Chemical restraints
April 29, 2012 12:59 PM Subscribe
The Boston Globe reports that nursing homes in the United States continue to administer antipsychotic medications to patients who do not fit criteria for these drugs, in many cases to manage behavior considered disruptive by staff. For example, "in 21 percent of US nursing homes in 2010, at least one-quarter of the residents without illnesses recommended for antipsychotic use received the medications." Overuse of antipsychotic medications appears to correlate with nursing homes that have higher staff:patient ratios and to homes that house more people covered by Medicaid/Medicare.
The Globe requested data related to use of antipsychotics in the nation's 15,600 nursing homes from the Centers for Medicare & Medicaid Services, and analyzed this data along with other demographic information, as described in this article. The newspaper has also created an interactive database that allows the user to compare use of antipsychotics at various nursing homes.
The Globe requested data related to use of antipsychotics in the nation's 15,600 nursing homes from the Centers for Medicare & Medicaid Services, and analyzed this data along with other demographic information, as described in this article. The newspaper has also created an interactive database that allows the user to compare use of antipsychotics at various nursing homes.
My mom was on anti-schizophrenia medication during the last couple of years of her life, even though she did not have schizophrenia. She had mild Parkinson's-related dementia, with some confusion and a few deficits but was generally alert and rational otherwise. I asked about the prescription and the nursing center doctor said it couldn't hurt.
posted by Peach at 1:06 PM on April 29, 2012
posted by Peach at 1:06 PM on April 29, 2012
Oops, self-edit fail. More staff = fewer antipsychotics, likely because there is more time for staff to manage patient behaviors individually.
posted by catlet at 1:08 PM on April 29, 2012
posted by catlet at 1:08 PM on April 29, 2012
My mother works in the best nursing home in the country and she brings home weekly horror stories of patient mistreatment. Night staff who mishandle/abuse patients, staff pressuring perfectly healthy people to sign DNRs so they can shuffle people in and out of the facility faster, administrations constantly looking the other way.
posted by timsneezed at 1:14 PM on April 29, 2012 [1 favorite]
posted by timsneezed at 1:14 PM on April 29, 2012 [1 favorite]
timsneezed, I would beg to differ that your mother works in the "best nursing home in the country", given her description. I'm certain that, although there are certainly abuses in some facilities, there ARE facilities where what she describes does not happen. My wife's grandmother was in an assisted living/nursing home facility until she went into hospice. The care was excellent, the staff compassionate and professional, and the medical oversight and use of pharmaceuticals was appropriate.
posted by HuronBob at 1:26 PM on April 29, 2012 [6 favorites]
posted by HuronBob at 1:26 PM on April 29, 2012 [6 favorites]
Which is why I took care of my late father-in-law at home. He was only in the nursing home the last few weeks of his life, due to CHF and not being able to stand up well. They even gave him a glass of wine with his evening meal. When my husband visited him, he talked about seeing Mother (his wife) and then he said, "and will I see the animals too?"
Psychotic is dosing our Elders and putting them in those shit-holes to begin with, let alone letting pill pushers pumping them full of drugs during their last years.
Let's say you and I were born today. Let's say we were in a place that did this to us, as babies. What do you think society would have to say about that? Yet we let our elderly endure it, and guess what?
WE are the NEXT ELDERLY. This is going to happen to YOU AND ME, in about 30 or 40 years. WE will be dosed up and forgotten by society, the government will be privatized, and our meds will be denied us, and our grand-children wil be slaves. This is not a cartoon show, people. This is us: they are coming for our throats.
Will you lie down and let them cut into your underbelly, or will you rise up and say "ENOUGH!" Enough of mistreatment, of both our Elders and our Young. Enough. Enough.
Enough of feeding us a shit sandwich and telling us to enjoy it. Enough. Enough. :::sigh:::
I have had enough of shit sandwiches, Brothers and Sisters. I am not a fanatic. I am just a little woman. But I know a shit sandwich when I see one, and I would rather eat dirt than their shit.
Are you with me? Say AYE!
posted by Marie Mon Dieu at 1:26 PM on April 29, 2012 [25 favorites]
Psychotic is dosing our Elders and putting them in those shit-holes to begin with, let alone letting pill pushers pumping them full of drugs during their last years.
Let's say you and I were born today. Let's say we were in a place that did this to us, as babies. What do you think society would have to say about that? Yet we let our elderly endure it, and guess what?
WE are the NEXT ELDERLY. This is going to happen to YOU AND ME, in about 30 or 40 years. WE will be dosed up and forgotten by society, the government will be privatized, and our meds will be denied us, and our grand-children wil be slaves. This is not a cartoon show, people. This is us: they are coming for our throats.
Will you lie down and let them cut into your underbelly, or will you rise up and say "ENOUGH!" Enough of mistreatment, of both our Elders and our Young. Enough. Enough.
Enough of feeding us a shit sandwich and telling us to enjoy it. Enough. Enough. :::sigh:::
I have had enough of shit sandwiches, Brothers and Sisters. I am not a fanatic. I am just a little woman. But I know a shit sandwich when I see one, and I would rather eat dirt than their shit.
Are you with me? Say AYE!
posted by Marie Mon Dieu at 1:26 PM on April 29, 2012 [25 favorites]
WE are the NEXT ELDERLY. This is going to happen to YOU AND ME, in about 30 or 40 years
This. A thousand times, this.
posted by DreamerFi at 1:31 PM on April 29, 2012 [2 favorites]
This. A thousand times, this.
posted by DreamerFi at 1:31 PM on April 29, 2012 [2 favorites]
My mother is 83. If you want to instill pure terror in her, simply mention the possibility of putting her into a "nursing home". Her mother ended her life in one, and it was a miserable experience. The place constantly smelled of piss and there was always at least one tenant who spent their day wailing to the void. Back then, that was the only option for elder care, save for the "retirement homes" the wealthy elderly could pay for.
