It was only four years ago that a group of north-side seniors struck a deal with the Illinois Masonic Medical Center, a deal heralded as a model for senior-citizen health care.
Together they created the White Crane Senior Health Center, which offered low-cost fitness programs--like yoga and t'ai chi--as well as on-duty geriatricians and nurses in a storefront clinic on Belmont.
"We wanted an integration of medical services and preventative medicine," says Ruth Shriman, president of White Crane's board of directors. "We wanted the best of both worlds, and we had it." Last October, however, the center closed.
Masonic has opened a new geriatric clinic, White Crane Medical Services, in a building near its main facility at 836 W. Wellington.
As for Shriman's group, they opened the White Crane Wellness Center in the second-floor banquet room of Ann Sather's restaurant on Belmont. They've managed to keep their exercise classes going, but money's tight. Without more contributions, they won't be able to pay Rob Skeist, their director. In the meantime, they've retained a lawyer--who's working free of charge--to represent them in a sticky dispute with the hospital over the rights to the White Crane name.
"It's sad that the White Crane model has died, but I don't think anyone should be blamed for what happened," says Suzanne Sullivan, Masonic's administrator for ambulatory care. "We had lost money on the program--about $1 million. We couldn't afford it. The real problem is that medicare won't pay for the kinds of wellness and exercise programs White Crane offered."
The idea for White Crane first came up seven years ago, during meetings organized by the Hull House Senior Caucus.
"We'd get together and hear each other's horror stories about doctors," says Shriman. "The medical profession can be rude; a lot of doctors are paternalistic. You'll complain of something, and they'll say, 'Well, what do you expect at your age? Here, take this pill.'"
In general, the seniors felt that they were being overtreated with pills and shots, particularly in cases of arthritis.
"The typical medical reaction to arthritis is to tell the patient to take aspirin or an anti-inflammation pill," says Skeist. "But there are other things you can do that don't involve taking pills. If you exercise the muscle around the joint, you can alleviate the pain. Or you can take t'ai chi, which improves the posture, which also helps the muscles."
The seniors proposed to open a center that would feature exercise classes as well as dispense the traditional pills and shots. Ideally, they wanted several nurses, geriatric specialists, eye doctors, and even chiropractors available. A patient who suffered from high blood pressure, for instance, could be treated at the center by a doctor and also take a low-salt-cooking class there.
The idea provoked some distrust among doctors. "If old people want to exercise, they should go to the YMCA," says one doctor not affiliated with Illinois Masonic. "I don't mean to sound harsh, but I don't like the idea of older people looking to hospitals as social institutions or sources of recreation. Too many old people already talk too much about their hospital visits. I'd rather hear them talk about their social clubs, their trips to Vegas, gardening, or whatever."
Despite such skepticism, in 1986 Illinois Masonic agreed to meet the challenge. "We felt this was a good model for future health care," says Sullivan. "It was an experiment worth making."
Masonic agreed to pay for staff, rent, and utilities--which together could come to as much as $400,000 a year. In return, administrators hoped to attract more patients to their hospital.
"The hospital saw it as a marketing tool," says Skeist. "Seniors who take t'ai chi might become the patients of a Masonic doctor. In other words, the hospital was hoping to use White Crane to take a larger share of the lucrative north-side medicare business."
Skeist, Shriman, and Yaho Fujii, White Crane's coordinator of volunteers, worked with north-side Jewish and Japanese social-service agencies and social clubs like the Kiwanis to recruit about 2,000 members. And Masonic asked each one to join Masonicare--the hospital's $175-a-year medicare-supplement plan.
"The most medicare pays is 80 percent of certain fees," Skeist explains. "But if you buy Masonicare--or any supplemental insurance--the hospital will pick up the remaining 20 percent of the cost. Most hospitals require that you go there for your treatments. It really is a pretty good deal for everybody."
The problem was that only a small fraction of White Crane's members accepted Masonic's offer.
"We knew we would be carrying expenses," says Sullivan. "What we didn't bank on is that seniors generally will not change primary-care providers. We should have figured that, because it makes sense. They're in the sunset years of their life. They may be facing chronic illness, and they would want to go to someone who knows their history."
