Warehousing America's Elderly

More than 1.4 million Americans reside in nursing homes. A few go voluntarily.  Most are placed in facilities by spouses or family members no longer able to provide around the clock assistance, despite their heroic dedication.  Costs are steep, the quality of care varies and abuse can be a problem.  

There are more than 15,500 Medicare and Medicaid-certified nursing homes nationwide. The Centers for Disease Control and Prevention estimates there are 1.7 million beds in licensed nursing homes.  The majority are small facilities with 61 beds are fewer.  About 70% are for-profit operations.

Typically, nursing homes provide assistance with daily living, including preparing meals, bathing, dressing and assisting residents to the toilet, managing medications and feeding residents. Skilled nursing is often available on site.  

Costs are an added stress for families.  A 2021 study by Genworth Financial, the most recent data available, found the average nationwide cost of care in a private room at a nursing home costs $108,405 annually, versus $94,000 for a semi-private room.  Costs vary by state but prices are towering. 

An estimated 80% of aged adults lack the financial resources to pay for two years of nursing care, reports a study by the National Council on Aging. The data shatters the myth that most seniors, especially Baby Boomers, have the financial resources to pay for nursing care.    

Only 12.6% of seniors have long-term care insurance to cover the cost. Medicare pays for the first 20 days at a skilled nursing facility. Many seniors are forced to sell their homes, cash in insurance policies, drain savings and bank accounts.  Often the money runs out while they are in the nursing home.  

A report by the National Center for Health Statistics documented that 83% of nursing home residents are 65 or older.  However, 38% are 85 or older and 26% are between the ages of 75 and 84.  Nearly one-half (49.1%) have Alzheimers or another form of dementia. 

About 818,000 Americans reside in assisted living facilities, which offer less care than nursing homes because patients are usually mobile and able to perform general hygiene.  About 18% of assisted living facilities have a dementia unit and 11% serve only patients with dementia or Alzheimers.  

Research published by the National Institutes of Health (NIH) found patients in long-term care settings are at high risk for abuse and neglect.  Physical abuse may include hitting, slapping, pushing or striking patients with objects, according to the research. Incidents of theft too often occur at a facilities.

Oversight of facilities is spotty at best.  The Centers for Medicare and Medical Services (CMS) is tasked with broad oversight. State regulators, licenses and inspects skilled nursing homes. Significant  violations of standards, may result in a state rescinding a facility's license.

Statistics are a sterile view of the nursing home industry.  Your reporter has seen first-hand the level of care at facilities where family members were housed.  These observations are admittedly unscientific, but most have been collaborated by others with loved ones in nursing homes.

A heartbreaking issue for patients being warehoused: About 7 in 10 receive no visitors. Ever. These poor souls are lonely, frail and virtually shackled to their beds.  They stare vacantly at a small television.  It is an existence in name only.  

It is gut-wrenching to watch patients waiting to be fed, their heads slumped down on tables.  Staff is too busy with other patients, which means some residents wait an hour or more for a meal.  Even those who can feed themselves, are not served in a timely manner in the dining area.  

The meals may include the minimum daily calories and dietary proteins but at the expense of appetizing food. Patient complaints about meals are disregarded as the ramblings of a grumpy old people. If staff were forced to eat the same meals, it would make a difference in quality and variety.

Patient rooms, even the private ones, are spartan and void of color. Wafer thin mattresses on the beds and lumpy pillows are standard. Some patients have televisions, but in many facilities the TVs are provided by the family.  The smell wafting from some rooms testifies to the lack of constant cleaning.

These conditions exist, despite dedicated, trained staff. Facilities are nearly always understaffed.  COVID dealt a devastating blow to nursing homes, killing more than 200,000 residents and staff, according to the Kaiser Family Foundation. 

Isolation protocols forced staff to work excessive long hours, which caused burnout, triggering a worker exodus at many facilities.  As of the fourth quarter of 2022, the annual turnover rate at a nursing home was 53%. One-quarter of facilities reported turnover rates greater than 64%. 

