Student 1
Stu Student[TC1]
Tomlinson
English 12-5
1 Feb. 2013
The Inadvertent Death Sentence
Sometimes, a nation’s economic decline can result in more than just ruined lives: it can also end them. As people age and their physical and mental states begin to deteriorate, social and physical activities become crucial components necessary for maintaining a high quality lifestyle. In assisted living facilities, event coordinators are placed in charge of overseeing the daily physical and emotional exercise of the residents living in the facility (Perschbacher 8). Nursing home staff and the array of activities offered by elder care homes form a foundation of support that contributes to the overall quality of life in end of life care homes (9).[TC2] However, when a financial crisis strikes the economy, elder care facilities begin to cut back on the programs they offer. Even nursing staff are sacrificed, just like any other business would lay off employees in an attempt to stay afloat. In situations like the economic downturn in America today, facilities have no choice but to cut staff, activity programs and downsize on the luxury living options they offer (Lenhoff).[TC3]In times of economic depression, the mortality rate of senior citizens increases dramatically, and these premature deaths can be directly linked to the slashing of activity programs and thereduction of amenities. By far the most damaging cost-cutting measure is the reduction of nursing staff. [TC4]
Historically[TC5], elder care facilities have been through a rollercoaster of public praise and abhorrence, as their track record in regards to resident care fluctuates. Elder care originated from a need in the early 1900’s to provide accommodations to house maturing individuals who could no longer care for themselves independently and had no family left to provide for them. Originally called the “poor farms” or “almshouses”, the concept of elder care was the absolute opposite of what it is today (Dentzer). Back in the 1920’s, the idea was to make these institutions as unappealing as possible in order to discourage elderly groups from seeking out these institutions as alternative solutions to their need for end of life care. The idea of discouraging the use government founded institutions lent itself to exceptionally poor living conditions in the homes (Carmichael 104). Instances of financial, physical and mental abuse were documented, and yet very rarely reported to authorities during this time period (Walter 45).
However[TC6] all of this changed in the 1930’s with the passage of the New Deal Act, which promoted the concept of the elderly population receiving federal benefits based on their level of need (Dentzer). It was from this point on that Americans began to transform the way they managed the aged population of people residing in the United States. Emphasis changed from trying to discourage older people’s use of elder care facilities towards a rationale of these institutions being places of safety and empowerment. But this transition was not without its own drawbacks. In April 1969 the then Department of Health and Human Services, wrote the “Intermediary Letter 371” (Dentzer). Frightened by the massive influx of individuals taking advantage of the Medicare system, the Department of Health and Human Services wrote the letters in an attempt to cut-off Medicare’s coverage of nursing home costs for retired individuals. The hope was that by cutting out aspects of Medicare which covered the cost of living in an elder care facility, they would take away much of the financial strain being placed on Medicare while still maintaining Medicare as a long term system (Dentzer).
This[TC7] attitude of cutting corners with Medicare has died out over the years as the baby-boomers begin to reach the age of retirement. Their influence over politician’s political agenda as a voting sector has helped to change the focus of voters toward end of life care to make it a top priority in American politics (Carmichael 57). With the general population becoming more involved in the politics of elder care homes, the quality of these institutions has increased exponentially. Dr. John Cottrell, head of the Aging and Adult Services program stated in an interview “It's not about what we've been, it’s about what we'll become” (qtd. in Walter 3). [TC8]This concept of making up for past flaws in the system by improving the current is one that is echoed by facility directors across the nation.
Over the years[TC9], legislation has been passed to ensure that elder care homes operate at standards which ensure each resident receives high quality care and effective medical treatment. One such legislation was the Nursing Home Reform Act. This act outlined, in detail, the standards that were expected of all elder care facilities across the nation in the areas of assessment, care and treatment. Emphasis on yearly reviews of Medicare funded homes and the enforcement of affirmative action was taken to address complaints about quality of life standards were stressed in the act (Corn). With[TC10] an estimated annual growth rate of twenty percent, elder care facilities are one of the fastest growing sectors in the business world (Blair 52). With this higher level of public demand, the pressure to deliver quality, safe and enjoyable living conditions has become the top priority of these homes (Kerse).
In order to make elder care homes more enjoyable and safe for the elderly individuals who live in them, facilities began exploring new innovative techniques that would help them excel in these categories. The introduction of off grounds activities has helped encourage social interaction amongst elderly individuals who may not otherwise leave their homes on their own accord (Kerse). The variety of activities that facilities coordinate for their residents require very minimal physical movement, but even this minor amount of exercise is enough to make a difference (Mashbum). According to a survey taken of residents in elder care facilities, “eighty-three percent of residents also take advantage of adult daycare and rehabilitative services that help them remain as independent as possible” (Mashbum).
