Technology has
increased longevity thereby making death even more frightful,
expensive, tortuous, and perhaps accumulatively more painful than
before. Is this progress?
“Never
before in history has it been so hard to fulfill our final earthly
task: dying. It used to be that people were "visited" by death. With
nothing to fight it, we simply accepted it and grieved. Today,
thanks to myriad medications and interventions that have been
created to improve our health and prolong our lives, dying has
become a difficult and often excruciatingly slow process.” Craig
Bowron, Physician
Bowron
speaks of a woman who suffers from something that physicians call
"the dwindles", which is essential a characteristic of old age in
modern times. Three days a week she spends in dialysis so that she
can spend the remaining four days of the week recovering; she is
miserable seven days a week.
Bowron
speaks of another patient who is 91 who lies in his bed helpless
with painful swollen arthritic joints after being felled with a
stroke.
There
are no lifesaving medications in such cases; only life-prolonging
pain can be offered.
Bowron
informs us that “everyone wants to grow old and die in his or her
sleep, but the truth is that most of us will die in pieces. Most
will be nibbled to death by piranhas, and the piranhas of senescence
are wearing some very dull dentures. It can be a torturously slow
process, with an undeniable end, and our instinct shouldn't be to
prolong it. If you were to walk by a Tilt-A-Whirl loaded with
elderly riders and notice that all of them were dizzy to the point
of vomiting, wouldn't your instinct be to turn the ride off? Or at
the very least slow it down? Mercy calls for it.”
The good
doctor is not speaking about euthanasia or even about the spiraling
cost of health care; he is speaking about a sympathetic and
rationalized dignity for those who have reached the end of a life
worth living.
“In the
past, the facade of immortality was claimed by Egyptian kings,
egomaniacal monarchs and run-of-the mill psychopaths. But democracy
and modern medical advances have made the illusion accessible to
everyone. We have to rid ourselves of this distinctly Western notion
before our nation's obesity epidemic and the surge of aging baby
boomers combine to form a tsunami of infirmity that may well topple
our hospital system and wash it out to sea.” Bowron
I think
that the good doctor and I agree that there comes a time in life
when “the only thing worse than dying is being kept alive”.
Old Age Ain't for Sissies
By Ken Connor
"Rise in the presence
of the aged, show respect for the elderly and revere your God. I am
the LORD."
Leviticus 19:32
Old age ain't for sissies—especially if you happen to be living in
one of America's 15,000 nursing homes.
While there are some fine facilities for the long term care of the
elderly, many nursing homes have become dangerous places for the
residents who live there. I know because I have seen their
suffering up close and personal. As a trial lawyer, I represent
many victims of abuse and neglect in nursing homes and assisted
living facilities across the country.
But you don't have to take my word for it.
A recent Department of Health and Human Services report found
that 94% of America's nursing homes have been cited for violating
federal health and safety standards. Perhaps even more disturbing,
however, is a study by
Consumer Reports that found that state regulators fined only 50% of
nursing homes whose misconduct warranted fines.
Pressure ulcers (bed sores) are all too common among the elderly in
nursing homes. They develop as a result of leaving a resident in
one position for too long without turning or repositioning them.
Pressure from a mattress or chair on a bony prominence deprives the
resident's tissue of blood flow and the skin breaks down. While
"bed sores" sound benign, they are not. I have seen countless
pressure ulcers that penetrate to the bone. They are gaping wounds
that are often infected and foul smelling as a result of
contamination with urine and feces. They develop because
short-handed staff frequently don't have enough time to turn or
reposition residents, or even to clean them up after they have
soiled themselves. Malnutrition is estimated to
plague up to 65% of nursing home residents and countless others
suffer from avoidable dehydration—all because harried staff don't
have time to assist with feeding or to provide fluids to thirsty
residents. Still others suffer broken bones resulting from falls
and the lack of supervision. Often this occurs when the resident's
call light isn't responded to in a timely fashion and the resident
attempts to get to the bathroom without assistance in order to avoid
soiling themselves.
Make no mistake about it—pressure sores, malnutrition, dehydration,
and falls in nursing homes are not the inevitable consequence of old
age and ill health. They are, all too often, the result of
understaffing of nursing homes and the resulting inability of the
staff on hand to provide the care their residents need and deserve.
