Sunday, August 29, 2010

The Nine Inch and Other Rediculous Rules in Nursing Homes

Mary, an 87 year old lady, sits in her room in a typical American nursing home. She has been living here for a month but on this particular day has, for an hour, been crying, because in her eyes, her family has ‘dumped’ her here and she has stated she feels like she is seen as a burden to them because it has become increasingly difficult for Mary to care for herself in her own home anymore especially after having fallen several times. She had come to this nursing home for therapy, which she also hoped would restore her strength so she could return to her former lifestyle. But her doctor and the therapist has spoken to her family about the dangers of her living alone anymore. To the therapist, the doctor and to her granddaughter, it makes perfectly good sense that Mary stay in the nursing home to be cared for and to remain safe. However, to Mary, it is easy for them to say because it is not their lives; it is her life they want to hastily disrupt. She stresses, to anyone willing to listen, how she had never imagined her family, who ‘she thought loved her’, could have done ‘such a mean thing as this to her ‘and she tells everyone within ear shot, how much she hates being in this nursing home. She especially hates the outlook of possibly having to live out the rest of her life in one. Mary has also taken to staying in her room, refusing to come out unless she has to, but will come to the lobby, almost daily, to tell staff she is ‘calling a cab to go home,’ which nearly always gets a rise out of the nurses, who panic and run to Social Services asking the Social Workers to ‘do something before she leaves on her own,’ which was exactly the response Mary was hoping for because she thought if she was annoying enough, her family would allow her to return home, since she hoped the facility would kick her out anyway. Down the hall in another wing of the same facility, another new resident,
Carol tells staff how she ‘put herself in here because she did not want her family to have to worry about checking up on her all the time.’ But she does say, with some bitterness in her tone: “I have six god dam children and not one of em can seem to take me in, the damned ingrates.” Carol is in relatively decent health, but she is legally blind due to macular degeneration and cannot drive and finds it difficult to live on her own anymore. Even further down the hall, in another wing, a married couple, Mr. and Mrs. Doran reside. Mr. Doran, much like Mary, has taken to crying, on occasion, and tells how he and his wife have spent the entire $100,000 they had ‘saved for retirement’ to pay for their stay here. He says now that the cash has been spent, they have to put their house of 40 years up for sale to continue to live here. He says he wishes they had spent every cent on enjoying an early retirement, but, instead it has all gone for room and board and medications due to his wife’s sudden illness. The sad look in the husband’s eyes tells me the optimism he once felt about retirement has been replaced by hopelessness and despair. Both of them are now in their 70’s and he is not strong enough to do the lifting that is required in order to take care of his wife’s needs in their home. All of these people, even though they reside in the same nursing home, are each experiencing different attitudes about the whole experience. One resident feels she has been abandoned by her family, another appears somewhat satisfied she made the ‘right’ decision to live in the home, but the decision was based on what she felt her family needed and has expressed that she would prefer to be living ‘in her own home’, and the third is feeling like he and his wife have been cheated out of a pleasant retirement and now they help support a corporate-run nursing home with their hard earned money. This sort of drama unfolds all the time in nursing homes all across America. I have witnessed the despair often felt by some people who find that they are living in a nursing home suddenly and who not only hadn’t made plans to live in one, but somehow thought it would never happen to them. Yet there they were, living not exactly what they thought their ‘golden years’ would be like at all, nor the American dream, but what one elderly gentleman dubbed it as: “ More like the American nightmare times ten.”