The maintenance of an independent feeling is crucial when dealing with elderly individuals. The ability to retain any form of independence in every day activities is what combats depression and physical deterioration in almost all aging persons living in end of life care facilities (“Depression”). Social interaction between external groups helps to keep the mental status of elderly patients positive, and the social stimulus that comes from these interactions help to release endorphins. These chemicals in the brain facilitate the inducement of positive physiological responses. These activities not only improve the overall mental status of residents, but also helps their physical condition as well (Perschbacher 43). With positive thinking comes the ability to better care for their own bodies, which helps to drive down the instances of malnutrition and poor dieting in the ageing population (Randal 24). Malnutrition and poor diets act as catalyst to many more severe mental and physical conditions such as strokes, kidney failure, diabetic coma, alcoholism and suicide (“Depression”).
With[TC11] the introduction of activity programs, nursing homes and assisted living centers have been able to increase to overall health of their residents while also increasing their quality of life standards. Social interactions between nursing staff also help to keep the environment pleasant in elder care facilities. Since nursing staff has more daily contact with residents than anyone else in the system, a relationship of trust and dependency must be established (Blair 54). This way if a resident is beginning to experience the symptoms of say a heart attack, they will feel comfortable confiding in their care taker about the newly surfacing symptoms. When compared with centers that have higher ratios, homes that establish a one to two staff to resident ratio have the lowest cases of sudden death from heart attack in the nation and have significantly decreased cases of elder neglect, (Zukerman 18-20). Overall, the importance of creating an extensive array of activity programs for their wards, along with establishing strong ties between staff and residents, helps to ensure that hospice facilities are effective and safe places for the elderly population.
When[TC12] hard economic times hit Americans in 2007, everyone began preparing for the worst, including hospice homes. Cuts were made left and right across the country in three main areas of facility operations: staffing, activity programs and luxury accommodations (“Eldercare”). The first major change in facility operation was in luxury living, which is composed of policy procedures and special living accommodations. For example, in California, nursing homes began turning all cases of abuse and neglect over to the local police for investigation. With the local authorities being overwhelmed by the number of cases to investigate, many where over looked. This resulted in death for multiple seniors, for whom help did not come soon enough (“As”). [TC13]For many elderly individuals, filing complaints of abuse or neglect are left as a last resort, and reserved for only the most extreme situations of abuse. Reporter Tara Siler for the broadcast station of NPR stated in an interview that, “National studies estimate that just one in five elder abuse cases is reported” (“As”). [TC14]With so many of the reported cases being ignored, it is no wonder that the death rate amongst the elderly is on the rise (Lenhoff[TC15]).
Luxury accommodations were also sacrificed in many eldercare centers across the nation in order to try and combat financial losses. One very common practice of assisted living centers in financial distress is to have residents share accommodations, which in turn opens up more living quarters for new tenants to occupy. This method does increase the amount of money flowing into a center, but it also takes a toll on the morale of each patient in the hospice center (Zukerman 16-19). Sharing a living space often leads to tension and stress between residents, and in some rare instances, physical violence has occurred. It was reported in 2000 that “roughly one of every 10 long-term care residents…changes roommates for compatibility reasons” (Wen). The stress that is experienced from tensions with roommates and the turmoil experienced during relocations can have a dangerous effect on the physical and mental health of hospice residents (“Depression”). One of the most rampant mental illnesses in elderly communities is severe depression. With the overwhelming pressures from their new environment and loss of independence, the added strain can be too much for many residents (Randal 45). Tension between roommates and the stress of being moved from one environment to another will often send an elderly individual into a depressed state.
