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!

The Senior Watchdog has not always been a big fan of nursing homes.  If you've been following these blogs, you've read about the horrific kinds of abuse that can happen in these places. 

As it turns out, however, some nursing homes can actually be Great Places!  Here's one of them:

For the past dozen years, Beatitudes provides a unique program of "person-centered" care: Dementia residents are allowed pretty much anything that provides comfort--even alcohol.  Tena Alonzo, director of research notes, "Whatever your vice is, we're your folks. 

And why not?  There's no cure for Alzheimer's, and no effective medical treatment for sufferers.  Researchers are finding that creating positive emotional experiences for Alzheimer's patients diminishes distress and behavior problems that are frequent side effects of these diseases. 
Once, Alonzo says, "The state tried to cite us for having chocolate on the nursing chart. They were like, 'It's not a medication.' Yes, it is. It's better than Xanax."

Beatitudes eliminated anything potentially considered restraining, from deep-seated wheelchairs that hinder standing up to bedrails (some beds are lowered and protected by mats).  Perhaps most important, the center drastically reduced dosing of residents with antipsychotics and medications considered primarily for "staff convenience," focusing on relieving pain, according to Alonzo.

The National Institute on Aging and the Administration on Aging are studying "Things that . . . make the life of an Alzheimer's patient and his or her caregiver less burdensome," says Sidney Stahl, chief of the Individual Behavioral Processes branch of the Institute on Aging.
Techniques include using food, scheduling, art, music and exercise to generate positive emotions; engaging patients in activities that salvage fragments of their skills; and helping caregivers to be more accepting and competent.

And at Beatitudes, the occasional cocktail or Snickers bar!

The Orders of St John Care Trust own and manage several British nursing homes, including Coombe End Court in Marlborough, Wiltshire.

Pictured above is the "reminiscence room" at the property.  Its intentional 1950s look helps residents recall memories of the good times of their youth.  

The room is used to help calm residents whose Alzheimer's/dementia causes agitation.  According to staff personnel at Coombe End Court, using the room has led to a "dramatic drop" in the use of antipsychotic drugs.

Sue Linsley, the manager of the home says, "The reminiscence room plays an important role in reducing the use of medication.  It's very, very effective. . . .  
Our clients can come in and it calms them down. This proves that you don’t need to use antipsychotics all the time."

http://www.greatplacesinc.com celebrates Coombe End Court: a Great Place!

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