements need to be made.
D.C. Village, which has been operating for almost 80 years, is isolated in a campus-like setting across the Anacostia River in the most southern tip of Southwest Washington. The pungent fumes of the neighboring Blue Plains sewage treatment plant often waft over the red brick buildings in the complex. There is little else nearby.
Inside, the one-story nursing home looks and smells like a hospital, with long corridors winding through different wings where most residents share neat but sparsely furnished rooms with pastel-colored cinder block walls and linoleum floors.
The 432 residents there are mostly old, poor and sick, many without close relatives, which makes them vulnerable. Nursing home experts say a lot depends on the attitude of individual staff members, but that the sheer size of D.C. Village can make residents feel "warehoused."
"They [residents] put up with it, because they have no place to go," said Fay Mays, a Southeast Cluster worker who regularly visits D.C. Village.
City officials and nursing home experts say it is difficult to compare conditions at D.C. Village with those at other nursing homes. Some of the problems there are common to nursing homes, both public and private, throughout the country, they say.
"It provides an acceptable level of care," said Frances Bowie, administrator of the D.C. Service Facility Regulation Administration, which inspects and licenses nursing homes in the city. The city has no way of judging which are the "best" and the "worst" of its nursing homes, but D.C. Village "has improved a lot" over the past few years, Bowie said.
Some residents said they are well satisfied with their treatment at D.C. Village.
"I've enjoyed myself, and I'm very pleased," said Annie Gerald, a resident for 1 1/2 years, in an interview in her room, which is designed to accommodate three other residents. She said that while D.C. Village does not have enough staff, nurses and aides have treated her well and it is cleaner than other nursing homes she has visited.
D.C. Village is licensed to operate 530 beds, and there is a waiting list to get in, but it has only 432 residents now. City officials said the home could not operate at full capacity with its current staff.
The nursing home, with an annual budget of $13.7 million, is authorized to have 622 employes, but now has only 584. It is recruiting applicants for some of the unfilled positions, said Yvonne Lanier, a public health commission spokeswoman.
Official city inspections at the facility over the last several years have reaped long lists of problems at D.C. Village, such as serious staff shortages and mice- and roach-infested rooms. Inspectors have found residents with bedsores, uncut fingernails and unbrushed teeth; residents without underwear, clothes or shoes, and residents kept in restraints for hours without turning or exercise.
Conditions got so bad in 1982 that the city voluntarily withdrew from participation in the Medicare program in its skilled nursing care unit to prevent the federal government from taking the unusual and embarrassing step of cutting off funds because of uncorrected deficiencies.
D.C. Village cleaned up enough of the problems, many of which involved quality controls at the pharmacy, to regain the federal funding a few months later. Regulating commission administrator Bowie said that the last inspection of the home -- in May 1984 -- showed no major deficiencies.
That report did cite several problem incidents, however. The family of one resident was not told for three days of the resident's death. Medicines were not labeled or were labeled improperly. A resident was injured after falling from a faulty patient lift, and the home's safety officer was not informed.
Idleness is a problem for most D.C. Village residents. Recreation aides schedule activities, but participation is spotty. One problem is a lack of staff to help residents get to activities, said one staff member.
On one recent afternoon, about 50 residents, most of them in wheelchairs, were having a "happy hour" in the auditorium. As rock music blared from a record player, the group sat eating corn chips and squares of bologna and sipping soft drinks, beer or wine. Few were talking or moving.
In another wing of the building, a group of about 20 wheelchair-bound women wearing nightgowns were lined up at a long table in a day room. Most of them were just staring straight ahead, doing nothing. They ignored the howls of one resident, as did the staff.
This kind of situation has been cited in city inspection reports. "When asked what the residents did during the day," a 1983 survey report said, a nurse "pointed to two residents and said that they liked to look at each other."
Barbara Frank, of the National Citizens Coalition for Nursing Home Reform, said the scene of nursing home residents just sitting doing nothing is one played out all over the country, but one that could be changed.
"People just sit there because there is no stimulation. There is not a reaching out to their minds and hearts," even if activities are planned, she said of nursing homes generally.
The federal government has some jurisdiction over D.C. Village because it receives Medicare and Medicaid funding. Inspections generally are left to local governments, but the federal government can do a "look-behind" review.
In light of the two recent deaths, Everett Bryant, regional administrator for the U.S. Department of Health and Human Services in Philadelphia, said that after the District takes action to prevent such tragedies in the future, he will send an inspector to Washington to check on the facility.
The two deaths "represent to us isolated instances of breakdowns in administrative management," said Robert Taylor, associate for health standards and quality in the HHS regional office.
After the second death, David Rivers, director of D.C.'s Department of Human Services, had Public Health Commissioner Andrew McBride set up a work space for himself at the nursing home to take control at the facility. McBride, who is working on recommendations for improvements, said he was not ready to outline any of his findings or proposals.
Celeste Galati, formerly of the D.C. Office of Aging and now with Catholic Charities Social Services, said it is hard to keep good staff because mediocore salaries and difficult working conditions make nursing homes unattractive places for a nurse to work. "In fact, it's the bottom of the barrel for the medical profession," she said.
The average base pay for a registered nurse at D.C. Village is $24,995, according to Lanier, the health commission spokeswoman. That puts it in about the middle of the pay range for D.C. nurses in general, according to the D.C. Nurses' Association, which said that, taking into account both public and private institutions, registered nurses in the District make between about $20,000 and $29,000 a year.
Fay Mays recalled that one day she was talking with a blind resident and there were small roaches crawling all over the woman's water pitcher. She asked the nurse to remove it and bring a new one.
"But her attitude was, 'So what?' " Mays said. "Some of them lack sensitivity."
"Nurses have their 'pets.' Other residents sometimes get a hard time," said one staff member, who asked not to be identified. Thefts are a major problem, this staff person said, and residents eventually get tired of reporting them.
Katheryn Spells Jackson, sister of George Austin Spells, the 71-year-old man who was scalded to death in D.C. Village, said that clothes she took to her brother often disappeared without explanation.
City officials acknowledge that missing belongings are often a problem, but they blame it on family members not marking clothes properly so that staff members can keep them straight when they go to the laundry. As a result, the nursing home soon plans to start marking clothes itself, a spokeswoman said.
Resident James Thompson also claims that he saw a nurse steal $50 out of his change purse when she thought he was asleep, and then called him insulting names when he confronted her.
The nurse, reached by telephone at D.C. Village, declined to comment.
Thompson had reported the incident to D.C. Village officials, but a department spokeswoman said officials had no substantiation for the charge, adding that that did not mean there had not been a theft.
While most of D.C. Village residents are elderly, there also is a unit of about 35 mentally or physically incapacitated children, and some younger young adults. The city plans to make 56 more beds available soon for patients now at St. Elizabeths mental hospital.
James Bush, 38, has been paralyzed from the neck down for the past 18 years, since he was shot in the neck by a D.C. police officer, and says he has been in a number of District institutions ever since.
Bush, with his limp arms taped to his motorized wheelchair and with a baseball cap in his lap, said he is one of a middle group of D.C. Village residents "caught in limbo" because they are too old for the children's programs and not old enough for the programs for the elderly. "Nobody knows we're here," Bush said.