Living the Nursing Home Saga

For the past month my sister and I have been living the one nightmare we all agonize about as we see our parents grow old and dependent – finding a suitable nursing and rehabilitation center worthy of their presence.

It began just over four weeks ago with a number of severe and inexplicable falls. Our mother, who had managed to age gracefully and retain her energetic independence until last winter, encountered her first serious fall while peacefully sitting on her bed. Although it sounds unlikely, our 86 year-old mother suddenly fell asleep in a sitting position and plunged to the cold and rigid tile floor, breaking the fall with her forehead. Although a grave scenario at any age, the accident could have been fatal for her because of the blood-thinning medication she takes to prevent blood clotting. Her cardiologist had warned us that any fall and, consequently, any blow to her head could cause her a massive, and possibly fatal, brain hemorrhage. We immediately called 911 and within minutes she was being screened for abnormal signs and symptoms.

After a long and nerve-wrecking eighteen-hour stay at the Emergency Room, the Doctor revealed that the damage had been just superficial. The skull and brain were intact – although, for the next several weeks, she would undoubtedly look like a boxer who just lost the fight to a heavy weight!

And so, we took Mom home and gladly pampered and cared for her round the clock – except for one single hour of the night where she went unsupervised.

Twenty-four hours after her first fall, our self-sufficient mother decided she could walk in the dark, in the middle of the night, without her walker! But her legs proved otherwise. As she reached the washroom she apparently slipped, falling this time on her buttocks and back.

The violent screams threw me from my bed. I dashed to find her on the floor yelling from the pain on her back – I feared the worst. As we walked her slowly to her favorite chair, the pain intensified. Within minutes, again, the rescue was at our door steps, and several minutes later four paramedics where immobilizing her whole body, from neck to toe, to prevent any further damage to her frail and pain-stricken body.

A succession of body scans and X-rays at the ER revealed a “compression fracture” on Mom's back – a serious injury for an elderly patient who suffers from a slew of cardiac and respiratory problems as well as from severe osteoporosis.

After several days of heavy sedation, hallucinations, and countless medical examinations, her physicians disclosed the seriousness of her condition as well as the treatment options. Surgery, of any type, was out of the questions due to her medical roster. The only viable option was to wear a body brace for the next two months while undergoing therapy in a rehabilitation center, until the brittle bones from her vertebrae solidified once again.

And so the journey to find just the perfect rehabilitation facility for Mother began. The hospital gave us just one day to find such a place – an almost impossible feat for anyone who is not well-versed in the art of geriatric healthcare.

The social worker at the hospital gave us a list of nine centers that would accept her insurance, which we fervently and swiftly began to call in an attempt to secure a bed for her that same evening. We visited those that had been recommended by friends who were undergoing the same painful process with their parents hoping to gain some sympathy as we met with the director of admissions face-to-face. “Not today – call us tomorrow after 10:30 am to see if anything becomes available” was the standard and indifferent response.

As we narrowed our search for lack of vacancies, our hopes to take our mother to the most respected centers in the city began to vanish. One final call, however, offered some hope - The Nursing Center at Mercy had one bed available and was willing to accept our precious mother.

This particular center we had not visited recently, but our father had been interned there towards the end of his life seventeen years ago. The experience then was positive and almost memorable. The name association with a respected hospital, where two of my own children were born, gave us peace of mind and the expectation that the center was a clean and caring facility with qualified compassionate staff that cared for the well being and conscientious recuperation of its patients.

Wrong! The nightmare began that same evening when my mother arrived by ambulance at the center. A series of unfortunate events during the week that followed would reveal that it is precisely centers like this one that give skilled nursing and rehabilitation facilities a terrifying reputation.

Without going into full detail, what follows is a chronology of the events that led us to seriously reconsider our decision to place Mother under the care of this facility. Paired with our own research on skilled nursing and rehabilitation centers available in our city, we were certain that we could find a much more suitable, compassionate, and professional center for her.

