My sister and I told our Mother we would never put her in a nursing home. That’s what we told her, my sister and me, without a thought about our own job commitments and physical limitations or the fact that Mom might eventually need 24-hour care with her Parkinson diagnosis advancing. Although our intentions were courageous there finally came a day that we had to break that promise even though we fought hard for every option we could scrape up.
So what were we so afraid of that a nursing home would be the very last option? The fears were many and unfortunately all too common. The primary ones were lack of quality care and compassion, neglect, bad food, loss of autonomy and deterioration of her mental health. Like almost all grown children faced with this decision we were somewhat optimistic at first, thinking if we looked hard enough we would be able to find that one nursing home that really cared, and, they would take Medicaid.
Even though I worked in the disability field at the time with experience to the contrary, my hopes were high. We carefully screened three or four skilled nursing facilities and included Mother in all the decision-making. By the time two months had passed we were transferring her into a third one. The nursing homes changed but the problems remained.
This process was wearing on Mother’s normally strong, courageous and happy attitude. I can tell you from experience that even the most aware and extrovert personalities will succumb to the daily chipping away of their self esteem until all that remains is the defeated complaining, and most important, complacent, victim. That is what happened to our Mother and in the end fear resided within her and she begged us not to “stir up” trouble as they make her pay for it later with neglect.
There are circumstances that I feel give way to a propensity for corruption of nursing home services. I have listed these below.
- A lot of registered nurses, because of inexperience or just plain “burn-out”, are unable to see past the documents they are required to complete to the true priorities in caring for their floor – safety, hydration, and attention to serious medical problems, adequate nutrition and cleanliness. Mainly for cost savings, nurse’s aides fill these important roles while the nurse does the exhausting paperwork. My Mother and many others on her floor seldom saw a nurse even though C-Diff infection continually ran rampant throughout the nursing home.
- Lack of supervisory staff especially on evening and all night shifts allows thievery and neglect and even abuse.
- Nursing aides and C.N.A.’s are hired and kept on minimum wages. They are not honored or valued for the compassionate work they do. This leaves an employee pool of mostly inexperienced, undereducated employees that are more often than not in desperate financial crisis. And, as anyone knows desperate people do desperate things.
- Lack of sensitivity training and communication skills leaves patients and their loved one frustrated and angry.
- Social Workers for the Nursing Homes are responsible for the entire population of residents. Almost always they have the education but no hands-on experience as well as no idea how to apply the social work “theories” so neatly addressed in text books to the overwhelming reality of old age. Once again, social workers directly out of school with no experience are less costly for the establishment.
- A kind of desensitizing effect happens as patients become room numbers and bed numbers. Being kind or socializing means you might become “attached” and then lose them.
I have been in a few decent nursing homes; however, they did not take Medicaid. And, in the nurse’s defense I think they probably started out caring and ended up in such a governmental paperwork cave-in that they just gave up trying. I really see the focus of the problem being how the money is allocated through reimbursements from both Medicaid and Medicare. Below I have included some ideas that I think would go a long way to solve at least some of the problems.
- Wage Pass-Through – I was reading about this on the Internet as a way to get the money directly to the people who do most of the work. A certain portion of public Medicaid monies can be passed on directly to nursing assistants. States could look at this policy instead of Medicaid monies going for overhead, misuse and profit first.
- Minimum staffing laws that are strictly enforced. Training and testing that a new employee must complete before starting. Review testing during six-month reviews.
- Allow residents to spend time with the facility’s dog or cat for emotional therapy of unconditional love. Non-Medicaid expensive nursing homes do this and it is very therapeutic. It’s a shame that the no-pet restriction is usually only for poor people.
- Nursing Home Workers Unions – this is done in some states and the quality of staff and treatment of patients has shown a rise in quality.
- Put in severe consequences when prosecuting corrupt nursing home corporations that defraud elderly Americans of huge amounts of money that should go to their care. Let this country take a stand – if you steal money intended for the care of our mothers and fathers, you will go to prison for a long time.
- All managers and supervisors read the study, “Quality in Long Term Care-What We Can Learn from Nursing Assistants”
- Take residents for walks or get a tandem bike for those who are able to ride one. But, most of all get them outside.
- Put their pictures on their doors (Younger ones too) and who they were, what they did. Some nursing homes are doing this now.
- Give nursing assistants a break. Congress should consider changing the Federal Tax Code to include, for example, something like, “If an individual is employed as a direct caregiver and earns fewer than 30K a year, one thousand dollar tax credit is available.
- Let residents vote on a different “employee of the month” and give that staff a small bonus or gift certificate or time off with pay
These are just some of the ideas I had. I am sure there are many more by frustrated loved ones like me. There has to be a better way than the current “waiting rooms” for death approach. At least now there is an option for aging in place with home care assistants like the programs from Independent Living Centers but still no funding for 24hr care.
My Mother did not have a dignified ending like my sister and I had longed for. She suffered for almost a year with C-Diff infection that half the nursing home had. It causes fever, diarrhea, vomiting and weakness. Mother had lost nearly half her weight from hardly eating and vomiting what she did get down. She sat in her recliner one evening ringing and calling for a staff that never came to help her to the bathroom. Sitting in her own urine all night was more than she could endure. She pushed herself up but before she could safely reach her bed just a foot away, she slipped in her own urine and broke her hip. A day later we were told about it when they decided to take her to the hospital. She had successful hip surgery but chose death anyway and refused food and water rather than life at the nursing home. Three days later she died. They called it “failure to thrive”.