My friend AR is 63 years old, divorced and in a hole. Always overweight, like her parents and brother, she had a big stroke 3 years ago, which left one side of her body poorly functional. Her mental ability is OK. Her employer kept her on for a while, but she couldn’t do much and was eventually laid off. She’s on SSI and social security, living alone, using a motorized wheelchair to get around. She hasn’t done well- she could walk 60 feet slowly 18 months ago when employed, now she can barely do 6 if she gets herself upright. She’s on a lot of medication Coumadin, 2 antihypertensive drugs, medication to help her sleep- the medicines probably contribute to her poor function, but being alone, eating more than she should and lack of exercise are the main factors IMHO. She doesn’t even cook.
AR fell 2 weeks ago, leading to hospitalization. Now she’s in an extended care facility- skilled nursing home for ‘rehabilitation’. She gets about 45 minutes of physical or occupational therapy 5 days a week. She can’t get herself out of bed and at night the facility has only one person in the building. They put on diapers on AR and all the other inmates, except for a handful who can get themselves out of bed safely without assistance. This is psychological abuse.
I visited this nursing home. It is clean and doesn’t smell of urine or feces. There are computers and gadgets, medications come in blister packs with each person’s name- reduces the risk of medication errors. There’s a therapy room into which patients are squeezed in groups of 8 or 10. I wanted to observe her therapy session, but the therapist didn’t show up. I spoke with the manager who told me that the night time toileting problem is one of personnel and cost.
“This would be hard work getting all these ladies (2/3 of the inmates are ladies) out of bed and to the toilet, some of them several times each night, we’d have to pay at least $12/hour, and might need two people. Medicare wouldn’t raise our payment.”. Many inmates seem to be sedated- they were asleep in their wheelchairs in midafternoon, mouths hanging open. AR is depressed- “I sit in a wet diaper half the night, with my roommate crying and moaning”. Two of her three chidlren visit almost every day- they bring hamburgers. When I asked why they bring their overweight immobile mother hamburgers, they say “That’s what she asks for” and became upset at my tone of voice. A nurse saw me taking notes and told me, “the snappy ones check themselves out before the month is over”. As with psychiatric care, the government allows a month in an ECF. When I asked about “snappy ones”, she took me to Mr EC. He has been there four days after a fractured hip and hip replacement. He lives alone. He said “I can do these exercises at home twice a day and make more progress than sitting around here. I can cook what I want, set my hours and my kids will bring groceries until I can drive again. I’m leaving when my son comes today.” EC is 79.
Will AR be any better when she returns to her apartment in 17 days? Hard to see how. She has been able to get to the toilet at home, with some difficulty. She is very depressed. Obviously, continent people should not be put in diapers for 10 hours to save money. Her children live some distance away- a 3d child is angry and disgusted and doesn’t visit. AR’s burgers and weight problem are a contributing factor. However, she, like many, has strong genetic factors to overcome- it’s hard, maybe impossible to begin diet and exercise at age 60 after a stroke when every movement is effortful. Her medicines and doctor visits are covered. She might do better with less medicine. Does her physician look forward to seeing this depressed and complaining 250 lb lady? “Give her medicine and food to shut her up”.
Where could money come from to humanize these nursing homes? I have distant relatives in Norway who say that nursing home care there is almost free for the elderly and disabled, not subject to a 30 day limit, and that they don’t leave people in diapers. I’m not sure that this is true. They do complain that elderly people are almost forced to retire by age 68 even if they want to keep working, and they complain that government healthcare is not as nice as it used to be. How many Americans would pay more taxes for better and more humane care for the elderly and disabled? Suppose that more taxes came in – the money would go into the Social Security Trust Fund, which is a theftbox. Any surplus goes out immediately for general expenses.. Can you name a Presidential candidate who understands this nursing home problem? The Mass. Health plan won’t help her. AR is covered now. Those people who talk about more efficient healthcare would shorten AR’s month to 15 or 20 days to save money, and would not support more people– more gadgets maybe.. They are happy with the fact that workers at this facility get no money for retirement other than social security. Only the nurses have health insurance.
Where would you start with this problem? What will you do when you or your loved one is in the hole?