Nursing Homes and Assisted Living

March 4, 2013 Updated: March 21, 2013

When I served as Special Counsel to the U.S. Senate Aging Committee we investigated fraud and abuse in public assistance programs. Medicaid provided health care to those that could not afford it and Medicare funded seniors’ medical needs. Both systems were rife with corruption and abuse. Our undercover operations proved that not only was the medical care poor but government programs were being ripped off by unscrupulous providers. When it came to nursing homes, only one, in all we investigated, delivered appropriate care.

A neighbor is taking care of her aged and infirm mother. It is a shared task between her and her sister. It is always difficult to care for a parent. Often it is a full-time job, especially when the infirmity makes it hard for the patient to take care of themselves and be mobile. Yesterday I overheard my neighbor in conversation with a friend: “‘I’ll do anything. Please do not put me in a home. I’ll do anything you ask,’ Mom said. It is so heartrending…”

The neighbor was reaching her limits of being able to care for her mother and was faced with the decision of how to cope with her chronic illness and full-time nursing needs. The aged parent didn’t want to face the possibility of being taken to a nursing home, having to live among strangers.

On some occasions when I visited nursing homes and assisted living facilities I was appalled at the lackadaisical attitude of staff. Taking care of long term nursing home patients is a difficult occupation. Doctors come and go. Many are prejudiced against the elderly. Too many physicians chalk sick and elderly off as being near death and thus unworthy of their time and devotion. They spend seconds with a patient, often only the minimum to be able to bill that patient’s insurance provider or Medicare. Licensed nursing staff is limited and rotates. The dirty work is left to immigrant labor. They take minimum wage jobs, have limited skills and no interest in the patients themselves.

Incidents of abuse and neglect are rampant in nursing homes and assisted living facilities. One chain in New York was owned by the same person. Of all things he was a Rabbi. He was a villain. His nursing homes were filthy, the patients’ care poor and the fraud perpetrated criminal. Some of his nursing homes even continued to bill government programs for patients long after they died.

There is no substitute for a patient advocate. Someone must continually monitor the nursing home and assisted living patient’s condition and care. Another friend had an uncle in a care facility. The man was not doing well. It seemed that no one was monitoring his medication. The doctor in charge of the case was neglectful and incompetent. 

Luckily the patient’s niece was a nurse. She and her husband checked the medications and found they were being administered in wrong doses and conflicted. They moved the uncle to a different facility, sought proper medical care and his condition and quality of life improved dramatically. They can even take him out on excursions and do things that enrich his life. Without their advocacy he would have died and no one would have been the wiser that it was caused by neglect and incompetent medical care.

On a recent visit to a patient we know in an assisted care facility, we found our friend in a wheel chair, left alone in a day room. We went looking for the aide that was in charge of her care. The woman spoke Creole and it was difficult for the patient to understand and communicate with her. We found the aide in the patient’s dining room, sitting at a table, talking with a fellow aide eating a snack. Before the aide saw us we spotted her casting furtive glances every so often out the doorway to see if a nursing supervisor was around. The nursing supervisor was behind her desk writing notes. It would not be likely that she would spot the errant workers shirking their responsibilities for patient care.

Patient advocates and relatives must use care in chastising staff. For most of the time the patient is alone with them. Too often neglect turns to abuse as revenge for affronts. Abuse is rarely if ever detected. A patient can fall, slip, an intravenous drip can go wrong. Many are old and their memories cannot be depended on to relate what has happened to them. Some suffer various forms of dementia making their care even more difficult. Older patients want their mementos, however, theft is rampant and valuables go missing.

We no longer live in a society where some member of the household is home all day long. Round the clock nursing care can be impossible at home despite the love and good intentions of family. Siblings often fight as a result of the burden of care for a parent falling more heavily on one than the other. This may be because of distance or work requirements. 

Caring for a person with special needs can be an onerous burden. It is also a thankless job. Older patients can be cranky and ungrateful. They can be accusatory and mean. Pain makes people react in unpredictable ways. The aging mind also causes patients to react to situations differently than when they were young and healthy.

Modern society has changed dramatically in the last decade. Both spouses must work to maintain the lifestyle they have adopted of an expensive house with a mortgage, two luxury financed cars and private schools and daycare for their children. Add the burden of an ailing parent and the equation does not work. Even with a maid thrown in, the children have little time left for themselves let alone to be able to attend to the needs of the patient. 

Nursing homes for those that need continuing care and assisted living where care is available if needed, meals and housekeeping chores provided, are inevitable. Whether they are good or bad is hardly discoverable by one cursory visit to the institution by relatives.

Investigation is imperative before making a choice of facility. Insurance pre-requisites and government benefits must be explored with the institution’s financial counselors. While difficult it may be possible to ask another patient’s relatives what they think during an inspection visit. Visitors are shepherded around the institution and have little chance for unsupervised conversations with staff, patients or relatives. Sometimes the parking lot is a good place to ask relatives leaving the facility what their experience is.

All that aside, the most important aspect of patient care is just that: caring concern. Do not try to overpower doctors, nursing staff or aides. Most important are visits that are unscheduled and at varied hours of the day and night. Check on the patient’s condition, medications and overall disposition. Check for any signs of abuse, bed sores, bruising or hematomas. Check the patient, bed, room and bathroom for cleanliness. Be sure that aides see you and understand your relationship with the patient. Let them see that you are and will be on top of the care given. No matter the facility a patient’s advocate is the best way to insure honest and competent treatment in any nursing home or assisted living facility. Good ones welcome it.

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Note: The views expressed in this article are the author’s own and are not necessarily representative of Epoch Times.

ABOUT THE AUTHOR: John Christopher Fine investigated government activities around the world while attached to the U.S. State Department’s Inspector General’s Office. He served in many posts including Special Counsel to U.S. Senate Investigating Committee and Senior Assistant District Attorney in New York County.



Views expressed in this article are the opinions of the author and do not necessarily reflect the views of The Epoch Times.