Industry experts estimates there is a shortage of 200,000 nurses at long term care facilities. Recruiting firms forecast it may take five years or longer to reach pre-2020 staff levels.  The workforce problem must be addressed to improve care at nursing facilities.

Another issue is economic.  Although Medicaid pays for most patients' care, the government program reimburses facilities only 86% of the costs for a patient.  Nearly half of nursing homes are losing money, according to the American Health Care Association (AHCA).

As a result, the number of nursing homes is dwindling. An estimated 300 closed in 2020 and a combined 400 went out of business from 2021 to 2022.  This year already 135 facilities shuttered their doors.  These statistics were culled from reports by the Centers for Medicare and Medicaid.   

Understaffing and economics aren't the only problems. With so many aged adults unable to afford more than two years of nursing care, Medicare and Medicaid are ill equipped to provide the safety net for the elderly. Both programs face financial shortfalls and prospects are dim for a short term fix. 

Nothing short of an overhaul of the nursing home model is required for America to meet the needs of a population living longer.  By 2030 more than 73 million Baby Boomers will be 65 or older. In 2035, the number of Americans 65 and older will outnumber those 18 years old and younger. 

Congress can help, but often Washington's heavy hand leads to regulations that add costs and disincentivize the adoption of technology and innovation. Throwing money at a problem without a coordinated plan leads to wasteful spending, fraud and misapplication of funds. See COVID spending. 

This issue requires an all hands of deck approach.

Solutions must involve the long term care industry, state governments, Medicare, Medicaid, nursing schools and organizations that represent seniors.  The technology industry has a role to play also. One solution to the staffing shortage is to use wearable devices to monitor patients. 

Alarm bells are sounding. Urgent action is required to prevent long term care from erupting into a national crisis. Up to now, the siren call is being ignored, putting in peril millions of elderly Americans.   

The Insidious Coronavirus Turns Personal

For months the Coronavirus outbreak has been viewed by yours truly as data.  Statistics.  It was a detached reality.  Now it is personal.  My remarkable 93-year-old mother-in-law Dorothy Anderson succumbed to the insidious virus last week.  It was a sad ending to her extraordinary life.

Mom, as I affectionately called her because she always treated me as her son, resided in a nursing home in Seguin. Despite precautionary measures, a worker at the long term facility tested positive for the virus two-and-one-half weeks ago.  Since that incident, four residents have been hospitalized.

This scenario has been too often repeated in the nation's nursing homes.  According to data, at least 42% of all Coronavirus victims been been residents in long term care facilities.  More needs to be done to protect the vulnerable among us.  No more excuses from governments or nursing homes.

Mom's iron determination was tested when she was quarantined to her room in March.  She could no longer use her walker to saunter to the dining room for meals or stroll the halls.  Her existence was confined a tiny room with a small bed and a recliner.

No longer could family visit her.  Her meals were eaten alone in her room.  She lost interest in reading. Although she had a television, her hearing had deteriorated to the point where she gave up listening. Oppressive silence was Mom's constant companion.

It was a cruel, lonely way to spend what turned out to be her last days.  As the months wore on, our usually alert Mom seemed confused and unable to carry on long conversations by telephone.  Her spirit sagged and you could hear the desperation in her voice to be spared further incarceration.

Her 93rd birthday in April was a dispiriting occasion instead of a joyful celebration shared with hugs and kisses.  Nurses wheeled her to a picture-frame window near the lobby of the nursing home where a clump of family members had gathered.   Mom initially looked haggard, dazed.

Family held signs, balloons and sang "Happy Birthday" to her as she listened on the mobile phone she clutched in her hand.  She smiled, waved and seemed to be cheered up.  But it was not a proper birthday party, such as her 90th where the entire family embraced her with love and affection.

More than a few tears were shed after the family dispersed.  We realized what incredible suffering Mom was forced to endure.  Yes, isolation was scientifically and medically necessary, especially for Mom who had a pre-existing heart valve issue that made her more susceptible to the virus.

