By THOM RANDALL
randall@poststar.com

LAKE LUZERNE -- Betty Cranston's friends and neighbors in Lake Luzerne gathered with their families and enjoyed traditional Christmas celebrations Tuesday.

But Betty didn't.

 She was stuck in a downstate nursing home where, she and family members say, she's been held against her will for more than a year.

 Betty, who needs a respirator to breathe freely, wants to go home -- to visit with neighbors, to be with family, to socialize with church members, and be a part of community life in Lake Luzerne.

 She and her son David -- who has cared for her for years -- want her to live at home enjoying the remaining years or months of her life among friends and family.

 But Betty is now in the Northeast Center for Special Care in Lake Katrine (Ulster County), sharing a floor with many patients who can't carry a conversation or who are close to death.

 David Cranston -- and some statewide disabled rights advocates -- believe Betty will thrive at home in the care of David and several home health aides.

 Cranston has worked for more than a year to get his mother released -- arranging for home health care, and taking health-related training courses. Yet the Northeast Center has repeatedly raised new obstacles to Betty going home, although her health has improved dramatically, he says.

 Officials at the Northeast Center -- a nursing home that has been investigated by the state for patient abuse and neglect -- have refused to discharge Betty, saying that the family has not yet proven that appropriate care can be provided for her at home.

 But Betty and her son believe she has the right to choose where she lives, and so does Bruce Darling, director of the statewide Center for Disability Rights in Rochester. His organization filed civil rights complaints recently with federal and state agencies on her behalf, demanding her release.

 "It's terrible what's being done to Betty," Darling said in a recent interview. "The nursing home has never been willing to put together a discharge plan that was real."



'I want to go home'

Thousands of people share Cranston's plight, Darling said.

 "There are many people who are stuck in nursing homes that don't belong there and don't want to be -- and when this happens, they give up hope," Darling said. "This has a huge effect on their quality of life and how much longer they live."

 Until about two years ago, Betty Cranston loved her life in Lake Luzerne -- more than 40 years of church activities, socializing with friends, raising children and working in real estate sales.

 But after a respiratory attack in 1999, her life changed. She was hospitalized, then sent to the Northeast Center for therapy and breathing rehabilitation. Since that time, she has improved dramatically.

 On a recent Wednesday, Betty finished a lunch of spaghetti and tried to strike up a conversation with an elderly woman whose mouth drooped open but was silent. Both use portable respirators that automatically sense their patterns of breathing and puff a shot of oxygen-rich air into their throats.

 "I want to go home, and to see what's going on in town," Betty said as she stroked her thick, curly white hair. "I miss my friends and I'd like to be near them so they can visit me."

 "We're going to do our best to get you back," replied Ted Galusha of the Glens Falls Independent Living Center. At the request of David Cranston, Galusha recently visited Betty at the home.

 On this visit with Betty in the home, Galusha and ILC agency advocate Shirley Dumont asked the nursing home administrators to meet with them to discuss Betty's case, but they refused.

 Northeast Center Administrator Don Dalger said Betty Cranston's case is held up because physician's orders are needed for her release, and Northeast Center officials need to see proof that she can receive needed health services in her home community.

 "We do what we can to discharge as many patients as possible back into the community, and we'd love to do it for Betty Cranston," he said. "But it's a matter of resources in the community."

 David Cranston disagrees.

 He accused Northeast Center officials of blocking her release, plaguing him and his mother with delays and denials since he started working on her release in June 2000.

 At first, the administrators said Cranston would have to take a course in cardiopulmonary resuscitation.

 He did.

 Then, they said he needed to learn how to operate a respirator and they'd train him. But when Cranston sought training, they said the institution staff was too busy to do it, he said.

 Then, nursing home officials said he'd have to line up home health aides for 24-hour assistance in the Cranston home.

 Cranston located health aides and provided the administrators with a list of them.

 Then the nursing home asked that all aides be certified in respirator operation, a requirement Cranston now plans to meet, he said.

 "Every time we got closer to the goal, they 'up' what they require for her discharge," Cranston complained.

 But the nursing home won't release her until her case is undertaken by a primary care doctor near Lake Luzerne and a home health care plan is in place under the auspices of her home county -- Warren County.

