Nursing Home Administrator Quotes

Dr. Gingrich and Mrs. Goodhall had prevailed upon the board of trustees; the board had requested that Larch comply with Dr. Gingrich’s recommendation of a ‘follow-up report’ on the status of each orphan’s success (or failure) in each foster home. If this added paperwork was too tedious for Dr. Larch, the board recommended that Larch take Mrs. Goodhall’s suggestion and accept an administrative assistant. Don’t I have enough history to attend to, as is? Larch wondered. He rested in the dispensary; he sniffed a little ether and composed himself. Gingrich and Goodhall, he said to himself. Ginghall and Goodrich, he muttered. Richhall and Ginggood! Goodring and Hallrich! He woke himself, giggling. ‘What are you so merry about?’ Nurse Angela said sharply to him from the hall outside the dispensary. ‘Goodballs and Ding Dong!’ Wilbur Larch said to her.

Physician, professor, and author Atul Gawande tells of a doctor working at a nursing home who persuaded its administrator to bring in dogs, cats, parakeets, a colony of rabbits, and even a group of laying hens to be cared for by the residents. The results were significant. “The residents began to wake up and come to life. People who we had believed weren’t able to speak started speaking. … People who had been completely withdrawn and nonambulatory started coming to nurses’ station and saying, ‘I’ll take the dog for a walk.’ All the parakeets were adopted and named by the residents.”5 The use and need for psychotropic drugs for agitation dropped significantly, to 38 percent of the previous level. And “deaths fell 15 percent.” Why? The architect of these changes concluded, “I believe that the difference in death rates can be traced to the fundamental human need for a reason to live.”6 Gawande goes on to ask “why simply existing—why being merely housed and fed and safe and alive—seems empty and meaningless to us. What more is it that we need in order to feel that life is worthwhile? The answer … is that we all seek a cause beyond ourselves.

The Nursing Home This Sunday, I paid a visit to a nursing home and noticed the empty bed in the room adjacent to my mom's. Crisp sheets stood proxy for where her elderly neighbor lay, an unshaven man or a woman with whiskers, I forget which, when I visited last ~ it couldn't have been a month, two at the most. The empty bed's corners were meticulously tucked in, like an army recruit's at boot camp, bleached of any possible embarrassment. After countless episodes of CSI, I cannot hear the word 'bleach' without thinking of incriminating evidence linking a victim to a killer. You must admit an empty bed at a nursing home is creepy; every empty room seems a trap, every lackadaisical nurse an accessory to murder, every administrator a potential Adolf Eichmann facilitating a program of geriatric genocide... Shit, I forgot to validate my parking. "Mom, I'll be right back," I say, with a smile, closing the room with the empty bed, bleaching my head of any possible embarrassment.

Another example, one that touches more people, is the nursing home industry. Numerous studies have shown that living at home, in a house or an apartment, is better psychologically, more fulfilling, and cheaper than living in nursing homes.14 Yet these institutions prosper when federal programs that foster living in the community are cut. There are also funding disincentives that the U.S. Congress, through Medicare and Medicaid, has created to ensure the profit bonanza of nursing homes. According to the activist disability journal Mouth (1995), there are 1.9 million people with disabilities living in nursing homes at an annual cost of $40,784, although it would cost only $9,692 a year to provide personal assistance services so the same people could live at home. Sixty-three percent of this cost is taxpayer funded. In 1992, 77,618 people with developmental disabilities (DD) lived in state-owned facilities at an average annual cost of $82,228, even though it would cost $27,649 for the most expensive support services to live at home. There are 150,257 people with mental illness living in tax-funded asylums at an average annual cost of $58,569. Another 19,553 disabled veterans also live in institutions, costing the Veterans Administration a whopping $75,641 per person.15 It is illogical that a government would want to pay more for less. It is illogical until one studies the amount of money spent by the nursing home lobby. Nursing homes are a growth industry that many wealthy people, including politicians, have wisely invested in. The scam is simple: get taxpayers to fund billions of dollars to these institutions which a few investors divide up. The idea that nursing homes are compassionate institutions or necessary resting places has lost much of its appeal recently, but the barrier to defunding them is built on a paternalism that eschews human dignity. As we have seen with public housing programs in the United States, the tendency is to warehouse (surplus) people in concentrated sites. This too has been the history with elderly people and people with disabilities in nursing homes. These institutions then can serve as a mechanism of social control and, at the same time, make some people wealthy.

The catastrophic outcome of deinstitutionalization, which displaced hundreds of thousands of mentally ill and disabled patients from state hospitals to the streets, nursing homes, and prisons (largely for petty, nonviolent crimes), had provoked stinging critiques of the government agencies responsible—particularly the Alcohol Drug Abuse Mental Health Administration (ADAMHA), the NIMH, and the Substance Abuse and Mental Health Services Administration (SAMHSA)—for failing to provide the community mental health care services needed to support the deinstitutionalized patients.

Having heard so many stories similar to Mrs. Thomas’s, several years ago I decided to study the needs for ministry in the nursing homes of my region. With the help of a local pastor, we interviewed the administrators, activities directors, and residents of twenty-seven nursing homes. We could have stopped after the first interview. We learned almost nothing new in the remaining twenty-six nursing homes. As soon as we began asking our questions, we found almost instant anger against pastors and local churches. Everywhere we went we heard that, with almost no exception, within a few weeks of admission, no representatives from local churches visited their patients. Were it not for the families’ visits, their patients would have been totally abandoned. Few families truly abandon their loved ones who have entered a nursing home or assisted living facility.

Private schools aren't very inspiring when it comes to innovation (nor are private nursing homes, for that matter). In general they are as convention-bound as their public counterparts They mostly differ in an invidious way, much like their public school sisters. There's a hierarchy among them, based mostly on how choosy the institution can be about whom it accepts. The fact that the choosiest schools attract higher-status families and select only the most promising students ensures their success. They cannot serve as general models; their value and advantages depend on their scarcity. But if the marketplace is not a magical answer, neither, experience suggests, can we expect that forced change from the top down will work any better. What results from such bureaucratically mandated change is anger and sabotage on the part of the unwilling, unready parents and professionals as well as the manipulation of data by ambitious bureaucrats and timid administrators. The end result: a gradual return to the status quo.