She is only slightly less afraid of the term "managed care".
posted by Thorzdad at 1:34 PM on April 29, 2012
She is only slightly less afraid of the term "managed care".
posted by Thorzdad at 1:34 PM on April 29, 2012
timsneezed, I would beg to differ that your mother works in the "best nursing home in the country", given her description. I'm certain that, although there are certainly abuses in some facilities, there ARE facilities where what she describes does not happen. My wife's grandmother was in an assisted living/nursing home facility until she went into hospice. The care was excellent, the staff compassionate and professional, and the medical oversight and use of pharmaceuticals was appropriate.
I think you're rationalizing. My mother does indeed work in the best nursing home in the country. A lot of these abuses never get reported because the patients are terrified of the staff getting back at them. My mother is a therapist in this nursing home so she hears from the patients themselves what's actually going on but they rarely report it to the staff or even to their families.
The problem is all nursing homes are stretched, even the best ones and even though the day staff are usually good in the better nursing homes they have lower standards in their hiring of the night staff. The night staff tend to be very low paid immigrants who are resentful of the better off patients.
posted by timsneezed at 1:36 PM on April 29, 2012
I think you're rationalizing. My mother does indeed work in the best nursing home in the country. A lot of these abuses never get reported because the patients are terrified of the staff getting back at them. My mother is a therapist in this nursing home so she hears from the patients themselves what's actually going on but they rarely report it to the staff or even to their families.
The problem is all nursing homes are stretched, even the best ones and even though the day staff are usually good in the better nursing homes they have lower standards in their hiring of the night staff. The night staff tend to be very low paid immigrants who are resentful of the better off patients.
posted by timsneezed at 1:36 PM on April 29, 2012
My mother, suffering from dementia and some other problems, recently started on one of these medications and the improvement is really, really noticeable. She is able to relax and enjoy spending time with family rather than crying and wanting to die because of all the irrational things she believed were happening to her. My fear is that, just like with pain medication, regulators will cause additional suffering due to fear of over-zealous use of these drugs.
posted by LastOfHisKind at 1:48 PM on April 29, 2012 [8 favorites]
posted by LastOfHisKind at 1:48 PM on April 29, 2012 [8 favorites]
modern pharmacy or drugging people up... sometimes I don't see the difference
posted by Alexander Brotschi at 1:50 PM on April 29, 2012
posted by Alexander Brotschi at 1:50 PM on April 29, 2012
I'm relatively young, (knock on wood) in pretty good health and, a few minor hiccups here and there aside, always have been...and yet, every time I see a doctor, s/he throws pills at me like someone feeding bread to ducks.
posted by The Card Cheat at 2:03 PM on April 29, 2012
posted by The Card Cheat at 2:03 PM on April 29, 2012
Timsneezed, most states require therapists to report abuse. Does your mother pass on reports of abuse that she's told about? If not, why? If so, is there a lack of response by police or state regulators?
posted by Grumpy old geek at 2:18 PM on April 29, 2012 [4 favorites]
posted by Grumpy old geek at 2:18 PM on April 29, 2012 [4 favorites]
This is why, in 2010, I chose to take care of my terminally ill 82-year-old mother (with the help of excellent hospice nurses) in my one-bedroom apartment for the last four months of her life. Mom was incredibly difficult at the best of times, and the arrangement caused me indescribable stress and contributed to the end of my relationship with my much-loved boyfriend of the time, but to this day I'm not one bit sorry. Rest in peace, Mom.
posted by FrauMaschine at 2:21 PM on April 29, 2012 [13 favorites]
posted by FrauMaschine at 2:21 PM on April 29, 2012 [13 favorites]
These kinds of stories make me very afraid -- for my family, for myself. I'm an only child, my mother is an only child, and my stepdad's family is incredibly untrustworthy. It's unlikely that I will every marry and decide to have children. Familial support for my parents when they get old is going to be me and me alone.
I watched my grandma decline over a period of ten years, and during most of those years she couldn't live unsupervised. My mom--still unmarried at the time--really struggled to get her the best care possible, but a home was the only option. It was a wrenching decision.
During those ten years, we actually had an elderly neighbor who decided not to put his wife with Alzheimers in a home. He was retired and able to stay home with her. One day, while he was doing yardwork, she wandered out of the house and was never seen again.
What am I going to do when my parents are old and sick and need care? I might not be able to do it alone. What am I going to do when I'm old and sick and need care, and don't have a family?
Our society needs a better way to cope with this than relying on families. Not everyone has families who are able to cope.
posted by Kutsuwamushi at 2:32 PM on April 29, 2012 [6 favorites]
I watched my grandma decline over a period of ten years, and during most of those years she couldn't live unsupervised. My mom--still unmarried at the time--really struggled to get her the best care possible, but a home was the only option. It was a wrenching decision.
During those ten years, we actually had an elderly neighbor who decided not to put his wife with Alzheimers in a home. He was retired and able to stay home with her. One day, while he was doing yardwork, she wandered out of the house and was never seen again.
What am I going to do when my parents are old and sick and need care? I might not be able to do it alone. What am I going to do when I'm old and sick and need care, and don't have a family?