Day 1-pm: Our mother was transferred into The Nursing Center at Mercy. She was placed in a room with a patient who had open ulcers that exuded a foul, putrid odor throughout the room - the stench was unbearable. Day 2-am: Our mother was transferred to another room, but because of the excessively cramped furniture in the room the door was almost inaccessible by wheelchair - her only means of transportation. Day 2-pm: The evening RN (Registered Nurse) administered medication to Mother without the consent from her attending physician. She experienced painful adverse reactions from the medication. The RN from the evening shift refused to call her Doctor and it was only after my persistent half-hour nagging session that another RN took it upon herself to place the urgent call. Day 3-am: The morning RN attempted to give Mother a medication that had been discontinued from her long list of meds due to possible adverse effects for a person with a condition such as hers. A second RN attempted to give her yet another medication that had been discontinued almost two months ago! Day 3-pm: A CNA (Certified Nursing Assistant), who was in a hurry to take her hour break, yelled and tugged at my mother to sit her on the wheelchair in a haste. After realizing what she had done, the CNA asked me not to tell her supervisor for fear of being dismissed. Day 5-pm: After discussing and following up for two complete days with the Social Worker at the The Nursing Center at Mercy, we were able to transfer our mother to another skilled nursing facility.

It was undeniable – we came to the unfortunate yet wise realization that we had to move her out of this center immediately since the events that had transpired in just a few days revealed that the care and service at this center was mediocre to poor at best.

Once again we were in the search. Armed with our laptops and smartphones we decided to educate ourselves with concrete facts about each of the nursing and rehabilitation facilities for which Mother qualified, in order to make an educated transfer decision. We concentrated our search on the nine possible facilities that would accept her insurance for the level of therapy she needed.

Through our search we discovered Medicare.gov - Nursing Home Compare, a site that offers valuable information and rankings for nursing facilities across the nation through its Five-Star Quality Rating.

According to Medicare.gov, the Five-Star Quality Rating assesses facilities that are certified to participate in Medicare and / or Medicaid. Developed as a result of the Omnibus Reconciliation Act of 1987 (OBRA '87), the rating system reports findings in three distinct areas: 1) health inspections, 2) staffing, and 3) quality measures. An overall rating is then calculated using the three individual ratings combined.

The following information provided by Medicare Nursing Home Compare, as reported in the nursing home directory Local Nursing Homes, another site we explored, helps to demonstrate that there might be a correlation between the level of service and patient care, and the level of qualified staffing. According to this directory, following are the ratings given to each of the nine centers we reviewed. The final  "Overall Rating" shows that The Nursing Center at Mercy ranked last out the nine!

As per Medicare.gov, “Federal law requires all nursing homes to provide enough staff to adequately care for residents. However, there is no current federal standard for the best nursing home staffing levels. The nursing home must have at least one RN for at least 8 straight hours a day, 7 days a week, and either an RN or LPN/LVN on duty 24 hours per day.”  Medicare.gov - staffing

Keeping this in mind we deepened our search to find specific information on staffing for each of the centers. These are the results:

At first glance these results might indicate that, when compared to the national standard, one staffing variable alone might not be indicative of the quality of care and service received at any one facility. However, when a number of these variables are consistently lower than the national average, as is the case in The Nursing Center at Mercy [Mercy], the quality of service provided at the facility might be severely compromised. My mother’s negative story is a clear testament to our hypothesis.

Needless to say, we were able to transfer Mother to St. Anne’s just five days after her initial arrival. Although we determined that the level of care at the first facility was beyond unacceptable based on the recurring mistakes and mistreatment, discovering these data reassured us that we were making the right decision.

A very personal story, I debated whether I should share it with the cyber world. Finally, after much internal deliberation I concluded that our testimony and statistical findings might help other families make the correct decision much sooner than we did, and thus, spare their loved one from any suffering and from further physical or emotional damage.

There has been increased media coverage of this topic in the last few months, particularly in our home city, but it is not enough. As citizens of the human race, it is our responsibility to ensure that, like our children, our elderly receive the care and respect they deserve. It is imperative that they are treated with great care, dignity, love, and compassion. As professionals and as humans we must never forget to advocate for them regardless of the condition in which they find themselves – physically, mentally, emotionally, or financially.

For Mother, it could have meant the difference between life and death.

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