Doctor’s Diary July 2, 2021: The nursing home crucible

(Snippets from the frontline)

The nursing home crucible

Harriet broke her hip and needed surgery. Post-operatively, the hospital was swift to push her out the door, while Medicare controlled the financial strings. Instead of going home, she went to a nursing home.   

During the pandemic, she never saw her family in person, then contracted COVID-19…and died alone.

For over 30 years, I have visited patients in nursing homes, and during this time saw older adults shepherded by the healthcare conveyor belt into this abyss.

The term nursing home has been modernized to “Skilled Nursing Facility” or “Rehab Center.” But a nursing home is a nursing home, and the walls, beds, curtains, and smells don’t change with the name.

The COVID-19 pandemic will be stigmatized by a shameful reminder how hospital greed and government failure contributed to the death of 136,000 senior Americans in nursing homes. 

Your initial notion on entering these doors is of permeating bodily smells and uncontrolled screaming. This is rare. But you soon realize you don’t want the doors to lock behind you.

Most of the time, rooms are shared with at least one other resident.  Privacy is separated by a thin curtain.  Rarely one has a ground phone line, no convenient WiFi, and sometimes no TV.  When you do have TV, it has only basic cable. 

Three bland meals a day are provided, and you are rolled out in a wheelchair in front of the nursing station to watch them work while they keep an eye on you.

There is no library, no garage to putz around in, and you cannot leave the facility unless you have a doctor appointment.  No grocery shopping, going to the mall, participating in senior center functions, or visiting family and friends. 

You are caged-in, controlled, and dependent on people you don’t know.  This is a sorrowful situation relegating seniors to hopelessness when they could have remained in their home and received the same care.  Our society has yet to provide this care as older adults are “put out to pasture” disregarding their experience, talents, education, and wisdom.

Harriet would never have expected not to return to the home where she raised her children, gave piano lessons, cared for her dying husband, and tended her garden.

How do we solve this social scourge corralling seniors into a living situation where they are made susceptible to disease, but also makes them languish in a restrictive, depressing environment hoping to go home, yet feeling locked-in and sometimes waiting to die?

In order for older adults to “age in place,” we must develop “age friendly homes” that adapt as we get older.  Preferably single story with minimal steps; wider doors and hallways for wheelchairs; outside ramp adaptable; roll-in showers; grab bars especially in bathrooms and bedrooms; night-lit hallways; and padded gym-like flooring to absorb impact in case of falls. 

We can have robots assist us, body exoskeletons to get us out of bed, Hoya lifts to help transferring, and autonomous cars to get us to the grocery stores and doctor appointments. 

Plus we need to have continual monitoring for safety, and WiFi for communications (like teleconference doctor visits).

Most importantly, we must provide adequate home care services including house calls from doctors, nurse practitioners, physician assistants, physical and occupational therapists.  We must have the ability to obtain blood work, x-rays, EKGs, ultrasound, and scanning.  This would have allowed Harriet to return home.

Providing senior friendly homes with adequate healthcare services will allow older adults to “age in place” and keep them out of nursing homes. 

Recognition and implementation of these changes are not yet on the horizon.  Until then, how can we make nursing homes tolerable and less threatening physically and psychologically for seniors?

Instead of modernizing the nursing home name, let’s try to improve the ambience and quality of the living situation for older adults who are relegated to these institutes.

Let’s enhance communications at nursing homes by furnishing WiFi with phone connections and cable TV.  Why shouldn’t they be given access to newly released movies and local sporting events?

Provide them a kitchen for supervised cooking, a garage to putz around in, and a garden to tend flowers with vegetables and fruits.  Let them have a library with ample access to newspapers, books and magazines, and a computer room to maintain contact with friends and relatives.

Rarely will you find any of these amenities in a nursing home.  Why not? 

Visit a nursing home and talk with some of the residents.  They are not only moms and dads, but also retired teachers, first responders, former athletes, government employees, and soldiers. The basis of our country’s past lives within these walls.

Older adults should be honored with the dignity they deserve.

As we again open as a society after this pandemic, make that commitment and visit a nursing home. 

Just make sure after you enter, the door doesn’t lock behind you.

Gene Uzawa Dorio, M.D.