Our society needs a better way to cope with this than relying on families. Not everyone has families who are able to cope.
posted by Kutsuwamushi at 2:32 PM on April 29, 2012 [6 favorites]
Man, I really wish this wasn't turning into a general "all nursing homes are evil" type thread. That's really a broad extraction from the study.
I come from a family of nursing home administrators in very rural parts of the midwest. There are lots of people who need 24 hour care, who are broke and abandoned by their families - or have no families - and for whom the nursing home offers a better quality of life, and often an extended life. You would not believe sometimes the circumstances that land people in a nursing home - I have quite literally seen people simply left outside the door. Often the people that end up in nursing homes might, sadly, endure worse treatment if their families had decided to continue to take care of them.
No one wants to end up in one, but the sad truth is that sometimes it is just inevitable, and there are caring, good places out there that exist for these times. Having spent my youth working in nursing home kitchens, many residents love the experience - they have friends, activities, they are taken care of. The alternative is often a struggle to complete daily tasks all alone, day in and day out.
The checks and balances on these things also vary widely from state to state. Iowa, for example, has really intense and strict state oversight. Illinois, not as much.
End of life care is extremely complex, especially when 'end of life,' for patients with severe dementia or other illnesses that do not allow them to take care of themselves, can go on for quite a long time. Overly medicated is probably a term that can apply to the population as a whole, and might speak to something more systemic than an isolated feature of some nursing home facilities.
posted by Lutoslawski at 2:41 PM on April 29, 2012 [15 favorites]
I come from a family of nursing home administrators in very rural parts of the midwest. There are lots of people who need 24 hour care, who are broke and abandoned by their families - or have no families - and for whom the nursing home offers a better quality of life, and often an extended life. You would not believe sometimes the circumstances that land people in a nursing home - I have quite literally seen people simply left outside the door. Often the people that end up in nursing homes might, sadly, endure worse treatment if their families had decided to continue to take care of them.
No one wants to end up in one, but the sad truth is that sometimes it is just inevitable, and there are caring, good places out there that exist for these times. Having spent my youth working in nursing home kitchens, many residents love the experience - they have friends, activities, they are taken care of. The alternative is often a struggle to complete daily tasks all alone, day in and day out.
The checks and balances on these things also vary widely from state to state. Iowa, for example, has really intense and strict state oversight. Illinois, not as much.
End of life care is extremely complex, especially when 'end of life,' for patients with severe dementia or other illnesses that do not allow them to take care of themselves, can go on for quite a long time. Overly medicated is probably a term that can apply to the population as a whole, and might speak to something more systemic than an isolated feature of some nursing home facilities.
posted by Lutoslawski at 2:41 PM on April 29, 2012 [15 favorites]
"Meanwhile, a tiny number of facilities - 146 nationwide, including five in Massachusetts - reported no use of the drugs at all in residents without these illnesses. That’s about 1 percent of the US homes with at least 50 residents."
I think this is incredible. I'd love to know more about what these homes are doing to reduce the use of restraints.
One question, though: why are nursing homes being demonized when they're not the ones prescribing the medications? Doctors (and PAs/NPs) prescribe medications, not nursing homes. I realize nurses & administration might lean on doctors to prescribe something, but the prescriber makes the final decision. Why aren't they being taken to task for this? Why does this say "nursing homes make heavy use of antipsychotic drugs" instead of "physicians over-prescribing antipsychotic drugs to nursing home residents"?
(The snark in me also wants to add that Seroquel just went off-label, so expect that to fade away and be replaced with something "new and improved" in the next few months.)
posted by pecanpies at 3:39 PM on April 29, 2012 [5 favorites]
I think this is incredible. I'd love to know more about what these homes are doing to reduce the use of restraints.
One question, though: why are nursing homes being demonized when they're not the ones prescribing the medications? Doctors (and PAs/NPs) prescribe medications, not nursing homes. I realize nurses & administration might lean on doctors to prescribe something, but the prescriber makes the final decision. Why aren't they being taken to task for this? Why does this say "nursing homes make heavy use of antipsychotic drugs" instead of "physicians over-prescribing antipsychotic drugs to nursing home residents"?
(The snark in me also wants to add that Seroquel just went off-label, so expect that to fade away and be replaced with something "new and improved" in the next few months.)
posted by pecanpies at 3:39 PM on April 29, 2012 [5 favorites]
I am all for death with dignity and being able to decide your own fate. I would never wish to burden another human being with constant caring for me I'll make do as best I can until I can't then make my peace with loved ones and exit stage right. Better they put me on an ice flow than warehouse me in a "managed care" facility. Life is beautiful but it can be ugly if you let the for profits get their mitts on you.
posted by pdxpogo at 4:01 PM on April 29, 2012 [1 favorite]
posted by pdxpogo at 4:01 PM on April 29, 2012 [1 favorite]
I'm just home from the local nursing home that takes people with only Medicare as that is where my aunt is. You would think it would be a hell hole as it is urban and one of very few that would take my aunt in when all other options were closed. She suffers from mild dementia and acute emphysema, is bedridden and can never be left alone.
Every thing about her life got actually better after the nursing home. She is never alone and the nursing home keeps her on her anti-anxiety meds. Without them she is anxious and fearful, with them she is able to enjoy what she can ( which isn't much, but she always was the type to lay around and watch TV all day).
