In the next few months, our healthcare system will change. How it will change remains to be seen, but I am certain that the frail elderly of our society will take a back seat to everyone else. As far as I can tell from history, this is nothing new.
Yet, we wonder how so many of our nation's children get into serious trouble. Could it be that the very people, who, after a lifetime of experiences, and education are dismissed as having no value.
We need to care for the frail elderly in order that during the caring process they have the opportunity to transfer a lifetime of accumulated wisdom to us.
An African proverb comes to my mind: "When an older person dies, a library burns down."
How many libraries will be abandoned and even lost today?
Thursday, July 16, 2009
Wednesday, July 8, 2009
"Your walking becomes ambulation..."
I'm reading "Gray Areas: ethnographic encounters with nursing home culture." The book is a collection of articles written by various experts, and edited by Philip B. Stafford.
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Just getting through the introduction of this book is difficult. Immediately, I think of all the people I've met over the years living and working in the long-term care system, and for the most part good and caring people. Yet they along with the elderly they care for, must endure a system that is neither good nor caring. In fact, the system is notorious for transforming good people with passion into disallusioned workers who leave the profession. Burnout is common among the staff. Turnover rates can reach 300%, even among management the turnover rate can reach 80%. The front door to the nursing home is a revolving door. One third of the 17,000 facilities in the U.S. have been cited for abuse, neglect, and other actions that led to the premature death of the people under their "care."
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If that isn't enough, fraudent claims for services that never happened or are exaggerated, cost the taxpayer somewhere in the neighborhood of $20 billion every year. That's a lot of money. Lawsuits are common, that is family members suing for negligence or wrongful death. In fact, one large nursing home chain, owning some 1,500 facilities, had so many lawsuits against them they had to change the name of the chain just to insulate themselves against all the bad publicity. And that's another trend, it's becoming increasingly difficult to know who even owns the facilities.
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But for me, the worst of all of these crimes is that the older person, who has managed to survive into old age, is not respected nor revered, instead they are robbed of their personhood. The title of this blog comes from Gray Areas, the Introduction on page 12. In it, Stafford writes:
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Just getting through the introduction of this book is difficult. Immediately, I think of all the people I've met over the years living and working in the long-term care system, and for the most part good and caring people. Yet they along with the elderly they care for, must endure a system that is neither good nor caring. In fact, the system is notorious for transforming good people with passion into disallusioned workers who leave the profession. Burnout is common among the staff. Turnover rates can reach 300%, even among management the turnover rate can reach 80%. The front door to the nursing home is a revolving door. One third of the 17,000 facilities in the U.S. have been cited for abuse, neglect, and other actions that led to the premature death of the people under their "care."
-
If that isn't enough, fraudent claims for services that never happened or are exaggerated, cost the taxpayer somewhere in the neighborhood of $20 billion every year. That's a lot of money. Lawsuits are common, that is family members suing for negligence or wrongful death. In fact, one large nursing home chain, owning some 1,500 facilities, had so many lawsuits against them they had to change the name of the chain just to insulate themselves against all the bad publicity. And that's another trend, it's becoming increasingly difficult to know who even owns the facilities.
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But for me, the worst of all of these crimes is that the older person, who has managed to survive into old age, is not respected nor revered, instead they are robbed of their personhood. The title of this blog comes from Gray Areas, the Introduction on page 12. In it, Stafford writes:
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"When you enter the nursing home as a patient, you experience a loss of self, of personhood. Your walking becomes "ambulation." Your food becomes your "diet." Your eccentricities become your "behaviors."
Your life becomes your "record."
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Of all the aspects of this system, that one can critque, I believe this is the worst of them all. Why? Because, many of the people living in nursing homes are survivors, great people who have endured life's trials. They perservered. They didn't quit. They worked hard all their life, getting educated, marrying, having and raising children, making major contributions to our society, only to move into the final stage of their life to be reduced to something less than human, to be stripped of their identity and forced into a "purgatory," suspended between the living and the dying. Is it any wonder that many of them will say to me, "I wish I would just die."
