Mr. Robert M. Philson, Chairman of Citizens Bank, retired Attorney,
District Judge, and Magistrate, exclaimed on July 14, 2015, “How can any business run like this?” Mr. Philson has not received a statement or billing notification of any kind for six months. Earlier in the year, he relocated his wife
to Goodwill Retirement Community in Grantsville, Maryland. His wife complains of terrible food and conflicts with some members of the nursing staff. She was a music teacher for years in the high school system. She developed
neuropathy for some unknown reason. There is no cure.
When a sudden deterioration of her condition occurred, she had a short stay in the hospital. Once it was determined that nothing more could be done, she was transported to the dementia unit at Goodwill Retirement Community. Finding it absolutely unbearable, her husband had her moved to a private room in skilled nursing. “The only way someone can stay in dementia or nursing at this place is to not know what is going on,” said her husband.
“Have you been in the business section? These people do not know what they are doing. They tell me that they cannot put a date on a statement! I am five years older than my wife and I am probably going to die before her. Who will take care of her? She cannot stand the chicken. I crossed off each meal of chicken on the menu so that she gets the substitute. But who will even put batteries in the clock in her room?” With teary, reddened eyes, the exasperation and fear of the future for his wife is clearly evident.
He has stents and medical problems, but visits his wife regularly. Still handsome, he was once a dashing young man who competed in tennis with the best and was admired by all in the legal world. His charm still radiates with a broad smile, compassionate eyes, and the dignity of graying hair. He once counseled his clients about the expectation of living three years in nursing home facilities and to plan their retirement accordingly. Now he faces the reality of actuarial sciences predicting the same three years for his wife living in long-term care. With downcast eyes, he murmurs, “I hope they take care of my wife after I’m gone.”
Even as a retired Attorney, Magistrate, Judge, and continuing as Chairman of a wealthy bank, his eyes and expression on his face speak loudly of the realities of aging. The once strong and capable of anything, Judge Robert M. Philson now walks a little bit slower with an unsteady gait at times. He stands at the door and looks over his shoulder saying, “She is never going to get any better. Who will take care of her when I’m gone?” He sighs and leaves the room.
Ms. Jan Bond wrote on July 13, 2015, “I have a plan in place that will make sure I never see the inside walls of any of these so called nursing homes. I’ve been a visitor in far too many of them and I haven’t seen any palpable change with regard to the facility in over thirty years. It scares me to death. The government doesn’t care or we would’ve seen changes by now. The private sector that run some of these so-called homes has been nothing but greedy, and that irks me to no end. People have to start to realize a plan has to be in place before they get to a point where they need this type of care.”
Ms. Bond continued to explain how she has an understanding of long-term care. “All of my knowledge comes from my precious, Aunt Phyllis, who passed away last year. She was in a wonderful assisted living facility that reminded me more of a very fancy hotel. The minute she started falling, she was tossed out of the facility. She was first moved to a nursing home that my great-grandmother was in and it was very old. Aunt Phyllis was only there a few months before she told her son she wanted out of there. They finally found a place about forty miles from the last home that admitted her. She did not know anyone there. Only one family member was close by and I give him credit for checking on her daily. She didn’t even make it a year in that place. I could tell when I visited her last June that things were going downhill fast. Her son relocated from California and moved right across the street from the home, but Aunt Phyllis just wasn’t happy. She was not getting the kind of care she needed which was lots of love and compassion. She only lasted about a year in her final nursing home. She deteriorated so fast and I truly believe it was because of the nursing home. No one at that nursing home was interested in her -- she was nothing but dollars to them. So, so sad, but so true! It broke my heart when she died last year. I had just seen her five months earlier and she was in a wonderful mood and full of life. How she deteriorated so fast is beyond me. One doctor said she had a stroke that the nursing home did not catch. It was her son who called a physician and he said it might have been a stroke, but he was not sure. Such incompetent people taking care of our elderly and/or those who are physically challenged. They deserve so much better!”