In the fall of 2007, an independent company ran a survey asking elderly people what they feared most about growing older. The results were this; the majority of elderly feared the prospect of having to live the rest of their lives in a nursing home more than they feared death. The survey stated that only 3% of seniors surveyed actually feared death. To many elderly in our society, nursing homes are inhumane places. Places where no one, in their right mind, wants to live and they represent losing our dignity once we are assigned to live in one. I realize not many people in our society are concerned with what happens to elderly people in nursing homes, although, unless people plan to live forever, they will grow old and should be very concerned. The chances of nearly everyone in our society needing nursing home services when older are very high. Maybe this idea sounds too much like a crusade, and maybe rightfully so because it means my 1960’s social conscience is still alive and well. Whatever anyone feels about this subject, the fact is, we all will grow old, no exceptions, excluding those who die young, and these issues, concerning nursing homes; will eventually need to be faced by nearly everyone but the very rich, in American society. Recently many people have been quite upset over the public health care debate because certain factions in the debate seem to be fixated on what some have dubbed ‘death squads.’ The death squad debate seems to stem from some people thinking it will be mandatory for physicians to have end of life discussions with elderly patients. If this is what some people consider death squads, then nursing homes in America have already been acting as such death squads, it is simply that no one noticed or cared, until we started to debate public health care. I have worked with the elderly, in different capacities, for many years, for a while as a home health aide, as a nursing assistant and most recently, as a Social Services Director. If Americans think President Obama has placed stipulations in his health care proposal about ‘death squads’ because they think it will be mandatory for older people to discuss end of life plans with their doctors, then nursing homes have always fit this description. Staff members in the nursing home, where I worked as a Social Services Director, were always approaching me to ‘discuss end of life, or Hospice plans’ with the elderly and their families. It seems nursing home staff eventually do get tired of sending elderly people to the ER when they become ill because ‘the ER cannot do anything more for them anyway’ as the reasoning goes. Unfortunately they are correct because Emergency Room personnel will only do so much and apparently feel time and life saving efforts are ‘wasted’ on very old, very frail people. The problem, when the elderly decide to get hospice services, is Medicare and Medicaid will not pay for any more room and board in a nursing home, so families have to pay out of pocket for their stay in the nursing home, which can be a significant cost. Usually, by the time a person needs hospice, the nursing home has already swallowed up all of their resources, so the choice now becomes; pay out of pocket for room and board or, if you have no money left, you get to die in pain so as not to lose your Medicaid or Medicare. Most people cannot return home for hospice services either, because usually people who receive Medicaid have no family left, or they have no family who can be in their homes with them 24 hours a day, which is required by hospice for home care. The nursing home directors try to discourage hospice care because it means the facility gets no more Medicare or Medicaid payments, which means it guarantees the facility gets their money, where paying out of pocket does not. None of those sounds like very ideal choices for the elderly. They certainly do not sound like any choices I would care to have to make when I am ill. Worse yet, I would hate to burden my loved ones with making those difficult choices for me either.
After talking to people over the years who had come to the nursing home, either to live or just for a short stay to complete therapy to be able to return home, it seems almost unanimous among them that what they all fear most about having to live in a nursing home is; loss of independence, loss of autonomy of being able to go where they want to go whenever they want to, fear of being forgotten, fear of being able to make their own decisions and fear of no longer being a part of a community. Basically, they fear losing all of the things we take for granted that help contribute to everyone’s quality of life. Especially the ability to make their own choices in daily living, such as; shopping when and where we want to, when we want to go to bed, when we want to get up, when we want to decide to take our medications, if we want to have a cocktail and even something as simple as deciding if we want to go outside or not, no matter what the season is.
Elderly are scared too because of the horror stories which tend to come out of nursing homes concerning resident abuse. Residents know their families cannot be with them in a facility 24 hours a day and many fear being ignored, or brushed off and not listened to because they may be considered senile. In fact, Science Daily (July 01, 2009), stated: “Complaints by the elderly are often treated as trivial by nursing home staff, which, in turn, makes it difficult for the elderly to influence their everyday lives.” Most of all, older people are afraid of the fact that their complaints could rain retaliation down on their heads. Who is to say if the staff person who has been complained about will now be a little rougher in their care, or take longer when answering a call light, or even worse, out and out uncivilized to the person who complained? If the allegations are covered up well by other workers, which is quite likely in these situations, they will probably be considered unfounded by investigators, so the chances of the accuser having to deal with the person they had complained about, is very high indeed. This can make it quite bumpy for the person who had problems with this specific staff person to begin with, so imagine if you will how much more so now if the worker is still employed and caring for that resident who complained. There seems to be two major populations of people who are seldom listened to in our society, the very young and the very old.
