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Neglected to death — travesties of good care for the elderly


Index

U.S. Nursing homes quietly kill thousands

They died painful, preventable deaths and left behind families tormented by their loss.

They are victims of poor care in nursing homes, a cross section cut from the fabric of America - mothers and fathers, war heroes and homemakers, black and white.

— PHILLIP O'CONNOR AND ANDREW SCHNEIDER,
writing for the St. Louis Post-Dispatch
in a series of articles on the state of nursing home care in the US
Oct. 12 - 19, 2002

Those articles are journalism at its best. I became aware of the series of articles on the deplorable — one could say deadly — quality of nursing home care in the US through the following quote from YahooNews in the LifeSite Daily News newsletter:

REPORT SHOWS HUNDREDS OF ELDERLY DYING IN NURSING HOMES FROM NEGLECT

Most of the deaths are caused by neglect traced to caregivers whom the elderly rely on for food and liquid, and for turning them in their beds to prevent life-threatening sores, investigators and researchers say. The latest national compilation of more than 500,000 nursing home deaths - for 1999 - lists starvation, dehydration or bedsores as the cause on 4,138 death certificates.

Yahoo News, Oct 15, 2002

Yahoo gave their article the header: "Nursing homes kill hundreds". I can't for the life of me guess what made them do that, given that the title, more correctly, should have been: "Nursing homes kill tens of thousands each year".

The tally of elderly killed by nursing-home staff identified a total of 4,138 death certificates that showed starvation (hunger), dehydration (thirst) or bedsores (flesh rotting at pressure points, often right down to the bone - due to a patient not being turned often enough in his/her bed) as the causes of death out of 500,000 nursing home deaths during 1999 in the US. The St. Louis Post-Dispatch did not once state anything that would have given YahooNews any reason for choosing their header. The title that the St. Louis Post-Dispatch gave their first article in their series is "Nation's nursing homes are quietly killing thousands".

Only 4,138 death certificates listed starvation, dehydration or bedsores as the causes of death, but, as Phillip O'Connor and Andrew Schneider identified in their series,

...death certificates alone don't begin to tell the story.  A handful of investigators and researchers, working in specific geographic areas, took the time to compare patient medical records with their death certificates. Plaintiffs' lawyers, representing aggrieved relatives across the country, have gone through the same exercise.

Their findings indicate that the number of preventable deaths attributable to malnutrition, dehydration and bedsores from bad care or no care is much higher.

Louisiana Sen. John Breaux, a Democrat and chairman of the Senate Special Committee on Aging, called deaths from nursing home neglect "a hidden problem."...."We know it's significant," said Breaux, noting that investigations by his staff and other research show that 500,000 to 5 million cases of elderly neglect and abuse take place in institutions and private homes each year, although about 80 percent go unreported.

"The number of avoidable deaths of our elderly could be in the tens of thousands," said Breaux, ....

— in Nation's nursing homes are quietly killing thousands
By Andrew Schneider and Phillip O'Connor
A special report by the St. Louis Post Dispatch
10/12/2002

The number of 4,138 deaths that occurred on account of obvious and quite possibly deliberate deadly neglect in 1999 is about four times as many as women that were being killed in spousal violence incidents in 1999 and almost three times as many as all reported spousal violence-related homicides in a given year.  The true disparity between those two causes of death, deliberate neglect and deliberate violence, could, going by what Louisiana Sen. John Breaux stated, be much larger than that.

Black men and women and White men are far less likely to run the risk of meeting that fate because their shorter average life spans don't permit most of them to live long enough to have to live out their days in a nursing home.   White women over 75 comprise most of nursing home inmates.  It stands to reason that they also comprise the majority of the victims of deadly neglect in nursing homes. 

Why is it that influential feminist organizations like NOW appear to be unconcerned about what is being done to women in nursing homes? Could that be because the nursing-home staff involved in those killings is mainly comprised of women? Perhaps the reason is nothing other than that NOW fears to have government funding reduced or withdrawn if it is critical of the federal government.

