12/17/2001

Readers Discuss Nursing Home Care

The recent letter about horrendous care in a Connecticut nursing home (see previous article) resonated with many readers. Responses came from residents whose parents have received excellent care, others whose parents have suffered similar neglect or abuse and still others who work in nursing homes and want readers to know how to demand the level of care their relatives deserve. On a positive note, the woman who wrote the original letter has found another placement for her mother, so their nightmare is finally over. She vows to continue fighting for better conditions in all CT nursing homes and hopes others will do the same.

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Dear Beth,

I have witnessed neglect and possible abuse in nursing homes. These acts are usually difficult to prove and sometimes could be called hearsay. One way to alleviate this problem is to pass a state law requiring surveillance cameras in each room and passageway with stiff fines assessed if the cameras are "out of tape," "not loaded properly" or not "turned on." These tapes should be randomly collected by a state worker, viewed and examined for any acts of abuse or neglect.

This sounds a bit "Orwellian" but it would at least provide some measure of feedback or confirmation for a given situation. It may even offer some protection for the staff and the patients. I would have welcomed surveillance cameras when my older brother was a patient in a "convalescent" home. His complaints led me to doubt the sincerity and professionalism of some of the staff. Our elderly definitely deserve our protection.

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I have been a Certified Nurse's Aide in a nursing home for 12 years. Your reader needs to call her ombudsman, as she has already done, and the State Dept. of Health. She might also consider calling O.S.H.A. to see if they can help her with safety issues. My nursing home has none of these problems. We treat our elderly with respect and dignity.

Perhaps the daughter should consider relocating her mother to a home that has an Alzheimer's/dementia unit, where her mom's environment would be more friendly to her needs. I am taking a copy of your article to work to show the some of the horrors that are happening to our elderly population. We in the nursing home community are trying to weed out the bad ones, but it takes time and money.

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When considering the quality of care at Connecticut Nursing Homes, readers should know that while there is absolutely no excuse for the kind of care described in the letter you received, the most pervasive reason that much nursing home care is substandard is built into the fundamental economics of the system:

1. Twenty-four hour personal care is intensive and expensive.
2. Children and families often do what they can to protect and hide the assets of their elderly parents from health care providers.
3. As a result, a great majority—70-80% of Connecticut nursing home residents—are paid for by government programs, principally Medicaid.
4. Medicaid reimburses nursing homes at LESS than their ACTUAL COST. I am not aware of any facility whose per-patient Medicaid reimbursement is equal to or greater than its per-patient actual cost. Providers are all regularly reimbursed for less than they actually spend. The only relief provided by Medicaid is that if a facility's private pay ratio goes below 20% Medicaid will allow the facility to ignore the waiting list rules until its resident population is again at least 20% private pay.
5. Nursing homes are directed to make up this built-in loss by charging those who pay their own way, "private pay residents," even more.
6. Because the ability of one private pay resident to pay the funding shortfall for three Medicaid residents (one of the most insidious hidden taxes in America) is limited, nursing homes cut costs by hiring fewer and less qualified personnel.
7. If personnel doesn't have high personal standards, or the culture of the home is not one of devoted service, or the home doesn't have regular community volunteer and philanthropic support, you get patient abuse.

The short-term solution? To the best of their abilities, adult children and government should pay for the care they expect and demand. The rest of us should volunteer our time and money to the good religious and community-owned nursing homes that are providing real care in the face of the tide that runs against them.

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It seems that in the past, maybe not as much today, parents did whatever was necessary to take care of and protect their children. As inconvenient as it may be, children might consider reciprocating.

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I am so glad you felt this issue important enough to publish since this hits close to home and my situation. My mother has been in and out of a variety of nursing homes and hospitals for the past 10 years. I have come to realize that there *is* a big difference in care from home to home, so I would like to give some advice to anyone considering putting a parent in one of these places:

Check it out first. Many nursing homes offer tours for the family of the potential client; the ones that do not offer these tours should be avoided.

Talk to other people who have a parent (or parents) in the place you are considering. Word-of-mouth advertising is the best kind.

If the institution gives inadequate care, consider having the infirm person live with you with live-in nursing help. This would depend on the medical problems the person has. However, I have known families who arranged this, even in a cancer scenario, without too much trouble.

