You've probably never heard of Charles Todd "Bud" Lee, although he was an award-winning photojournalist whose work has been published in "Life" magazine, "Esquire," "The New York Times Magazine" and even "Rolling Stone." His photo of a bleeding 12-year old boy in Newark, New Jersey, who'd been caught in the crossfire of a police shooting, graced the cover of "Life" magazine in July, 1967. Almost exactly 16 years later, however, Bud suffered a stroke that left him semi-paralyzed and landed him in a Florida nursing home.
It turns out that Florida law requires nursing home care for Medicaid recipients, rather than allowing them to live wherever they choose. Bud is still there, in the Community Care Center in Plant City, Florida, an involuntary resident, more than five years later--and he's really angry.
Last September, Bud's plight caught the attention of Matt Sedentsky, a writer for the Associated Press. Sedentsky's subsequent September 21st article, arguing that Florida nursing homes, fearful of losing money, have successfully pressured politicians to make such alternatives as in-home health care difficult for Medicaid recipients to obtain.
He reported that Bud Lee has filed a lawsuit in federal court on behalf of the approximately 8,500 Floridians who are similarly institutionalized. As Bud succinctly described his situation, "Most of the people come here to die, so you want to die. It is a prison. I can't escape it."
A recent study found that seniors fear moving into a nursing home and the loss of their independence far more than death. Indeed, according to the study commissioned by Clarity and the EAR Foundation, fully 89 percent of America's elderly want to age in place, and will use adaptive technology to stay independent. Their Baby Boomer children, the study noted, are equally concerned about nursing home care for their parents, and they're eager to support their parents in this quest.
More than one-quarter of the study's respondents cited as a fear a loss of independence, which is closely aligned with the fear of nursing homes. Moving from their home into a nursing facility is a fear of 13 percent of seniors, while a mere three percent of research study participants identified the fear of death.
These fears appear to be justified. A recent report by the Department of Health and Human Services found that about 17 percent of nursing homes had deficiencies that caused "actual harm or immediate jeopardy" to patients, including infected bedsores, medication mix-ups, poor nutrition, and patient abuse and neglect. In fact, approximately 20 percent of the complaints verified by federal and state inspectors involved abuse or neglect of nursing home patients.
Last May, the 18,000 residents of Albert Lea, Minnesota were shocked to learn that 15 residents of the Good Samaritan nursing home, all suffering with Alzheimer's or dementia, had been verbally, emotionally and sexually abused by local high school girls who were working at the facility. The subsequent report by the Minnesota Department of Health quoted one employee as saying that "When (the students) would do these things, they would pull the curtain enough, so when they heard a door open, they could stop. They were quite sneaky about what they were doing. The ones they were targeting were those that have Alzheimer's so bad, that they wouldn't be able to say it or remember."
The report found that the abuse involved spitting and putting fingers in mouths, poking breasts and nipples, touching and tapping genitals, sticking buttocks in faces, rubbing buttocks and penises, anal insertion, and restraining residents and teasing them.
Following investigation by state and local authorities, a 19-year old and an 18-year old were charged with gross misdemeanors, carrying a maximum penalty of one year in jail and a $3,000 fine for each count. One of the teens faces 11 charges; the other, 10, including abuse of a vulnerable adult by a caregiver, abuse of a vulnerable adult with sexual contact, disorderly conduct, and failing to report suspected maltreatment. Four of the others, all 17 at the time of the alleged abuse, were charged in juvenile court with failure to report maltreatment.
More than 1.5 million people live in the nation's 15,000 nursing homes, which are typically inspected annually. They are required to meet federal standards as a condition of participating in Medicaid and Medicare, which cover more than two-thirds of their residents, at a cost of more than $75 billion a year.
Although there are obvious acts of nursing home abuse-long-term over-medication, for example--others are more subtle, or as in the Albert Lea situation described above, difficult to detect because of the dementia of the patient. Consequently, these cases can easily be overlooked by family members. Following are some indicators of abuse:
Bedsores or open wounds are common instances of neglect or abuse. Nursing home personnel often claim that bedsores are normal among frail or immobile seniors. Unfortunately, concerned family members are duped by these explanations, and their parents and loved ones suffer pain and sometimes die from these sores. Experts say that almost all bedsore cases are caused by abuse or neglect. Guidelines require nursing homes to move patients regularly and ensure that sheets and clothing are kept dry. Should a family member find a bedsore, insist that the victim is moved to a medical facility for treatment.
Unexplained bruises, cuts, burns or fractures are often evidence that residents are being dropped or abused by staff personnel. This often occurs when the senior is in a medicated condition. Family members are urged to ask questions to get clarification about these situations, and vague or questionable responses often indicate abuse.
Torn, bloody or stained garments are the best evidence of sexual abuse, which, as described above in the Albert Lea story, frequently occurs in nursing homes, where victims are often medicated or suffer from Alzheimer's or dementia. Refusal to allow contact with a resident, or unexplained delays in making the resident available for a visit, indicate underlying abuse, that is, the nursing home staff is attempting to intimidate or prevent the victim's reporting of the abuse or neglect.
Modifications to the resident's financial documents, including wills and trusts, are cause for suspicion, particularly if these changes occur abruptly or if the resident cannot adequately explain why they occurred. Such changes suggest that the resident may have been coerced or threatened.
Each of these warning signs should spur action among family and friends, including reports to police. Suspicions of sexual or physical abuse require changing nursing facilities, as well as police involvement. Nursing home residents, who are frequent targets of abuse, nonetheless have civil rights that need to be protected, most often, unfortunately, by concerned family members and friends.
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