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Substandard eldercare: It's more than a COVID worker shortage

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Inferior eldercare has been systemic, apparently linked to profit enhancement – at the expense of our loved ones, a reality that hit me when a fall upended my mother’s life.
By: Jean Greenwood

Substandard eldercare is nothing new. Inadequate staffing, supervision and accountability have been chronic. COVID has merely highlighted and exacerbated pre-pandemic problems. A 2020 Elder Voice Family Advocates report revealed 44% of central Minnesota long-term care providers were investigated for care violations in 2018-2019.

Pre-pandemic staff shortages appear tied to low wages and benefits. Meanwhile, the senior housing industry reaped 12% profits over a 10 year period ending September 2020, while according to the National Investment Center for Seniors Housing & Care hotels earned 4%. Not surprising that between 2000 and 2018 private equity firms increased their investment in the industry from $5 billion to $100 billion according to the New York Times.

Inferior eldercare has been systemic, apparently linked to profit enhancement – at the expense of our loved ones, a reality that hit me when a fall upended my mother’s life.

Mom, in her 90s, loved assisted living, and everyone loved her. She was active, happily walking (with 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 from exercise activities and walking to her apartment, without contacting staff. She then left Mom there at lunchtime, without notifying staff or bringing her to lunch.

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

Mom’s aide 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 more than 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, a cascade of errors. After the first hospitalization, Mom’s facility terminated her care, after nine years’ residency, saying they couldn’t meet her needs. “We don’t know what Mom’s needs will be,” I protested, unsuccessfully.

Everywhere we went: “Have you considered hospice?” Hospice? With no life-threatening conditions, Mom wanted medical, not just comfort, care. An ER doc asked, “What’s your goal for your Mom?” “To get well,” I said. He looked surprised. Ageism? Records indicate staff everywhere expected Mom to live well past six months.

No life-threatening conditions, that is, until nursing home rehab, where the care was so substandard that her prognosis declined. It wasn’t just that the Care Plan was ignored –hydration/toileting didn’t happen – but, most critically, they failed to meet Mom’s medical needs.

For weeks her first rehab facility failed to address Mom’s bladder infection or monitor her medical status, despite my entreaties. 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. Finally, against medical advice, I took her to the ER – she had life-threatening sepsis.

After 10 days hospitalization, Mom entered rehab number two to improve her walking. At admission, the nurse manager, without knowing Mom’s history, said, “Be realistic. People go downhill at this age,” his mantra, chanted frequently. I was startled – this is rehabilitation? Ageism?

Sadly, given substandard care, Mom did go downhill. It wasn’t just call button response time often nearly an hour, but, again, staff failed to monitor and address her medical needs, or to communicate with other staff or family. Insomnia went untreated for weeks, despite my pleas, thus ending therapy – Mom struggled to stay awake, failing to make consistent progress.

Mom became wheelchair-bound. For 12 days, no walking, despite promised ambulation – two staff were never available to help and family weren’t allowed to assist. Anticoagulant wasn’t prescribed to prevent clots. Staff noted excruciating pain in Mom’s legs, documenting one leg doubled in size – potentially signaling blood clots – but they didn’t take action or inform family.

The ER doctor reported Mom’s entire leg was clotted. She died the next day –pulmonary embolism, two days after rehab discharge.

Mom didn’t die of a virus or chronic health condition, didn’t die a natural death, as we’d always hoped. She suffered and died due to substandard eldercare and medical neglect in nursing home rehab – a preventable, premature, painful death.

How can we, in good conscience, subject our elderly, our kin, to care we wouldn’t tolerate? And given the evidence, why aren’t more people concerned? Do we secretly think they’re disposable and going to die anyway? Short-term thinking, given our destiny. Our elderly have lives of meaning and purpose, and we have work to do.

Jean Greenwood is a Minneapolis mediator/facilitator/circle keeper, writer, adjunct professor, and Presbyterian minister with a passion for justice and a love of nature.

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