The government carries without any doubt a substantial part of the blame for the state of nursing-home care.  Andrew Schneider and Phillip O'Connor report a number of causes for the state of affairs of US nursing homes that appear related to action and inaction by the governments, amongst them:

  • Nonfunctioning or badly operated complaint systems;

  • Reluctant prosecutors;

  • Medical examiners who play down the problem;

  • Lax inspections and apparent collusion (nursing homes are often aware when inspections will take place and do their best to make a good impression and to doctor their records accordingly);

  • Lack of enforcement tools;

  • Increasing workloads;

  • Inadequate laws;

  • Jurisdictional conflicts, and

  • Powerful lobbies and political action committees acting on behalf of the nursing-home industry.

The articles also identify that non-profit nursing homes such as those run by churches provide a markedly better quality of care.

What is worrying is that by reading the series of articles in the St. Louis Post-Dispatch one gets the impression that the situation is very likely much worse than the articles reported. " Autopsies are rarely done, medical records are sometimes falsified to conceal the lack of care, and nursing home officials are often less than forthright in discussing incidents leading up to the deaths."

The problem is so large and pervasive that it boggles the mind. 

Deficiencies are rampant

About 3 million people a year pass through America's 17,000 nursing homes. Patients occupy about 1.8 million beds on any given day; most are white women who are at least 75 years old.

Many of the 1.3 million cooks, janitors, administrators, nurses - the majority working for near poverty-level wages - treat their jobs as a calling to ease the pain and safeguard the dignity of their charges.

But it is the homes and workers that don't perform up to standard that concern most of the 700 professionals interviewed by the Post-Dispatch for this series. They include nurses, researchers, physicians, patient advocates, death investigators, nursing home operators, prosecutors and federal, local and congressional  investigators.

In their eyes, government regulators are losing the war - and in some cases, not even fighting the battle - of preventing negligent deaths of the elderly.

(The full series of articles in the St. Louis Post-Dispatch)

Elder abuse elsewhere

We have not seen the last of the collapse of our society.  The elderly being killed in our nursing homes are nothing but an early indication of worse things to come.

The issue of the killing of elderly through neglect in nursing homes is not just an American one.  A similar state of affairs appears to exist in the U.K., in Canada and in other developed nations. (See Annotated Bibliography, Clearinghouse on Abuse and Neglect of the Elderly (CANE), National Center on Elder Abuse, July 2002, Elder Abuse - A Global Issue)

Recently, an investigation of suspicious deaths of 62 elderly in London hospitals was launched. The administrator for the London hospitals only had to say, "What do you expect us to do? We need the beds", when it was found that elderly patients are frequently killed through giving them sedatives and withholding food and liquids from them, even though they may have entered the hospital only for minor health complaints, such as an arthritic knee.

We now and then hear complaints about the quality of nursing home care in Canada. It seems that the media are not too interested in the issue, although just a few days ago I read an article from a small-town paper in Ontario in which the author complained about the large differences in the care provided for Canada's prison and jail inmates who have access to full medical care and the right to a daily bath, compared to the weekly bath and the lack of care given to our elderly mothers and fathers in nursing homes, elderly who barely are given enough time to eat their meals (they have, according to the example cited, a little over one minute for each of their three daily meals).

Will things improve?

Not many detailed stories about the care for the elderly are being published in Canada's liberal and Liberally controlled media. Perhaps the reason for that is that if objective reporting were to be done, it would destroy the myth that the Canadian health-care system is the best in the world, as our politicians are prone to tell us, even though that claim is far from the truth. [Update 2003 12 09: That statement is no longer quite true.  The Toronto Star is presently publishing a series of articles on the shocking neglect of the elderly. ]

Here is a link to story about the horrible experiences of Jean Warden.  Jean Warden's story made the evening news on TV on October 10, 2005.  Her son, Bob Warden, with the help of Ruth Adria, an advocate for the elderly in Edmonton Alberta, is doing an excellent job of getting to the roots of that story. 
   Doing so will not bring Jean Warden back to life.  She died of the consequences of dehydration, starvation and inopportune infections that she contracted as a result of common and apparently deliberate neglect in an area assisted-living apartment.  However, getting to the root of the problem will help to improve living conditions for many others that have good reasons to expect to have to die under similar circumstances, as enormously large numbers of elderly presently do.

