ProPublica: Life and Death in Assisted Living - page 2

ProPublica: Life and Death in Assisted Living by A.C. THOMPSON and JONATHAN JONES, PROPUBLICA Last updated: Monday, July 29, 2013, 9:51 AM... Read More

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    Here's a perspective of ALFs from a nurse who's been there several times:

    As the only licensed nurse in a building of 80+ residents, I held a position of great responsibility but very little authority, even though I was the DON and staff trainer. I had no say-so in the discharge of residents who were no longer appropriate for ALF due to cognitive deficits, falls, exit-seeking behaviors etc. because "the family is paying $4,000 bucks a month and doesn't want their Mom in memory care" or "he could fall just as easily in a nursing home as here".

    People with psychiatric issues were mixed in with residents with dementia, and then the powers that be had the nerve to be surprised when fights broke out. There were only four resident assistants and two med aides for the entire facility---on day AND evening shifts, and only two at night. On any given day, about 85% of our population needed medication, toileting, and other ADL assistance, 50% needed escorting to meals or meal reminders, and about 25% needed a higher level of care due to falls, need for 2-3 person transfers, or behaviors associated with dementia. One particularly memorable resident had a history of Alzheimer's, bipolar 1 disorder with psychotic features, adjustment disorder, and ADD; she was finally moved out only after she'd beaten the hell out of several staff members, destroyed the carpet in her room with daily incontinence episodes, and tried to get herself run over in the street.

    And I, as the Registered Nurse, had the privilege of co-signing Corporate's B.S. in keeping my mouth shut about the need to move residents at risk for wandering or those with severe memory loss to a higher level of care. Well, I didn't stay quiet, but nobody listened to me when I did advocate for move-out, and in the meantime I had a minimum of 15 incident reports to comb through every week, staff who didn't know how to manage behaviors, and NO other nurse to consult with when I ran into a wall trying to figure out what might be going on with one resident, while still dealing with four score others.

    Looking back, it's a wonder that I didn't have my nervous breakdown a year or more before I did. I felt 100% responsible for these souls entrusted to my care, but the little I could do to improve their situation was a spit in the ocean.

    What's sad is, this was actually a GOOD facility. I've seen a couple of bad ones, and I wouldn't put my worst enemy's dog in there, let alone anyone I care about. The purpose of assisted living is SUPPOSED to be as a sort of halfway house for elders who are no longer safe to live at home, but who don't need 24/7 nursing care and can perform most of their own ADLs. Fifteen years ago, ALFs didn't even consider sliding-scale diabetics, two-person transfers, assisted feeders or anyone with a catheter; now they take all that and much more. Yet the staffing hasn't increased, and often, one nurse must oversee several of the company's buildings and delegate most nursing care to unlicensed assistants who haven't even taken CNA courses.

    Scary, huh?

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    As long as assisted living remains relatively unregulated, they will continue to admit residents who are completly inappropiate for their accuity level.

    I think assisted living has a place in the spectrum of health care, but right now it's admission policies consist largely of poaching skilled nursing-level patients, which benefits no one. (except their profit, of course).

    Assisted living should be an option for relatively independent and stable elderly who just need, well, assitance. But I see some of the children of residents at my faclity (a SNF) looking into tranfering mom or dad to an assisted living facility because it's "nicer". Said residents are total care, require mechanical lifts for transfer, and take literally dozens of medications including insulin, narcotics and nebulizer treatments. I'm sorry, but a minimum wage HHA popping in a couple times a day and a "med tech" to give all those meds is just not going to cut it.

    I grow weary of LTC being the "bogey man" of healthcare. It's not some horrible institution where we "warehouse" residents so they can wait to die. It's this preception that drives people to assisted living.

    But the lack of oversight and regulation for AL ensures they will continue to take any resident they want, without providing the proper nursing staff such residents need.

    I suspect the AL industry will fight tooth and nail any attempt to regulate it's practice. Because if they were regulated they would be forced to provide skilled nursing services for their skilled-level residents. And then, what would there be to differentriate themselves from traditional nursing homes?
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    Sounds much like some of the facilities I have worked at.

    I think my worst moment was:

    Walking into the unit I sight one of the residents on the ground crying for help. The [doesn't] "Care[r]" walked past and acknowledged her. Left the unit and went home 15 minutes early. As I approached the resident she was incontinent of urine and faeces.

    If children were treated like this there would be international outrage. Why such a different train of thought for our vulnerable elderly?
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    VivaLasViejas, I could have written your post and left running almost a year into a job with the same unfortunate circumstances. And as you posted, I was at a facility well respected by the community. It also appeared once a Resident's care exceeded the needs of the facility (either upon admission or through decline) Hospice was asked to consult. This in my opinion was only a bandaid, as many of hospice services were not continuous and once 6 months hit and the residents were found no longer appropriate for hospice they were back to square one. I am so saddened that this appears to be the norm, not the exception for ALFs in this country. Something has to change.
    VivaLasViejas likes this.
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    As a country we have to deal with the fact that:
    Most adults work outside of the there is no caretaker in the home for grandma anymore.
    More adults get to adulthood with chronic and debilitating diseases than they did 50 years ago.
    People are discharged from the hospital earlier than they were 50 years ago.
    People who were once "sick" enough to be in the hospital are now cared for at home.
    The cost of caring for a loved one in the home has sky rocketed with all of the other costs related to health care.
    The wages of the majority of Americans who find themselves in this pickle have NOT risen appreciably.
    Insurance coverage has become more expensive and less comprehensive.

    Most Americans are poor, have been poor recently, or will be poor in the future...we have so little compassion for our neighbors.
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    If you didn't catch the show on PBS, you can watch it online.
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    It was a fantastic program. I think i went from shaking and crying to really p!ssed off the whole show.
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    This thoughtful reporting demonstrates what everyone should know about for profit care of is NOT about the care, it is NOT about the outcomes, it is NOT about the patient...

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    Don't you love the part where the Emeritus attorney says that Emeritus is "a victim of their success".
    Gee, seems to me like their residents are the victims of their success, right?

    Also interesting that the ONLY remedy or recourse for patients and families is litigation. Of course, we will very soon allow those corporations to limit that remedy through tort reform...most Americans have a sense that this is a good idea, to protect those poor providers. Actually, it is an attempt to protect the profits of corporations exactly like Emeritus, by limiting their accountability and responsibility to the people who pay for the care and service.

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