Anyway this is just to say I just watched overworked, underpaid CNA staff bring people their dinner trays, enage each one and hug those who were open to it. Extreme old age when accompanied by dementia and other health issues is a bitch. In the last few years I have been part of care for a few old people and don't expect that to change as I get older. Each of them was helped immesurably by modern chemistry. I don't know of many options when you deal with dementia. The day to day difficulties in dealing with mobile, agile people with dementia, which often manifests as fear, paranoia and anger can be overwhelming. And you can see in their eyes that the elderly that keep living through these hellish days are beyond any coping mechanism they might have had. It all sucks and there are no easy answers.
posted by readery at 4:25 PM on April 29, 2012 [9 favorites]
Every thing about her life got actually better after the nursing home. She is never alone and the nursing home keeps her on her anti-anxiety meds. Without them she is anxious and fearful, with them she is able to enjoy what she can ( which isn't much, but she always was the type to lay around and watch TV all day).
Anyway this is just to say I just watched overworked, underpaid CNA staff bring people their dinner trays, enage each one and hug those who were open to it. Extreme old age when accompanied by dementia and other health issues is a bitch. In the last few years I have been part of care for a few old people and don't expect that to change as I get older. Each of them was helped immesurably by modern chemistry. I don't know of many options when you deal with dementia. The day to day difficulties in dealing with mobile, agile people with dementia, which often manifests as fear, paranoia and anger can be overwhelming. And you can see in their eyes that the elderly that keep living through these hellish days are beyond any coping mechanism they might have had. It all sucks and there are no easy answers.
posted by readery at 4:25 PM on April 29, 2012 [9 favorites]
Timesneezed: speaking of whether or not your mother is a mandated reporter* -- and based on my (admittedly geographically limited) experience in human services I'd be surprised and dismayed if she isn't -- it bears mention that she could likely file suspicions of vulnerable adult abuse anonymously, and also that one is only required to suspect abuse, not know that it's going on.
In other words, if she believes that someone who cannot protect themselves is being abused or exploited, I sincerely hope that she'll spill the beans to the state. By doing so she may ensure that that "best nursing home" that she works at stays that way.
posted by mr. digits at 5:06 PM on April 29, 2012 [1 favorite]
In other words, if she believes that someone who cannot protect themselves is being abused or exploited, I sincerely hope that she'll spill the beans to the state. By doing so she may ensure that that "best nursing home" that she works at stays that way.
posted by mr. digits at 5:06 PM on April 29, 2012 [1 favorite]
my mother is a licensed psychologist who has been practicing for 40 years and has headed a geriatric unit at a very well regarded mental hospital for fifteen years.
I just asked her and she said that she has reported it but nothing is ever done. She wanted to clarify that it's not frank abuse -- like hitting. She said it's a more subtle form. They're treated very coldly, at times they will yell at them, or neglect them and sometimes not come when the patients call for help.
posted by timsneezed at 5:12 PM on April 29, 2012
I just asked her and she said that she has reported it but nothing is ever done. She wanted to clarify that it's not frank abuse -- like hitting. She said it's a more subtle form. They're treated very coldly, at times they will yell at them, or neglect them and sometimes not come when the patients call for help.
posted by timsneezed at 5:12 PM on April 29, 2012
*she reported it the administrators
posted by timsneezed at 5:13 PM on April 29, 2012
posted by timsneezed at 5:13 PM on April 29, 2012
I can't really give more details unfortunately because it might break her confidentiality.
posted by timsneezed at 5:13 PM on April 29, 2012
posted by timsneezed at 5:13 PM on April 29, 2012
It is not just nursing homes! My mother-in-law broke her wrist and went to a skilled nursing facility for rehab. They gave her Celexa, (for some unknown reasons) and she started to have suicidal thoughts and hallucinations (all side effects of Celexa). She was taken to the emergengy room and admitted to the hospital because she had developed pneumonia in the meantime. My husband asked the doctor to stop the Celexa when he found out what she had been given, told them she did not need a antipsychotic. They switched her to Risperidal which made her catatonic. After ten days of that wonderful care, they sent her to a nursing home because she was not responsive enough to physical therapy.
She is barely recovering now, after all the crap medication was stopped. It is going to be a long and expensive recovery for her. American health care system for the elderly at its best!
posted by francesca too at 5:17 PM on April 29, 2012 [1 favorite]
She is barely recovering now, after all the crap medication was stopped. It is going to be a long and expensive recovery for her. American health care system for the elderly at its best!
posted by francesca too at 5:17 PM on April 29, 2012 [1 favorite]
The problem is families are in denial and don't want to believe their relatives are being neglected, so these problems are never fixed.
Of course a nursing home is better than living alone if you have dementia or no family but that's a really low bar.
The facility where my mother works is full of wealthy people who can afford the best care, but the administration puts most of their money into making the place look really nice so people want to come there. Yet they don't spend enough on the actual nursing care and paying their staff. It's basically a facade.
posted by timsneezed at 5:26 PM on April 29, 2012
Of course a nursing home is better than living alone if you have dementia or no family but that's a really low bar.
The facility where my mother works is full of wealthy people who can afford the best care, but the administration puts most of their money into making the place look really nice so people want to come there. Yet they don't spend enough on the actual nursing care and paying their staff. It's basically a facade.
posted by timsneezed at 5:26 PM on April 29, 2012
The facility where my mother works is full of wealthy people who can afford the best care, but the administration puts most of their money into making the place look really nice so people want to come there. Yet they don't spend enough on the actual nursing care and paying their staff. It's basically a facade.
