PERHAPS EVEN MORE than their fear of cancer, people are terrified from their earliest childhood years by the thought of "growing old," "losing their minds," and "being put away" in a nursing home. Of course, not everyone who is put in a nursing home has lost his or her mind. Other conditions lead one down his path as well. But certainly, the devastating and dehumanizing diseases of the brain are common causes of institutionalization.
In other words, the primary problem in dealing with the distressing shortcomings of nursing home care derives from our innate capacity to deny painful reality. Whether we are physicians, other health-providers, legislators, decision-makers, or members of the public at large, our dread causes us to retreat into ignorance.
Fromer Senator Frank E. Moss, chairman of the Long Term Care Subcommittee of the excellent U.S. Senate Special Committee on Aging, and the Committee's counsel, Val J. Halamandaris, have laid out all the facts:
Here are but a few of the facts behind their judgment:
Nursing Homes Without Nurses: The nearly 60,000 registered nurses who work in nursing homes are generally overworked and overburdened with administrative duties. And the approximately 45,000 licensed practical nurses also must perform supervisory health-care and administrative functions. As a result, nearly 90 per cent of the day-by-day care is provided by 280,000 untrained, unlicensed and poorly paid nurses' aides and orderlies, who have a 75 per cent annual turnover rate.
The Profitability of Nursing Homes: Moss and Halamandaris speak of the "geriatric gold rush" and quote the former administrator of the Cost of Living Council: "There is an immense profitability in owning and operating nursing homes." It has proven particularly lucrative for large nursing home chains whose gross assets, total revenues and net profits have increased dramatically between 1969 and 1977.
The Absence of Geriatric Medicine and Geriatric Nursing Education : American medical and nursing schools do not comprehensively and systematically provide teaching about human aging and geriatric medicine.
The Farce of Enforcement: HE can withhold funds from an entire-state and from specific nursing homes. But states often lamely claim that they close homes, there will be "replace else to put the patients." Enforcement of nursing home standards by states and the federal government is uncommon.
The Frequency of Fires : There were some 9000 nursing home fires in 1976, an average of 25 a day for each day of the year. An estimated 500 patients died up single-fatality fires. For major tragedies took the lives of 41 patients.
In 1974, Dr. Faye G. Abdellah, the director of the Office of Nursing Home Affairs, announced that 59 per cent of the nation's 7000 skilled nursing homes did not meet the minimum fire safety standards set by the government. In 1975, HEW noted that two thirds of the nursing homes surveyed had more than four fire safety deficiencies.
Dumping of Patients : If a state releases its older mental hospital patients unconditionally and maintain the fiction that they are simply indigent elderly, the federal government will pay 100 per cent of the cost of their support through the Supplemental Security Income program. For every individual moved from a state hospital to a boarding home, the average states budget will be richer by the sum of $1,157 a month (1976 figures).
Our cities have "geriatric ghettos." There are 13,000 patients discharged from Illinois State hospitals living in an area called "uptown" Chicago. Closer to home, numerous ex-patients are found near Ontario Road in Northwest Washington.
Racial and Ethnic Discrimination : Title VI in the Civil Rights Act of 1964 prohibits discrimination based on race, color, or national origin in any institution which receives federal assistance or participates in federally assisted programs. Nursing homes can receive federal financial assistant through some 50 programs. However, only two per cent of the older people in nursing homes are black, with another two percent from other minority groups.
These are but several of the painful facts that potentially affect each and every American who grows old. If we force ourselves to accept the reality presented by Moss and Halamandaris, we will be better able to take positive action to improve nursing homes in America.
Too Old, Too Sick, Too Bad is a valuable, straightforward, effective book on nursing homes in America. But will people read it? Speaking plainly, there have been other books and numerous newspaper reports about investigations of nursing homes over the past 30 years. But the subject is so paintful for people of any age to absorb that I doubt most are able to look objectively at their future aging selves.