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Dorothy Peterson

Dorothy Eleanor Peterson, in her 90’s, loved her life in Assisted Living. She’d just gotten a new pacemaker, and was active, walking (with walker) to all activities, attending family gatherings and her church every Sunday, with gorgeous smile and big heart, until…

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Sometimes Life Experience is a Painful Teacher

By Jean Greenwood, daughter

If I ever wondered about the quality of eldercare or the pervasiveness of ageism, no longer! The reality hit me when my mother’s life was upended by a fall.

 

One day, a volunteer, delivering flowers and cookies, ignored her agency’s protocols, likely with good intentions, removing Mom from exercise class and walking to her apartment, without contacting staff. Then she left Mom there at lunchtime, not bringing her down to lunch or notifying staff.  

 

Unfortunately, the building lacked volunteer protocols. Staff never spoke with volunteers. If the volunteer had checked with staff, she’d have known that Mom never walked without staff escort, occasionally needing to sit, if she tired. 

 

Meanwhile, Mom’s aide had noticed the stranger taking her from exercise but didn’t inquire, and didn’t fetch Mom for lunch 15 minutes later, as scheduled. He waited over an hour to check on her. Alone in her apartment, a bit confused from an untreated bladder infection (I wasn’t informed of recent wandering episodes, which always signaled “bladder infection,” as staff knew), Mom fell, fracturing her neck. 

What ensued? Four hospital stays, two rehab placements, and a cascade of errors. After the first hospitalization, Mom’s facility terminated her care, despite her 9 year residency, saying they couldn’t meet her needs. “We don’t know yet what Mom’s needs will be,” I protested, unsuccessfully.

 

Everywhere we went: “Have you considered hospice?”

 

Hospice? Mom had no life-threatening conditions, still had a life.

 

“No, she’s not ready for hospice, still wants medical (not just comfort) care.”

 

An ER doc asked, “What’s your goal for your Mom?”

“To get well,” I said.

 

He looked surprised. Was this ageism? Records indicate staff everywhere expected Mom to live well past 6 months. No life-threatening conditions, that is, until nursing home rehab, where the care was so substandard that her trajectory headed downward.  Not only was the call button response time often nearly an hour, ambulation protocols not followed, facility-induced delirium blamed on dementia, Care Plan ignored—hydration/toileting didn’t happen—but, critically, they failed to meet Mom’s medical needs. 

 

For weeks, the first rehab failed to address Mom’s bladder infection, despite my entreaties, and neglected to monitor her medical status. One day she couldn’t even speak or get out of bed. “Shouldn’t she go to the ER,” I pleaded. “Not necessary,” they insisted, though she’d also picked up bronchitis. Two days later, against medical advice, I took her to the ER—she had life-threatening sepsis.

 

After 10 days, recovering, she entered a second nursing home rehab to improve her walking. I was startled at admission, when the nurse manager, not knowing Mom or her history, said, “Be realistic. People go down hill at this age,” his mantra, chanted frequently. This is rehabilitation?! It felt like blatant ageism.

Sadly, given the rehab’s substandard care, she did, in fact, go downhill. Staff failed to monitor or address her medical needs/status, or to communicate with other staff or family. Insomnia went untreated for weeks, which ended therapy—Mom struggled to stay awake and couldn’t, therefore, make consistent progress.  Her progress was intermittent.

 

She ended up immobilized, wheelchair-bound for 12 days, with no walking, despite promises of ambulation on the unit—2 staff were never available to help and family weren’t allowed to assist. And no anticoagulant was given. Staff noted excruciating pain in Mom’s legs and one leg doubled in size—potentially signaling blood clots—but they didn’t take action or inform family. The ER doctor reported her entire leg was clotted. She died the next day, 2 days after leaving rehab, when clots travelled to her lungs.  

 

Mom didn’t die of a virus or chronic health condition, didn’t die a natural death, as we’d always hoped. She died of chronic medical neglect in nursing home rehab, a preventable, premature death, and suffered immensely, because of a “perfect storm” of errors.

 

Do we really want to subject our vulnerable loved ones to care we wouldn't tolerate? With the pandemic highlighting substandard eldercare, why aren’t more people concerned? Do they secretly think the elderly are dispensable—they’re going to die anyway? That would be short-term thinking, given where we’re all headed. The elderly are not disposable—they have lives with meaning and connection, and they’re our kin.

 

Time for some soul-searching, individually, collectively. By what measure do we ascribe value to a human life—prestige, attractiveness, wealth, power? Who are the people we value, and who's dispensable—the mentally ill, poor, homeless, immigrants, the elderly? Then you …or me? Is there a hierarchy of value, or are we all equally valuable as humans, worthy of honor, respect, care? That's the critical question. 

 

How do we want to be treated when we're elderly?

What did I learn from this searing experience? That little things matter, that good intentions are not enough, that ageism can seem invisible until it’s in your face, and visceral. I believe ageism is a justice issue permeating our society. It was certainly tangible when I accompanied Mom on what became her final journey. Ageism is not just a nice idea to consider. It’s a matter of life and death.

We have work to do.