When nursing homes go wrong, they go terribly wrong: here are 6 tips to help you find the good ones
Here's a cinematic riddle for you: Question: What do you get when you combine The Snake Pit with One Flew Over The Cuckoos' Nest, and Whatever Happened to Baby Jane? Here's your Answer: a horrible nursing home.
I ought to know. Six months ago, I raced back and forth between two bad ones, but probably not the worst. If I can save anybody else the time and trouble of seeing grandma or a favorite uncle treated like a sack of Idaho potatoes, read on. I'm suggesting 6 tips I learned for selecting a good Nursing home for your loved one:
1. Do NOT use location to your home as your sole criteria when choosing a nursing home. Many nursing home stays are required after an elderly person breaks a hip or bones in their bodies. After surgery and a 3-day stay a hospital, patients who need more recovery time are released to a nursing home. Here's where the emotional trauma begins. Hospitals generally do not make recommendations for nursing homes. I was handed a 2-page list and asked to choose one where my Mom could be sent. Many people choose the closest nursing home, because a lot of travel is involved. "Choose a close location," was the only suggestion I got.
2. If you decide to visit before selecting a nursing home, question the tour and pricey brochures the nursing home administrative staff gives you. Instead, check out the nurse-to-patient ratio and the reviews on the Internet. Since I had no idea and never knew anyone who had been in a nursing home, I went with the one closest to where my Mom lived. I had only 1 day to check a facility. So I called my Mom's doctor, and his nurse said, "All of them are terrible." She could also give me no recommendation, but she said several patients had gone over to one nursing home I shall call The Cuckoo's Nest. The Hospital released my Mom after hip surgery and we met her at The Cuckoo's Nest. Mom wasn't there for more than 5 minutes when she recognized how bad it was going to be. There were 160 beds, and only a handful of aides and one nurse on duty at the time to cover all of them. We had to demand bed-rails, because Mom was fall-prone, and it took them 30 minutes to find them. My woozy Mom (who never takes pain medication, but was now on some) was ready to cry. That night, when she called for help and no one came to her assistance, she decided to get out of bed on her broken hip and go to the bathroom. She promptly fell and cracked her head open, which meant another trip to the ER, this time with a severe head laceration, requiring numerous staples. I saw there was NO way she was going back to Cuckoo's Nest, so the following day, I went on the hunt to find a better nursing home, because now she had two injuries. While Mom was in the hospital, recovering from her head wound, we found nursing home #2. But the first one (Cuckoo's Nest) didn't want to give Mom's personal property back to us; that is, unless we paid for her 6-hour stay. I was told by the insurance rep if my Mother wasn't there at midnight, her stay was not billable (she was taken out by ambulance at about 9:30 PM). Finally, after a loud argument and a fierce demand for Mom's possessions, her property was returned to me. In the next week, I filed a complaint with the State against this facility for negligence, which leads directly to Tip #3.
3. Although you have very little power or say when you step over the threshold of a nursing home entry, you can and should lodge complaints if your family member is mistreated or neglected. These complaints (which can result in published deficiencies, and in the worst cases, closure) are taken seriously by the completely overwhelmed and overworked State investigators, at least in our State. You can find a list of deficiencies, state by state, on some of the sites I am going to recommend for you at the bottom of this article. Some States seem better at regulating and rating nursing homes than others. I can't understand why California rates restaurants (A for the best) and posts these ratings on the front door, but they do not publish nursing home ratings Were they to post an alphabet letter on a Nursing Home's front door, it would make the bad nursing homes get better fast or go away.
4. An Attorney can be of little help unless the damage to your loved one results in serious injury (a skull fracture) or loss of life. The attorney we consulted for the head laceration was yet another person who told us how many violations nursing homes commit, but the law (and the lawyers) are only looking for certain cases. Well, he didn't say big money exactly, but that's what he inferred. It may vary, again, from State to State, but here in litigious California, a case must involve major damage to a patient, even though the little damages may hurt the mind, body, spirit and the checkbook.
