VINCENT PRICE was raised in poverty as a foster child, then spent much of his adult life on the streets, addicted to drugs. He was in his early 50s, laid low by severe emphysema and out of options, when he landed four years ago at the Philadelphia Nursing Home on Girard Avenue.
The experience gave Price a new sense of purpose in life: getting out of the city-owned, outside-managed North Philadelphia institution.
"It was like being in a minijail," complained Price, who chafed at not being able to leave the building, the erratic times that his breakfast showed up and the tedium of his life.
It took Price - who breathes with help from an oxygen tank - two years and considerable help from a social-service agency to get out and start a new life, with a Section 8 apartment on Hunting Park Avenue and a volunteer job at the agency, Liberty Resources.
Not everyone at the city's nursing home is as fortunate as Price. With little fanfare, activists have been protesting for years and pleading with City Hall to shut down the home, winning vague words of support from top officials but little or no action.
In an era when many counties are shutting down public nursing homes because of better options for home care, the Philadelphia Nursing Home remains open as a shelter of last resort for more than 400 patients - and a monument to civic frustration in finding a good way to care for sick people amid a sea of poverty, homelessness, AIDS and gun violence.
"We want more people to be able to stay in their own homes, become taxpayers, be able to have a life, get married, have a job - but when you're put away, that's difficult," said Nancy Salandria, director of independent living resources for Liberty Resources. It was her group and a sister organization called ADAPT that staged a sit-in outside the nursing home in 2008 and won a promise from Mayor Nutter that "we'll be announcing some plans very shortly that you'll appreciate."
Since then, the number of beds has been reduced from about 450 to 403. The shrinkage hasn't come fast enough for disability-rights groups like Liberty Resources, which has watched roughly half of Pennsylvania's counties get out of the nursing-home business, including neighboring Montgomery County, which sold its home last month for $41 million. Based on past news accounts, the number of patients at the Philadelphia home is actually greater now than it was 20 years ago.
"The census has been reduced, but there is no plan to close the facility altogether as there are not good alternates for many of the residents it serves," said Jeff Moran, spokesman for the city Health Department, which oversees the nursing home. Over the last five-plus fiscal years, Philadelphia taxpayers have chipped in almost $5.5 million to operate the home and nearly $3.14 million on capital expenses, according to the department.
For the last full fiscal year, 2013, the city spent $497,091 for operating costs and $1,312,657 on capital expenses. Much of the cost of health care at the home is reimbursed, primarily through Medicaid.
The drab, four-story brick building across from Girard College weathered a wave of scandals in the early 1990s, before the city contracted with outside management. Despite its name, the majority of patients at Philadelphia Nursing Home are not senior citizens. Officials say that 56 percent of the current patients are actually under age 65, and a majority (57 percent) are male - many of them homeless people or crime victims in need of intensive medical care who have no other place to go. Unlike a typical nursing home, for example, the Philadelphia facility gets a disproportionate share of gunshot victims.
Tracy Pugh's son Eric ended up in the nursing home in January 2011 - six months after he was shot in the head, requiring months of treatment at Albert Einstein Medical Center and a local rehab hospital. When his initial rehab ended, the Pughs were told that Philadelphia Nursing Home was one of just two options and the only one that the mother, who lives in Bristol and doesn't have a car, could reach by mass transit.
From the day her son was admitted to the home, Pugh said, she pleaded with city and home officials to have him released and to help arrange for home care.
"I said, 'You can't make me keep my son here - he will surely die,' " she recalled telling a worker with the Philadelphia Corporation for Aging.
She complained that the nursing home smelled of urine, that meals were left in the room in places where her now-disabled son could not reach them, that with only two baths or showers a week his shirts were often brown, and that at one point he was getting up and falling on the floor so they just left a mattress on the floor next to his bed. After jumping through bureaucratic hoops for a couple of months, Pugh said, she finally brought her son home to Bristol, where he received state-funded home health care and has shown some improvement, now able to walk 150 feet with a brace and assistance.
Advocates say that getting out - as Price and Pugh eventually did - shouldn't be that difficult. In 1999, the U.S. Supreme Court issued a landmark ruling in the Olmstead v. L.C. case that the Americans with Disabilities Act meant that patients who'd fare better in the community than in a nursing home have a right to home care - but officials say that obeying that judgment has proved difficult, especially for patients who now lack housing options.
"We have a population that is not particularly welcome by other nursing facilities," said Molly Hess, the executive director of Fairmount Long-Term Care, a nonprofit that has administered the nursing home for the past decade.
She noted the array of problems - not just severe medical conditions but psychological issues, criminal records or histories of drug abuse - that make it very difficult to find other placements, particularly for independent living, even in Section 8 or other subsidized housing.
Not surprisingly, Hess paints a vastly different picture of the situation at the nursing home than advocates do. She said administrators work hard to discharge patients when they can - releasing between 75 and 95 of them in each of the past four years. She also said conditions at the home are sound, staffing exceeds the current requirements, and patients are offered an array of activities and are cleaned regularly, by hand in addition to the two required weekly showers.
But advocates and administrators can't even agree on the nine cats that roam the hallways of the nursing home. Hess says that the felines were brought in as patient therapy and have been a "great addition." The home's critics suspect they're there to control mice, and complain they're making a mess.
"They had cat feces because no one wants to dump the litter box," Pugh said.
There seems to be only one thing about the Philadelphia Nursing Home that all the parties can agree upon, which is that - despite years of lobbying by activists - it seems unlikely to close anytime soon. That frustrates Steve Gold, Philadelphia lawyer and longtime disabilities-rights advocate. Argues Gold: "There's no one in there who could not be provided for in the community cheaper."