Ms. Susan Aycock Webb also wrote on July 13, 2015, “We had an experience when Jerry’s dad was
in an assisted living facility and the podiatrist came in to take care of his feet. A good thing, right? No, not in this case! The podiatrist decided to shave off a callous which by the way, was causing no problems since Ray was wheelchair-bound.
In the process, the podiatrist left a cut that got infected and caused Ray many problems before we got it cleared up. After that, we did not let the podiatrist who came to the facility take care of his feet. Either we took him to another doctor,
or I cut his toenails myself.”
“Whatever is going to happen to the nursing homes with incompetent people at the helm? The powers that be do not want any part of fixing the problems. It is so frustrating to deal with
slow turning wheels of people who could make a difference. I am just so sorry that anyone has to live in that kind of confinement. My husband’s parents spent their final days in a nursing home. Even though it was in a small town in
Indiana, it just seemed like people did their jobs without caring.” Ms. Jane Albertson contributed this paragraph in writing on July 17, 2015.
From testimonials above and many others appearing in blog posts, it is plain to see that aging means big changes and uncertainties in life. Along with aging, the current numbers indicate that 40% of the people over age 65 are also in the category of disabled and protected by the Americans with Disability Act. Even at government protection is no guarantee that our loved ones will be safe in long-term care. Have we become a culture of indifference? Do pleas for help fall on deaf ears? Do healthcare providers listen?
Communication Problems:
Most healthcare workers are task oriented which means that rarely is a nursing aide, nurse, physician, physical or occupational therapist listening or interacting with the patient. Just getting the task done is more important than trying to build rapport or help a patient feel comfortable in an information exchange about a health condition. Starting with the physician, it is important to note that the best physicians are like an Alfred Hitchcock. They listen for all the pieces of the puzzle or all of the symptoms that the patient is experiencing. The good physicians are detectives. They put the case together based on the evidence and make the best diagnosis. Yet, so many breakdowns in communication interfere with what the physician and nurses need to do in order to help people. This is a very serious situation for elderly in long-term care.
There was only one study conducted that found 20% of the communication in nursing homes is baby talk. In many ways dementia patients and Alzheimer’s patients have the mentality of a two-year-old, so it may be essential to scale back the choice of words and simplify the delivery of messages. Of paramount importance is respecting the rights and dignity of each patient regardless of their physical, mental, or spiritual state. Both the provider and the patient need to respect each other’s boundaries, but it is important for the patient to be active and form a collaborative relationship with the healthcare provider. This is no easy task for someone in a state of dementia or physical decline. Empathy is absolutely essential.
Good patients always tend to get better treatment than bad patients. This can carry over to families. Compliance and agreement are always favored as opposed to questioning, disagreeing, or seeking legal help for mistreatment of any resident in long-term care. Each communication should be built on trust, compassion, empathy, and care. However, healthcare providers can use a host of blocking tactics that make it difficult to be the so-called good patient. Be cautious of any healthcare worker that spends little time talking with patients because there are so many tasks that need to be done. Be wary of any provider that interrupts. Look out for a healthcare provider that spends more time looking at the laptop than making eye contact with the patient. These are not only blocking techniques, but can cause anyone speaking to lose track of his or her thoughts.
Watch out for inappropriate
humor, a lack of providing encouragement, a threatening tone of voice, ignoring the severity of any problem, or even rejecting the patient’s information about a physical problem. Healthcare workers underestimate the patient’s need or desire
for information and overestimate the amount of information they give. Storytelling and narratives about illnesses are commonplace in any medical setting. The downside is how much time it takes to get the relevant information about the patient’s
condition. Not just the patient, but healthcare providers also tell stories. The patient can frequently become overwhelmed with emotion when relating the story and it is very important for the health care provider not to interrupt.
Patients remember as little as 3% of the information they receive from any healthcare provider. It is always best to have another listener in the room with your loved one. Dealing with these problems is of utmost importance for one reason.
