COLUMN ONE : In Nursing Home, Only a Pal Can Lighten Life : They’re frail but friendship keeps them feisty. James Crouse and Joseph Pillar help each other survive in a place where nobody wants to be.

On the night his new roommate moved in, James Crouse fell asleep with the radio on. It played all night, but Crouse didn’t hear a thing. He had already removed his hearing aids. His roommate, Joseph Pillar, didn’t mind. He stayed up late, listening to talk radio, fascinated by discussion of the war in Bosnia.

In the morning, Crouse felt sheepish. At 90, he is nearly blind. He suffers from emphysema; an oxygen tank, strapped to his wheelchair, enables him to breathe. “Why didn’t you tell me to shut it off, Joe?” he asked.

Pillar, 77, his left hand curled in his lap, immobilized by a stroke, just shrugged and said: “There were too many interesting things to listen to.”

The two old men met at the Beverly Manor Nursing & Rehabilitation Center in Burbank six months ago. Their worlds collided when Crouse, struggling to regain his strength after pneumonia nearly killed him, was transferred here from the hospital. Thrown together, they became friends. In June, when Crouse’s roommate died, he put in a special request for Pillar.

“I found an honest man,” he later explained.

It may seem a mundane act--choosing a roommate--but at Beverly Manor, or at any other nursing home, choice of any sort is a rare and precious gift. This is a place where pleasure is found in simple ways, and sometimes not at all, where time is punctuated by the clatter of the medicine cart rolling down the hall, where there are schedules for meals, for showers, even for going outside.

It is a place where lucidity can be as much a curse as a blessing. And it is a place where choices--including the biggest choice of all, whether to live here--are usually made by somebody else.

Nobody wants to live in a nursing home. But an estimated 1.5 million Americans do. They are among the most vulnerable citizens--the frailest of the frail, the oldest of the old. There are 16,808 nursing facilities in the nation; one in four Americans over 85 lives in one. The majority, like Crouse and Pillar, do so at taxpayer expense.

Over the next 25 years, as advances in medicine prolong lives, America’s nursing home population is expected to double. The over-85 group is growing faster than any other in the country, and the nursing home patients of the future will be older and sicker than those today.

At the same time, money to care for them is stretching thin. Medicaid, the $157-billion government health care program for the impoverished and disabled, is crumbling under the financial burden of long-term nursing care. Congress and the President are crafting plans to scale back Medicaid’s growth. The debate is not over whether to cut, but how much.

What is lost in this discussion, all too often, are the voices of the people who inevitably will be caught in the squeeze. They are people like Crouse and Pillar, living in places like Beverly Manor.

Not Main Street

Like so much else in and around Los Angeles, Beverly Manor is a drive-by. If you weren’t looking for it, you would probably never see it.

Its address, in a city that is home to Warner Bros. and Disney, says Main Street--a misnomer. The nursing home is, in fact, on a side street, tucked between Rocky’s, Home of the Jumbo Burger, and the parking lot of the Calvary Bible Church. Lucky patients have a view, past the asphalt lot, of the Hollywood Hills. Others look out on the beige stucco wall that is the back of the Winston Tire Co.

In an industry that has been beset by scandals, Beverly Manor’s record is clean. Although part of a huge chain, Beverly Enterprises, that has previously been the target of criticism for substandard care, the Burbank facility has received no citations from state inspectors for five years, according to the California Advocates for Nursing Home Reform. A spokeswoman for the watchdog group says Beverly Manor-Burbank probably will make its list of the state’s 50 best nursing homes this year.

There are 184 beds and, at any given time, roughly 179 residents. All are here because they cannot perform at least one of what the nursing home industry calls the five “activities of daily living,” as if living could be reduced to five simple tasks. These are eating, bathing, dressing, using the bathroom and getting in and out of bed.

The average nursing home patient needs help with four of the five, according to the American Health Care Assn., a trade group. Scott Carlson, a fresh-faced, 30-year-old lawyer who is the administrator of Beverly Manor, says his facility reflects that figure.

Physical impairment, however, is only part of the story. Carlson estimates that 40% of Beverly Manor’s residents think clearly enough to recall both the recent and the distant past.

This statistic, which holds true nationwide, is quick to reveal itself.

It is a weekday morning and the main hall is crowded with people in wheelchairs, staring at an elegant wood-and-glass case that houses seven brightly colored finches.

A woman wearing a pink cardigan sweater, a blue quilt draped over toothpick legs, is muttering under her breath. “I’ve been here too long,” she said, to no one in particular. “I want to go home.”

Inside the dining room there is a meeting of the Five Senses Club, so named because it is intended to stimulate the senses of its “members.” Three women and three men recline in cushioned chairs, eyes fixed open, mouths agape, bodies motionless.

