Call it what you want: Nursing home, skilled nursing facility, rehab center, convalescent home, or post-acute care. They are all the same and a common destination should you survive a recent hospitalization.
But they all have an existing reputation and can ultimately diminish the dignity of older adults. Never in my four decades of practice has anyone ever said, “Please, Dr. Dorio, send me to a nursing home!”
As a geriatric physician, I have visited countless nursing homes caring for those who have been conveyor-belted through hospital illness, and then jettisoned out to these facilities. Sometimes, home care is inadequate or unavailable, so post-hospitalization care must be contoured for those who are still too weak to survive at home. But a nursing home?
Most of these patients are seniors and are insured under Medicare, so they have an established yet unreliable “star rating” system for the care rendered in these facilities.
Not until the situation arises, most of you have never visited a nursing home. The advent of odor eliminators has minimized their malodorous reputation, and demented screaming has been suppressed by drugs. Yep, older adults have been sanitized for a star rating.
No one can anticipate illness, so when you or your loved one requires hospitalization and expect discharge, you might have a day or so to decide where they will send you for further care. Potential facility internet site photos and descriptions are publicity-polished, crying out, “Choose me!” Sad.
I have never seen a library, community garden, kitchen for personal use, or a worthy outdoor space to be with nature in my nursing home rounds. Rarely have I seen a barber shop or beauty salon. Some patients will return home, but for most, this is their home.
Sure, there are some activities like physical therapy, but most of the time, patients sit in wheelchair-lined hallways or remain in bed where they receive meals. Sometimes, they have no purpose or goals and wallow life away. Wouldn’t your dignity diminish?
What about the basics of life, like glasses, dental work, or hearing aids? Even sitting in a wheelchair lineup in hallways might not allow one to see, hear, or eat meals. Is this quality of life, or instead, where society has decided to relegate their seniors?
Unfortunately, nursing homes have no full-time staff physicians in-house or on-call who know all patients and their problems.
What can be done?
Let’s start with my expertise: Enhance the availability of house calls from physicians, nurse practitioners, physician assistants, and home health agencies. This way, patients can receive care at home after hospitalization and “age in place” instead of being institutionalized.
Examine the root cause of why hospitals shove patients from acute care into nursing homes: Money and profit. Criteria must be reexamined not from a coercive business viewpoint, but from a humanitarian and medical standpoint. Instead of hospital administrators establishing discharge standards, let it be in the hands of medically experienced doctors and nurses.
Educate patients and families about governmental oversight agencies, including state health departments or licensing agencies, and CMS (Center for Medicare & Medicaid Services) at the federal level. A worthy star rating system provided by the public is better than a “Choose Me” internet site.
Use newly minted residency-trained doctors to staff nursing homes to carefully watch over all patients. Medical school loans can be forgiven for each year of service provided to a nursing home.
Legally, legislate basic needs, including a library, community garden, personal kitchen, worthy outdoor space, and hair and beauty salons. Let us ensure all older adults are screened yearly for vision, dental, and hearing problems.
How much will this cost? It depends on you. Much of the cost can be mitigated by community volunteers and organizations willing to provide time and creative efforts to maintain quality of life for those who are aging.
For those who care, visit a nursing home and perhaps “adopt a resident,” especially one who might not have family or an advocate.
Many seniors are veterans, teachers, former first responders, retired nurses, doctors, social workers and more. Importantly, they have provided the shoulders we all stand on.
As we age, no one should face the potential of being institutionalized in a nursing home and not be allowed to age in their home.
We can do better medically as a nation, but we must first learn to treat our older adults with dignity.
Dr. Gene Dorio