Communication breakdowns are the most common root cause of health errors that harm patients and that includes residents in long-term care. A misinterpretation of a single word can lead to delayed care or medical errors (Charles Stewart and William
Cash, Interviewing: Principles and Practices. 2014).
Gender research repeatedly points out that women’s concerns are taken less seriously by healthcare providers, yet the vast majority of people in long-term care are female. Women tend to be more concerned about their health and spend more time with healthcare providers, but ironically providers take their concerns less seriously. The older, educated, female patient tends to get more information from a healthcare provider. Crossing over the research for both women and men is a growing movement in the United States healthcare industry for patient centered care with the emphasis on the patient as consumer. Regardless of the research, what happens when everything goes wrong?
The Gainesville
Nursing Home Case:
This is one case where the resident was not treated as a consumer, nor valued and cared for as a patient. It is a demonstration of one communication breakdown after another along with incompetency at every level of healthcare. It was 2010. The title of the article is, Maggots Found in Eye Socket of Man in Nursing Home with Palm Beach County Ties. It was reported by Mr. Charles Elmore in The Palm Beach Post. The daughter of the resident said that he had lost an eye to cancer. Maggots have been discovered in the eye socket of a 76-year-old man under the care of a Gainesville nursing home with ownership ties to Palm Beach County and the Treasure Coast. A state investigation is under way. "It's absolutely inexcusable," Patrice Ripley said. "Quite frankly, I'm angry."
Her father, John Stumpp, had been under the care of Gainesville Health Care Center when the maggots were found in an examination at a Veterans Administration facility, according to Ripley. The Gainesville nursing home is part of a chain that includes Glades Health Care Center in Pahokee, controlled by the family of executive Maxcine Darville of Okeechobee.
An investigation by The Palm Beach Post last year found Darville and family members enjoyed salaries above industry norms and spent money on luxury cars and hot tubs while two of three nursing homes in the chain, including the Gainesville home, received the lowest possible one-star rating from state regulators. Darville and other officials with the chain could not be reached to comment.
A VA official confirmed the agency filed a report with the Adult Protective Services unit of the Florida Department of Children & Families. "Please note that the discussed veteran was not under VA care when this matter occurred at this non-VA nursing home," said VA spokeswoman Cindy Gaylord in an e-mail. "The veteran was brought to our medical center for care and shortly thereafter, the issue was forwarded to Adult Protective Services, Department of Children/Family Service for investigation."
DCF spokesman John Harrell said, "We are very concerned about these disturbing allegations. We are actively and thoroughly investigating to get to the bottom of what happened." Harrell said he was limited in the details he could provide because the investigation is ongoing. The department has been sharing information with agencies including the Agency for Health Care Administration and the Attorney General's Office, Harrell said.
Stumpp, who lost an eye to cancer, had an infection in the eye socket, his daughter said. An unannounced AHCA inspection of the Gainesville Health Care Center on August 18 cited the nursing home for failing to notify a doctor of problems carrying out a physician's order to change an unidentified resident's eye bandages twice a day.
The resident was often uncooperative and refused to allow staff to change his dressing on the second shift 43 out of 57 times, the ACHA report said. The nursing home was required to notify the resident's doctor or legal representative, according to the AHCA. The inspection found a bottle of liquid bleach was left on a resident's dresser and an elevator needed repair and cleaning.
The landlord for the Gainesville Health Care Center is one of the most prestigious teaching hospitals in the nation, Shands, affiliated with the University of Florida, the Post reported last year. The annual rent: more than $1 million. Shands had an "arm's length" relationship with the nursing home. Bradley Pollitt, vice president of facilities for Shands HealthCare, said at the time, "We're not in their business and don't pay attention to their business." Shands HealthCare spokeswoman Kim Rose said the nursing home remains a tenant, but is not affiliated with UF or Shands.
By November 2009, the AHCA had flagged 39 violations at the Gainesville Health Care Center in the previous two years on matters including sanitary food storage and maintenance of sprinklers and ventilation. An overall one-star rating from the AHCA places the nursing home in the bottom twenty percent of nursing homes in its region. The nursing home is licensed to the Gainesville Council on Aging, which lists Darville as its registered agent.
