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An Old-Age Problem
I could not read Stuart Steers "Dying for Dollars," in the October 15 issue, to completion because of the painful memories it brought back.

After a stay in Lutheran Hospital, my mother was transferred to Cedars Health Care Center for rehabilitation in late 1996. I chose Cedars because of the assurances they offered to my family of a pro-active program to return her home by June 1997. In her "dementia," my mother told me of the horrible way she was being treated. I began to show up for her "scheduled therapy sessions" only to find her lying in bed in a filthy condition. I would ring for the nurse and wait for up to an hour for a response. One day I received a call from Cedars that my mother was being transferred to St. Joseph's Hospital. She was moved from St. Joseph's to St. John's Hospice, where under their caring hands she passed away. She was only 67 years old.

I wonder to this day if by my own hand I placed my mother in harm's way. Ironically, she is buried under an Alberta pine on a mountain just west of town.

John Moreno
Edgewater

Maybe these lawmakers, lobbyists, nursing-home owners and aides should start to think a little more about their own aging/mortality. Would they want to stay in the facilities they are creating? Wall Street won't be there for them when they must stay in these hellholes. The American Association of Retired Persons seems to have so much clout to keep Social Security insolvent and stagnant--why don't they do something about the nursing homes?

I guess money will always be the driving factor. Who cares about dignity, compassion and simple cleanliness? They don't pay the bills.

Cheryl Bower
via the Internet

After reading "Dying for Dollars," several of my co-workers at a quality Boulder nursing home and I were dying to be heard! To judge "the industry" most heavily on the alleged actions of one nursing home is outrageous! I don't know about the health care at Cedars, and I don't intend to defend it here. I work at a home where families are content and staff are skilled and caring.

The guilt of putting a loved one into a nursing home and the denial of that person's declining condition is often transferred by family into anger toward the staff. Families often struggle for control and experience a clouded perception of the situation. From an objective view, the answer as to why an eighty-something Alzheimer's patient (with any number of other physical ailments) is declining in condition, falling and having mood swings is obvious. To a loving family, it is not.

Unfortunately for the elderly, falls, bruises, skin tears, fractures and nutritional problems are common and are rarely signs of abuse. Thin skin tears very easily. "Unusual fractures" are not so unusual in the elderly due to loss of bone mass and density, and they often occur spontaneously. Malnutrition and dehydration may be the result of a patient's refusal of food and drink. Some patients spit out food or drink, even becoming combative when staff attempts to feed them. This raises the question of patient's rights. It is a paradox: While families don't want patients to go without food or hygiene, they don't want staff to "abuse" the patient by forcing it on them. Ultimately, it is up to the patient.

Bad facilities and caregivers do exist. Families need to inspect and tour a facility thoroughly before admitting a loved one. We also need to have realistic expectations of the elderly. Let's face it: Unless admitted for short-term rehab, people don't go to nursing homes to get better. I'm all for improving our nursing homes--mine included--but I couldn't stand by silently as a slanted article insulted my profession and, therefore, me.

Erica Rubenstein
Denver

When nursing homes and hospitals were owned and run by local organizations that were based in the communities they served, they seemed to be more accountable. Peer pressure from the community meant that people came first, profit second. The community helped support the home or hospital in rough times. Nowadays, these organizations are run on the business model, and the bottom line is what counts most. Downsizing and cutting corners do not make for good service. This is very apparent in the number of cases filed against these organizations for poor care, substandard care and wrongful death. The hidden link between the companies that own insurance plans and hospitals, nursing homes and interim-care facilities has created a conglomerate in which CEOs and shareholders win and patients, communities and society lose.

Debora Beck-Massey
via the Internet

As a nurse who works in long-term care by choice, I was glad to see Stuart Steers's article on the profitable nursing-home industry with sometimes deplorable care, staffing and salaries. Poor patient outcomes are related to reduced staffing ratios in both hospitals and nursing homes. The media must address these issues on a regular basis.

Getting back to nursing homes, it is important to remember that an elderly person is placed in long-term care for a reason: Their health does not allow them to live independently anymore. It can be very challenging to promote independence while maintaining safety for a frail or confused elderly patient. We cannot automatically administer psychotropics or apply restraints. The care of residents is guided by a multi-disciplinary approach with strict protocols.

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