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Growing old in America, can mean having to learn how to live in this world of "suspended animation." Our ageism, deeply embedded in every corner of our culture, perpetuates this system. Ageism is in our workplace, in our entertainment, in our families, and even in our worship. As a society, we are blind to it. Like other forms of prejudice, our blindness results in the wrongful death of many valuable people, and in this case, the premature death, of literally thousands of older people living in nursing homes.
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So what can or should we do? The first step is simply to admit that we are blind. Then we need to begin the task of finding ways to correct our vision, our thinking. I believe one of the best places to start is in our faith communities. Does your programming reflect ageism? Is your community segregated by age? Do segregated groups ever mix? Does your programming promote intergenerational contact? Exposure to one another is the most powerful way to break down false stereotypes, untrue myths, and provide the catalyst for change.
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If we don't address this bastion of "hate crimes," and that is exactly what they are, wrongful acts based in the hatred of our elderly, then the ground will remain drenched with the blood older people. I think we can do better.
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I quote Isaiah 1:17 often:
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"Learn to do well, seek justice, relieve the oppressed, defend the fatherless and plead for the widow."
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Let me encourage you this week to carefully read, and meditate on Isaiah 1:11-29.
Wednesday, May 20, 2009
"Remember Me"
This weekend coming is Memorial Day, and I hope that all of my readers will have a great holiday, and stop for a few moments to remember and honor the men and women who gave their lives defending our way of life and keeping us safe.
I was thinking about what to write today, and the words, "...remember me," came to my mind. Some time ago, I was invited to speak to a group of pre-school children about the work that Desert Ministries is engaged in. Well, how do I explain all this to someone so young?
As I looked across the room at all the young bright-eyed, smiling faces, I asked them, "How many of you were brought to school today by your parents? A majority of those tiny hands went up almost immediately.
Then I asked them, "Has your mother or father ever forgotten to pick you up from school?" Again, quite a few hands went up. I asked, "How did you feel about that?" One girl spoke up and said, "Scared!" Another child piped up and said, "Afraid!" And yet another piped up and said, "Alone!" These responses led to an avalanche of responses from the rest of the children. Each one identifying with the terrifying fear, the feelings of being vulnerable, and the feelings of fear when one is forgotten.
Once the children quieted, I looked at them, and the adults who were standing in the back of the room, and quietly said, "That's exactly how someone feels who lives in a nursing home."
Remember them.
I was thinking about what to write today, and the words, "...remember me," came to my mind. Some time ago, I was invited to speak to a group of pre-school children about the work that Desert Ministries is engaged in. Well, how do I explain all this to someone so young?
As I looked across the room at all the young bright-eyed, smiling faces, I asked them, "How many of you were brought to school today by your parents? A majority of those tiny hands went up almost immediately.
Then I asked them, "Has your mother or father ever forgotten to pick you up from school?" Again, quite a few hands went up. I asked, "How did you feel about that?" One girl spoke up and said, "Scared!" Another child piped up and said, "Afraid!" And yet another piped up and said, "Alone!" These responses led to an avalanche of responses from the rest of the children. Each one identifying with the terrifying fear, the feelings of being vulnerable, and the feelings of fear when one is forgotten.
Once the children quieted, I looked at them, and the adults who were standing in the back of the room, and quietly said, "That's exactly how someone feels who lives in a nursing home."
Remember them.
Wednesday, April 1, 2009
April Showers Bring May Flowers...
Ok, what can I say? I've been saying that little rhyme for years, and I couldn't resist it. But as I as stop to think about it for a moment, I hope that May is full of flowers. We need to look at something lovely. It will help distract me for just a few minutes and soften the very deep concern I have and sadness I feel for what is happening inside our nursing homes.
It used to be that once in a while I would hear a story about an older person being neglected or receiving poor care. Lately, it seems like a daily event. For years, I've known and have talked publically about the decline of our long-term care system, but I believe now that what may have been interpreted by some as "nay-saying" is now an horrific reality.
