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.