Masonic officials estimated that, for the hospital to gain one new patient, White Crane had to recruit as many as seven members. Meanwhile, the annual rent and utilities costs for the storefront were $90,000. All told, the hospital was losing over $300,000 a year.
"Most of the wellness programs are not covered by medicare," says Sullivan. "That's a problem with that system. It pays for operations, but not for classes that might prevent operations. It's a fact of life we did not create."
The budget problems were heightened by a series of squabbles between administrators and the seniors who also sat on White Crane's board. The seniors, for example, wanted to hire a chiropractor. The administrators refused, saying that that would anger many doctors on the hospital's staff. The seniors accused administrators of having a paternalistic attitude toward them--an accusation that only irritated hospital officials. In time, little issues snowballed into larger confrontations. They squabbled over the name (it comes from an Asian symbol for good health), and then had a major showdown over fund-raising.
"Originally, we had hoped to cover most of our expenses through fund-raising," says Skeist. "But we were having trouble raising the money." The hospital insisted that it do the fund-raising, and under Illinois Masonic's name.
"We wanted to use the White Crane name to raise funds," says Skeist, "because we felt that more foundations would be willing to contribute to a community project rather than a hospital. Masonic's reaction--which I can sort of understand--was, 'Oh, our money's good, but not our name.'"
Last summer Masonic discontinued the partnership, and in October it opened White Crane Medical Services.
That move outraged many seniors. "White Crane is our name," says Shriman. "At first, [Masonic] didn't even want to use it. Now that we have built its credibility in the community, they want to keep it. That's not right."
Hospital officials counter that Masonic earned the right to the White Crane name. "We have the right to use that name in conjunction with medical services," says Sullivan. "We've invested tremendous time, energy, faith, and resources into this project. To walk away from it makes no sense."
After the decision to break off the partnership, White Crane seniors met, in a series of face-to-face severance negotiations over several months, with Dr. Gerald Mungerson, Masonic's president.
"They wanted to use the name and the logo, and we said no," says Shriman. "They wanted to make it look as though there had been no split, when in fact there was a split. We wanted them to make a contribution of $150,000, over two years, to the wellness center. At one point, Mungerson said, 'I'm tired of this; either you agree or the money's off the table.' I said, 'I don't think it's reasonable for one party in negotiations to tell the other to cave in.' Mungerson said, 'Negotiations? We're not negotiating with you.' It was difficult for them to treat a ragtag group of seniors as their equals. Since then, they have refused to meet face-to-face."
Masonic officials take strong exception to her comments.
"It's insulting to us that they would say we treated them with disrespect," says Sullivan. "We made a commitment to this project. Some of the highest level of administrators attended those White Crane meetings. We worked hard for the center; we wanted it to work. We are probably the only institution that I know of that started a program like this. We employed a 72-year-old t'ai chi instructor, for gosh sakes. We have nothing to apologize for.
"The problem is that the state and federal governments are not willing to fund wellness programs like White Crane's. The seniors have a hard time understanding that the health care environment has changed. There are increasing constraints on us. Look at all the cutbacks. You see hospitals closing. You have trauma centers closing. This is not an era for experimentation. I wish it were, damn it. I wish it were ten years ago, and we had more leeway and the luxury to try programs like White Crane. But it isn't, and we don't."
Tension between the two sides has softened a bit over the last few weeks. Two local politicians, state representative Ellis Levin and 44th Ward Democratic committeeman John Merlo, have agreed to meet with Mungerson on the seniors' behalf.
In the meantime, the wellness center continues to operate out of Ann Sather's in space donated by Tom Tunney, the restaurant's owner. Tunney's mother is a White Crane member.
"We plan to raise enough money to weather these hard times and stay in business," says Skeist. "We won't offer medical services, but we can continue the wellness classes. We still have a lot of community support. The other day a guy from the Kiwanis club came up to me, gave me a hug, and said, "Here's 25 bucks, let me know what the Kiwanis can do to help.' We have a lot of grass-roots support. We're not through yet."
Art accompanying story in printed newspaper (not available in this archive): photo/Jon Randolph.