It's well known that much of the funding for long-term care comes from Medicaid. In our current economic crisis, funding for Medicaid is receiving increasing scrutiny, as it should, since some 20-30 billion dollars of fraudulent Medicaid claims. This of course needs to be cleaned up. However, skyrocketing costs will probably lead to capping benefits, and/or restricting benefits. We simply cannot collect enough tax money to pay for all the long-term care that will be required.
Compounding the funding issue is the staffing issue. Staff shortages are severe and getting worse. I've seen projections for staffing shortages reaching as high as 29% over the next three decades. Currently, we are experiencing about a 9% shortage. Translated: there are about 125,000 nursing positions open.
What does this mean for the vulnerable old person who needs nursing care? At best, it is a dismal picture. Poor care, as a result of neglect,and sadly abuse is not the exception any longer. On the other side of the coin though and in fairness to the people who are working in nursing homes, nursing home workers are doing the best they can under difficult circumstances.
The average rate of pay for a nursing aide, the person who is on the frontlines, i.e., bathing, bathrooming, feeding, grooming, dressing, people, is $8.50 per hour. Jobs at fast food places pay more than that. The reimbursement rate on Medicaid invoices is 60 cents on the dollar. Translated: A nursing home loses about $15 per bed per day. If I have 100 beds in my nursing home, that's $1,500 I will lose each day. Oh, I can't forget to mention the 300% turnover rate. All of this adds up to disaster.
I've seen firsthand, great people, great workers with great work ethics, great attitudes, caring loving people, burned out after 18 months of working in a nursing home, and then like the majority of their co-workers, quit, leaving behind the frail elder who has little or no say in what is happening to them. Imagine how frightening that must be for them.
Once, during a major exodus of nursing home workers, I heard a old woman look up into the face of aide and ask: "Are you leaving too?"
Well, if I stare into this "picture" too long, I get depressed. So I need to take a periodic break and find something nice to think about, something lovely like a field of newly blossomed flowers. I really do hope for all our sakes that April showers will bring May flowers, especially to people living and working in nursing homes.
It used to be that once in a while I would hear a story about an older person being neglected or receiving poor care. Lately, it seems like a daily event. For years, I've known and have talked publically about the decline of our long-term care system, but I believe now that what may have been interpreted by some as "nay-saying" is now an horrific reality.
It's well known that much of the funding for long-term care comes from Medicaid. In our current economic crisis, funding for Medicaid is receiving increasing scrutiny, as it should, since some 20-30 billion dollars of fraudulent Medicaid claims. This of course needs to be cleaned up. However, skyrocketing costs will probably lead to capping benefits, and/or restricting benefits. We simply cannot collect enough tax money to pay for all the long-term care that will be required.
Compounding the funding issue is the staffing issue. Staff shortages are severe and getting worse. I've seen projections for staffing shortages reaching as high as 29% over the next three decades. Currently, we are experiencing about a 9% shortage. Translated: there are about 125,000 nursing positions open.
What does this mean for the vulnerable old person who needs nursing care? At best, it is a dismal picture. Poor care, as a result of neglect,and sadly abuse is not the exception any longer. On the other side of the coin though and in fairness to the people who are working in nursing homes, nursing home workers are doing the best they can under difficult circumstances.
The average rate of pay for a nursing aide, the person who is on the frontlines, i.e., bathing, bathrooming, feeding, grooming, dressing, people, is $8.50 per hour. Jobs at fast food places pay more than that. The reimbursement rate on Medicaid invoices is 60 cents on the dollar. Translated: A nursing home loses about $15 per bed per day. If I have 100 beds in my nursing home, that's $1,500 I will lose each day. Oh, I can't forget to mention the 300% turnover rate. All of this adds up to disaster.
I've seen firsthand, great people, great workers with great work ethics, great attitudes, caring loving people, burned out after 18 months of working in a nursing home, and then like the majority of their co-workers, quit, leaving behind the frail elder who has little or no say in what is happening to them. Imagine how frightening that must be for them.
Once, during a major exodus of nursing home workers, I heard a old woman look up into the face of aide and ask: "Are you leaving too?"
Well, if I stare into this "picture" too long, I get depressed. So I need to take a periodic break and find something nice to think about, something lovely like a field of newly blossomed flowers. I really do hope for all our sakes that April showers will bring May flowers, especially to people living and working in nursing homes.
