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In Incredible Pain
Behind this appalling care is a familiar problem in the nursing professions: too few staff assigned to too many patients. "Everyone should know there is a certain amount of neglect that goes on in every nursing home because they simply don't have hands-on staff to take care of people," says Barbara Hengstebeck, who was Florida's nursing home ombudsman for six years before becoming executive director of the nonprofit Coalition to Protect America's Elders. In fact, the Department of Health and Human Services found that more than 90 percent of nursing homes don't have enough staff to provide proper care.Janet Wells, a policy expert at the National Citizens' Coalition for Nursing Home Reform in Washington, D.C., says, "We frequently get calls from nursing assistants who say they are taking care of more than 30 residents a night." Yet Wells's organization warns that this is more than twice the number of recommended patients per certified caregiver.
It's shameful that facilities are routinely understaffed, given that the majority of nursing homes are for-profit enterprises and operating in the black. Nonetheless, staff tend to be overworked and poorly paid, leading to a high turnover rate of caregivers.
According to a GAO study, replacement rates at some facilities approach 100 percent a year. What's lost, of course, is institutional memory and the continuity of care that goes with it.
The family of Glen Macaux learned the terrible price nursing home residents can pay when staff are inattentive. Macaux, a father of five who ran a life insurance office in Green Bay, Wisconsin, was fairly robust when he entered a nursing home for rehabilitation after knee surgery at age 82. He'd been diagnosed with Parkinson's disease and had diabetes, but both conditions were stable. "It wasn't like he was in bad shape," daughter Carol Macaux, 52, recalls. "The expectation was that after he had his physical therapy, he could use his leg."
After the first week, though, things went very wrong. Glen Macaux seemed groggy and was becoming unresponsive. According to Carol, when the family questioned the nursing home staff, "they just said, Well, he's on antibiotics." Then a physical therapist noticed redness near the surgical bandages on his knee.
"It turned out they didn't change [the bandage] or inspect the surgery wound for six days," Carol says. "When they moved him into his wheelchair, I could see him wince. My eyes were just bugging out because he was in such incredible pain."
Rushed to a hospital, Macaux was already suffering from septic shock and renal failure, with a pressure sore now growing on his heel. "He was literally at death's door," his daughter contends. His knee incision required three painful debridements, which meant doctors had to detach ligaments and tendons to remove the infection. He would never regain use of his leg. "The surgical nurse started crying because of the state of the wound," Carol says. "Everyone was just mortified that [the nursing home] had allowed this to happen." (The family ultimately settled with the nursing home, which denied any responsibility.)
Part of the shock for families who experience poor nursing home care is that they're usually paying a bundle to keep their loved one in a facility. The average cost of an annual stay is $71,000 for a private room and $62,500 for a semi-private room, according to a national study released in March 2006 by Genworth Financial, which sells long-term care insurance.
It's especially galling that these prices don't guarantee basic care, leaving older people vulnerable to very preventable illnesses. "Dehydration is extremely common," says Wells, whose organization briefed Congress last April. "It's a terrible problem, people just being thirsty and not getting access to water."
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