Nursing Homes: Diminishing the dignity of older adults
Call it what you want: Nursing home, skilled nursing facility, rehab center, convalescent home, or post-acute care. They are all the same and a common destination should you survive a recent hospitalization.
But they all have an existing reputation and can ultimately diminish the dignity of older adults. Never in my four decades of practice has anyone ever said, “Please, Dr. Dorio, send me to a nursing home!”
As a geriatric physician, I have visited countless nursing homes caring for those who have been conveyor-belted through hospital illness, and then jettisoned out to these facilities. Sometimes, home care is inadequate or unavailable, so post-hospitalization care must be contoured for those who are still too weak to survive at home. But a nursing home?
Most of these patients are seniors and are insured under Medicare, so they have an established yet unreliable “star rating” system for the care rendered in these facilities.
Not until the situation arises, most of you have never visited a nursing home. The advent of odor eliminators has minimized their malodorous reputation, and demented screaming has been suppressed by drugs. Yep, older adults have been sanitized for a star rating.
No one can anticipate illness, so when you or your loved one requires hospitalization and expect discharge, you might have a day or so to decide where they will send you for further care. Potential facility internet site photos and descriptions are publicity-polished, crying out, “Choose me!” Sad.
I have never seen a library, community garden, kitchen for personal use, or a worthy outdoor space to be with nature in my nursing home rounds. Rarely have I seen a barber shop or beauty salon. Some patients will return home, but for most, this is their home.
Sure, there are some activities like physical therapy, but most of the time, patients sit in wheelchair-lined hallways or remain in bed where they receive meals. Sometimes, they have no purpose or goals and wallow life away. Wouldn’t your dignity diminish?
What about the basics of life, like glasses, dental work, or hearing aids? Even sitting in a wheelchair line up in hallways might not allow one to see, hear, or eat meals. Is this quality of life, or instead, where society has decided to relegate their seniors?
Unfortunately, nursing homes have no full-time staff physicians in-house or on-call who know all patients and their problems.
What can be done?
Let’s start with my expertise: Enhance the availability of house calls from physicians, nurse practitioners, physician assistants, and home health agencies. This way, patients can receive care at home after hospitalization and “age in place” instead of being institutionalized.
Examine the root cause of why hospitals shove patients from acute care into nursing homes: Money and profit. Criteria must be reexamined not from a coercive business viewpoint, but from a humanitarian and medical standpoint. Instead of hospital administrators establishing discharge standards, let it be in the hands of medically experienced doctors and nurses.
Educate patients and families about governmental oversight agencies, including state health departments or licensing agencies, and CMS (Center for Medicare & Medicaid Services) at the federal level. A worthy star rating system provided by the public is better than a “Choose Me” internet site.
Use newly minted residency-trained doctors to staff nursing homes to carefully watch over all patients. Medical school loans can be forgiven for each year of service provided to a nursing home.
Legally, legislate basic needs, including a library, community garden, personal kitchen, worthy outdoor space, and hair and beauty salons. Let us ensure all older adults are screened yearly for vision, dental, and hearing problems.
How much will this cost? It depends on you. Much of the cost can be mitigated by community volunteers and organizations willing to provide time and creative efforts to maintain quality of life for those who are aging.
For those who care, visit a nursing home and perhaps “adopt a resident,” especially one that might not have family or an advocate.
Many seniors are veterans, teachers, former first responders, retired nurses, doctors, social workers, and more. Importantly, they have provided the shoulders we all stand on.
As we age, no one should face the potential of being institutionalized in a nursing home and not be allowed to age in their home.
We can do better medically as a nation, but we must first learn to treat our older adults with dignity.
Gene Dorio, M.D.
Dr. Gene Dorio is a geriatric physician in Santa Clarita, is past President of the Los Angeles County Commission for Older Adults, and serves on the California Senior Legislature. 
I served as medical director at 1 nursing home and attending at 2 nursing homes for over 20 years from 1988 to 2008. This was in Oak Hill, WV. Because of the dysfunctional system that Dr. Dorio describes and that brought us to PNHP, I agree that living and surviving in a nursing home is no one’s first choice. But for me as a practicing geriatrician and medical director, I liked the work because it gave me the opportunity to advocate for the NH residents, to protect them from bad medicine, and also to honor the hard work that the entry level CNA’s were doing every day and night often understaffed. Same for the nurses, mostly LPN’s. Two of the biggest things I could do were to get people off useless, dangerous Beers list meds and protect them from being dumped to the ER in the middle of the night because of a cough or a fever. And caring for the families of residents was important as caring for the residents themselves.