Having spent a lot of time in nursing homes, I stand by my opinion that this is the exception, not the norm.
posted by Lutoslawski at 5:30 PM on April 29, 2012
Having spent a lot of time in nursing homes, I stand by my opinion that this is the exception, not the norm.
posted by Lutoslawski at 5:30 PM on April 29, 2012
Having spent a lot of time in nursing homes, I stand by my opinion that this is the exception, not the norm.
It's important to remember that the patients don't complain to staff a lot of the time because they're afraid of reprisals. So even if you've worked in nursing home kitchens, I don't think you're necessarily getting the full picture.
posted by timsneezed at 5:37 PM on April 29, 2012
It's important to remember that the patients don't complain to staff a lot of the time because they're afraid of reprisals. So even if you've worked in nursing home kitchens, I don't think you're necessarily getting the full picture.
posted by timsneezed at 5:37 PM on April 29, 2012
Also, coming from a family of nursing home administrators will no doubt give you a vested interest in believing this isn't true. I'm not saying you're being dishonest but there's a lot of bias built into your opinion.
posted by timsneezed at 5:38 PM on April 29, 2012
posted by timsneezed at 5:38 PM on April 29, 2012
Antipsychotics are a bitch when you need them. I can only imagine what they're like when you don't. (sinks back in to Abilify coma)
posted by Biblio at 6:02 PM on April 29, 2012
posted by Biblio at 6:02 PM on April 29, 2012
well i've worked in a few nursing homes and generally i found most residents weren't abused.
one of the nursing homes i worked in wasn't really a nursing home--it was more like a halfway house for chronic mentally ill adults. every resident was on medication there--and in fact it was my job to round them up when they didn't take it. despite it's mental health position it was considered, and licensed as a nursing home.
posted by lester's sock puppet at 7:10 PM on April 29, 2012
one of the nursing homes i worked in wasn't really a nursing home--it was more like a halfway house for chronic mentally ill adults. every resident was on medication there--and in fact it was my job to round them up when they didn't take it. despite it's mental health position it was considered, and licensed as a nursing home.
posted by lester's sock puppet at 7:10 PM on April 29, 2012
Up until this thread legally assisted suicide almost seemed like a good idea... Now, not so much. Having said that, people prescribing me euthanasia because I'm penniless seems almost preferable.
posted by yoHighness at 7:26 PM on April 29, 2012
posted by yoHighness at 7:26 PM on April 29, 2012
In my last years that is. As a good nursing home starts from $800 a week. Also I've worked in nice nursing homes where say ex Oxbridge academics would live out their days ... and those weren't that good yet. Doom. Doom. Doooom. /miss bitters voice
posted by yoHighness at 7:31 PM on April 29, 2012
posted by yoHighness at 7:31 PM on April 29, 2012
My sister worked as an LNA at a nursing home where patients screamed at her, spat on her, called her a bitch or the devil, hit her, kicked her, bit her hard enough to bleed, and grabbed her ass hard enough to bruise. She did not take it personally. However, as her sister, I am not against the use of chemical restraints.
posted by maryr at 8:58 PM on April 29, 2012
posted by maryr at 8:58 PM on April 29, 2012
"Are you with me? Say AYE!"
YES! I have jumped up and yelled AYE! And I feel very passionately that I am in agreement in opposition to these terrible shit sandwiches and I want to do something and I think we should altogether do whatever that is!!! I wish the combined forces of good would collaborate in powerful action!! Combined, we could be great! We could defeat the forces of suffering and injustice and create a humane world for all to experience and participate in!
So... uh..... what should we do? All together now!!! As for me, I'm going to go get another cup of coffee and think really hard about wanting things to be different. Anyone have a better plan?
(I've been doing this for a really long time and I will warn you all that wishing really hard for things to be different hasn't yet seemed to demonstrate very strong clinical efficacy).
My thoughts are-- nursing homes need more staff, vegetable gardens (everything needs vegetable gardens DUH), better quality food, more attention, more activities, more opportunities to contribute within the bounds of limited physical and mental functioning...
Better in home caregiving services to allow families to care for their elderly with assistance to make the process easier is another option that could actually be cheaper and better.
(Remember that NPR piece about veterans whose families wanted to provide care and that getting in home assistance/medical care for disabled veterans was frequently cheaper than live in facilities, depending on the condition. No idea if that's true? )
Also we need to do better research on how to keep people as healthy as possible into old age. And by research on how to keep people healthy I don't just mean more pharmaceutical research, I mean research on lifestyles, activities, social interaction, cognitive beliefs, diet, occupational impacts on health etc etc-- and we need to facilitate and promote lifestyles and behaviors that are positively associated with long term health, and make those kinds of choices easier for the general public-- because having a social network or community that wants to be involved with you is not accessible to everyone, having job options that match health needs are not always options, having the energy to cook fancy healthy food is not always an option. Etc.
There is a lot more we can do to promote long term human health and well being and mental functioning-- and the healthier our elderly are up until death, the more attention staff and family can give without being emotionally (or physically) injured in the process.
posted by xarnop at 6:40 AM on April 30, 2012 [2 favorites]
YES! I have jumped up and yelled AYE! And I feel very passionately that I am in agreement in opposition to these terrible shit sandwiches and I want to do something and I think we should altogether do whatever that is!!! I wish the combined forces of good would collaborate in powerful action!! Combined, we could be great! We could defeat the forces of suffering and injustice and create a humane world for all to experience and participate in!
So... uh..... what should we do? All together now!!! As for me, I'm going to go get another cup of coffee and think really hard about wanting things to be different. Anyone have a better plan?
