Life in a Virginia Nursing Home

Old Woman Dozing (1656)
Nicolaes Maes Photo: Wikipedia

I never know what to expect on my weekly visits to the nursing home. The lobby has an occasional patient wheeling herself or pushed by a family member for a stroll around the property. There is a small park in the back with winding paths cracked here and there by the growing roots. Majestic trees surround the grounds.

The elevators and doors operate with codes – they don’t want Alzheimer patients to take off for unknown locales and the highway is too close to the parking lot. I am greeted every time by the same patients and a thin black woman in a wheelchair who always smiles. I wonder why she is there; she is cogent, always happy and friendly.

On second floor, as soon as I step off the elevator,  I see the opened door to the lady on the corner who never speaks and seldom has visitors; only a young woman twice in two years.  She waves and smiles weakly.

Geo, the longest resident, is wheeling himself slowly in the middle of the corridor, stopping from time to time, lost in deep thought.  He told us how much he misses his mom; she used to make him the best pancakes. He knows his parents’ names and his brother’s.  I wonder if they are still alive. I’ve never seen anybody visit poor Geo in the two years since I’ve started going every week. I feel sadness for him that nobody comes to visit. We take extra care to engage him if he is willing to talk.

Silvia, a German lady, always sits in the dining room by herself, watching re-runs of Bonanza on TV or eating her meal. I strike up a conversation with her in German and her face lights up. She lost a limb to diabetes. She has a sister in Germany with whom she talks on the phone from time to time. She always wears institutionalized clothing. We made sure this year she got something nicer from Santa Claus.

An elderly black gentleman walks around with a cane, still mobile enough and seems like his mind is still sharp. He told me stories about his lovely daughter who lives in New Jersey. I’ve never seen anybody visit him either.

Some patients wear alarm wrist bracelets if they were caught wandering away from the building, hitching an elevator ride with visitors. The unfortunately named Arcadia suite is always locked with coded pads because the state of Virginia does not allow patients who may do harm to themselves to be restrained. 

The beds do not have safety rails either. This causes some patients to fall out of the narrow beds and get injured. One has to be hypobaric before they can get a slightly larger bed. The vinyl-covered mattresses are thin and do not seem to offer much comfort to a frail and bony elderly body.

It is impossible to control infectious diseases in this nursing home when so many patients with difficult needs are cared for by orderlies from third world countries who sometimes do not fully understand vectors of disease and do not wear gloves or change them between patients.

Ambulances and medical transports come and go, carrying patients to the hospital, to medical appointments, and to dialysis. Families hope their loved ones are well taken care of in a timely manner. I know that sometimes appointments are missed, paperwork lost, transports don’t show up, items are missing, dentures are lost, never to be found or reimbursed, everybody blames the other party, and clothes and personal items disappear. Who can keep up properly with all the mounds of laundry? No amount of monogramming can assure that items are returned to their rightful owner.

Bonnie has incipient dementia and is constantly packing her bags to go home. Her family comes often to visit and they dote on her. There is a gentleman who is in alcoholic rehab.  Katy tells stories of her past in between cries for help that nobody answers anymore. She has cried wolf too many times. I am glad she spends most of her days in the wheelchair in the middle of the corridor in case she chokes. Her respirator often dangles unattached even though she needs it.

Brenda is very frail, lost her eyesight to diabetes, her ability to speak, and is on dialysis twice a week. In spite of the fact that she weighs so little and is so frail, her strong voice carries across the hallways. She screams gutturally non-stop as if calling for her mom. Her brother and 88 year-old mom come to see her religiously three times a week and spend a few hours talking to her. Her arms are purple and blue from the dialysis IVs.

The staff comes and goes, there is a huge turnover, most of them are Africans from a different culture who try to do a very hard job but the patients are unable to give feedback to their families if their care is adequate or not. You have to be a very hard human being not to be affected by so much pain and need, and to be patient in order to deliver proper care.

In two years, I have never seen a priest or any indication that patients are allowed to pray on the premises or have a place dedicated for prayer. Small choirs of children and visitors from local churches come around Christmas time and Easter to visit and entertain the residents.

A beautiful  golden retriever makes her rounds to see patients on both floors. Lucy loves a good belly rub and stretches lazily on the tiled floor in the lobby during week days.

Commotion arises from time to time when a belligerent patient refuses to bathe and screams for help because they’ve bathed last month, they don’t need it again. Some patients are crying in their rooms that they want to die. Wails of “nurse” are seldom answered and the push buttons don’t really work because the nursing home is understaffed. A patient representative from a lobbying group shows up from time to time to make sure they are treated humanely.

The nurse on duty distributes medicines from the locked cart, taking blood pressure and glucose readings. The meals never come on time, are often cold, and inadequate on weekends. Nobody complains because they can’t or are afraid to. Some have to be fed by hand and others through the stomach.

Some of the patients could be cared for at home but in Virginia, Medicare/Medicaid only provides three hours of in-home care per week. In other states, like New York, the state provides 24 hour in-home care instead of forcing patients into a nursing home where the monthly bill, on the average, is $11,000 per patient.

It’s such a sad and dehumanizing way to spend the last years of one’s life. No wonder people would rather die than go into a nursing home.

When I was growing up, extended-family members, who lived nearby, took turns and cared for their aging parents and relatives until they passed on.

A childhood friend who had married abroad, used to drive several times a year back to our hometown to deliver adult diapers and other items for her elderly mom who was cared for by her brother. In-home adult care products were not available under the communist regime.

These long-term patients were once lively and productive human beings.  They probably never thought that they would ever wind up in a nursing home. Now they are just a room number. It is profoundly sad.