In their waning years, all came to live in a nondescript, single-story building at 505 Miller Ave., a 120-bed nursing home in Mill Valley.
The setting was ironic. Testaments to the North Bay's reverence for the young, fit, and pretty surrounded the Mill Valley Healthcare Center. A couple doors away a company made mountain bikes, like the ones seen in soft-drink commercials. Farther up the street was a town plaza where breezy clothing boutiques, designer health-food stores, and sprightly coffee shops formed the palette of West Coast chic.
In this cradle of youth-obsessed sensibility, a horrible thing happened this spring.
After managing the nursing home incompetently -- and some say negligently -- a Massachusetts corporation washed its hands of the Mill Valley Healthcare Center and cast out its occupants. In just two years, under the management of Lenox Healthcare Inc. of Pittsfield, Mass., the community that these elderly patients had carved out for themselves was torn asunder and scattered to the winds.
Lenox Healthcare's owners did not respond to repeated requests for interviews from SF Weekly. But court filings, state inspection reports, and interviews with former patients and their family members show that, under Lenox's reign, conditions at the home deteriorated to such a miserable level that at least one family member says she was warned by local paramedics to "get her mother out of there" for her own safety.
Care became so bad, so swiftly, following Lenox's purchase of the home in 1997, that the state of California suspended Lenox's license to provide for Medi-Cal-funded patients eight months after the company took control of the facility.
Then -- so promptly and efficiently that some suspected it was by design -- Lenox attempted to evict all 70 of the patients whose bills were paid by Medi-Cal, the least profitable for the company. When a judge stopped Lenox from doing that, the company eventually decided to simply close the home down. All of the patients were told they must leave, and the Mill Valley Healthcare Center was shuttered and sold. It stands empty to this day.
Whether there was some grand scheme to Lenox's behavior -- some design to maximize profits -- or this was an act of colossal strategic bungling by an otherwise shrewd company, remains unknown. The answer, perhaps, will emerge from the lawsuits soon to come from former patients and their families.
Almost from the time Lenox instructed orderlies to start packing patients' belongings into black plastic bags and hired ambulances to take them away -- some at night -- suspicions have lingered that Lenox planned the scenario all along.
"How can a company like Lenox, that has facilities all over the country, fail to correct problems like that, unless they didn't want to correct them?" asks David McGahey of Sausalito, whose mother lived at Mill Valley. "I thought it was rather brutal the way they did it."
In comments to the local Marin County press, former Lenox Vice President James Hardee was quoted as saying that his company did not purposefully seek to purge the home of Medi-Cal patients.
And Hardee's replacement, Joyce Hogue, said that while she had no firsthand knowledge of Lenox's actions at Mill Valley, she found the idea "hard to believe."
The story did not end when Lenox emptied out the home.
Within three months of their evictions, 10 people -- some of whom had lived at the center for years without life-threatening health problems -- died. Eight of those were possible victims of a syndrome known as "transfer trauma," according to an official with the Marin County Department of Health and Human Services. Sometimes, current medical understanding of this phenomenon holds, older patients who have been forced from their homes and routines become so distraught that they simply give up living.
It's not possible to prove, definitively, that the closing of the Mill Valley Healthcare Center killed anyone. Perhaps there are other reasons why some of its former patients withdrew, or stopped eating, or willed themselves to die.
That will be for the courts to decide.
As brutal as a forced eviction is for anyone, for the elderly it can amount to a death sentence. Medical science calls the condition "transfer trauma" -- a wave of disorientation and despair so intense that it can kill.
Marcella Adamsky is a San Francisco clinical psychologist and expert on the syndrome. For people at an advanced age, she says, stability -- familiar people, surroundings, routines -- are important elements for sustaining life. An elderly person's first move, from their private home to a nursing home, is almost always traumatic, Adamsky says.
If there's another, subsequent forced move, it can be deadly. California law recognizes the potential trauma involved with evicting elderly nursing-home patients. State law requires nursing-care providers to be especially careful when transferring patients. They are supposed to provide counseling and other services to help ease patients into their new homes. Lenox's critics say no such help was provided for the former patients at Mill Valley.
"They finally carve out a niche, a home, and when they least expect it, an outside force demands that they move," Adamsky says. "This is disturbing for older people, especially for people who have been in the same environment for a while."
People like Astrid Lindman, a Swedish nanny who came to America when she was 55 years old. The former Chicago nurse's aide, the San Francisco I. Magnin employee who loved hats, who loved flowers, who grew up dreaming of living someday in the United States, had made a home at the Mill Valley Healthcare Center before it closed.
After she was forced to move, according to her daughter, Lindman found herself in a strange Colma nursing home which was not her home, and which she did not want to make her home. Lindman apparently decided to die.