Your "Golden Years" Shouldn't Seem So Much Like Prison
Anthony L. Fisher writes at reason about elder care and how regulations and fear of lawsuits prevent nursing homes from allowing patients basic autonomy:
You wake up in an institution and are ordered out of bed. Though you would much rather sleep in for a bit, you have no right to dictate your own schedule. You are marched to a sterile, cold room where you will be served food you don't want to eat, seated at a communal table with people who don't want to be there any more than you do. Nearly all the activities that will make up the rest of your day will proceed in similar fashion, until "lights out" is called and you are commanded to a lonely slumber. With each passing day you are plagued by loneliness, helplessness, and boredom. This is all done in the name of your safety and security, not as punishment. You are not a prisoner; you are a "resident" of a nursing home....Over 1.3 million Americans live in nursing homes, but thanks to byzantine regulations designed to mitigate any risk to the physical health of residents (which take little consideration of the mental health of those same residents), many nursing homes can resemble minimum security prisons.
In response, The Eden Alternative, a Rochester, New York-based non-profit, has for two decades sought to de-emphasize "top-down, bureaucratic authority, seeking instead to place the maximum possible decision-making authority into the hands of the Elders or into the hands of those closest to them."
The Eden Alternative's CEO, Christopher Perna, told me in a phone interview, "It's almost militaristic, the way many nursing homes are run, where the administration is the top dog. They make all the decisions and the staff basically do as they're told." He adds, "it's very easy to settle into a series of institutional practices that keep you within boundaries that are defined by the government. It can lead to a very sterile, very lifeless environment."
...Kapp adds, "requirements that beds must be placed only within certain spaces in a resident's room make it impossible for residents to rearrange their furniture as they wish. Regulatory prohibitions on open kitchens prevent residents from fixing snacks whenever they wish. If we are serious about making nursing homes more comfortable and homelike, a review of existing regulations and amendment or removal of those regulations that impede culture change must be put into place."
For his part, Perna says that for the past 20 years, he has worked with nursing homes to venture as far they can into the "grey areas" of regulations. His goal is to help "reinstitute a degree of autonomy" for both their seniors and their caretakers, which he says "is just a crucial factor for quality of life." Perna adds, "if residents want to sleep in in the morning, let them sleep in. If they want to be an early riser, let them wake up early. If they go to bed early, let them go to bed early. If they like to be a night owl, let them be a night owl. And adapt the organization and staffing approaches to the needs of the elders."
Feeling a sense of control over your life -- down to the smallest measures -- is essential to our well-being. A system that takes that away is not caring for people; it's destroying them, just in a slow way, and while calling that "protecting" them.
As Fisher writes:
Only true regulatory reform, with policies that allow for residents and care providers to assume a reasonable amount of risk, will prevent predatory lawsuits from holding nursing homes hostage, and facilitate a widespread cultural shift in elder care.You've lived a long life, you've paid your taxes. The least you deserve is the right to arrange your room the way you like it, and occasionally make a snack without official permission from an officious authority figure.







You've lived a long life, you've paid your taxes. The least you deserve is the right to arrange your room the way you like it, and occasionally make a snack without official permission from an officious authority figure.
This is all done in the name of your safety and security, not as punishment. You are not a prisoner; you are a "resident" of a nursing home.
If only they hadnt continued to vote for the politicians promising to make everything "safe" all their lives.
Sure it sucks for them, but they got EXACTLY what they clamored for, safety above all else
lujlp at February 22, 2015 11:23 AM
In the US, a microwave comes with a booklet with WARNING top and bottom on each page. Each paragraph starts with "WARNING:", advising things like not using it in the bathtub or the rain, to fry chicken, to dry a wet cat, or to attempt running it with the door open by jamming sticks in the door mechanism.
Every one of those warnings comes from a lost lawsuit with damages paid. The law and juries believe that the company is at fault unless they give specific warnings, no matter the stupdity. Soon, even warnings won't do, as lawyers claim that the device was inherently dangerous, and the warnings are no subsitute for making the product twice as safe and three times as expensive.
Children cannot walk three blocks to school because it is unsafe. They must be watched at all times.
Why do legislators and courts impose this system? The US has been Democrat for almost all of the last 80 years. The Democrat philosophy is control from the top, lawyers and litigation are part of that control, and lawyers are big supporters of a powerful government and intrusive law.
I suppose it would not be much different under 80 years of Republican control.
There is no chance that litigation will be effectively reduced in nursing homes. Prisons it will be.
Andrew_M_Garland at February 22, 2015 12:36 PM
At first glance to me this is a bogus POV and it is always a cost issue since you can always pay for add'l support.
The assisted care living facility my uncle was in was an 'apartment' w/a mini-kitchen (microwave/sink), living room, bedroom, and bathroom. Meals were provided in the common area and are made-to-order w/in reason. He moved to a more intensive care facility due to health problems and lost most of the freedom to do as he wishes.
The nursing home my Mom is in is as described in the article, BUT my Mom can no longer safely do the things advocated. Caring for a large number of individuals (meds, showers, potty changing, feeding, etc.) at her facility requires a schedule. I can provide ($18/hour for 4 hours min.) additional care to do what is advocated.
I can also increase her costs 2.5X and get what is described in the article, however ...
Bob in Texas at February 22, 2015 12:57 PM
"fear of lawsuits"
Perhaps, but also concern for the elderly residents well being.
