Guest Opinion

Exceptional People, Exceptional Care” reads the impressive Web site
for a local nursing home, adorned with photos of palm trees and a plate
of “fine cuisine served with a Tucson touch,” along with assurances to
prospective guests and their families that the facility is
“comfortable, safe, modern and convenient.”

My friend who resides in this facility finds this laughable.
Battered by torturous noise levels from television and the wailings of
patients in wheelchairs lining the hallway, he finds it hard to sleep
even though he is, like many of the residents, sedated with
medications.

All terms used in promotion are, of course, relative and subjective.
Anyone can walk in through unlocked doors, but I haven’t complained.
The open doors are convenient—I don’t have to walk through long
corridors on filthy carpets to reach my friend’s room.

Such openness also provides at least a smidgeon of ambiguity when
items are stolen from rooms. Last year, I took my friend some new
clothes, and they were stolen overnight, the tags still intact. On
holidays and birthdays, I’ve brought other gifts, like an expensive
blanket, and haven’t commented when I later noticed they were
missing.

The Arizona Department of Health Services inspectors, despite
discovering several serious violations of state and federal rules, gave
this nursing home a 2009 rating of “A” for excellent. A few months
earlier, the Arizona Daily Star cited U.S. Centers for Medicare
and Medicaid Services assessments of this and three other area nursing
homes as “much below average” and seven others as “below average.”

The DHS and Medicare evaluations are so contradictory and
paradoxical that they defy imagination. On the one hand, they impose
relatively modest fines and note, for example, failure to enforce
policies on problems such as skin care, change of medical conditions
and wound monitoring. On the other, they give an approving nod to
obvious mismanagement and perpetuation of bad practices. Any visitor
with eyes open could easily list a dozen serious lapses in hygiene and
care.

When you can’t find a clerk in Home Depot or Wal-Mart, it won’t cost
your life, but in a nursing home, the inability to access prompt
medical attention could. Attendants are clearly doing their best with
their wide-ranging multiple duties, stressed as they move from serving
food to changing diapers, with not even convenient hand sanitizers in
reach. In the facility my friend calls home, no staff, nursing or
otherwise, answers the phone on weekends (at least on the occasions
I’ve called), and efforts to get him medical attention for critical
problems have been met with hostile reminders that it takes a long time
to qualify for a doctor’s visit. Get on the list!

When I visit my friend, I try not to respond to those who line the
corridors in wheelchairs—it’s simply too heartbreaking. A woman
begs me for a soda, for she knows I bring Dr. Pepper along for my
friend, but I don’t know if she’s a diabetic or on a special diet. A
couple of years ago, I stopped for brief chats with a woman in her
wheelchair and evoked what may have been her first smile in years when
I brought her a doll which she was always hugging after that.

When I arrive in my friend’s tiny room, I usually find him sleeping
or sitting up in his wheelchair watching TV. I pick up litter,
sometimes wipe spilled food off his beard and clothing, take a filthy
glass to the bathroom and give it a rinse, and sometimes pause to wipe
smears of excrement off the toilet seat. The double room is cramped,
and the visitor’s chair is usually occupied by a pack of diapers. Since
he’s been a resident, the other single bed has been emptied and
refilled a number of times.

After that Dec. 19, 2008, article in the Arizona Daily Star appeared with the headline, “Ratings give 11 area nursing homes low
marks,” I arrived for a visit one day to see a huge van unloading new
beds. The halls were cleared of wheelchairs, and the carpets looked
like they had been vacuumed. My friend’s room was clear of litter. But
this was only a temporary improvement.

So long as Americans tolerate such a system rather than expanding
Medicare and subsidizing preventive and home care to cover everybody so
that all may enjoy their life, liberty and happiness, these conditions
will prevail. Meanwhile, we can add visions of helplessness to our
other anxieties. Personally, I’d rather be nuked.

This article appears in Sep 10-16, 2009.