The next alteration made to cut costs is to reduce the amount and type of activity programs offered by facilities. According to recent studies, 42% of elderly individuals in nursing homes suffer from depression (Dentzer). With cuts currently being made in activity programs that percentage is on the rise (“Eldercare”). Many elderly individuals suffering from a lack of stimulation in their lives become depressed and begin to further isolate themselves from social interactions. This self isolation can often lead a complete shutdown in communication between nursing staff and residents. Many depressed elders will withhold information concerning new medical symptoms that have surfaced from staff members. This makes catching cancers, strokes and mental disorders very difficult for care takers (“Eldercare”). Without the constant stimulation of social and physical activities, the health of a seemingly vigorous elderly individual can decline at an alarmingly rapid rate (Kerse).[TC16]
The last, and most life threatening cut made by hospice centers, is staff reduction. With the current economic situation, many nursing homes and assisted living facilities where forced to lay-off staff to help cut costs (Durkin). According to the Service Employees International Union, one out of every 257 staff nurses where laid off last year during the economic down turn (“Eldercare). With such drastic cuts the ability of facilities to keep up with the daily demands of their patients was strained. Reports of residents’ calls for help going unanswered all day long, cold food, malnutrition, falls, and residents being left in unsanitary conditions increased (Durkin). When the Department of Health and Human Services presented Congress with their findings concerning the number of hours worked by staff members at elder care facilities and the resulting quality of life for residents, the consequential reports were disturbing. According to the department’s research, residents needed at least 4.1 hours of care daily to maintain a healthy lifestyle and be taken care of medically in an efficient and timely manner (Lenhoff). On average, nine out of ten facilities in the nation fell grossly below that recommended number. In most facilities where patients received less than the 4.1 hours of care the rates of elder death due to infection, malnutrition and depression were three times higher than those of homes that met or exceeded the minimum time ratio (Lenhoff). Clearly, reducing staff makes it incredibly difficult for homes to meet the 4.1 hours of care per patient needed to avoid experiencing the consequences of falling below the minimum. [TC17]
When it comes down to the final line, being an elderly individual in America during times of economic instability can be more than scary: it can be life threatening. The fact that the death rate of individuals over the age of 75 has increased by five percent in the past four years shows that this problem cannot be ignored (Blair 175). The seemingly simplistic and necessary cuts being made by hospice homes across the nation need to be recognized for what they are: inadvertent death sentences. While laying off a few employees and cutting an off-campus activity may seem like a reasonable sacrifice, the reality of the situation is that people are dying because of these cuts. Our mothers and fathers, who raised us and cared for us, deserve the same level of care and protection. All the money in the world cannot buy back the lost knowledge that dies each year with the estimated six-hundred and seventhly thousand elderly individuals who die yearly (94). It is time to reform the way we view Elder Care, and change it from a subsidized branch of Medicare that functions for a profit, to a form of public good that all elderly individuals have access to and are guaranteed quality care regardless of the current economic times. When dealing with people’s lives, it should never be acceptable to make cuts if those cuts result in ending a person’s life prematurely. [TC18]
Works Cited[TC19]
“As Calif. Budget Shrinks, Services for the Elderly Slip.” Morning Edition. Narr. Steve Inskeep. National Public Radio. 3 June 2009. Radio.
Blair, Cornelia. Growing Old in America. Eugene: Information Plus, 2000. Print.
Carmichael, Richard. Economics for Everyone: Basic Economics- 2009 Edition. New York: Create Space Publishing, 2009. Print.
Corn, Jane. “New Nursing Home Regulations a Giant Step Forward.” Indianapolis Business Journal 16 Apr. 1990: 6B. ProQuest Database, ProQuest. 16 Dec. 2009.
Dentzer, Susan. “Today’s Nursing Homes.” Online News Hour: Health Spotlight. PBS, n.d. Web. 16 Dec. 2009.
“Depression in Older Adults and the Elderly.” Helpguide.org. Direct Media Incoporated.Web. 4 Nov. 2009.
Durkin, Erin. “Layoffs Creating Care Woes, Say East New York Nursing Facility Residents.” The Daily News 1 Oct. 2008. Print.
“Eldercare Difficult for Families as Economy Suffers.” Behind Closed Doors. Narr. Michel Martin. National Public Radio. 9 Mar. 2009. Radio.
Kerse, Ngaire. “Does a Functional Active Programs Improve Function, Quality of Life, and Falls for Residents in Long Term care? Cluster Randomized Controlled Trial.” British Medical Journal (International Edition) 2 (2007): 129-135. Full Text Periodicals, ProQuest. Web. 23 Nov. 2009.
Lenhoff, Donna. “The Bottom Line of Caring.” The Atlanta Journal - Constitution 4 Aug. 2
2002: pag. G6. ProQuest Newsstand, ProQuest. Web. 15 Dec. 2009.
Mashbum, Sarah. “A Place Called Home: Not-for-Profit Organizations Provide Innovative Housing and Services for Older Adults.” The Journals of Gerontology 61B (2006): 311-315. Full Text Periodicals, ProQuest. 25 Nov. 2009.
Perschbacher, Ruth. Assessment: The Cornerstone of Activity Programs. Philadelphia: Venture Publishing, 1993. Print
Randal, Lawrence. Aging and the Elderly: Psychology, Sociology and Health. New York: Nova Science Publishers, 2007. Print.
Walter, Laura. “Choices Define the New Face of Assisted Living.” The Cleveland Jewish News. 5 May 2006, B8-B9. Print
Wen, Patricia. “Nursing Home Clashes Mar the Golden Years.” Boston Globe 27 Nov. 2009: B1. ProQuest Newsstand, ProQuest. Web. 15 Dec. 2009.