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We always hear of the neglect and abuse in nursing homes. I work at a facility in CT, and I am very proud of our home. We are a family and truly respect our residents. We treat our residents with dignity and compassion. No one wants to be in a nursing home, so how about spreading around some the positive stories!

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My 20-year-old daughter just started working in a nursing home, and she says that the people she works with treat the patients terribly. She is a CNA and did home care until recently when she had a baby. Her job taking care of people at home was much better, because she didn't have to put up with other caregivers who don't care and are even mean to the patients. I feel that somebody should hire undercover caregivers to report the wrongdoings to patients. The patients are paying big dollars to get the best care possible, not to be abused or have inadequate care. I know my daughter loves her job and does it well, and is almost in tears when she tells me what she sees.

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I just finished reading your column on Nursing Home Neglect and Abuse. Having been a nurse who has worked in a Long Term Care Facility for 20 years I feel compelled to write and defend nursing homes in general. I find letters like these quite disturbing since the facility that I work in would never allow incidents such as the writer described to continue.

Certainly people fall, more so now than ever, because the state regulates very carefully the use of restraints. There are forms to be filled out by the facility, the physician and the resident's family if they wish the resident restrained for their own safety. I am not defending the nursing home in which the writer placed her mother, but, there are many nursing homes in Connecticut. I hope that the writer researched the facility and its care prior to placement.

There are some families that harbor such guilt at placing a loved one in a nursing home, that no matter what the facility does, it would not be right or done to the family's satisfaction. Where I work, every incident must be accounted for in writing, every bruise researched to determine its origin. If the state sends inspectors to the facility, they want a full account of every incident. If the facility can't provide this they are cited and if not corrected within a certain time period they are fined. If the facility does not make the corrections it can be discredited and closed down.

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My grandmother has Alzheimer's, arthritis and dementia. I took care of her and my grandfather for three years. She never got hurt. However it got to the point where we had to put our love and emotions aside and provide her with supervised, full-time care. Out of all the places we checked, we found one we thought was the best. They were staffed well and the place was clean, with no smell of urine or any other foul smells. The patients were dressed and clean. That was close to four years ago.

Things started to go downhill fast. They started to be under staffed. Often no one knew who her nurse was that day. They never could give me a straight answer about medications and medical appointments. She has had seven falls during these four years. The last one she broke a hip. She has been in the hospital several times for pneumonia. I have found several black and blue marks on her body that they say are from lifting. A professional knows how to do lifts without hurting the patient. There are other problems, too numerous to go into.

Convalescent homes need to have an oversight organization to watch over the treatment of clients. Someone needs to look after the money so it isn't being mismanaged or embezzled. We do have to look after the best interests of our elderly.

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I have been a Nurse's Aide for 30 years and have worked in many homes. I always end up quitting because of the poor care. It seems like I pretty much stand alone in being so upset about all that goes on. I tried going to the heads of departments. They seem like they can't believe this or that is going on but nothing ever gets done. All they care about is the paper work is in order.

I feel torn because I love my job, but then I feel overwhelmed when I stand alone. I get comments like, "You're too fussy. We don't have time to give good care."

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That is just the tip of the iceberg. Try seeing what it's really like on the inside as a Nurse's Aide. The good ones know the truth, but can't do much about it. When you take people off of unemployment and train them to be a Nurse's Aide in a few months, what do you expect? The pay is horrible for anyone who tries to make a living being a can; you have to work double shifts in order to make ends meet. Management wants only $$$ from the residents and they don't care about them. They promise you everything when you want to place your loved one there, but then the heck with you and them, for now they got you. Go shopping for another nursing home. Many of you have brought this upon yourselves, for when nursing homes go on strike, you should support them. They are only trying to get better conditions for staff and residents.

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Unfortunately, nursing homes like the one your reader described do exist, but fortunately, they are the exception to the rule. I am an LPN in a Connecticut nursing home, and have been for the past 4 years. In the home where I work, residents are treated with respect, compassion and kindness at all times. In spite of the nationwide nursing shortage, their care remains excellent. Although I agree that families need to be aware of the treatment of their loved ones in nursing homes, and to act as their advocates, there's no reason to assume the worst unless there is evidence that this is the case.