Wednesday, March 11, 2009
People who have seen thier "better days."
There's nothing more disconcerting than turning on the radio on the way home and listening to someone rationalizing for their listeners reasons for not providing health care for people and I quote: "...who have seen their better days." The rationalization is that, as one would expect, the money would be better spent on children.
More distressing is, once the program host shared this profound wisdom, the number of listeners who called in and agreed. The tension between providing for children versus providing for older adults is nothing new in human history. Let me suggest that this conflict is not one of capacity to provide, but one of will. Watching the government print trillions of dollars and extending bailout money to banks and corporations shows that if we, as society have the will to do something, we will do it.
The issue then is not do we have enough money. The issue is do we have enough heart to care not only for children, but for older adults as well. We owe our older population a debt of gratitude for providing for our home, our education, and our quality of life.
Theologically speaking, the Ten Commandents address the care of our parents. The first four commandments instruct us in how we are to relate to God. The next five commandments instruct us on how we are to relate to each other.
Starting the second group of commandments,is the commandment to "...honor our father and mother:"
"Honour thy father and thy mother, as the LORD thy God hath commanded thee; that thy days may be prolonged, and that it may go well with thee, in the land which the LORD thy God giveth thee." Deutronomy 5:16.
When I hear pronouncements like the one I referenced in this blog, I can understand why God would highlight the care of parents. When we prioritize need for support, the elderly will naturally fall to the bottom of the list. Why? Because we can see no apparent return on our investment, (ROI).
Knowing how we think, God then places this commandment first in the series of how we relate to one another, and different from the other commandments, God adds two promises, and if I may paraphrase: "Take care of your mother and father, and if you do, I will make sure you have a long and prosperous life, and not only for you, but for the nation in which you live.
Of course, some people will think that this is simplistic, but I do not. I think it is this simple. I believe if we made the care of our older adults a top priority, many, if not all, of our social ills would vanish. Why? Because, first it would force a change in our own thinking, and God would indeed fulfill His promise to us.
However, reading the history of the treatment of older adults does not leave me optimistic. But you never know, we might actually be the first society in history to take God at His word. As for those people who are described as "...having seen their better days," you know well that you are living in your best days now.
What do these kids know anyway?
More distressing is, once the program host shared this profound wisdom, the number of listeners who called in and agreed. The tension between providing for children versus providing for older adults is nothing new in human history. Let me suggest that this conflict is not one of capacity to provide, but one of will. Watching the government print trillions of dollars and extending bailout money to banks and corporations shows that if we, as society have the will to do something, we will do it.
The issue then is not do we have enough money. The issue is do we have enough heart to care not only for children, but for older adults as well. We owe our older population a debt of gratitude for providing for our home, our education, and our quality of life.
Theologically speaking, the Ten Commandents address the care of our parents. The first four commandments instruct us in how we are to relate to God. The next five commandments instruct us on how we are to relate to each other.
Starting the second group of commandments,is the commandment to "...honor our father and mother:"
"Honour thy father and thy mother, as the LORD thy God hath commanded thee; that thy days may be prolonged, and that it may go well with thee, in the land which the LORD thy God giveth thee." Deutronomy 5:16.
When I hear pronouncements like the one I referenced in this blog, I can understand why God would highlight the care of parents. When we prioritize need for support, the elderly will naturally fall to the bottom of the list. Why? Because we can see no apparent return on our investment, (ROI).
Knowing how we think, God then places this commandment first in the series of how we relate to one another, and different from the other commandments, God adds two promises, and if I may paraphrase: "Take care of your mother and father, and if you do, I will make sure you have a long and prosperous life, and not only for you, but for the nation in which you live.
Of course, some people will think that this is simplistic, but I do not. I think it is this simple. I believe if we made the care of our older adults a top priority, many, if not all, of our social ills would vanish. Why? Because, first it would force a change in our own thinking, and God would indeed fulfill His promise to us.