The executive summary of the Fraser Institute report "How Good is Canadian Health Care? An International Comparison of Health Care Systems" (2002 08 19) concludes:

The comparative evidence is that the Canadian health care model is inferior to others that are in place in the OECD.  It produces inferior access to physicians and technology, produces longer waiting times, is less successful in preventing deaths from preventable causes, and costs more than any of the other systems that have comparable objectives.  The models that produce superior results and cost less than Canada's monopoly-insurer, monopoly-provider system have: user fees; alternative, comprehensive, private insurance; and private hospitals that compete for patient demand. The overwhelming evidence is that Canada has a comparatively underperforming system of health care delivery, and needs to emulate the more successful models available elsewhere amongst those countries that offer their citizens universal access to health care.

In its news release announcing the report, the Fraser Institute states that "Canada spends more on health care than any other industrialized country providing universal access yet winds up near the bottom of the heap in quality of service".

It appears that no comparative international evaluation of the treatment of our elderly fathers and mothers has been undertaken by any agency in the world.

If one wishes to obtain information on the quality of service provided in the care for our elderly, one must speak with relatives of people in nursing homes or with staff who work there and are appalled by the conditions that prevail in many of those institutions.

In conversations with one of my sisters, who provided in-home care for her husband and two of her children until she was well into her 70s, I gained the impression that the situation is no better in German nursing homes.

That impression was confirmed through my oldest sister's husband who had been the city alderman for the elderly in my town of birth, Duesseldorf.  That was why he and his family, too, decided that when my oldest sister finally succumbed to her long battle with cancer, they would do what they had done as much as they could up to that point, keep her out of the hospital. They provided palliative care for her at their home until her death in 1995.   They were blessed with the circumstance that my oldest sister was ambulatory until about six weeks before her death.

Let the few of us who have loving and caring relatives that are willing and able to make the sacrifices necessary to care for their relatives, until those meet their maker, count their blessings. The State is one of the worst imaginable substitutes for loving and caring families.

However, there are other culprits, all of us and our families (or the lack of them). Nobody should have illusions that all families are better care-providers than the State is. That is a matter of attitude and love.  That needs to be learned, not legislated. Loving care is something that once was taught in families and even in our schools. Along with that came also the teaching of duties and obligations, not the current emphasis on self-esteem, self-fulfillment, and sex-education promoting alternative life styles including different "family types". But those issues are material for more extensive discussions, and they are covered elsewhere on this website. [Update 2008 05 11: It is strongly recommended to take a look at "SHOULD SCHOOLS TRY TO BOOST SELF-ESTEEM? Beware the dark side", by Roy F. Baumeister]

One thing is certain, when we still had a sufficient number of functioning and loving families, we did not have costs for the care of the elderly that escalated at 25 percent annually as they do now. That was when grandparents still played an important role within their families and made possible the intergenerational transfer of cultural- and family traditions. That was when the elderly were not yet ware-housed in places with names like Golden Sunset, Park Acres or New Horizons. That was when our parents still lived out their days in true homes, the homes of their families.

Now that we brought about the deliberate destruction of a large portion of our families and largely prevent the formation of new ones, we pay — through our taxes, with our life savings, and by putting our future earnings into hock — to have strangers do for profit and for a living what our families used to live for and to provide free for the love of it.

Still, there are many cases where elderly family members must be hospitalized, and where the risk of them being abused and neglected can be prevented by relatives that make sure, on a daily basis, that their suffering relative receives the required care.  We know of many instances where family members did just that.  In one of those cases a blind elderly man suffering from complications that arose from him being diabetic spent the declining years of his life in a local hospital.  His brother came to visit him several times each day, fed him and made sure that all of his bodily needs were taken care of.  The hospital staff did bring enough food for the sick man but had expected that patient to feed himself, which he could not.

