More About Nursing Homes

Caring for our elderly in nursing homes has become a profitable and very expensive industry that few dare to talk about. It speaks to the resilience of some elderly who remain alive despite the abuse and neglect they experience in nursing homes.

Some nurses and assistants start out and remain caring despite the long hours, the low pay, the back-breaking work, and the unrewarding environment. Other staff members do not care and abuse or neglect patients in front of their loved ones.

Perhaps Americans don’t want to work as CNAs because the pay is low and the hours are long. Many immigrants, legal or illegal, are more than happy to fill the vacuum.  One thing is certain, as I’ve experienced for the last four years in a nursing home in Fairfax, the work ethic in this new wave of immigrants leaves a lot to be desired. There are always a few remarkable exceptions.

Recently one nurse’s aide dropped a patient she attempted to hoist with a broken device, the patient fell and was injured, but she never filed an incident report. She was hoping nobody would find out as the patient spoke only Spanish. The next day the patient was covered in bruises but without broken bones.

I arrived one day to pick up my mom for her doctor’s appointment. She was in wet socks, no shoes, her shirt was on backwards and food-stained, she needed a diaper change, and the male nurse handled her roughly causing her unnecessary pain and suffering radiating from the hip which had been recently operated on. And the nurse helping her did all of this right in front of me. Can you imagine what they do to patients in the absence of relatives?

There is an ombudsman in the nursing home to represent the patients but patients and relatives are afraid to report anything wrong for fear of staff retaliation. I learned the hard way that, every time I would report a bad incident, the nursing staff would treat mother much worse.

Many elderly are so sick, they never say ‘thank you’ or smile even though they may be grateful that they are being taken care of – they are in so much pain to remember to be polite. Other patients no longer know who they are.

Some elderly patients don’t have any relatives; others do but nobody comes to visit, life keeps them busy. Yet many have relatives who do come to visit but never bring as much as a warm blanket which they desperately need because the nursing home blankets are never warm enough in winter. A few only visit at Christmas time to make sure they are still in the will.

The elderly, who have their mental faculties but are immobile, are often depressed despite the bingo, occasional music, ice cream social, and other activities organized by the nursing home. Television becomes the only mental stimulation some may have. A few read Bibles and others wheel themselves in the hallway watching the world go by.

They cannot leave the floor without an elevator code and they have heavy alarm bracelets. Those with their mental faculties who are semi-mobile have hospital armbands with information which tells the outside world that they are patients in the nursing home. It is a loss of freedom that is not unlike being an inmate in a prison. On the other hand, a few patients do not have a clear legal status so they need these bracelets.

Depending on the time of day, there is always a permeating smell of urine and feces mixed in with the smells of food and disinfectant. Diapers, trips to the bathroom, and showers are never done timely because there are too many patients assigned per CNA. And if the CNAs do not take their jobs seriously, they compound existing problems in the quest of earning a paycheck.

Many elderly refuse showers for various reasons, the major one being that the water is really cold most of the time, making it a frigid and painful experience, particularly in wintertime. The elderly are usually cold and should be showered with much warmer water.  I had to shower my mom in the nursing home and the water was lukewarm even though I let it run for quite some time.

The lack of timely diaper changes and showers cause a lot of UTIs in the elderly female population. Cross-contamination occurs because not all of the staff understands bacterial transmission through contaminated gloves not changed between patients.

Other staff members are really hard-working but the job gets to them eventually after seeing so much pain and misery.  The last chapters of our human lives are not pretty and are made worse by chronic disease and pain.

The indignity of incontinence is very hard to deal with in a fully grown adult. It is difficult sometimes to change the diaper of a small baby, can you imagine changing the diapers of adults who cannot be placed on a changing table and are often combative?

Five star facilities can be abusive and neglectful too. Many reject people who do not speak English under the pretense that they cannot meet their needs. It is a subtle form of discrimination. 

Most people cannot afford the $7,000 per month assisted living fees or the $12,000 per month in-home care. Insurance does not even begin to cover such outrageous costs. Medicaid pays nursing homes a little over $6,500 a month for their patients that require specialized nursing care which is just about everybody already there.

The Alzheimer patients are separated in a locked area unfortunately called Arcadia. Many are ambulatory and would disappear without a trace if left to their own devices.

Western societies are supposed to deal with their elderly in a more humane way but, in the process of insuring that they are taken care of, the family may suffer terrible financial burden even with two income-earners. And they cannot possibly care for the really sick loved ones who need shots, blood drawn, emergency trips to the nearest ER, and other measures to save that patient’s life.

Because they do not want to be a burden on their loved ones, many choose to have a do not resuscitate (DNR) order in their wills and others move to countries that allow euthanasia. They prefer those measures as opposed to lingering in a nursing home and be forgotten, neglected, and abused while in pain.

Rhonda, not her real name, was blind, unable to talk, and on dialysis for several years before she passed in her sleep. She wailed from the top of her lungs all day long.  She was transported twice a week to have her blood cleaned. Her tiny bony frame was covered in large, purple bruises from the dialysis needles.  

Some societies use the entire tribe to care for the elderly in the last part of their lives. They treat them with love, dignity, and the respect they deserve.

A Nordic country allows students to live in a wing of the nursing home, rent free, as long as they adopt an elderly person and interact with them on a daily basis.

But many patients who still have their faculties prefer visits from and time spent with their loved ones. They don’t want much as they near the end of the lives, just their children’s, grandchildren’s, or siblings’ time.

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.