However, reading the history of the treatment of older adults does not leave me optimistic. But you never know, we might actually be the first society in history to take God at His word. As for those people who are described as "...having seen their better days," you know well that you are living in your best days now.
What do these kids know anyway?
Monday, January 5, 2009
Off to a great start!
It looks like we're off to a great start in 2009. First, I want to thank our supporters who have kept this ministry going and growing for nearly 17 years. Some of you have been with us from the very beginning, August 1992. You really are the best. Because of your generous and committed support we have been able to touch the lives of thousands of elderly people living in nursing homes and assisted living communities.
"Christmas In Our Hearts" our annual Christmas concert was just spectacular. Again, we have some incredible people who underwrite that event, making it possible for hundreds of elderly people to attend. My hat is off to all the volunteers who worked very hard to make that concert a success. Be sure to mark your calendars now for the first Thursday in December 2009, December 3, 2009.
I am very excited about the fact that it appears that many of the University of Nebraska at Omaha athletes will be visiting nursing homes and assisted living communities this year. With the great help of Lyn Holley, PhD, Gerontology Department, UNO, and the UNO Athletic Department, it looks like all the teams will be encouraged to adopt a facility, and visit the residents and possibly bring those that are able to their games.
It's always been my pipe dream that one day, activities directors would start calling me telling that they have too many volunteers and please stop sending so many! Maybe 2009 could be that year.
In the meantime, Ruth McGrath our volunteer coordinator is gearing up for another great year. Last year, she started 24 new volunteers taking our volunteer force over 150 volunteers visiting care facilities. She'll be working with several Omaha churches as well to include Dundee Presbyterian, Thanksgiving Lutheran, Kingsway Christian, Emmanuel Fellowship, to name a few.
If you feel like you are being drawn to volunteer, contact Ruth and she will get you started. It is a great way to get involved in your community, make a real difference in the life of an older person, and make a real difference in your life too!
December 20, 2008 was the last live Radio Hour broadcast. After 12 years of continuous programming, I am sad to let radio go. I loved doing it, and it is a great way to reach a lot of people. But this year, I am going to take that 60 minutes and break it up into 60 soundbites across the week.
In addition, I am going to be developing and expanding our website that will include behind the scenes podcasts that will be available to you 24/7. I will invite our volunteers, friends, boardmenbers, and experts to join me weekly to talk about the role of the church in the long-term care community, how families can avoid the chaos of trying to find a nursing home during a crisis, and a host of other topics as well. My favorite of course is inviting our volunteers to share their stories. They are always remarkable.
That's it for today. Someone told me I should write a book. This probably would not be the place to do that. Now, go to the Donate page make a large contribution , thanks and I'll see you later.
Blessings,,
"Christmas In Our Hearts" our annual Christmas concert was just spectacular. Again, we have some incredible people who underwrite that event, making it possible for hundreds of elderly people to attend. My hat is off to all the volunteers who worked very hard to make that concert a success. Be sure to mark your calendars now for the first Thursday in December 2009, December 3, 2009.
I am very excited about the fact that it appears that many of the University of Nebraska at Omaha athletes will be visiting nursing homes and assisted living communities this year. With the great help of Lyn Holley, PhD, Gerontology Department, UNO, and the UNO Athletic Department, it looks like all the teams will be encouraged to adopt a facility, and visit the residents and possibly bring those that are able to their games.
It's always been my pipe dream that one day, activities directors would start calling me telling that they have too many volunteers and please stop sending so many! Maybe 2009 could be that year.
In the meantime, Ruth McGrath our volunteer coordinator is gearing up for another great year. Last year, she started 24 new volunteers taking our volunteer force over 150 volunteers visiting care facilities. She'll be working with several Omaha churches as well to include Dundee Presbyterian, Thanksgiving Lutheran, Kingsway Christian, Emmanuel Fellowship, to name a few.
If you feel like you are being drawn to volunteer, contact Ruth and she will get you started. It is a great way to get involved in your community, make a real difference in the life of an older person, and make a real difference in your life too!
December 20, 2008 was the last live Radio Hour broadcast. After 12 years of continuous programming, I am sad to let radio go. I loved doing it, and it is a great way to reach a lot of people. But this year, I am going to take that 60 minutes and break it up into 60 soundbites across the week.