Lorne Gunter, writing for the Edmonton Journal in a 1998 article The sorry facts behind common-law marriage, addressed the question: "What business is it of anyone else if two consenting adults decide to live together rather than marry?"  He described the enormous consequences and social costs of common-law marriages, of relationship break-ups and of single-motherhood, and then answered the initial question, "Just one thing: the cost of cleaning up the wreckage."

The escalating costs to society of providing care for our orphaned elderly must be reckoned with in the consequences of the systematic destruction of our families and thereby of civilization.  It should be clear by now even to the most obstinate ideologues that the experiment of re-engineering society has failed.  The State cannot and does not want to do things as well as our families once could and did.  It appears that the primary objectives of the State are to cater to business and industry, and to perpetuate itself.  Families are not only last on the State's list of priorities, they are still being systematically deconstructed and abrogated.

Patrick Fagan and Robert Rector, in The Effects of Divorce on America, (a Heritage Foundation report), identify beyond any doubt that the systematic deconstruction of our families is destroying society.  They stated:

Fiscal conservatives should realize that federal and state governments spend $150 billion per year to subsidize and sustain single-parent families. By contrast, only $150 million is spent to strengthen marriage. 

Thus, for every $1,000 spent to deal with the effects of family disintegration, only $1 is spent to prevent that disintegration.


How to recognize elder abuse in institutions and where to go for help:

For descriptions of the methods used to speed-on a patient to his end, check Patient Protect.  It is an organization in the U.K., but the methods they describe are generic.  After all, there are only so many ways for hospitals by which to kill, but at least you will be able to recognize the methods when you encounter them. 

In Alberta, Canada, Alberta Health recommends the following via their help line if a given complaint deals with the quality of care in a hospital:

  1. Complain (in writing) to a given hospital administrator;

  2. Complain (in writing, including copies of documents used under #1) to the Health Region authority, and

  3. Complain (in writing, including copies of all documents used under #2) to the minister of health.

I'm reasonably sure, that will work about as well as it would have if a Jew in Nazi Germany would have followed the line of command from the camp commander to Heinrich Himmler to complain about the quality of the accommodations in the concentration camp into which he got placed.  Does it help if the hens that are being killed complain about that to the foxes that guard them?

Quite possibly, a more practical method is that recommended by Mrs. Nancy Mereska, an advocate for a better and improved health-care system.  Mrs. Mereska suggests that if one needs to launch a complaint that it will help to "write letters to your Member of the Legislative Assembly and to your Member of Parliament, and to make presentations to the applicable Regional Health Authority—IN PERSON."

It will give your efforts more weight if you keep media and consumer advocates informed of your progress with your complaint, and to make sure you let the individuals in the hierarchy to which you complain know about that.   Make your efforts to obtain publicity is known to them in no unmistakable terms.

Mrs. Mereska identified another source of information:

Roger Epp of Augustana College, Camrose, Alberta, and [Dave Whitson,] a colleague, put together a book, Writing Off the Rural West: Globalization, Governments and the Transformation of Rural Communities.   Page 263 has a chapter called "A Good Place to Grow Old?", which addresses the declining services in rural Alberta. The book is published by The University of Alberta Press, Ring House 2, Edmonton, Alberta T6G 2E1, uap@ualberta.ca.


All of us are getting older. There is no use denying that. I saw it the last time we met — those of you I did meet.  We are all getting older, one day at a time, day by day.

Be careful about the kind of retirement home you choose.

The Toronto Star ran a series of articles describing the quality and condition of nursing homes that care for the elderly. It's not good. It's about as bad as things are in the US in that regard, and, from what I hear, things are not very good in that regard in Alberta either.

If you should wish to check out a home for the elderly, it's a good idea to follow your nose. If it smells like urine, don't go there.   I know quite a few of them that smell about as bad a public urinal whose flushing system ran out of water.  I know a few hospitals that smell that bad, even though they regular meet accreditation requirement.  I guess the government inspectors either lost their sense of smell or they hold their noses when they do their inspections — that are supposed to happen at random and unannounced but are known about in advance by those that are supposed to be inspected.
   See, it must be that the staff of the hospitals about to be inspected are clairvoyant.  Perhaps that is one of the job requirements they must meet to become employed.

