We have rarely gotten the volume of responses to a blog like the one posted by Laurence on the Senior Watchdog.  Almost all were professionals who had worked in senior care facilities or hospitals and had personally witnessed the over- or under-drugging of patients.  Some agreed, but asked that we consider the state of our healthcare system and the pressures that are on the people who work within its sometimes impossible constraints.  One reader took us to task and we want to share her letter with you.  This is what Bobbi had to say:

Seniorcide.......you have to be joking......before you put information that is misleading onto your web site I suggest you know what you are talking about and be a bit more realistic in your information.

50-60 percent of all seniors die within two years of placement in a nursing home..........yes, a very true statement. BUT what you are NOT saying is that the percentage of seniors you are referring to have multiple complicated health issues and often are at the end stage of their diseases.  The average age of seniors placed in nursing facilities is 70-80 years of age WITH complicated medical issues.

Alzheimer's - basically the same as above, when persons get to the end stage of this disease many other health issues arise.

Long Term Care Insurance quotes that the average length of stay in a nursing facility is 3 years.  WHY....because it is nearer the end of our natural lives.

Bedsores.....are you aware that these do not always occur from neglect of care but often are medically unavoidable due to numerous complicated health issues that deteriorate the body's ability to maintain healthy viable skin?  Nutrition and blood circulation problems can affect a person's skin integrity and over all health in many ways.

Do you realize that many nursing home state tags for abuse are mostly paper compliance issues?  I do agree that their are "BAD" nursing facilities and it is the families' responsibility to tour, investigate and know the facility they are choosing for their loved one.

Staffing Levels.......I have been involved with nursing facilities since 1989....not once has our Federal government increased the amount of staff hours they require for good quality nursing care, yet they continue to place more PAPER compliance on the staff to prove they are giving quality care and following regulations.  To compound this, the acuity level that seniors are entering nursing facilities is much higher than 20 years ago...YET the government has not REQUIRED that the nursing companies increase the staff ratio; therefore, the owners/operators are not going to increase staffing to adequately meet the change in levels of care so that staff may provide quality care.  To compound this further the government continues to cut the reimbursement for care given while continuing to demand higher standards and in some states the facility may wait up to six months to receive payment for services rendered all the while, still having to pay utilities, food and staffing to provide care to our seniors.

Physical and Chemical Restraints - are you aware that these are highly regulated and monitored by our public health?  Physicians must give an order to administer, specific documentation must be in place on alternate methods attempted prior to using either type of restraint first, and when either type is used they have to be assessed regularly and decreased as quickly as possible.  Physical restraints in a nursing home are basically never heard of other than alarms notifiying staff they have put themselves at risk for fall by getting up. 


ALSO.....if you are going to list star ratings on your website, please update as freqently as Medicare does so that the correct up to date information is displayed.  Anyone can list ratings but it is not good to your customer if it is not the correct updated results.

Your efforts to protect seniors may be better spent if focus was put on hospitals which are much less regulated in areas of chemical and physical restraints, notification to families of changes in medications and overall conditions and overall basic care.  They pretty much are allowed to do as they feel is in the best interest of the patient, whether the family is in agreement or not.  And that is just the beginning of the tip of the iceberg in regards to hospitals........maybe someday you will find yourself flat on your back unable to even lift your head and have to depend on hospital staff for everything.......believe me, care, attention and response time is certainly no worse than the worst nursing home.  

In response to the comment that we should “KNOW WHAT THE HELL WE ARE TALKING ABOUT,” I visit more than 250 nursing homes, residential care facilities, assisted and independent living facilities each year.  Most are in the central region of the country and few hospitals are on my list.  In many the owners and staff are dedicated care providers and are simply constrained by the system and funds available.

But more than a few are badly run with uncaring staff.  I also hear from many readers about abuse.  I have witnessed patients who are sitting or lying in soiled diapers for extended periods, talked with physicians who admit to over-medicating patients when pressured by staff, overheard disrespectful and abusive language from staff toward patients and heard from many managers that dismissal of staff for pilfering medication is fairly common.

Medicare is the only national rating system.  Our technology isn’t automated, so the data must be pulled by hand.  So it isn’t easy for us to update and it s only done twice each year.  However, should a rating be found to be inaccurate or outdated we will gladly make changes that are brought to our attention in the interim.  Bobbi is correct in stating that the errors noted during inspections may simply be paperwork.  Also, the ratings from state-to state showed dramatic differences.  Where one state might have the majority of homes ranked a level four or five overall another might have that same percentage ranked at a one or two.   Whether this is a sign of a varying degree of standard compliance from state to state or the level of scrutiny of the investigators involved I cannot say.

