Before the demands of my doctoral program took over my life, I spent a year working as a state-(California) certified Ombudsman for the Elderly. If this title is unknown to you, the simple definition is ‘elder-advocate’ for those who are living in a private home (Residential Care Facility for the Elderly, RCFE) or institution (Skilled Nursing Facility, SNF). Care facility elder abuse and neglect is real and alarmingly prevalent, at least in my state. California has laws in place to protect elders, but what is the reality of how well those laws actually serve and protect this vulnerable population?
I was fortunate (I suppose, considering other possibilities) that when the time came for me to re-locate back to my hometown to address my father’s needs, I was able to do so without too much hassle. Dad was fortunate in that he had a daughter who was willing to attend (my two brothers claimed they could not help) to him, and also that he had the resources to eventually hire in-home care, once that became necessary. My father’s illness and decline into hospice is what drove me to become an Ombudsman. Through direct experience, I learned a lot about the process of ‘parenting a parent’ (the topic of so many articles and books now): how emotionally and physically wrenching it is; how satisfying it is to care for the adult who cared for you; how important it becomes, looking back, knowing that you eased the end-of-life transition of your parent in the most selfless way you will ever ‘give’, apart from nurturing your own child.
Being an Ombudsman, however, introduced me to the settings in which elders are being “cared for” by non-family. Sometimes this is the result of a family’s practical acknowledgment: they cannot logistically handle the workload of caring for a parent in decline (or, perhaps they live in another state and can’t re-locate). But very often, I found, elders who were unable to live independently did not have family taking the initiative to 1) explore care-options, or, 2) consider the quality of care and treatment provided to their family member.
Elder care is Big Business. “Nursing homes” and private facilities rake-in money from family members and insurance companies (to a lesser extent, Medicare is involved). It’s a very lucrative business that, in my opinion, capitalizes on the strong desire we feel to protect our parents in decline. Before I continue in my exposé, I want to issue a Disclaimer: the statements and observations that I offer here are based on my own experience as an RCFE Ombudsman, and on the occasions I had to visit, and speak with Ombudsmen who were assigned to, SNFs.
· Quality of care is determined by the family’s ability to pay: savings accounts, private insurance, Medicare, or a combination of these.
· Even under the best circumstances (a high-quality home or private facility), your loved-one’s care still needs to be monitored. You need to go, hang-out, talk to other Residents, definitely look around: kitchen, bathroom, laundry, bedroom; sniff the air. You know what the tell-tale odors are of a poor environment. Look closely at your elder, for signs of dis-ease or lack of care (being dressed by staff in the same clothes, for consecutive days, is common).
· Know that, although all state-licensed facilities are assigned Ombudsmen, we have multiple facilities to monitor, are only required to monitor once per month, and are doing so out of kindness and concern (Ombudsmen are volunteers).
· All care facilities must be licensed and commit to obey the laws governing an elder’s right to thrive. “Resident’s Rights” must be posted, along with other important information (such as how to contact an Ombudsman), near the front door (RCFE) or throughout the hospital (SNF).
All Residents of care facilities and their families have the right to have any concerns addressed promptly. The first point-of-contact is the Ombudsman. Speaking from experience in this role, I urge you to listen to your elder in care and take her/his concerns seriously. Elders in facilities will, if not disabled in some way that hinders them, ‘complain’ about their situations. The quality and amount of food (insufficient); other Residents; indifference of staff toward Residents; lack of privacy; loneliness and boredom, and depression. Aches and pains are more noticeable to the elder who’s in care. But even if your elder is not complaining, sometimes this is out of fear of retaliation from staff. I’m sorry to share that, in one of my RCFEs, the Residents were utterly compliant when with family and visitors (even myself, at first) because they were terrified of the care provider who was at the home the majority of the day.(She was later reported and issued a reprimand).
Finally, it’s important to know that, in the State of California at least, identifying, reporting, and resolving abuse or neglect cases in elder care facilities can be difficult and a long-term process. It begins with the elder, or family, being vigilant about care.
Many families don’t have enough money, and therefore options, when it comes to caring for aging and infirm parents. Whether you choose to become care provider yourself ( prepare for a grueling experience), hire an in-home care provider, pay rent at a Residential Care Facility, or allow your elder to enter a Skilled Nursing Facility, please remember one thing: the person in decline was once a vibrant, active, healthy person. Even if, in the aging process, they’ve morphed into a cantankerous curmudgeon, a chronically ill or feeble man or woman, or have descended into the frustrating throes of dementia, they need and deserve love and attention. Care facilities are counting on the fact that, as busy adults who need to schedule and control key aspects of our lives, placing our family member in “a home” of some kind allows us the reassurance that they’re being well-cared for. Yes, that is our comfortable assumption. And we all know about where assuming too much typically lands us.