A United Press International news item claimed that there is "shoddy care at nursing homes." It says that "Government inspections showed that nearly one in four nursing homes administers drugs improperly and about the same number did not provide adequate personal hygiene for residents."

A USA Today news item reported that "Nursing homes must clean up their act. Nursing homes are not home, sweet homes. They are places of pain, despair and death. Because they care for those who can no longer care for themselves or be cared for by their families. Because they are often the last stop for loved ones who are dying. But nursing homes should never humiliate patients. They should never mistreat or neglect them. Sadly, they often do. That's the conclusion anyone with a loved one in a nursing home must draw from the 93-volume, 74,000-page, federal report released (May, 1990) on our 15,000 nursing homes and their 1.3 million patients."

The United States Department of Health and Human Services researchers identified seven categories of abuse. Ninety-five percent of those surveyed said they felt that all seven are problems for nursing home residents:

Physical abuse --infliction of physical pain or injury.

Misuse of restraints --chemical or physical control of a resident beyond physician's order or outside accepted medical practice.

Verbal/emotional abuse --infliction of mental or emotional suffering.

Physical neglect --disregard for the necessities of daily living.

Medical neglect --lack of care for existing medical problems.

Verbal/emotional neglect --creating situations harmful to the resident's self-esteem.

Personal property abuse --illegal or improper use of a resident's property for personal gain.
Across the USA, the federal report concluded that in nursing homes:
24% improperly administered drugs according to the written orders from the attending physicians (60% in New Jersey);

26% did not provide adequate personal hygiene (67% in the state of Washington);

21% did not follow proper isolation techniques to prevent the spread of infection;

20% did not provide each resident with a urinary catheter with proper routine care;

36% did not follow rules requiring that food be stored, prepared, and served under sanitary conditions (62% in Alabama);

18% failed to provide patients' bathroom needs according to federal standards (33% in Michigan);

12% didn't properly treat bedsores; and

15% didn't provide patients with privacy during treatment and personal care.
USA Today said, "The numbers are abominable." They mean thousands of people whose dignity should be respected are being humiliated, mistreated, and neglected because they've grown old.

Mental Health in Nursing Homes
In hearings by the United States House of Representatives Select Committee on Aging, in August 1989, expert witnesses testified to the seriousness of mental health problems in nursing homes. Some statements include:
The rates of psychiatric disorders in nursing homes have been estimated to be at least 50% to 94% of the population; these people are in need of mental health consultation.

It is likely that widespread overuse and misuse of psychoactive medications add to the psychological woes of nursing home residents (a news article in SF Chronicle claims 44% of nursing home patients in U.S. are controlled by powerful psychotropic drugs, 70% in California). First, when psychotropic drugs are used inappropriately they may cause depression, agitation, sedation, and confusion. Second, they may mask psychological disease and make depression, anxiety, and confusion difficult to recognize.
Who's Blaming Who?
Healthcare experts, nursing home operators, and federal officials have made statements concerning nursing home problems as follows:

Some tend to view the problems identified by the government researchers as relatively minor incidents overblown by critics. They say the data fail to distinguish between major problems and minor ones that do not affect patient care. At best, the report is an outdated snapshot of a facility. At worst, it leads people to the false conclusion that this guide substitutes for visiting nursing homes during the selection process (this statement is by Paul Willging, executive vice-president of the American Health Care Association). Mr. Willging essentially states that improvements will result only by legal action and by enforcement.

Some say there is a substantial unmet need for trained nursing home staff to care and to cope for mentally disordered geriatric patients, for mental health services, and for funding them.

Faced with heavier levels of care, such as residents with more debilitating diseases, frustrated staff take out more of their stress on the residents. Many believe stress is caused by the difficulties of caring for impaired and dependent residents, who require help in many of the activities of daily living.

Much of the abuse cannot be attacked directly because it is never reported.

Nurses aides who provide most of the care for nursing home residents sometimes have no training.

The federal Health Care Financing Administration, who administers Medicare, has missed every deadline so far set for providing the state with guidelines and regulations.

Only about 20 states have drawn up sanctions to be taken against offending nursing homes short of closing them down, as the law requires.

The nursing facilities lack the capability, particularly in terms of specialized staffing, to manage many of the behaviors that are characteristic of major mental illness.
What You Can Do!
There is a strong need for family involvement in:
The patient's course of treatment;

Setting strict standards for rehabilitation; and

Providing stronger mechanisms for complaints against negligent facilities.
As a family member or friend of a resident you can:
Continue to monitor the nursing home's treatment of their residents, not just for one resident but for others as well;

Participate as much as possible in the home's activities to gain firsthand knowledge of what actually goes on;

Examine the medication records to see that the resident is not being overmedicated;

Periodically review the Health Care Financing Administration's or the State Department of Human Services' report on complaints filed against the nursing home; and

Get involved in filing complaints if you find there are real problems and abuses.
As a senior citizen you can:
Get involved in the political process by writing your congressmen, both state and federal, to enact better standards, improved funding for mental services, and improved supervision of nursing homes.

Make your voice heard in the community against records of residents abuse.