(I've been doing this for a really long time and I will warn you all that wishing really hard for things to be different hasn't yet seemed to demonstrate very strong clinical efficacy).
My thoughts are-- nursing homes need more staff, vegetable gardens (everything needs vegetable gardens DUH), better quality food, more attention, more activities, more opportunities to contribute within the bounds of limited physical and mental functioning...
Better in home caregiving services to allow families to care for their elderly with assistance to make the process easier is another option that could actually be cheaper and better.
(Remember that NPR piece about veterans whose families wanted to provide care and that getting in home assistance/medical care for disabled veterans was frequently cheaper than live in facilities, depending on the condition. No idea if that's true? )
Also we need to do better research on how to keep people as healthy as possible into old age. And by research on how to keep people healthy I don't just mean more pharmaceutical research, I mean research on lifestyles, activities, social interaction, cognitive beliefs, diet, occupational impacts on health etc etc-- and we need to facilitate and promote lifestyles and behaviors that are positively associated with long term health, and make those kinds of choices easier for the general public-- because having a social network or community that wants to be involved with you is not accessible to everyone, having job options that match health needs are not always options, having the energy to cook fancy healthy food is not always an option. Etc.
There is a lot more we can do to promote long term human health and well being and mental functioning-- and the healthier our elderly are up until death, the more attention staff and family can give without being emotionally (or physically) injured in the process.
posted by xarnop at 6:40 AM on April 30, 2012 [2 favorites]
Also, coming from a family of nursing home administrators will no doubt give you a vested interest in believing this isn't true. I'm not saying you're being dishonest but there's a lot of bias built into your opinion.
So will vicarious knowledge of one facility, through a family member, no doubt.
Also, I've worked all over the nursing home - but I think you get to know what's going on most intimately through the kitchen. You have to prepare each meal according to the dietary restrictions of the residents, you spoon feed them, you deliver the snacks to their rooms, you chat with them, you play piano for them during lunch, you set up after-lunch bingo.
I do not doubt that some abuse goes un-reported. In fact, I'm quite positive that it does. The unfortunate thing, however, is that with nursing homes people jump to the belief that isolated events are automatically indicative of something systemic. If a person gets bad medical treatment, the doctor of that hospital gets blamed, not usually healthcare as a whole, because we tend to think that hospitals are overall good things, places we can go to get well and then leave. Nursing homes, though, when something is reported at one or two, the whole system is abusing residents. I think people do this because we don't like the idea of them, don't like the idea that we might end up in one, a place you don't leave, a place you go to die, and so we cast them as overall evil places where all of this abuse is happening. In reality, nursing homes are compassionate places that care for those who usually have no other options.
Perhaps sometimes abuse reports are ignored. There is no excuse for that and if I knew of such a thing, I would certainly not just tell the VP of whomever - I would tell the state board. In many states, the oversight and inspections for nursing home facilities are quite stringent. But I think abuse reports being ignored is the exception. Most administrators will fire a nurse or aid without second thought for any type of abuse or mistreatment complaint. I also know that many complaints are erroneous. I know that it is a complicated and not always black and white matter. I know one nursing home that was sued by the grandson of a resident because staff did not stop that resident from having sex with another resident, and that the grandson considered this abuse. I also know that nurses and aids don't control what the doctors prescribe the residents. The point is: it's complicated, and it's really silly and reductive to make general aspersions against nursing homes in general (as it is to do so with almost any institution).
posted by Lutoslawski at 9:18 AM on April 30, 2012 [1 favorite]
So will vicarious knowledge of one facility, through a family member, no doubt.
Also, I've worked all over the nursing home - but I think you get to know what's going on most intimately through the kitchen. You have to prepare each meal according to the dietary restrictions of the residents, you spoon feed them, you deliver the snacks to their rooms, you chat with them, you play piano for them during lunch, you set up after-lunch bingo.
I do not doubt that some abuse goes un-reported. In fact, I'm quite positive that it does. The unfortunate thing, however, is that with nursing homes people jump to the belief that isolated events are automatically indicative of something systemic. If a person gets bad medical treatment, the doctor of that hospital gets blamed, not usually healthcare as a whole, because we tend to think that hospitals are overall good things, places we can go to get well and then leave. Nursing homes, though, when something is reported at one or two, the whole system is abusing residents. I think people do this because we don't like the idea of them, don't like the idea that we might end up in one, a place you don't leave, a place you go to die, and so we cast them as overall evil places where all of this abuse is happening. In reality, nursing homes are compassionate places that care for those who usually have no other options.
Perhaps sometimes abuse reports are ignored. There is no excuse for that and if I knew of such a thing, I would certainly not just tell the VP of whomever - I would tell the state board. In many states, the oversight and inspections for nursing home facilities are quite stringent. But I think abuse reports being ignored is the exception. Most administrators will fire a nurse or aid without second thought for any type of abuse or mistreatment complaint. I also know that many complaints are erroneous. I know that it is a complicated and not always black and white matter. I know one nursing home that was sued by the grandson of a resident because staff did not stop that resident from having sex with another resident, and that the grandson considered this abuse. I also know that nurses and aids don't control what the doctors prescribe the residents. The point is: it's complicated, and it's really silly and reductive to make general aspersions against nursing homes in general (as it is to do so with almost any institution).
posted by Lutoslawski at 9:18 AM on April 30, 2012 [1 favorite]
Remember that NPR piece about veterans whose families wanted to provide care and that getting in home assistance/medical care for disabled veterans was frequently cheaper than live in facilities, depending on the condition. No idea if that's true?