In addition, I am going to be developing and expanding our website that will include behind the scenes podcasts that will be available to you 24/7. I will invite our volunteers, friends, boardmenbers, and experts to join me weekly to talk about the role of the church in the long-term care community, how families can avoid the chaos of trying to find a nursing home during a crisis, and a host of other topics as well. My favorite of course is inviting our volunteers to share their stories. They are always remarkable.
That's it for today. Someone told me I should write a book. This probably would not be the place to do that. Now, go to the Donate page make a large contribution , thanks and I'll see you later.
Blessings,,
Wednesday, December 10, 2008
"Bailout?"
At this time of year, I'm tempted to take the month of December off, (but of course I won't, but I am tempted). From now until December 24th or so, our nursing homes will be filled with singers, dancers, musicians, great desserts, and all sorts of activities. The nursing home residents will enjoy tidal waves of volunteers and visitors from all corners of our society from the early morning hours continuing late into the evening.
By December 24th, most of the nursing home residents will have all six verses of "The First Noel" memorized, they will be able to recite the story of "Silent Night," without giving it a second thought, and their blood sugars will have reached new highs.
Now don't get me wrong, all of this activity is great, really great in fact. I'm glad people are out visiting the nursing homes, and like me, some of them may end up working in the field of gerontology, starting their own volunteer organizations, and so on. But, most of them probably will not. My chore these days is to get them to come back in January, when the nursing homes will be like ghost towns.
Feeling alone is painful, and it has been proven to be bad for your health. Only half of nursing home residents get visitors from anyone, and that is probably a conservative estimate. One resident told me, "I have a lot of staff around me, but there is no one here just for me." Staff do not have time to sit down and visit with residents. Care staff hit the ground running at the beginning of their shift continuing to run right through lunch right up to the end of their shift: bathing, grooming, bathrooming, giving meds, and so on.
In the midst of all the staff flurry, the nursing home resident ends up sitting alone, and eventually they shut down, (die, failure to thrive). Incident rates of Alzheimers's disease, and clincal depression are linked to loneliness. Loneliness kills people. All sorts of people have their handouts these day, bail outs they call them. The nursing home residents need a bailout too, except their bailout is not measured in dollars and cents, it's measured in time spent with a "friend." The nursing home resident that gets visitors gets better care.
This year, I'm asking for a bail out too. I'm asking Santa to bring us more volunteers this year for Christmas, and I'm asking him to see what he can do about getting them to come back in January too.
By December 24th, most of the nursing home residents will have all six verses of "The First Noel" memorized, they will be able to recite the story of "Silent Night," without giving it a second thought, and their blood sugars will have reached new highs.
Now don't get me wrong, all of this activity is great, really great in fact. I'm glad people are out visiting the nursing homes, and like me, some of them may end up working in the field of gerontology, starting their own volunteer organizations, and so on. But, most of them probably will not. My chore these days is to get them to come back in January, when the nursing homes will be like ghost towns.
Feeling alone is painful, and it has been proven to be bad for your health. Only half of nursing home residents get visitors from anyone, and that is probably a conservative estimate. One resident told me, "I have a lot of staff around me, but there is no one here just for me." Staff do not have time to sit down and visit with residents. Care staff hit the ground running at the beginning of their shift continuing to run right through lunch right up to the end of their shift: bathing, grooming, bathrooming, giving meds, and so on.
In the midst of all the staff flurry, the nursing home resident ends up sitting alone, and eventually they shut down, (die, failure to thrive). Incident rates of Alzheimers's disease, and clincal depression are linked to loneliness. Loneliness kills people. All sorts of people have their handouts these day, bail outs they call them. The nursing home residents need a bailout too, except their bailout is not measured in dollars and cents, it's measured in time spent with a "friend." The nursing home resident that gets visitors gets better care.
This year, I'm asking for a bail out too. I'm asking Santa to bring us more volunteers this year for Christmas, and I'm asking him to see what he can do about getting them to come back in January too.
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