Behind closed doors, we nursing home residents across the country are meeting up on a regular basis and we have come up with several ways to get our voices heard by the public so that we can help be a catalyst for change. We hope that you will all listen to our experiences being nursing home residents in different parts of the country. It is insane, the same exact patterns of behaviors like retribution and attrition-like retaliation we nursing home residents go through on a daily basis, and lies that are told by admins, social work, direct caregivers to break our spirits so that we either leave, get kicked out, or die from failure to thrive to stop us from speaking out our truths, THE truths. We plan to get loud and expose those who are guilty. Keep an eye out for us in the media! Thank you so much Dr Dorio, for your well written and very thoughtful writing. I hope to hear much more from you!
Those with LO in an ALF: SHARE YOUR ASSISTED LIVING STORY
I watched the Senate hearing this morning on: Assisted Living Facilities: Understanding Long-Term Care Options for Older Adults
They are asking for feedback on ALFs
With an estimated one million older adults and adults with disabilities residing in assisted living facilities, it is critical to ensure families have accurate and timely information about the costs and quality of assisted living services. I want to hear from you about your experiences as you navigate assisted living facilities for yourselves and your loved ones. Use the form below or email AssistedLivingBills@aging.senate.gov to share your stories and bills.
https://www.aging.senate.gov/assistedlivingbills
The video of the hearing is on YouTube
https://www.youtube.com/watch?v=d0Drrub4NQM&t=2335s
Dr. Dorio,
Thank you SO much for bringing attention to the ills of Long Term Care. Much needs to be done. I work with several grass roots advocacy groups and desperately want to see the day when legislation gets on board to assure positive changes are made.
Quality of Life is Medically Necessary
Melody Taylor Stark
Essential Caregivers Coalition
Melody A. Taylor Stark
“There are only four kinds of people in the world: those who have been caregivers, those who are currently caregivers, those who will be caregivers, and those who will need caregivers.” – Rosalyn Carter –
My 81 year old mother died from a staph infection due to no post surgical wound care at what I call the “Lack of Care Center” that she was shipped to after hip replacement surgery. Her surgical site was never cleaned or bandage changed hence the infection and her subsequent death.
Dr. Dorio’s treatise is spot on. The profits realized in so many “care” centers or nursing homes are astronomical if one digs deeply enough.
My hope is that no one in my life will ever allow me to be placed in one. Thank you, Dr. Dorio, for your exposure of this egregious handling of our precious older adults.
Thank you Dr. Dorio. You speak the truth and I speak from experience in saying that the end of life care of our neighbors, friends, and family can be much improved. I and my family did in home care for three family members for over 15 years; it was intense. You were their in home doctor and we relied on you more than we can say. There were no other solutions then and there are no good solutions now. Many of these folks come from the “silent generation” but there are now more than enough “baby boomers” back filling the roles and none of them have their voices. I’m now a senior in-home caregiver, as you recommended, and each shift I feel is my most valuable contribution. We simply must find a better way and it all starts with awareness. Please, go visit a nursing home near you, today, for that simple action has the potential to change the lives of so many. Perhaps, you may come back here and join the ranks of helping our senior population.
Nursing homes are the worst. The level of care is horrible. They are under staffed and most staff do not give proper care to your loved one. It is a topic that needs to be addressed and change needs to happen. Our seniors deserve better.
Gene is right on target. My wife broke her leg and was shipped to rehab (nursing home). One of the worst experiences of her life. Except for some physical therapy, she laid in bed all day. When she or her roommate had to go to the bathroom, often no staff member showed up in time. My daughter took a video of the hallway one afternoon. For 10 minutes, people were screaming for help but no one showed up. If this happens again, I will choose home care instead.
I visited at least 5 nursing homes in the SCV/San Fernando area in 2017 when I was told by the hospital he could no longer stay there. He could not be left alone and I was still working. I was appalled by the conditions in these facilities. I walked out of two immediately as I walked down the first hallway! The “stench” of human excrement permeated the air. No way would I leave a loved one in any of those places that left them lying in such condition. I paid out of pocket for personal home care for four months while I was away at work. Our society provides better regulations for pet care than for human care. Nursing homes are a sad situation.
The indignities start well before the nursing home time-frame! For example, the county requires yard clean-up for fire-prevention purposes–understandable and well-and-good. However, no agency offers even a data base of low-cost options for seniors who no longer have the physical capability to do the job. I was in this position last year; took the low bid that was more than my mortgage payment, and was lucky to have my step children volunteer to cover the cost. It’s a wonder there are any seniors who can age in place in their own homes!!
Sad. He has the right idea. Both my mom and dad were plagued at one time or another of being sent to rehab which meant nursing home. I personally said Hell NO. They stayed at home with in home care. They were the lucky ones they had dual insurance and my sister changed her whole life to help. I was there as much as I could be. I miss them both. I will never regret my decision to keep them out of any and all nursing homes.