I don't have a citation handy, but ADAPT, of which I'm a member, usually says nursing homes are as much as four times as expensive. Our focus is on people with disabilities, and not the elderly specifically, but many of the same motivations are there for avoiding nursing homes, and a lot has been done to make in-home/community-based services and support available to people on Medicaid, rather than requiring them to enter a nursing home unnecessarily. The website seems to be a bit behind, but just last week, HHS released the CFC Option regulations, which are a major step in making that happen. There's still a lot of work to be done to get states to take that option, but last week's issuance was a historic moment.
Or, as Joe Biden might put it, a Big Fucking Deal.
posted by spaceman_spiff at 9:55 AM on April 30, 2012 [1 favorite]
I don't have a citation handy, but ADAPT, of which I'm a member, usually says nursing homes are as much as four times as expensive. Our focus is on people with disabilities, and not the elderly specifically, but many of the same motivations are there for avoiding nursing homes, and a lot has been done to make in-home/community-based services and support available to people on Medicaid, rather than requiring them to enter a nursing home unnecessarily. The website seems to be a bit behind, but just last week, HHS released the CFC Option regulations, which are a major step in making that happen. There's still a lot of work to be done to get states to take that option, but last week's issuance was a historic moment.
Or, as Joe Biden might put it, a Big Fucking Deal.
posted by spaceman_spiff at 9:55 AM on April 30, 2012 [1 favorite]
The point is: it's complicated, and it's really silly and reductive to make general aspersions against nursing homes in general (as it is to do so with almost any institution).
This sounds to me like typical bureaucratic speak. You could use that to defend any number of corrupt systems, that it's silly and reductive to make general aspersions about them. Or that it's "complicated." I see that as a cop out and a way of pointing the finger back at someone who is addressing a real problem. Some systems are corrupt, and brushing off legitimate complaints with "it's complicated" or "stop demonizing us" only prevents the underlying problems/abuses from being fixed.
If you've only worked as a staff person in nursing homes, then it's unlikely you're hearing from the patients directly what they're experiencing because you don't have their full trust. You're part of the system in their eyes, and they feel extremely vulnerable.
The instances of mistreatment and neglect aren't isolated where my mother works. Most of her patients make these complaints, are depressed by their environment and she sees the ones who are in assisted living dreading having to one day be moved to the nursing ward. My mother has no investment in believing nursing homes are evil. In fact, she makes most of her living off of the referrals she gets from this place so if anything she'd be biased in its favor. But what she's seen there convinced her to take her own mother in after her father died, even though her house is barely large enough to accommodate another person.
posted by timsneezed at 10:18 AM on April 30, 2012
This sounds to me like typical bureaucratic speak. You could use that to defend any number of corrupt systems, that it's silly and reductive to make general aspersions about them. Or that it's "complicated." I see that as a cop out and a way of pointing the finger back at someone who is addressing a real problem. Some systems are corrupt, and brushing off legitimate complaints with "it's complicated" or "stop demonizing us" only prevents the underlying problems/abuses from being fixed.
If you've only worked as a staff person in nursing homes, then it's unlikely you're hearing from the patients directly what they're experiencing because you don't have their full trust. You're part of the system in their eyes, and they feel extremely vulnerable.
The instances of mistreatment and neglect aren't isolated where my mother works. Most of her patients make these complaints, are depressed by their environment and she sees the ones who are in assisted living dreading having to one day be moved to the nursing ward. My mother has no investment in believing nursing homes are evil. In fact, she makes most of her living off of the referrals she gets from this place so if anything she'd be biased in its favor. But what she's seen there convinced her to take her own mother in after her father died, even though her house is barely large enough to accommodate another person.
posted by timsneezed at 10:18 AM on April 30, 2012
BTW, there's a follow-up article on the front of the Globe today about one of the homes that does not use anti-psychotics.
posted by maryr at 10:39 AM on April 30, 2012
posted by maryr at 10:39 AM on April 30, 2012
This sounds to me like typical bureaucratic speak. You could use that to defend any number of corrupt systems, that it's silly and reductive to make general aspersions about them. Or that it's "complicated."
Maybe, but of course it is complicated. And you can't make generalizations about large systems, generally, save something like formal logic. That'd be kind of crazy tea-party-esque 'all government is bad!' type thinking, when the reality of the situation is of course quite different. Or the cries of 'public education is in the shitter!' It is in many places, but there are still lots of great public schools. Broad claims are almost always, even prima facie, false.
Look - I'm not defending nursing homes because of my personal attachments. I'm not in the business and would never want to be - it's an awful business to be in, frankly. I'm just trying to add some nuance and perspective. I guess I sort of resent this claim you keep making that I'm defending them because of some personal attachment. I only brought up my experience to lend a little hermeneutical perspective to my argument, not to ensconce it in some kind of axe grinding crusade.
If you've only worked as a staff person in nursing homes, then it's unlikely you're hearing from the patients directly what they're experiencing because you don't have their full trust. You're part of the system in their eyes, and they feel extremely vulnerable.
Well, plus having two great grandmothers and one very close grandmother all spend their final years/months in one. And you'd be surprised at how candid the residents are, even to employees. They make their needs known. Not all the aids or nurses are angels, of course. But abusers are a small percentage, is the point.
But what she's seen there convinced her to take her own mother in after her father died, even though her house is barely large enough to accommodate another person.
