elderly and nursing homes

I will lay the frame work for you for my opinion/observation. I am a physical therapist at a large hospital. The goal of many hospitals is to discharge patients as soon as the patient is medically stable in order to turn a profit. Part of my job as a physical therapist at a hospital is to perform an evaluation to determine whether or not the patient is fit to return home or not. I serve a large number of elderly people and many patients have been bedridden for a while because of their illness and need to be placed in rehab prior to returning home.

I use the term rehab loosely. There are two types of inpatient rehabs, inpatient meaning you live there for the time. There are Acute Rehab Units (ARU's) and Skilled Nursing Facilities (SNF's). ARU's are intense rehab units have rules they must go by for admission. Everyone goes home after an ARU stay. However, the patient must be able to tolerate 3 hours of therapy a day, have a need for more than one type of therapy discipline (physical, occupational and or speech therapy) and 75% of thier population must have one of 13 particular diagnosis' the majority being neurological diagnosis' i.e. spinal cord injury, brain injury, stroke. As you can guess most elderly people do not fall into these categories. They are so debilitated they cannot handle 3 hours of therapy a day, they came in for something far from the diagnosis they need to be accepted and often only need one discipline - physical therapy or occupational therapy. AND many of them have cognitive problems i.e. dementia, alzheimers.

So where do these people go? Well they can go home with 24 hour supervision requiring someone to assist them to the bathroom or clean them up often as many of them are incontinent and get bedsores from lying in urine/stool unknowingly. They need someone to prepare their meals, to dress them, to bathe them. Some require so much supervision you cannot even step out of the room to go to the bathroom yourself without fear they will fall out of bed and break their hip.

If you are like many of those in the baby boomer generation - which I happen to know the author of this coffee shop topic is. You have a strong desire to take care of your elderly parents, yet are still working because social security for you and your parents isn’t what you thought it would be. So you hope that your were able to make enough money in their life time to hire an aid for 24hrs a day or you are wealthy enough to quit your job and take care of them yourself. I would say that this is the case in only about 5% of the patients I see. So what happens to the other 95%?

Answer: the aforementioned SNF. Skilled Nursing Facility is usually a fancy name for nursing home with a therapist. In fact many residents are there for boarding care and receive no therapy. Once your time given by insurance is up you usually are transferred over to boarding care. There is a low requirement for participation in SNF’s – 1.5 hrs a day that can be broken up between several disciplines of therapy above and there is no requirement on diagnosis or number of disciplines of therapy needed. In addition, this is usually covered by insurance unlike ARU’s and a more fiscally reasonable option for that baby boomer with a dying mother.

In a nutshell. I’m the one who decides for hundreds of patients each year if they go to a nursing home or not.

I don’t believe that being religious and willing to take care of your family members has as much to do with it as money. My own grandmother suffered a very large stroke herself several years ago and was so debilitated she could not get acceptance into an ARU despite her diagnosis, need for several disciplines of therapy and insurance covering it because she could not tolerate the required amount of therapy a day. My family was forced to place her in SNF until she was able to be strong enough to go home with 24 hr care, a feeding tube which the caregivers had to be trained to use and a hospital bed – you can imagine the state she was in before her therapy. Luckily my grandfather had amassed enough money before his death to make this possible for her, but even my parents do not know when this money will run out and have cut her caregiver hours down to 8 a day.

I’m sorry to tell you this, but religion does not give you the money to care for your loved ones. That is unless you have read Joel Osteen’s book “Your best life now” and believe that God owes you money if you are faithful and pray to him. To that I say read the book of Job or Rick Warren’s book “The Purpose Driven Life” – which has outsold Osteen’s by a ratio of 7 to 1 and refutes this theology. Ironic eh? But I digress. I agree if you are a member of a catholic faith this may have been instilled in you, but it is not the only factor. How the elderly are is multifactorial.

Besides faith you must consider culture. I would say that culture plays more of a role in how you decide to care for your loved ones. Let’s take the Hispanic culture for instance. At work I often work with the generalization that my low income Hispanic patient likely has a large family that is willing to take the financial burden of caring for their loved one whether or not they are catholic. Note: a generalization is different than a sterotype which I will not explore at this time. They usually have several family members who are not working or they work different shifts and can take turns taking care of the patient. This is very unusual for other cultures where there is a small family and this burden would be too great to spread among only 2 individuals.

On another note regarding elder abuse, where do you think the elderly are going that are being abused? By those that do not value them? They cannot stay home, so in fact isn’t the portion of society that values elders assisting this person by allowing them to stay in a nursing home?

Now let’s consider the intrinsic value of that individual instead of looking at them merely as elderly, those how abused their children for instance. These children feel no need to take care of their loved one because of the years of abuse they suffered and are often estranged. It would be very presumptuous of you to say that these children don’t value the elderly, they may in fact just not value their parent because they have known the things they are capable of. Would you feel so inclined to take care of an elderly murderer? Or rather leave him in prison? It’s essentially the same. I would go as far to suggest that many of these elderly are the ones that you think are “throw away parents”. Not only that, but you cannot assume they are parents at all just don’t have any family. They opt to be somewhere with people their own age. Where are they supposed to do when they become feeble, become shut-ins?

I understand that many people’s knowledge of nursing homes is only the stereotypical negative things that they have heard. They assume those who place loved ones in nursing homes devalue the elderly. I understand how this opinion is formed as I know how depressing they are. I spent many afternoons in our town’s nursing home as a child visiting my own family members and then in high school with those who had no family. In fact unless there is another person on this site who actually works in a nursing home I would say that I am probably one of the top 5 most experienced O-nerds regarding this topic.

I value the elderly who are 1. worth being valued, because of 2. my religion and 3. the culture of my familiy. So before you are so quick to judge those placing others in nursing homes think of these things. Also think about your God who regards a complete loss of dignity as a beautiful thing. I don’t consider crapping myself daily and forgetting who I am to be a beautiful thing. I consider it sad. I agree with smcbride, those elderly worth value as he described should be valued and not all nursing homes are a bad thing. I guess that was a lot to write to come to that conclusion, but hopefully this has enlightened many of you who have no idea how the healthcare system works.

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