While working in nursing homes, I have seen allegations of abuse covered up, verbal abuse especially, because it leaves no physical marks and it is a ‘he said, she said’ proposition, making it easier to conceal. I have seen residents’ complaints brushed off because the complaining resident has been pegged as a chronic complainer, or simply as having misunderstood what was said. The fears elderly people in nursing homes have in this area are not without merit, and most times, very correct. The allegations of abuse may not be what we are familiar with such as hitting or name calling or even isolating anyone to their rooms. I have been appalled by what I called the small, daily assaults that can make a person’s life miserable. On one occasion an incident I observed involved certain staff members who would make a habit of snapping at certain residents for various reasons during the course of the day. For instance, many staff members, including nurses, always had their ‘favorites’ and would treat them with more courtesy and, as a rule, with more respect than the others. One day a resident, who had mild dementia, was saying she wanted her water pill; she came to my office and said nobody gave her one. We walked to the nurse’s station and the nurse informed me she had ‘given her one 10 minutes ago,’ talking as if the resident were not there. When the resident heard this, she became furious and raised her voice, saying; ‘I want my pill, I did not get it yet.’ The nurse then turned and proceeded to yell; ‘I gave you your pill, I already told you that.’ I said something to the nurse about being abrupt, but still, these are the sort of daily assaults that do not necessarily get reported to anyone, but amount to verbal abuse. I am sure, thereafter, that particular resident understood not to tick off any of the staff for fear of retaliation. Unfortunately this scenario took place way too often. Anyone who has ever been in an abusive situation, verbal or otherwise, will tell you that being snapped at, even once, will convey the message. The message conveyed is this; snapping at some people is effective even if it only happens once because once you’ve been snapped at, you are fully aware that the person snapping at you is capable of doing that if they disagree with you. For some mild mannered residents, snapping at them just once will make them shy away of requesting almost anything they may need in the future. At times, residents may feel the need to use the bathroom quite frequently, either due to the aging process or medication or even urinary tract infections, and will request frequent trips to go pee. I even received a behavior sheet once concerning a resident getting upset because she had been taken to the bathroom and in five minutes requested another trip there. The staff was frustrated because ‘she had been told, repeatedly, she had just been taken to the bathroom already’ now I’m wondering if staff is my bladder and can tell me I do not need to go again because they felt I have been enough? How much constitutes enough? These forms of abuse are not sensational enough to make the front page, or any page of a newspaper, but these incidents do make for a poor quality of life for residents. Imagine going from your own home where you are able to do basically as you please, to having to now put up with a bunch of strangers snapping at you almost daily. No one is saying staff has to be perfect, or that they are not allowed an occasional bad day in their lives, but there is no excuse, in my book to be rude and downright mean to a resident. This problem exists in nursing homes all the time, even the so-called ‘good’ nursing homes. Those daily verbal attacks are reminders that this place is not your home. This form of verbal abuse is humiliating and constitutes mental abuse as well, even though many nursing homes do not always see it as such. The Administrators and nursing staff often try to dismiss it as ‘a person having a bad day,’ but this is more than that to the resident who has to live here and be a captive audience. The horror stories concerning neglect and abuse is just another reason contributing to why elderly fear nursing homes more than death. At least in death, no one can hurt you anymore. We like to think of nursing homes as places of compassion, where caring people work. Unfortunately, some staff people, including some nurses, are there simply for the paycheck. I think, in this bad economy where the most jobs are in the medical field, this rings all too true. If anyone thinks customer service in the retail and restaurant industry has gotten bad, it has gotten even worse in nursing homes. If I have bad service in a restaurant, I have a bad evening. A bad day in a nursing home can mean I have a bad month, year, or life. Probably not a week goes by when we cannot find an article concerning some form of abuse in nursing homes someplace in America. Is this what you want for your grandmother, father, mother, or even for yourself when old? If the situation is not remedied soon, it will only snowball. There is no reason why every single nursing home across America cannot change for the better, except for laziness on the part of owners and corporations.

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