We all know the current state of our nation’s nursing homes. “Deplorable” is not too strong a word. Some of the problems are simply structural–the average facility is about 30 years old. Some of the problems are due to poor management and lack of caring, and some problems lie in the dehumanizing nature of large institutions.

An article in today’s Boston.com talks about a different kind of nursing home, a “Green House.” Compare the typical nursing home with this image, as described by writer Kay Lazar:

The aroma of spaghetti and garlic bread wafts from the kitchen as Marie Burke aims her walker toward the dining room table, where several of her housemates, a couple of them in wheelchairs, already have taken positions. Lunch is being dished up family style, and the conversation bounces from favorite meals — meatloaf and brisket — to friendly ribbing about who in the house is the real card shark.

Forget the long sterile corridors, antiseptic smells, and assembly-line feel. In this nursing home, elders rule. Residents decide when they want to get up, what they want to eat — and it’s all freshly cooked by specially trained nursing assistants who pull up chairs, fill their own plates, and join in the conversation.

This describes life in the $34 million Leonard Florence Center for Living–a new Green House Project home–in Chelsea, Massachusetts. The Green House concept was created by Harvard-trained geriatrician Dr. William Thomas to provide residents with an environment that fosters autonomy, personal choice, and social interactions.

The good news: Green House nursing homes have operating costs on par with traditional nursing homes. That means quality of life with no additional expense.

The bad news: There are only 89 Green House nursing homes, in only 16 states. An additional 27 are in development. Compare that with a total of about 16,000 traditional nursing homes across the country.

Could homes on this model be one way out of the nursing home mess our country is in? We certainly hope so. One thing’s clear: Most of us would never choose to live in a traditional facility. Is a little humanity too much to ask in our final years?  The nursing home abuse attorneys will keep their eyes on these new nursing home models–if they maintain their integrity and caring, we’ll be happy to call ourselves supporters.

For more information:

Boston.com article

Green House Project

HensonFuerst Nursing Home Abuse Team

According to an article on WRAL.com, the North Carolina Department of Health and Human Services (DHHS) has recommended that the Centers for Medicare and Medicaid Services fine Britthaven of Chapel Hill nursing home for violations that led to the hospitalization of six patients in February. One patient, 84-year-old Rachel Holliday, died.

Ms. Holliday and eight other patients tested positive for opiates, powerful and controlled pain medications–and many of them had not been prescribed opiates at all.

Angela Almore, 44, of 724 Berwick Valley Lane in Cary, was indicted in June on one count of second-degree murder and six counts of felony patient abuse. Almore worked as a registered nurse at Britthaven. Prosecutors allege that Almore drugged the patients to make them more manageable. [from WRAL.com]

After an extensive investigation, the DHHS Nursing Home Licensure Section found that Britthaven of Chapel Hill “didn’t ensure patients were protected from abuse, its services didn’t meet professional standards, unnecessary drugs were prescribed and significant medication errors occurred.”

The requested fines were $2,500.00 for each violation, for a total of $20,000.00.

HensonFuerst’s Nursing Home Abuse team continues to conduct an independent investigation into these and other episodes of nursing home abuse and neglect. If you have questions about potential abuse, we’re here to provide answers. Call us anytime, day or night, at 1-800-4LAW-MED.

Aging isn’t always dignified. That’s especially true for people with dementia. Alzheimer’s disease dismantles a person’s life piece by piece: short-term memory is the first to go, followed by long-term memory, recognition of family members, recognition of self, all cognitive abilities. In addition, a person loses physical capabilities–the ability to walk, to talk, to balance, and even to eat.

Eventually, a person with dementia becomes totally dependent on the care of others. Because the medical needs are intensive, families are generally unable to provide adequate care and a loved one is placed in the hands of a long-term care facility.

We’d like to think that a nursing home that courts families of dementia patients would provide trained and compassionate care. Unfortunately, that’s not always true.

In a letter to the Chicago Tribune, Kim Warchol (of Dementia Care Specialists, Inc.) notes that nursing home residents can’t achieve their best lives unless nursing home staff are properly trained to provide safe, therapeutic care. She states:

“Based on my experience, between 60 to 80 percent of those living in geriatric nursing facilities have dementia, and well over 50 percent of those admitted to assisted living facilities have functional loss due to cognitive impairment. And with a new diagnosis being made every 70 seconds, long-term care facilities must empower their staff for the challenges ahead.” [Kim Warchol, letter to Chicago Tribune]

Her wish is that new laws be enacted to encourage facilities to move from an impairment-based practice to an abilities-based practice, which respects the person behind the disease. What a fantastic idea. Why does it have to even be mentioned as a “revolutionary” concept? It seems basic–dignity for all, but especially for those who lose everything else.

Feeding Dementia Patients with Dignity

A related article in the New York Times this week talks about the “revolutionary” concept of feeding dementia patients with dignity. After a person loses the ability to eat, the family typically is asked whether they would prefer to have a gastric feeding tube inserted so nourishment can be forced, or not…which is the equivalent of withholding nourishment. The decision is always heartbreaking.

But get this…some social workers are suggesting that there is a third option: to feed the patient carefully and slowly by hand, stopping when the person has enough, starts choking, or becomes agitated.

Doctors are calling this new option in palliative care “comfort feeding only.” In a recent paper in The Journal of the American Geriatrics Society, the authors argue that feeding tubes do not necessarily prolong life in patients with advanced dementia, and that surveys indicate that a vast majority of nursing home residents say they would rather die than live with a feeding tube.

“Just imagine someone interacting with the patient, talking to them, cueing them into eating,” Dr. Teno [Joan Teno, professor of community health at Brown University's medical school] said, “as opposed to someone walking to the bedside and pouring a bottle of Ensure down the feeding tube.” [from New York Times article]

Dignity…who knew it could be so revolutionary. At HensonFuerst, every day we fight for the basic dignities of people in nursing homes. We agree that special training should be required of everyone who treats dementia patients, but we would like to take that one step further. Let’s require compassion, caring, and, yes, dignity for our parents and grandparents when they live their days in a nursing home.

HensonFuerst Attorneys provide a voice for people in long-term care, and their families. If you have questions about how your loved one is being treated and suspect neglect or mistreatment, feel free to contact us. If you have questions, HensonFuerst has answers.

What is it really like to live in a nursing home? Anna Mae Halgrim Seaver wrote notes while she lived in one. After her death, her son found them and had them published.

“This is my world now. It’s all I have left. You see, I’m old. And, I’m not as healthy as I use to be. I’m not necessarily happy with it but I accept it. Occasionally, a member of my family will stop in to see me. He or she will bring me some flowers or a little present, maybe a set of slippers — I’ve got 8 pair. We’ll visit for awhile and then they will return to the outside world and I’ll be alone again.”

The full note, with attribution to Newsweek, is available on the ElderCare Rights Alliance website: My World Now. It is touching, and makes you want to immediately pick up the phone and call your mother or grandmother. I did.