"I can't let this go," Ripley said. "I can't let this go for my dad, and I can't let anybody else be mistreated either."
Unfortunately, the Gainesville case is not an isolated situation. The carelessness of a nursing aide who left a man outside of the Aristocrat nursing home in Naples, Florida, in 90° weather, or the death of the Heisman football trophy winner from drinking dish soap that was not locked in the cabinet at the Emeritus nursing home are extreme cases, but how many people die horrible deaths at the hands of human error or indifference? It may not be a death, but how many infections have to be treated in the elderly because of physician carelessness such as Ms. Webb described about the podiatrist that treated her father in law? How many communication breakdowns lead to unnecessary infections and deaths in long-term care? How often do family members seeking answers for their loved one’s treatment get dismissed by administrators who care more about their own self aggrandizement? Mr. Dave Berry said on July 21, 2015, “We have to remain steadfast in our efforts to rebuke administrative carelessness, apathy, and outright abuses."
Questions for Consideration:
1. No matter whether the abuse is passive aggressive behavior, dismissive behavior, apathy, miscommunication, misrepresentation of facts, or lying, makes no difference. The end result with a nonresponsive administration is a lack of dignity and respect in caring for those elderly people and their families who are in need of compassion, understanding, and assistance. The dismissive behavior can be something as Mr. Philson described about the treatment of his wife and his request for monthly statements. Without a statement from Goodwill Retirement Community, he cannot file claims with Metropolitan Life Long-Term Care, nor Medicare, nor supplemental insurance. Talk to people who have loved ones in facilities and find out how business matters are handled or not handled.
2. Mr. Hugh Watters corresponded on July 16, 2015. He advises everyone to make use of media outlets. “That is the only way to go. My wife’s stepfather was in a nursing home and they took all of his money along with all of his furnishings. They claim that we owe them money! He did not get good care. We have five attorneys on the case. A woman from a local radio station overheard my wife in the store talking about the nursing home situation and pestered her several times to get the story. Unfortunately, my wife was too shy. It is however the only way to get information out about what really happens behind the doors of nursing homes.”
3. In several of the final episodes of Sound Medicine on NPR during the spring of 2015, there was considerable discussion about the communication problems in the healthcare industry. The biggest complaint was the use of computers and laptops that interfere with eye contact and attention that a physician can give the patient. In fact, even physicians interviewed from Indiana University Medical Center advised everyone to tell the physician to put the computer away during the office visit. Another recommendation apart from the use of computers was to be sure the healthcare provider is not distracted. This may be difficult at times, but the suggestion from a physician was to simply ask, “May I have your undivided attention?”
4. Another complicated issue that surfaces when hospitals interface with long-term care facilities was discussed by physicians on multiple program airings of Sound Medicine. More hospitals are finding it difficult to exchange records with long-term care facilities that are woefully lacking in technology. One complaint was about trying to get medical records transmitted to the nursing home from the hospital and finding that the only way to transfer information was by hard copy. The physician complained of needing to send mounds of paperwork with an elderly patient making the transition to a nursing home. The transition for a loved one following a serious medical issue, such as a stroke and moving to a nursing facility is only exacerbated by the lack of a compatible technology and software that allows a quick exchange of information. As unbelievable as it sounds, there is a serious digital divide with regard to communication exchange of medical records.
5. Prepare in advance of a crisis. A hospital administrator only cares about moving a patient
out when the time has lapsed for treatment of a certain condition. That means any bed available in a long-term care facility is fair game. Visit the surrounding nursing homes and be sure of what facility provides the best care for rehabilitation,
therapy, or long-term care. In a crisis situation, even knowing which ambulance service is covered by health insurance can make a big difference. Patients and their families have the right to request certain transport services, but not all services
may be covered by insurance such as Blue Cross.
July, 2015