Substandard elder care is nothing new. The lack of staff, supervision and accountability is chronic. COVID has only highlighted and exacerbated pre-pandemic issues. A 2020 Elder Voice Family Advocates report found that 44% of central Minnesota long-term care providers were investigated for breach of care in 2018-2019.
Staffing shortages before the pandemic appear to be linked to low wages and benefits. Meanwhile, the senior housing industry made 12% profit over a 10-year period ending September 2020, while, according to the National Investment Center for Seniors Housing & Care, hotels made 4% . It’s no surprise that between 2000 and 2018, private equity firms increased their investments in the industry from $5 billion to $100 billion according to The New York Times.
Substandard elderly care has been systemic, seemingly linked to improved benefits – at the expense of our loved ones, a reality that hit me when a fall turned my mother’s life upside down.
Mum, 90, loved assisted living and everyone loved it. She was active, walking happily (with a walker) to all activities, attending family gatherings and her church until one day a volunteer, delivering flowers and cookies, ignored her agency’s protocols, removing mom. physical activities and walking to his apartment, without contacting the staff. . She then left mum there at lunchtime, without telling the staff or bringing her to lunch.
Unfortunately, the facility lacked volunteer protocols. The staff never spoke with the volunteers. If the volunteer had consulted the staff, she would have known that mum never walked without the escort of the staff, sometimes needing to sit down.
Mom’s helper noticed the stranger taking her off exercise but didn’t ask and didn’t pick up mom for lunch 15 minutes later as planned. He waited over an hour to check that she was okay. Alone in her apartment, a bit confused with an untreated bladder infection (I was not informed of recent wandering episodes which always signaled a bladder infection, as the staff knew), mom fell, fracturing her neck.
What followed? Four hospital stays, two rehabilitation courses, a cascade of errors. After the first hospitalization, Mom’s facility ended her care, after nine years of residency, saying they couldn’t meet her needs. “We don’t know what Mom’s needs will be,” I protested, to no avail.
Everywhere we went: “Have you thought of the hospice? » Hospice? With no life-threatening conditions, Mom wanted medical attention, not just comfort, care. An ER doctor asked, “What is your goal for your mother? “To heal,” I said. He looked surprised. Ageism? Records indicate that staff everywhere expected mum to live well beyond six months.
No life-threatening conditions, that is until rehabilitation in a nursing home, where care was so poor that his prognosis declined. It’s not just that the care plan was ignored – hydration/bathing didn’t happen – but, more importantly, they failed to meet Mom’s medical needs.
For weeks, her first rehab center failed to treat mom’s bladder infection or monitor her condition, despite my pleas. One day, she couldn’t even speak or get out of bed. “Shouldn’t she go to the emergency room?” I begged. “Not necessary,” they insisted, although she also caught bronchitis. Eventually, against medical advice, I took her to the emergency room – she had life-threatening sepsis.
After 10 days in the hospital, mom entered rehab number two to improve her walking. On admission, the nurse manager, without knowing Mom’s story, said, “Be realistic. People descend at this age”, his mantra, chanted frequently. I was surprised – is it rehabilitation? Ageism?
Unfortunately, given substandard care, Mom went downstairs. It was not just the call button response time, often close to an hour, but again the staff failed to monitor and attend to his medical needs or communicate with other staff or family. Insomnia went untreated for weeks, despite my pleas, thus ending therapy – Mum struggled to stay awake, failing to make steady progress.
Mom became wheelchair bound. For 12 days no walking, despite promise of ambulation – two staff were never available to help and family were not allowed to help. No blood thinners were prescribed to prevent clots. Staff noted excruciating pain in mum’s legs, documenting a leg doubled in size – potentially signaling blood clots – but they took no action or informed the family.
The ER doctor reported that Mom’s entire leg was clotted. She died the next day of a pulmonary embolism, two days after leaving rehab.
Mom didn’t die of a virus or a chronic illness, she didn’t die a natural death, as we had always hoped. She suffered and died due to substandard elder care and medical negligence in nursing home rehabilitation – a preventable, premature and painful death.
How can we, in good conscience, subject our elderly, our loved ones, to care that we will not tolerate? And given the evidence, why aren’t more people involved? Do we secretly think they are disposable and will die anyway? Think short-term, given our destiny. Our seniors have lives with meaning and purpose, and we have work to do.
Jean Greenwood is a Minneapolis mediator/facilitator/circle keeper, writer, adjunct teacher, and Presbyterian minister with a passion for justice and a love of nature.