A family friend is in such a facility as describe. They used to allow microwaves and hotplates in their rooms; but not any more - because there have been fires due to someone who couldn't handle such things.
Do we want someone on staff to determine who can and cannot handle such stuff? Boy, that would be a way to get residents up in arms and at each other. "She can have a hotplate and I cannot - why? she is more senile than me!?" Or, "I've always used a microwave; why are you taking it from me!?" Or some residents would be sneaking into each other's rooms to use the "forbidden" equipment. Nope, it is much easier to issue blanket bans rather than have fights with the residents.
The same is true with setting schedules; who didn't come to dinner and why? Was she just not feeling hungry? Was she wanting to watch a TV show instead and will eat later? Or is she really not feeling well and needs to be checked up on? I'm by no means an expert or anything; but depression is not uncommon among the elderly living in such places - trying to diagnosis depression instead of someone just being quirky I think might be a problem.
Yes, the ideal that is described in that article would be nice - let them do as they please. But, the truth is a lot of folks in such facilities are there because they cannot care for themselves. If each of them "do as they please" (e.g. eat meals whenever they wanted, stay up late, sleep in, etc.) just how would the staff know who has been eating properly or not getting enough sleep or is taking a downturn in health instead of just being different?
The answer would be to hire more staff to keep an eye on everyone and their different habits. But, then who could afford such expensive facilities other than the wealthy?
charles at February 22, 2015 2:10 PM
"to dry a wet cat"
Phew, glad I read that Andrew_M_Garland! My cat just came in out of a rainstorm and I was about to nuke her! Thanks!
Charles, I see your point. But, as long as people aren't hurting others, can't they live their lives the way they fucking want? The goal of aged care shouldn't be to treat it like a boot camp and monitor their sleep and eating habits. It should be for them to be happy, even at the expense of a possibly shortened life.
My grandfather managed to electrocute himself at 75 trying to fix a washing machine (he grabbed something live and got locked onto it) and badly burnt his hands. His first complaint was that the nurses wouldn't hold a cigarette for him (his hands were bandaged up). He'd smoked for 60 years for chrissake, yet they felt it necessary to tell him no. Who cares? He lived to 87, all but the last couple of years in his own home. Fuck em.
(His second complaint was that the nurses were pretty free with their hands during his sponge baths. My mother was able to convince him that on that one at least, he was imagining it)
Ltw at February 22, 2015 10:08 PM
Coincidentally, Friday I watched the 1032 movie "If I Has A Million," a series of vignettes, the last of which was set in an "old age home" as described. I also have family who own a "nursing home" also much as described.
But, for a price, there is a alternative. Shortly before she passed at 91, my mother was on a waiting list for one subsidized by her Church. She would have basically a studio apartment, her own furniture, private bath, small refrigerator, microwave, etc. But staff for most cleaning, on-site nurses, doctors on call, and other amenities.
John A at February 22, 2015 11:54 PM
"The answer would be to hire more staff to keep an eye on everyone and their different habits. But, then who could afford such expensive facilities other than the wealthy?"
The answer? Did someone mention taking care of the elderly at home, and I missed it?
That's your choice. Illness and Death should have shown you that life is not "fair" now, and it's not going to be.
Take the lesson.
Radwaste at February 23, 2015 7:39 AM
The timing of this is really something - my Dad just passed away in a nursing home 2,000 miles away. Either Parkinson's, or a case of Guillan-Barre that never really went away, plus a multitude of minor conditions. E.g., where the mule kicked him 80 years ago started to hurt again. I'm not sure if I feel bad or relieved, because ever since my mother passed away he was doing nothing but waiting to die.
John A: "my mother was on a waiting list for one subsidized by her Church. She would have basically a studio apartment, her own furniture, private bath, small refrigerator, microwave, etc. But staff for most cleaning, on-site nurses, doctors on call, and other amenities."
My parents were in an apartment similar to this in Rogue Valley Manor in Medford Oregon. AFAIK, this is about as good as retirement communities and nursing homes get. It had another advantage - my aunt and her husband live there. He is a doctor and doesn't consider being 80-something reason to quit entirely, so it just takes a phone call to get a second opinion I can trust.
First, they were in a duplex, homelike but small. When they reached the point of needing more services, they moved to an apartment in one of the main buildings, two rooms with a tiny kitchenette - but mostly they ate at the cafeteria. Aside from being costly, there is only one thing wrong with that place - it's full of people who are just waiting to die.
And it did not last. My mother developed Alzheimers, and reached a point where Dad could not take care of her. Advanced Alzheimers patients require help with everything, and tend to wander away; they _have_ to be imprisoned, either with a staff that can keep a 24 hour watch, or with locked doors. He couldn't have handled it much longer even if he'd been in good condition, and when the Guillian-Barre syndrome started he was quite unable to handle feeding and cleaning. So she had to move to the Alzheimer's ward, and she was gone within six months, mainly from not eating. Dad had had to entice her into eating for several years, mostly with ice cream, and the staff didn't do as well. At least they didn't force-feed her to keep her body alive a while longer. _She_ wasn't there anyhow.
markm at February 24, 2015 2:41 PM
Amy Alkon
http://www.advicegoddess.com/archives/2015/02/22/your_golden_yea.html#comment-5866298">comment from markmSo sorry to hear this, markm.
Amy Alkon
at February 24, 2015 7:18 PM
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