The Best Care in Town

My father-in-law, who suffers from Alzheimer’s disease, had a stroke in August, and he has been in a wheelchair ever since. He was in a nursing home for two months. You would think that at least my mother-in-law would be relieved that he would be taken care of professionally, wouldn’t you?

Nursing homes are commercial facilities here. Apparently everyone can call themselves and expert (kind of like house painters) and open a nursing home. You do need licenses, but that can’t be too hard, considering the results.

My father-in-law went to the facility with the best reputation in the area. This high-quality nursing home does not have a doctor. A general practitioner is purportedly on call, but he only comes on Fridays. My father-in-law came there from the hospital on a Friday after the doctor had already been, so he didn’t see a doctor until he had been there a week. In the meantime the nurses were experimenting on their own with tranquilizing medicines, since he can be excitable, with some advice over the phone from the doctor who had never seen him.

There was also no dietician. All those old people, with all their various ills and circumstances, all got the same food. My father-in-law hadn’t eaten or drunk anything for three days, and his first meal was brisket. Not only shouldn’t they have given him beef on his quite literally empty stomach, but his food should’ve been pureed, since he had just had a stroke and couldn’t chew properly. But that was apparently too complicated for the kitchen staff. Or too labor-intensive to be profitable. For breakfast he got toast (white bread), for dinner pizza, macaroni with cheese, hamburger, or some other high-fat, non-fiber meal. None of which the nurses made much of an effort to feed him, so my mother-in-law was there every morning at 8 with food that she had prepared, and she fed him.

She went home at night, but even there the responsibility for her husband’s well-being was apparently still hers. When she came to the nursing home in the morning, she got detailed accounts of how difficult he had been, and who all he had kicked that night, making her feel guilty, for God’s sake.

An intake-interview took place after he had been there two and a half weeks. Maybe someone there should look up the definition of the word. A doctor, the head nurse, and a social worker were present. Only then was it decided what kind of therapy he needed (and Medicare only pays for the first month in a nursing home).

During this interview my husband and his half-brother mentioned the bad – if not absent – care their father had received so far, and the response was that if there was anything they were not satisfied with, they should not hesitate to call the head nurse. In other words, the family has to supervise the nursing staff, and then tell their boss about it, who is the one actually paid to do the supervising. So my mother-in-law was there from early in the morning to about 9 at night, and if she needed a break she would pay someone from outside (on top of the thousands of dollars she was already paying) to do the work the nursing home staff should be doing.

You may think that it was my mother-in-law’s fault. That she enabled the staff not to do anything by doing it herself. Surely most of the other old folks don’t have somebody sitting there with them all day. Well, actually, they do. And those that don’t probably don’t live long. If my father-in-law hadn’t had family or an outside paid caretaker there to make sure he got the care he needed, the following would have happened: He wasn’t eating, so he would end up having a feeding tube. He was difficult when the nurses tried to change his diaper, so he would have been heavily sedated, and because of that he would have slept all day, not eaten anything, and not had any therapy. He would have continued living like a vegetable for a short time, and then he probably would have died of starvation or some infection. And that would at least be a somewhat peaceful death.

Nobody supervises the staff, and nobody supervises the patients, either. My father-in-law couldn’t walk, so for him it was not an issue. But there are also walking patients, and this best nursing home in the region has no reception area and no receptionist. The front door is always open, and at night the back door is open. My husband’s half-brother and his girlfriend regularly went to visit my father-in-law at 2 in the morning. They would come in through the back door and walk across the entire building to my father-in-law’s room without seeing a soul. So anyone can get in, and anyone can get out. At some point during the last weeks of his stay in that nursing home the local television reported that an old man had left his nursing home (a different one) in broad daylight, and walked straight under a car on the busy through street that the nursing home was on. Dead. The police are still looking for the driver, who kept going. No mention of locking up the nursing home staff who were responsible for his well-being.

(From a letter in October, 1997)