“Today is Wednesday, June 21, 1995!” a recreational assistant named Mayra Escobar shouts. ‘We are in Beverly Manor, Burbank! We’re going to start by smelling some garlic, OK? Everybody, smell some garlic!”

Escobar waves jars of garlic under the residents’ nostrils. Only two react. One sticks out her tongue. Another turns her head.

This is considered a good response for these patients, who would probably sleep all day if the staff let them. On a five-level scale that Beverly Manor uses to measure mental awareness, these men and women are classified as Level Two. Level One is comatose.

Men Outnumbered

Crouse and Pillar are Level Fives.

They share Room 234, a 12-by-15-foot cube with a red sign on the doorjamb that says: “Oxygen In Use. No Smoking.” Inside, twin beds sit side by side, separated by pale blue curtains, two aging wooden night tables and a television set that, Crouse says in amazement, “has 42 channels.” Pillar’s bulletin board sports pictures of children, grandchildren. Crouse’s is bare; it does not pay to have pictures if one cannot see.

It is not easy being a man in a nursing home. Nationwide, three-quarters of residents are women, and this is true at Beverly Manor. It is a fact of life that brings many benefits to the ladies of the home.

By sheer virtue of their numbers, women have a wider choice of rooms and roommates. They control the selections on the recreation room TV; the O. J. Simpson trial appears to be the current favorite. Those who can eat on their own have their pick of dining partners. Each day, the same little cliques share the same tables.

A man, particularly a proper gentleman, does not want to intrude. It is easier simply to stay in one’s room. That is precisely what Crouse did when he arrived at Beverly Manor last winter, so frail he thought he would surely die.

He had been living on his own in an apartment in Burbank, cooking and caring for himself. He thought he was fine. He wasn’t. “I guess I was starving myself,” he says now.

One night, he collapsed. It took him 30 minutes to crawl to the living room to call his landlady, who called his son, James Jr. A monthlong hospital stay ensued. When he was released, the younger Crouse selected Beverly Manor as his father’s new home.

Crouse hated it from the start, hated the physical therapy designed to make him strong, hated being dressed and bathed by somebody else, hated being told what to do and when to do it. He couldn’t stand the moans of the little old ladies who babbled about their mothers and begged to go home. Damn it, he thought, I want to go home myself.

He felt silly with his nose hooked up to an oxygen tube; he might as well have been wearing a dunce cap, or parading about in his underwear for all the world to see. He refused to come out of his room, refused an offer of a portable oxygen tank so that he could meander the facility and meet some folks. He had no interest in meandering or meeting.

“I told my son, ‘Get me out of here as fast as you can.’ He said, ‘I’m sorry, Dad. We’ve done as much as we can.’ ”

Then the nurses sent Joe Pillar his way.

A wisecracker with a mischievous bent, Pillar has been living in Beverly Manor for more than two years. He is a survivor, and he knows the delicate, unwritten rules of nursing-home life.

Rule No 1: Know the moods of the nurse’s aides. If they were out partying late the night before, they might be cranky this morning. Cross them and “they’ll handle you as if you were so much baggage.”

No. 2: If you want to keep something, lock it up. Belongings have a tendency to develop legs. In recent months, Pillar has lost two pairs of shorts, a couple of packages of Fruit of the Loom underwear, a brand new Gillette Sensor razor from K mart and a pack of Wrigley’s Big Red chewing gum. “That,” he said, “teed me off something fierce.”

No. 3: If you need a little money, you can have some. Social Security allots nursing-home patients $35 a month for their personal use--a valuable tidbit that Pillar recently shared with Crouse.

The older man was astonished to learn it; his son handles his finances and, thinking his father didn’t need any money, had not been passing along the $35. But there was the time the nursing home staff took some residents to a restaurant. Crouse, with no cash, didn’t eat. And there are, he says, a few things he would like to buy.

“I want to get a hairbrush before I lose it all. I’d like a little thin one,” he said, running his fingers over his ears, “for this part of my hair, because I think I’m going to keep that.”

Crouse liked Pillar’s wit, and he appreciated his advice: “You’ve got to let things fall where they may,” the younger man suggested. Mostly, he liked his new friend’s stories--stories of hunting elk in the Sierra, stories of his great-grandfather, a Prussian baron “who told Bismarck to go to hell,” stories of his “battle with the bottle” and how he wound up working as the night manager for a 12-step recovery house for alcoholics.

“I listen to Joe; I think he’s interesting,” Crouse said. “I need help, and he needs help, a little, physically. I thought we could do pretty good together. How long it will last, I don’t know.”

Independent Lives

Once, these men had other lives. Pillar, divorced since 1958, spent nearly 20 years working at Lockheed, then did odd jobs before finding comfort--and free housing--at the New Way Foundation in Burbank. “I sobered up a lot of drunks,” he said.

