A Call to Action on Substandard Nursing Homes

The New York Times recently published an article about younger people trying to experience what it’s like to be old (“Simulating Age 85, with Lessons on Offering Care”). The usual stuff, they suggested smearing petroleum jelly on eyeglasses and putting corn kernels in shoes. It’s an old approach. In response to the article, one reader suggested that to really understand what it’s like to be old, spend a week in a nursing home.

Nursing homes offer three kinds of beds: Medicare-paid beds used by people to recover from surgery or hospitalization, Medicaid-paid beds for people who live at the nursing home, and long-term care beds for people who live in the nursing home and privately pay exorbitant fees to live in what is frequently an unsafe dump.

For years, nursing homes have spent money to upgrade and remodel their Medicare wings but have spent next to nothing to remodel Medicaid and long-term care rooms. Why? Medicare pays a healthy rate to nursing homes for rehabilitation services, and competition for customers is growing.

When my mother broke her other hip, she moved to a nursing home for rehabilitation. They didn’t have a Medicare bed available, so they put her in the long-term care wing. I’m not sure that was legal, but that’s what they did. It was a three-bed room at the end of the hall. It had old plywood cupboards, mismatched stands that were essentially useless, and dingy, yellowing walls. It was very near the room where the dirty sheets went after beds were changed. The smell of human excrement punched you right in the face about halfway down the hall.

Here’s the problem: in many states, long-term care dollars pay for few long-term care alternatives to the nursing homes. The nursing home lobby is strong and fighting to keep it that way, which is why Americans need to embrace the commitment to end nursing homes as we know them today. No one wants to go to a nursing home, and no one should have to. Viable alternatives are available.

Here’s what you can do:

• STEP ONE: Demand better. Tell the facility’s administrator what’s wrong with the place. Don’t mince words. Write a letter to the parent corporation if it’s not a private enterprise.
• STEP TWO: Talk to your local ombudsman if you have questions about what’s going on. They know the issues well.
• STEP THREE: Get involved with your state’s politicians regarding long-term care. Call your legislators and say you want them to support good, community-based alternatives to nursing homes. If they hedge, support other candidates. After all, the good care you support may someday be your own.

Bill Thomas, MD, a geriatrician and a pioneer in nursing home alternatives, said, “A hospital and a poorhouse got together and they had a baby, and the baby was a nursing home. . . . There's the grim ambiance of bare floors, and of nearly incapacitated patients doubled up in crowded rooms. . . . What you're seeing right now is the end of the American nursing home. It is finished. And the big question that really ought to be on the lips of the politicians and the leaders is what comes next.”

To find a contact for the long-term care ombudsman in your state, visit the National Long Term Care Ombudsman Resorce Center. For examples of model long-term care, check out the following providers: Providence Mount St. Vincent, ElderHealth Northwest, and Luther Manor.