Shockingly, government studies show that more than half of nursing
homes fall below the "minimum" staffing standard proposed by the
Health Care Financing Administration (n/k/a the Center for Medicare
and Medicaid Services) of two hours of care each day from certified
nursing assistants, and nine out of ten homes fall below the HCFA
"optimal" standard of 2.9 hours of care each day from certified
nursing assistants. Iowa Senator Chuck Grassley rightly observed,
"More than half the nation's nursing homes don't meet a minimum
benchmark for staffing. That means residents don't get fed enough.
They don't get turned to prevent bedsores. They end up in the
hospital much more often than they should."
But why wouldn't nursing homes provide adequate staffing to take
care of their frail elderly residents? Two words: "corporate
greed", the same two words that are at the root of our current
economic meltdown. You see, the largest expense of a nursing home's
budget is "labor." Nursing home executives have learned that one
surefire way to increase the profitability of their homes is to
reduce costs by "shorting" the staff. That pumps up the bottom
line. In the process, however, residents who depend on the staff
for their basic needs are shortchanged.
One example from the New
York Times is
informative: Habana Health Care Center was taken over by private
investment firms in 2002. The firms immediately cut the staff,
reducing the number of registered nurses (RNs) by 50%. Budgets for
care were slashed. Fifteen residents died and their families sued
the home for negligent care. Regulators warned the home time and
again, but received no response. These procedures are commonplace.
Sixty percent of homes which have been bought out by private
investment firms in recent years have cut their number of RNs,
sometimes to illegal levels.
The offending nursing homes often try to conceal their perfidy by
falsifying patients' charts. In an attempt to deceive state
inspectors about the level of care being delivered, nursing homes
frequently host "charting parties" where staff will hastily fill in
blanks in patients' charts. The result is that they often chart
care as having been given on non-existent days (February 31), or
after the resident is dead, or, perhaps, before the resident was
even admitted to the facility. Sometimes, they will chart care as
having been given despite the fact that the identified care giver
wasn't at work (a review of the employee time cards reveals this
fraud). Such actions no doubt account for John T. Bentivoglio's statement in
the Washington Post on February 4, 2000 that, "A number of high
flying nursing home chains appear to have incorporated defrauding
Medicare as part of their business strategy." At the time he made
that statement, Mr. Bentivoglio served as Special Counsel for Health
Care Fraud at the Justice Department. His statement is no less true
today than when he first uttered it.
Lamentably, there is little media coverage of elder abuse. Perhaps
that's because much of it goes on behind the closed doors of nursing
homes. Perhaps it's because our culture is obsessed with youth and
no one wants to contemplate getting old. Or perhaps it's because we
simply devalue the elderly—after all, many of them have
substantially degraded mental and physical abilities. For whatever
reason, no one seems to pay much attention to elder abuse these
days.
The Ethics and Public Policy Center is a rare exception. It
recently acknowledged that elder abuse is on the rise: "According to
a National Center on Elder Abuse survey, more than 565,000 cases of
suspected elder abuse were reported in 2003—an increase of nearly 20
percent from 2000." But, mark it down: things are only going to get
worse. The perfect storm is brewing. A massive age wave has
begun. The over-65 population will more than double between
2010 to 2040. The leading edge of the Baby Boomers is approaching
retirement age. Huge numbers of Boomers will need nursing home
care. They will overwhelm existing capacity, and they will do so at
a time when America's old age entitlement programs are on the verge
of collapse. In 2017, Social Security's cash flow is projected to
go negative,
and in 2019 Medicare is slated to go broke.
Meanwhile, our national consensus has shifted from a sanctity of
life ethic to a quality of life ethic. The elderly suffering the
ravages of time—strokes, dementia, disability—do not score well
using quality of life calculus. It will become easier to view them
as "disposable" when they cost more to maintain than they produce.
Americans need to wake up to the implications of what it means to
become a mass geriatric society. Individuals need to prepare now
for the years when they will live in decline. Families must prepare
to assume a greater role in caring for their aging loved ones. The
church must acknowledge that the elderly are part of the "least
among us" and reach out to lend a helping hand. Government needs to
get its head out of the sand and prepare for a crisis that will make
Hurricane Katrina look like a walk in the park. And the nursing
home industry must mend its ways and be held fully accountable
whenever it abuses, neglects or exploits those it has agreed to care
for.
We all have a stake in averting this crisis.
Center for a Just Society - 1220 L Street, NW Suite 100-371 Washington DC, 20005