5. Do not take your insurance company's recommendation for a Nursing Home until you check it out yourself. Sadly, at Nursing Home #2, there was evidence of collusion, although my mother had reasonably good care for the first 10 days (the length the insurance policy would pay at 100%). She had arrived, again by ambulance, but this time, with a catheter, so that she wouldn't attempt to get out of bed herself. Again, woozy on pain meds, she lost her appetite. Her stomach was upset and she was a bit confused by another move. But my mother's insurance rep assured me this Nursing Home was incredible: small (which is generally good for care), with quality staff and nurses. She said she knew that, because she had once been Director of Nurses there (red flag). But I was so glad to get Mom out of the Cuckoo's Nest and into a reasonably quiet and nicely decorated facility, I believed the insurance rep. Had I read the list of this nursing home's problems, found on the Internet, I would have learned that catheters should be taken out fairly quickly (my Mom's was inserted for 2 weeks) because they can cause bladder infections. Because my Mom had lost weight (she's small, anyway), they put her on Boost and also a strong anti-depressant, known to cause weight gain. I took the word of the head nurse and the nutritionist that she was gaining a little weight, but they never divulged to me the drug was ordinarily given to the severely depressed. (When my Mom's doctor finally learned about this drug, he immediately took her off of it. But he didn't learn until she left #2, because they didn't tell him). When the Nursing Home case manager informed me on My mom's 3rd week there that she was not making progress and could not be released, I grew worried. I had seen her up and walking on her walker (thanks to great physical therapy) and she had put on some weight once the stomach problems ceased. They told me the insurance company had stopped covering her; she would be responsible for paying $198/day. And that meant no more physical therapy, either. Just lying in bed, vegetating, waiting for someone to authorize her release. They recommended my Mom move to an under-construction, expensive ($5100 a month), new private-pay center in their building with 24-hour-nursing. This area was for people not ready for independent/assisted living (such as severe strokes). At that point, I blew my stack. Their plan triggered an alarm not unlike a small earthquake. At that point, we threatened to write a letter to the company's owners, telling them what had happened. We were informed we could take Mom out of there, at any time, and did not have to wait for a release. In record time, we found an Assisted Living residence and moved her there 3 days ago. I am still working on getting her settled, once again.
6. Be aware there are greedy nursing homes and they will cut every corner and treat patients like vegetables if you do not know patient's rights and your rights as family. It is very difficult to find resources to check the quality of nursing homes, but each State may rate them on the Internet. Medicare also has a rating system. The best, to my mind, is at U.S. News & World Report.com. Also check out nursing home ratings at Patrick.net. On one of these sites, I found Mom's second nursing home had a Quality Rating of 1 (1-5, with 1 as the lowest) and an overall average of 2. Past deficiencies included not giving the patient a recovery plan (we received none). I learned from one of these sites that leaving a catheter in a patient is cause for a deficiency, but happens often when Nursing Homes are under-staffed. Diapering continent patients so they don't have to be taken to the bathroom, is another cause for deficiency (neglect) in an under-staffed facility. Diapering robs patients of dignity and further brainwashes them into thinking they can not recover to their pre-injury stability.
To my investigative reporter's mind, bad nursing homes are a stain on the entire health care system of this Country and the fabric of our lives. Seniors are treated like piggy banks that can easily be broken into by some caring for them. Dogs and cats at the shelter I volunteer for are treated much better than the elderly patients in nursing homes like those my Mom experienced. Dogs and cats are given affectionate care, daily, constant supervision, and exercise.
This horror story could have been worse. In attempting to vegetate and fleece my mother, she might have lost her will to live. There are cases where nursing home patients died, due to neglect, abuse or maltreatment. You can Google the numbers of Nursing Home lawsuits - and they are staggering. As a family and a nation, we should not allow our elderly to be treated so badly. I do not intend to stop protesting nursing home mistreatment with the writing of this article.