My advice to the woman whose mother's care is obviously unacceptable is to explore her options regarding another home in her area. There are plenty of reputable nursing homes available in this state where residents are given the quality of care they deserve.

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Your article on elderly abuse in Nursing Homes was so sad but so true. I worked as an aide some 30 years ago in a Nursing Home in the Bronx. I witnessed two aides slapping an old lady's back to get her into the shower, and I watched this elderly lady weep like a child. I reported this incident back to my supervisor. I believe there should be video cameras, or a special hired shift worker to observe workers at work, or even a snitcher's reward for workers who tell on the co-workers when this happens. The elderly do not deserve this type of treatment and I pray there will be a day when this horror stops happening.

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Tell the woman who wrote you, and your readers, that nursing homes seek accreditation from the Joint Commission for Accreditation of Health Care Organizations (JCAHO) and that their Web site has a place for individuals and health professionals to register a complaint about a particular nursing home, without fearing reprisal.

The JCAHO Web site address is: http://www.JCAHO.org

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I have practiced as an Occupational Therapy Assistant and a CNA in a variety of nursing home settings over the last six years and have witnessed some difficult situations and have the following comments.

There is indeed a high turnover of staff in some of these facilities, which prevents the ability to establish bonds with the residents. Every facility I have worked in was "no restraint," which meant that the resident had the "right" to fall. I found this appalling but it did not come from the facility but from the state. The facilities appeared to be understaffed. However, it is the state that mandates the ratio of aid:resident so perhaps a closer look should be taken by the state so that these folks are guaranteed safety 24 hours a day, seven days a week.

CNAs work very hard. They certainly do not choose the profession to make lots of money. They choose it because most of them love people and want to be in a position to help. Many of them have hopes of furthering their education and becoming nurses. However, from what I saw, there is not an awful lot of incentive or encouragement to do so. They are paid a decent wage and usually comfortable benefits, but I would like to see scholarships and grants presented in an obvious, straightforward manner in order to provide the incentive to go on with their education. Many of these folks are single parents struggling with debt, and would benefit from a program that assists and encourages them to move forward.

In order for there to be a decrease in turnover, perhaps increasing the staff to alleviate some of the load and affording quality time with each resident during bathing, dressing as well as recreational activities for 1-on-1 and groups would improve the quality of life for our seniors. This could also provide the necessary vigilance of those residents who are not safe in their environment and are the fall risks.

Be a very active partner in the care of your family member, as family feedback and involvement is important and welcome.

Blatant abuse should be brought IMMEDIATELY to the attention of the supervising nurse and/or administrator as such behavior must not be tolerated.

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Do your homework and your footwork. After finding several facilities that meet your needs and have good reputations, apply to them all and apply to them early. You will find that good nursing homes have long waiting lists. Get your loved one on the list ASAP and call them every couple of weeks.

What happens an awful lot is that once admitted, the loved one is forgotten. Bad move. The family needs to stay on top of the case as the person who wrote to you is doing. Make your presence known, ask questions, if you see something that is not to your liking, address it. If you do not get satisfaction at that level, kick it up higher and keep going up until you get your needs met. There are quite a few resources out there to protect the rights of the elderly. Use them if you have to.

The nurse:patient ratio is pathetic and the aide:patient ratio is horrible partly because of insurance and Medicare/Medicaid not paying what they used to (to put it superficially) and forcing staffing cuts. Which leads to burnout for staff because of increased workload on top of an already impossible caseload. Who suffers? The patient, unfortunately. This has been an on-going problem with no easy solution in sight as long as insurance companies wield the power they have. Sad that it has become dollars and cents instead of a human life that needs care.

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I have worked in three different nursing facilities. One was horrendous! I saw elderly people treated like cattle. I saw an elderly woman, with dementia, who had a baby doll that she took with her everywhere. She gently loved that doll, perhaps thinking it was the daughter who so conveniently stuck her mother in this home and then left the state. The aide threw the doll against a wall and the poor woman screamed about her "baby"! I was sickened by this sight. The food that was given to patients was the cheapest junk and hardly resembled food, of any sort.

When the State came to visit, it was not a surprise visit. The facility owner was informed in advance, so out came the nice clothes and the aides being especially nice. It was heartbreaking to watch how these poor people were treated. Those patients, though, that had regular visitors were treated much better then those that sat alone, day after day, in a gerichair, facing a blank wall.