Yet for her and the other residents it was more like prison than simple seclusion.  Her world had shrunk to the unbearable.  It extracted a terrible toll on her mental and physical well being. We could all see it and it was excruciating to watch.  No one should be forced to involuntarily endure this.

Her final hours were more heartbreaking.  Last Thursday, Dianna visited Mom along with a few family members.  They waved to Mom as she slumped in her wheelchair in front of the nursing home's picture-window.  Dianna instinctively knew there was something visibly wrong.

Later Mom was whisked by ambulance to the Seguin hospital, complaining of shortness of breath.  Hours droned by before she was given a COVID test.  It came back positive.  She was placed in an isolated ward and given respiratory aid.  Her breathing was labored.  The end was drawing near.

Friday afternoon the hospital graciously agreed to push Mom's bed next to a hospital window so we could say our goodbyes.  Tears flowed as we viewed Mom surrounded by dedicated health care workers.  One nurse held Mom's hand, stroking it gently, sweetly.

We wanted to be the ones clutching her hand  and comforting her.  Giving her a hug.  Assuring her she was loved and would soon be in the arms of her merciful God.  All we could do is talk through the window of the hospital, praying, hoping she could hear us.  She nodded faintly a few times.

As family somberly drifted away, Dianna and I took turns standing vigil at the small window.  Mom's last breath was thankfully peaceful after she had been sedated.  It was the most distressing end because we knew she would have liked nothing better than to be surrounded by her family.

This is a mournful tale but I make no apologies.  Americans need to understand this evil virus has been worse for the elderly, especially those over 80.  Like Mom, many spend their final months, locked away for their own protection, only to still contract the virus.  That is unconscionable.

Workers and patients at the facility had been tested for the virus.  But the tests are not conducted daily.  Workers, especially, should be required to submit to daily testing.  Quarantine is no guarantee anyone's safety because staff deliver meals, check patient vitals and perform close contact duties.

Until this happened to Mom, neither Dianna nor I knew anyone personally with the virus.  Since less than 1 percent of the population has been infected, most of you are probably in the same situation.  We felt removed from this wicked virus, but we nonetheless follow the guidelines faithfully.

Next time you view a headline announcing COVID deaths, remember each one of those numbers is a real person.  Each is more than a statistic.  And family members are devastated by their passing.  They too are victims of COVID.  Not just those whose lives are claimed by the virus.

Finally, another lesson of Mom's experience is that it is human nature to search for a scapegoat.  Who is to blame for her sudden death?  The nursing home? The local government? The state? Washington? This virus is foreign born, transported to our country by unwitting carriers.  No one wanted it.

What matters is that we demand more be done to protect the 2.1 million Americans in long term care  facilities.  Our voices should also advocate for more humane treatment of those forced to be locked in their rooms.  Facilities must find more ways to spare residents a sense of imprisonment.

Anger and blame, no matter how understandable, will not change what happened to Dorothy Anderson or the hundreds of thousands of elderly held captive until they are taken from us.  The search for answers can only be found in faith and prayer.

Mom's life should not be defined by this demon virus.  She had a dynamic presence and was the personification of Texas grit.  She conquered breast cancer, a heart attack, a near fatal automobile accident, two knee surgeries, two devastating floods and cared for her Alzheimer's-stricken husband.

She and her husband John were pioneers in the pecan business, wholesaling and retailing the nuts. They managed multiple orchards, harvesting and shelling pecans too.  Mom operated a tractor, laid irrigation pipe, packaged pecans, worked as hard as any farm hand.

She served as the state representative for the Texas Pecan Growers Association, a rare post for a woman. She volunteered  to be on the city of Seguin's "Welcome Wagon" team, taking newcomers gift baskets and greeting them with a smile and kind words in her unique way.

Her joy and pride was birthing her five children into the world.  She fiercely defended and protected each one.  Raised them to be strong and independent.  Her life revolved around family, especially grandkids in later years. This is how I want Mom to be remembered.  God Bless you Mom.