I totally agree that this should always be the first option, if possible. Like I said, no one wants to go to a home (well, I have met some people who generally wanted to be there, even though they could have managed just fine on their own). All the nursing homes I'm familiar with are charity, non-profit facilities. No one is getting rich off of this. It's a service for people who don't have the option of home care. Being taken care of at home by a relative is of course the ideal. It's just that it isn't feasible for everyone, for a number of reasons. Some people need 24-hour close medical attention. Some families don't have the time/patience/desire to blend their parent's meals and mix it with thick it and spoon feed them three times a day. Dementia and alzheimer's are other major factors in the decision. Nursing homes are a last resort, and should ideally come after home care, assisted living, etc. have been considered or tried. Costs are also a factor. Home care can be more expensive than a non-profit nursing home. It should be a source of hope that assisted living facilities have boomed in the past 20 years, and have largely replaced nursing homes in many communities, saving nursing homes for those really critically in need residents.
Anyway, I think that's all I will say on this subject. There are millions of people in this country who have dedicated their lives to taking care of elderly or terminally ill people with no one else to care for them. They are not all evil abusers. In fact, most of them are quite the opposite. It is a thankless (evidence this thread), difficult, and emotionally taxing job, and many do it out of a sense of purpose and compassion.
posted by Lutoslawski at 12:29 PM on April 30, 2012 [3 favorites]
Maybe, but of course it is complicated. And you can't make generalizations about large systems, generally, save something like formal logic. That'd be kind of crazy tea-party-esque 'all government is bad!' type thinking, when the reality of the situation is of course quite different. Or the cries of 'public education is in the shitter!' It is in many places, but there are still lots of great public schools. Broad claims are almost always, even prima facie, false.
Look - I'm not defending nursing homes because of my personal attachments. I'm not in the business and would never want to be - it's an awful business to be in, frankly. I'm just trying to add some nuance and perspective. I guess I sort of resent this claim you keep making that I'm defending them because of some personal attachment. I only brought up my experience to lend a little hermeneutical perspective to my argument, not to ensconce it in some kind of axe grinding crusade.
If you've only worked as a staff person in nursing homes, then it's unlikely you're hearing from the patients directly what they're experiencing because you don't have their full trust. You're part of the system in their eyes, and they feel extremely vulnerable.
Well, plus having two great grandmothers and one very close grandmother all spend their final years/months in one. And you'd be surprised at how candid the residents are, even to employees. They make their needs known. Not all the aids or nurses are angels, of course. But abusers are a small percentage, is the point.
But what she's seen there convinced her to take her own mother in after her father died, even though her house is barely large enough to accommodate another person.
I totally agree that this should always be the first option, if possible. Like I said, no one wants to go to a home (well, I have met some people who generally wanted to be there, even though they could have managed just fine on their own). All the nursing homes I'm familiar with are charity, non-profit facilities. No one is getting rich off of this. It's a service for people who don't have the option of home care. Being taken care of at home by a relative is of course the ideal. It's just that it isn't feasible for everyone, for a number of reasons. Some people need 24-hour close medical attention. Some families don't have the time/patience/desire to blend their parent's meals and mix it with thick it and spoon feed them three times a day. Dementia and alzheimer's are other major factors in the decision. Nursing homes are a last resort, and should ideally come after home care, assisted living, etc. have been considered or tried. Costs are also a factor. Home care can be more expensive than a non-profit nursing home. It should be a source of hope that assisted living facilities have boomed in the past 20 years, and have largely replaced nursing homes in many communities, saving nursing homes for those really critically in need residents.
Anyway, I think that's all I will say on this subject. There are millions of people in this country who have dedicated their lives to taking care of elderly or terminally ill people with no one else to care for them. They are not all evil abusers. In fact, most of them are quite the opposite. It is a thankless (evidence this thread), difficult, and emotionally taxing job, and many do it out of a sense of purpose and compassion.
posted by Lutoslawski at 12:29 PM on April 30, 2012 [3 favorites]
A related story, for anyone who's still following:
Abbott Laboratories agrees to $1.6 billion settlement over marketing of Depakote
From the article: "Global pharmaceutical giant Abbott Laboratories has agreed to pay federal and state governments $1.6 billion in criminal and civil fines for illegally promoting unapproved uses of its drug Depakote, including to sedate elderly patients in nursing homes" (emphasis mine).
And further down: "In its marketing, Abbott highlighted the fact that Depakote was not covered by a 1987 law designed to prevent the use of unnecessary medications by nursing homes. So if nursing homes used it in place of other options, they could avoid the administrative costs and burdens of complying with that law."
Depakote (a trade name for valproic acid) has been approved by the FDA to treat seizures, migraine headaches, and manic episodes in patients with bipolar disorder.
posted by pecanpies at 6:39 AM on May 8, 2012
Abbott Laboratories agrees to $1.6 billion settlement over marketing of Depakote
From the article: "Global pharmaceutical giant Abbott Laboratories has agreed to pay federal and state governments $1.6 billion in criminal and civil fines for illegally promoting unapproved uses of its drug Depakote, including to sedate elderly patients in nursing homes" (emphasis mine).
And further down: "In its marketing, Abbott highlighted the fact that Depakote was not covered by a 1987 law designed to prevent the use of unnecessary medications by nursing homes. So if nursing homes used it in place of other options, they could avoid the administrative costs and burdens of complying with that law."
Depakote (a trade name for valproic acid) has been approved by the FDA to treat seizures, migraine headaches, and manic episodes in patients with bipolar disorder.
posted by pecanpies at 6:39 AM on May 8, 2012
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posted by Ardiril at 1:03 PM on April 29, 2012