David Hoppe

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:: No state for old people

Indiana's nursing home disgrace

By David Hoppe

The first thing that hit us when we walked through the door at the nursing home where my mom spent the past summer was the claustrophobic smell of unflushed urine. That's what you get when you pack several hundred human beings who are too weak or off balance to take care of themselves in a single building with low ceilings and crowded hallways.

My mom, who turned 80 while she was there, has a diabetic condition that's caused her to lose the feeling in her feet. This makes it hard for her to walk and, in April, she tripped on the lip of a handicap ramp - yes, something supposed to make life easier for people like her -- as she was trying to get in to see an exhibition about a local architect at the art center in Michigan City. The fall broke her leg in three places just below the knee. This necessitated surgery and the implementation of an excruciatingly painful steel contraption, like something out of a torture porn movie, pinning her leg together from the outside. Mom's doctor said the Russians developed this device under battlefield conditions during World War II. This was not exactly reassuring.

When the subject of nursing homes came up, nurses in the hospital where mom was being treated told her they wouldn't want to be stuck in any of the facilities in Michigan City. A place in another town, a few miles away, was recommended. This would mean driving an extra 20 minutes or so each way, but my dad, 84, loves to drive so this didn't seem like a problem.

This was our introduction to the world euphemistically known as elder care. Sounds and images come to mind: The hallway traffic jams of despondent or confused men and women in wheelchairs. Raspy voices crying out through different doorways for help or attention. The little crowd of aides who were always gathered outside the supply room to smoke cigarettes near my mom's window.

And, I should add, the daily kindnesses and, when called for, the forthrightness that many of those same aides provided.

We would learn more. Not long after my mom was released, my wife's dad, also in his eighties, who suffers from Parkinson's, fell and broke his hip. His wife, my mother-in-law, chose a nursing home that had the advantage of being close to where she lived. At first blush, the place looked great. The rooms were good-sized and furnished rather like a mid-scale motel. The TV, in other words, wasn't screwed to the ceiling. They also served raw fruits and vegetables - a seemingly obvious nutritional thing to do that was somehow overlooked at the place my mom stayed.

The smell, though, was the same. And as weeks blurred into one another, it became clear that living conditions at dad's nursing home were pretty much the same, too - only bigger. This was a considerably larger facility with, as it turned out, a seemingly smaller staff.

So it didn't come as a shock when we found that a national study recently released by the Centers for Medicare and Medicaid Services gave the nursing home my father-in-law stayed at the lowest rating on a scale of 1-5. What's more, the study found that Indiana ranks among the ten worst states in the nation when it comes to quality of care. More than one in four of the state's nursing homes received the lowest grade possible, and about half of the 500 facilities here were considered "below average."

It's been said that Indiana doesn't take good care of its kids. Well, the situation is worse if you're old.

As we could see for ourselves, the biggest problem in nursing homes is staffing. The American Health Care Association has determined that Indiana has a mind-boggling 93 percent one-year staff turnover rate for certified nursing assistants. No wonder. At one point an aide asked my mother-in-law if she might consider hiring her to help them in their home once dad was released. When my mother-in-law said she could only pay $10 an hour, the aide said that would be great since she only made $8 per hour at the nursing home.

Both facilities we experienced last year were for-profit. This means that necessities like raw fruits and vegetables are considered luxuries and that staff is kept to a minimum. The place my mom stayed was supposed to have a doctor, but he lived miles away and, a nurse told me, literally phoned his directions in.

It was also interesting to note how the care provided to both our parents was abruptly considered sufficient after about 100 days - or once Medicare coverage expired.

"Live fast, die young, and leave a good-looking corpse." Whoever said that must have visited Indiana and seen the alternative.