 But Darling said last week that Warren County won't conduct an assessment of Betty Cranston until she's at home. But she can't get home until the nursing home, which requires thorough assessments, releases her.

 "Betty is facing a 'Catch 22,'" he said. "Because she would have to leave against medical advice to have the county assess her, but if she leaves like this, then she's not eligible for community-based services including home health care."

 Also, David Cranston has asked several times over the past three months, he said, for the nursing home to provide his mother's medical records for a doctor in the Lake Luzerne area. But for the nursing home to release records, Cranston needs a confirmed appointment with a doctor.

 Cranston set up an appointment in October, November and now January for his mother with Dr. Surendra Nevatia, a Glens Falls pulmonologist. But administrators at Northeast Care called Nevatia and canceled the appointments, Cranston said.

 Both Cranston and the Center for Disabled Rights have repeatedly asked Northeast Center for copies of Betty Cranston's medical records, but to date, the facility has refused to turn them over, Cranston said Wednesday.



A matter of health or money?

Northeast Center respiratory therapist Alicia Aldridge said the issue was more basic.

 "We need to be assured there are properly trained health care providers to care for this lady, so she won't be put at high risk for death," she said. "She needs personnel trained in respirator and ventilator management 24 hours per day. This is a matter of life and death."

 But Cranston said Monday he has been well-trained, and he has lined up health aides who are willing to take training as soon as the facility provides clear specifications.

 Although the nursing home administrators worry about the care Betty Cranston would likely receive at her Lake Luzerne home, David Cranston conversely worries about the care she's now receiving at the nursing home. He says he is sure he can provide more attentive, comprehensive care than they can.

 Betty Cranston said Wednesday that staff members at the institution often don't respond when she presses her emergency call button for help. Often, she said, she has to get the nurses' attention by telephone, calling the nursing home's public phone number and asking for the nurse on her floor.

 Also, she complained that they don't get her dressed until midday, although she's routinely up by 8 a.m.



Center cited for 'gross neglect'

Cranston also said he was disturbed how the nursing home has been cited by state and federal health authorities for "gross neglect" and abuse of patients, and had allowed outbreaks of two strains of drug-resistant bacteria to infect patients.

 Government investigators found instances of patients suffering assaults, and one instance of patient sexual abuse.

 The center was cited also for inadequate patient assessment and for patients wandering off the property -- several were once found unsupervised on train tracks near the institution, according to a report issued in August by the state Health Department. The report notes that one female patient said she was given an enema and was then left sitting on a bedpan for two hours when no one responded to the call bell.

 In July, the state censured the institution with an "immediate jeopardy" notice -- a threat to close it down because patients' lives are potentially at risk. Although that status was lifted, a ban on admitting new Medicaid or Medicare patients was put into effect for a time. A similar ban in 2000 cost the center about $4 million.

 State Health Department spokesman Rob Kenny said last week that a more recent investigation by his agency has found additional violations that need to be corrected, most relating to medical neglect.

 "At this time, Northeast Center is not in compliance, and they have violations that need significant correction," he said.

 And if Northeast Center is again barred from admitting new Medicare or Medicaid patients, those patients now in the facility are that much more important for the nursing home to hold onto, Darling said, because they might not be able to replace the revenue. Galusha figures that caring for Betty Cranston earned the center $167,000 in Medicare and Medicaid payments since April.

 "Northeast Center may not want to lose a profitable, low-maintenance patient," Darling said.

 Aldridge disagreed about the reason they are holding onto Cranston.

 "We want her to get home, but we want her to be safe and have a comfortable environment and a wonderful life," she said.

 And that's just what Galusha and Dumont are seeking for Cranston, they said.

 To that end, Galusha and Dumont are meeting Wednesday with a respiratory therapist trainer to get an inventory of equipment Cranston needs and to set up training for home health aides, and they're contacting doctors in the area who will sign up as Cranston's primary care physician.

 "We're sick of the runaround we've been getting," Galusha said. "She wants to be at home and we'll get her there -- whatever it takes. She's not going to remain a prisoner in the nursing home."