But one thing is clear.  Many caregivers are amazing creatures who deal as best they can with the physical and emotional pain of the people in their care.  And Bobbi is right about another thing.  I am likely to find myself flat on my back unable to lift my head and dependent on a hospital staff for everything.  And, frankly, it scares the hell out of me.

In contrast to Bobbi’s letter, we also heard from many individuals who wanted to report tragedies that they claim to have experienced.  Here is one such letter from Carl in New York.

My wife works at (name unpublished here) and comes home with horror stories of neglect and mistreatment of elderly patients by other employees. My wife is a 3pm-11pm supervisor and it's hands-down the toughest shift. You get admits, feeding time, recreation, showers, med pass and more just on that shift, which is already buzzing with activity due to the fact it's in the middle of the day. I worry about my wife's nursing license being tainted from some slacking RN, LPN, or aide's mistake. And the close-calls are daily. Not to mention that two admits dies over the past two months within 24 hours of being admitted. One was apparently a situation where the new trainee gave the wrong medication to a resident. And the nurse’s aides and other employees pocket the patients' Xanax because they think the patient has dementia…

At Great Places, Inc. we are most grateful for your support and feedback.  Please continue to share your thoughts with us!

I’m mad as hell about the way our elderly population—our parents, relatives, all our senior relatives and friends—are shoved aside, tormented, victimized and abused.  That shoving, tormenting, victimizing and abuse of helpless elders happens most often at home.  Not in nursing homes, although the abuse that happens there frequently captures headlines, but at home, where the family dynamic can camouflage mistreatment.  According to the American Psychological Association

"Most elder abuse and neglect takes place at home. The great majority of older people live on their own or with their spouses, children, siblings, or other relatives--not in institutional settings. When elder abuse happens, family, other household members, and paid caregivers usually are the abusers. Although there are extreme cases of elder abuse, often the abuse is subtle, and the distinction between normal interpersonal stress and abuse is not always easy to discern."

A Great Places reader, who's following the Senior Watchdog blog, shares her story of familial abuse.  We learn from her experience that the impact, the guilt and the shame, can last for decades.

"I can’t remember whether it was sunny or cloudy that August morning when the phone rang.  The only thing I remember for sure is that it was Rachel, my niece, on the line.  Rachel was 50 that year, but she looked at least 80: smoking, drug abuse, and most recently, methamphetamine addiction, had left her toothless and wrinkled.  Her voice was deep and raspy that morning. 'Your sister is back in the hospital, Aunt Edna.' 'Oh no, her heart again?' 'No.  Elaine is in surgery.' 'For what?' 'Aunt Edna, she had a bedsore and they had to operate.'

"My heart sank. I’m a nurse. I know that if it’s necessary to operate on a bedsore, the situation is dangerous. I immediately set out on the four-hour drive to the small-town hospital. When I arrived, my sister was in the intensive care unit, hooked up to IVs and drainage tubes. I looked at the pump discharge from her draining bedsore and realized it was serious.

"For several months I had pleaded with Elaine to go to a nursing home.  She refused: 'You’re not going to talk me into moving into a nursing home. I’ve heard enough horrid stories about those places.' This time, though, she agreed that I could look for one. When I asked whether Rachel had abused her, she turned away from me and whispered, 'No.'  I didn’t believe her. I discovered that the hospital had sent the police to her home to investigate the possibility that Elaine was being abused. Not surprisingly, neither Rachel nor Elaine admitted anything.

"My sister was suffering; the infection in her bedsore was beyond belief. When I got ready to leave, I promised that I’d be back soon, and told her how much I loved her. She said, 'I love you, too, Sis.' Soon after I got home, the hospital administrator called and told me that Elaine had died.

"I know that my sister died of abuse and neglect—not in a nursing facility, but in her own home. Elaine died of Seniorcide. It breaks my heart to say this. I should have been more assertive and taken her to a nursing home. I feel the guilt every day."

We at Great Places
are appalled by how our seniors are victimized--and we won't be quiet when family members abuse infirm seniors. 

The SENIOR WATCHDOG is on the case.