Crouse is twice a widower. The Pennsylvania native came to California in 1943, when Burbank was “a dusty little country town,” trading office work for a sales route with the now-defunct Helms Bakery. “I had a chance to become a Helms man,” he recalls with pride, “and I did.”

In another place or time, these men might be living with family. Both are fathers. But in a quirk of modern American life, neither entertains this notion.

Pillar tried it once, 15 years ago, back in his drinking days. He moved in with his son, Joseph Jr. It didn’t work, Joseph Jr. says. His father drove his wife crazy; she swore she would never live with the old man again. These days, although sober, Pillar needs more care than his family can provide. Somebody would have to give up a job to tend to him, and the couple can’t afford it.

Crouse, meanwhile, says he is set against living with his children. “I don’t believe in it,” he declared. “Not unless everybody’s destitute and you have to survive.”

But everybody is not destitute; the taxpayers have seen to that.

Although Medicare is the nation’s health plan for the elderly, Medicaid has become their safety net. Established in 1965 to provide health coverage for the poor, it also pays for long-term nursing care. Many elderly recipients have worked all their lives, turning to welfare only in retirement.

Experts estimate that one-third to half of the Medicaid budget is now spent on long-term care, and the program’s projected growth rate is a phenomenal 10% a year. Congressional Republicans have proposed capping this growth at 5%; without a cap, says economist John Cogan of Stanford University’s Hoover Institution, Medicaid “will most certainly break the bank.”

At Beverly Manor, Medicaid covers all or part of the cost for 62% of residents; 30 people, or 17%, pay their own way. The remainder are short-term rehabilitation patients whose costs are covered by Medicare.

Crouse and Pillar are both on Medicaid. Crouse receives a company pension and Social Security income of $830 a month. Pillar’s Lockheed pension, coupled with Social Security, totals roughly $500. Beverly Manor charges $2,220 a month for their care. The taxpayers pick up the difference.

How these two would be affected by cutbacks remains unclear. The plan before Congress calls for converting Medicaid into a “block grant,” which means each state would fashion its own program and choose its own cuts.

But experts offer several scenarios. Perhaps nursing homes such as Beverly Manor will be reimbursed by the government at a lower rate and will be forced to cut services. Perhaps they will slash salaries, which would mean hiring less-qualified people.

Perhaps families will be forced to pay more. Perhaps eligibility requirements will change and patients such as Crouse and Pillar--who, in the words of head nurse Kathy Callahan, need only “minimal assistance” compared to most Beverly Manor residents--will become ineligible for long-term care at taxpayer expense.

Carlson, the facility’s administrator, offers several scenarios of his own. Already, he says, California plans to cut his reimbursement for Medicaid patients from $74 to $69 per day. Something will have to give. He could lay off nurses and nursing assistants--depending on the shift, he employs two to five more than the minimum required by state law--but he believes the state standards are too low to provide high-quality care.

He could start charging more for private patients--they pay $99 a day, which subsidizes the cost of the Medicaid beds. Or he could quit accepting Medicaid, in effect pushing patients like Crouse and Pillar toward facilities that are not quite as nice. “I have two choices,” he said. “Either I continue the way I’m going and eventually go out of business, or I make cuts.”

As to the roommates, the whims of Washington are a distant concern. “What will be,” Crouse said, “will be.”

No Permanence

Nothing is forever in a nursing home. People come and people go. “I lost two of them,” Crouse said. “Two little old women.”

He used to visit them to break the tedium. One went home to her daughters in Texas. “She outdid me,” Crouse said. “She got the heck out of here.” The other simply switched rooms. She would wave to Crouse as he wheeled by, and he would stop at the door to chat. Now she no longer occupies the bed closest to the hall. Crouse is reluctant to enter her room.

“I can’t see her any more,” he explains. “She’s in the middle bed.”

Not so long ago, death was the only route out of a nursing facility. Going home was so rare at Beverly Manor that patients who left got a party. That has changed over the last five to eight years, says head nurse Callahan. Now, the trend is toward assisted-living arrangements for those too frail to live on their own but not sick enough for nursing homes.

Pillar is antsy to get into such a place. He says he would feel less restricted there. Ann Thole, a social worker at Beverly Manor, is looking into it, but she is not optimistic. With his left side paralyzed, Thole says, Pillar needs the care Beverly Manor provides.

Crouse is better positioned to go. Although he still needs enough care to justify his stay, Thole says Crouse would do well in an assisted-living environment, presumably at less cost to taxpayers.

But there is more to this decision than the bottom line. After six months, Crouse has adjusted. He feels safe at Beverly Manor. He doesn’t want to leave.

“It seems,” he said, “like everybody’s looking at an end to this, one way or another. They want to go someplace else. I don’t look at it that way. I don’t want to go anyplace else. This suits me just fine.”