One of the problems identified for the Ontario homes is that, by provincial law, patients or residents were to receive a bath once a week, but that law has now been taken off the book.
   That is very intriguing. Canadian prison inmates have the right to take daily showers. Maybe it would be a good idea to try to spend one's last days in prison. Considering the alternatives, a shower a day, enough food to eat, and all of the medication needed to be kept in good health sounds pretty attractive.

It will not take much to earn the privilege of a shower a day. All you have to do, if you should happen to live in town, is to refuse to shovel the snow off your sidewalk.  That is what an elderly lady in Edmonton did this winter.  She refused to clear the snow off her sidewalk.  When the City of Edmonton sent her a notice, she still refused.  The City of Edmonton then charged her with a fine of 85 dollars.

The ticket was issued Feb. 24 when Friesen refused to strip off the final one centimetre of densely packed snow on the sidewalk in front of her house. Although the bylaw says homeowners must make sure their sidewalks are bare and dry within 48 hours of a snowfall, Friesen argued her walk was safe and pedestrian-friendly.

To no avail. Last week Friesen lost her case and, when she refused to pay the fine, she was sentenced to jail time.

Mind you, 69-year-old Olga Friesen took that extreme course of actions in protest against three years of harassment by city-inspectors that her neighbour kept sicking on her, but don't let that hold you back.  You will become eligible for better accommodation than that you get at many nursing homes with literally no effort.

And if you still live on the farm, that's no problem either. Just take your .22 for a walk and shoot a few gophers. However, for that you'll have to wait a few months. So it may be best to forget about the gophers, but take the .22 anyway. A shower a day and no utility bills, that sounds pretty good; and, from what I hear, the food is supposed to be pretty good too. 

So far it is all free of charge — well, not entirely free, as there is no such thing as a free lunch.  The taxpayers provide about $80,000 (for men) and more than $120,000 (for women) to accommodate a single jail inmate for one year; far more than what nursing homes charge to accommodate an elderly individual and letting him die of starvation and neglect.

Toronto Star

Dec. 6, 2003. 01:00 AM

KEN FAUGHT/TORONTO STAR

Shocking neglect of elderly

Exclusive study reveals inadequate care is widespread

At least one third of 544 homes have history of injury, abuse

Most nursing-home staff, fearing reprisals, are reluctant to talk about conditions in homes. Worker Dorothy Algar, above, feels speaking out can only help residents get better care.

THE STORY SO FAR

Part 1: Natalie's story

Part 2: 'I'm so sorry'

Part 3: Helpless family

Part 4: Shocking neglect

Part 5: Secret records

A daughter's sad diary (Dec. 7)

Minister promises change (Dec. 8)

All related stories

Voices: Your stories

Services for the elderly are declining not just in rural Alberta.

Is Canada's health-care system really that bad? The death of a neighbour

If you have concerns about these and other issues related to the condition of seniors, visit, contact and perhaps even join:

SUN — Seniors United Now

The up- and coming, rapidly-growing advocacy organization for seniors (55 years and over) in Alberta

There are in the order of about half a million or more people of age 55 and over in Alberta. If all of them were to join SUN, they would become the most powerful advocacy organization in Alberta; and seniors would no longer be robbed of their comforts and otherwise ignored.
   At the price of one package of cigarettes seniors will be able to gain a voice that will be heard by a government that otherwise can and will take from seniors what they worked for all their life to enjoy in their old age.

If you are concerned about how seniors are affected by the planned, systematic destruction of our families and society, a search at google.com (for elderly OR seniors OR grandparent OR grandfather OR grandmother site:http://fathersforlife.org) will provide you with the links to about 84 web pages at Fathers for Life that will be of interest to you.

(More information will be identified here as time goes by.)


Back to Index of Health Issues

White RoseThe White Rose
Thoughts are Free

__________________
Posted 2002 10 23
Updates:
2002 12 09 (added reference to Toronto Star series of stories on neglect of the elderly, and related comments)
2004 06 24 (added entry for SUN — Seniors United Now)
2005 10 21 (added link to Jean Warden's story; reformated page)
2005 10 22 (added index)