It Shouldn't Be This Way: The Failure of Long-Term Care

Chapter 7. Nursing Home

101 7 Nursing Home Sunset had made it very evident that they could no longer care for our mother. Hiring a full-time aide on top of the money we were paying for the assisted living that provided ever less assistance seemed unworkable and expensive. At the same time Ruth’s financial resources were beginning to diminish rapidly. For the first time, we began to seriously think of her as a potential Medicaid candidate . If she were eventually to go on Medicaid we knew our chances of finding a good nursing home would be much improved if she entered as private-pay patient. Most nursing homes will give priority to patients who can pay with private funds and thus avoid some of the government oversight. Many of those private-pay residents, however, will eventually spend down to become eligible for Medicaid. Paying privately usually means higher rates but presumably somewhat better care and often nicer rooms. With great reluctance, we set about to identify a nursing home for Ruth. This step, clearly a last resort, was especially painful because a Kane&WestFinalPages.indd 101 3/26/05 12:07:27 AM I T S H O U L D N ' T B E T H I S WAY 102 career of studying long-term care had convinced Robert that nursing homes are socially (but alas not physically) sterile environments. Furthermore, our mother’s only experience with a nursing home was the one she had had with her own father, who was so unhappy after he was placed in a nursing home that he tried to kill himself. That event left a scar on our mother’s soul, as well as a profoundly strong reason to avoid such a placement for Ruth. We found one nursing home in the area that came with very positive reviews from both the informal experience of family members who had used it and the official statistics available on the Medicare Web site that lists the characteristics of every nursing home and the results of the most recent federal survey (see Appendix 2). However, to be sure we were making the best decision, we arranged to visit several others. Earlier we had visited the home recommended by a geriatrician as the ideal place to manage dementia. Although it had a full-time gero-psychiatrist in residence and a good complement of staff, it was a socially sterile environment that seemed to be heavily custodial. Moreover, it had few single rooms. We identified several others by reputation and reviewed their characteristics on the Web site. When we visited each of them we were disappointed. The corridors were crowded with wheelchairs filled with people lined up for meals or baths or other activities. The residents looked uncared for, and the staff seemed to focus on avoiding accidents rather than enhancing the lives of the residents. Each place, even those newly constructed, seemed terribly institutional. The highly recommended facility, which we will call Sincerecare, was part of a large campus operated by a nonprofit organization. Because we were told that there was a long waiting lists to get in, we decided to play all our cards. Robert called the medical director, who Kane&WestFinalPages.indd 102 3/26/05 12:07:27 AM N U R S I N G H O M E 103 was familiar with his work, and explained our situation. He agreed to give us a personal tour. This facility, like the others, was institutional but here we got the impression of a great many staff and active efforts to make the place as hospitable as possible. These extras were affordable because of private donations over and above the fees charged. Indeed, the walls were covered with plaques acknowledging donors. The facility seemed very clean and well maintained. However, even the newest addition was built with primarily double rooms. When we asked why, the medical director cited cost concerns. Many nursing homes that evidence great concern about their care, we learned, persist in building semi-private accommodations rather than single rooms. The often repeated concern that the cost of construction is prohibitive is simply not true. Moreover, the flexibility gained by providing more single rooms will help keep occupancy high. Sincerecare had a fully staffed medical clinic on the premises that included several geriatricians who provided the primary care for residents . Even specialists came to the facility at scheduled...