Later I went to a facility that was a year old, beautiful, no odors, no patients with mix matched clothes, no patients left unattended. The facility director made sure that the patients were treated with respect. There were no foolish parties with patients wearing silly hats. Instead, there was an organized recreational department that stimulated the residents. They had high standards and demanded that their nursing department was staffed with kind and considerate people.

It was a pleasure to work there. I was not involved in patient care but would frequently visit the residents and listen to them talk about the past. I learned quite a bit from these elderly people. Those that were senile or had Alzheimer's were treated just as well as those who had their mental faculties intact.

People have to realize that there is no "chain of command" when dealing with the worst places. Go right to the TOP! When they realized that people are serious about bringing suit against them, they stand up and took notice. I always question, question again and demand answers from any physician, nurse or ancillary personnel who deals with my family. If I don't receive satisfaction at the bottom level, I skip the middle and go right to the top.

There is a "Patient's Bill of Rights" which should be posted in every facility and must be adhered to by those entrusted with caring for people. Any infraction should be reported to the proper authority. Call the Department of Health at the State level and continue to call until you are satisfied.

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My father had Alzheimer's Disease. My mom and I took care of him at home for three years or so, but he eventually needed more care. It broke our hearts to have to place him somewhere, but the disease was progressing. We had applied to several nursing homes, but not one was available. We then heard of this assisted living place and met with the administrator. He stated he had many patients like my father, and were equipped to handle his care and meet his needs, as they had a few "pods" of Alzheimer's patients and his staff was trained with Alzheimer's. So we placed my father in this facility (at $4,000 per month out-of-pocket). What it really amounted to was room rent.

My mom and I visited dad daily and we also called every day to see to it that he was okay. Every time we called or went to the facility, they said he was doing just fine and adjusting well.

Within his first week there, my mom was present during lunch and they served him clam chowder—it's a good thing she was there because he had a severe allergy to all shellfish, and all of his allergies were on record. My understanding is that there is no dietician in this facility.

During several visits, we constantly had to ask for towels, top sheets for his bed, and for him to be bathed. They were supposed to cut up his food, and yet they never did, therefore, he lost much weight and became dehydrated. There were several times we noticed his face was raw around his mouth and to our discovery, the aids were using a disposable razor on him rather than the electric razor that sat on his bed stand. It was apparent that the aides had no training for how to care for Alzheimer's patients. The turnover of aides as well as nurses was constant in this facility.

We couldn't find him a skilled nursing facility, so we took him home, because we knew we could care for him better than they ever could. Administration had the gall to threaten us that if we were to take him home, they had to report us to the State Advocacy for the Elderly. And they did so, but not before we reported them first! Social Services came to our home, and couldn't believe the condition my father was in and immediately started to find a skilled nursing facility for him.

When we took my father out of the assisted living, we requested all the daily logs of his care. They were to send them to us via the mail.

As soon as we brought him home, he started having bad nosebleeds—the same day, we received the daily logs of his care. We were absolutely shocked to read that he had a fall approximately 2 1/2 weeks prior at the assisted living facility (he was found on the floor with his head against the wall). He was rushed to the emergency room and stayed there for several hours by himself. We were never notified of this at that time or at any time after his fall. Can you imagine what my father was thinking? We couldn't believe what we read.

We rushed my father to the hospital emergency room—he stayed in the ER in a "holding pattern" for four days—he couldn't eat, walk or barely talk. He was placed in a skilled nursing facility on the fifth day and died exactly 2 weeks later. We, however, were very pleased with this particular nursing home. The cause of his death was due to the fall he had had at the assisted living place. It states it right on his death certificate. He had trauma to his brain, causing a stroke.

We have serious concerns about the assisted living facilities. We have since then found out that they are not regulated by the State and can do what they want. No one should have had to endure such treatment. The only way it will improve is if people like us speak up. We have been in touch with the State Health Department and the State's Attorney's Office verbally and we are currently in the process of writing to them regarding our situation. One thing on our side is that we have learned that this particular assisted living facility has been charged and found guilty of elderly abuse. We hope other readers will take notice and make a difference - we need to protect our elderly.

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Please send questions or comments to bbruno@snet.net.