Commentary : Do We Care Enough to Pay to Treat Our Elderly With Tenderness?

The elderly woman waited helplessly in bed for her morning allotment of nursing care. It was 2:20 p.m.

“Her eyes were matted, her mouth was stuck together with thick yellowish mucus,” the inspector wrote.

A sign over the woman’s head reminded that she needed her false teeth put in every morning; they were in a denture cup. She needed her glasses put on; they weren’t. Her tortured hand was supposed to be coaxed around the bed’s handrail; it wasn’t.

“When asked if a.m. care had been given, she shook her head no and tears welled up in her eyes,” the inspector wrote.

Such are the stories tucked away in thousands of pages of inspection reports on San Diego County’s 80 nursing homes. Safely filed for reference, dutifully catalogued until next year’s inspection, the vignettes leap from those dispassionate pages.

The worst of the incidents--the immediately life-threatening ones--result in fines and threats to revoke licenses or certification for government funds. Those are the only sticks the state can wield against nursing homes, known technically as skilled nursing facilities. But such penalties apply only to the worst incidents.

The rest--the majority--disappear into a paper-work ritual of hand slapping and promises to do better. A year later, inspectors could find the same problems, or worse, and we on the outside once again can ask ourselves why we let them occur.

No one disputes that the elderly are a demanding population to care for. Often they have become too much of a burden for their families, which is why they end up in nursing homes.

Their needs are no different than those of the rest of us. They want their hair brushed, their teeth cleaned. They need to eat, bathe and go to the bathroom. They want some attention. They need exercise. But many cannot do these things for themselves adequately. When the nursing home and their families fail them, even if in “little” ways, they are helpless.

Take the 47 patients at one home who need help getting out of bed, but who lacked any call lights for summoning aid. That same inspection noted that three patients had become regularly incontinent because they weren’t helped from bed to go to the bathroom.

Equally dependent and overlooked at dinner time, some bedridden residents do the best they can but get as much nutrition on their sheets as in their mouths. Or they wait in vain every morning for someone to brush their teeth and comb their hair.

Asked about the “fortified” diets provided to shore up the health of deteriorating patients, a cook at one nursing home said: “We just add margarine and mocha mix.”

Then there was the physically healthy, but chronically mentally ill, man known for his fondness for dancing around the halls of the institution that was his home. His dancing days ended when he was restrained in a wheelchair after wandering away from the home. Two months after the incident, he remained in the wheelchair, having been allowed to walk just four times during the previous week.

Page after page in the state reports, stories like these emerge.

An incident that seemed dehumanizing early in the list doesn’t look so awful near the end. So what if people don’t get their teeth brushed or hair combed for days on end? It won’t kill them. Indeed, whether because of emotional overkill or societal impotence, death becomes the milepost against which care is measured at the homes.

Yet who among us would be comfortable without brushed teeth and combed hair every day? How do we measure what these simple acts of caretaking add to the quality of our lives? How helpless, lost, worthless would we feel if, whenever we needed help, no one came?

The answers to such questions seem obvious, but every day in San Diego County and in California we answer quite differently when the questions apply to our weakest adults.

That is, we let the state pay $48 a day for the care of Medi-Cal patients in nursing homes. And we do it knowing that corporations will be trying to turn part of that sum into profit.

We expect trained professionals to subsidize the system by working, day and night, for not much more than the minimum wage to care for the problems we’d rather not see.

We tolerate a national medical system that lets a woman languish in bed, incapacitated by a partly necrotic bedsore that government agencies won’t pay to surgically correct--apparently because she never paid Social Security taxes.

So any debate over what to do about problems at California’s nursing homes is not really about the effectiveness of any regulatory bureaucracy.

It is not about the failings of administrators or the staff in the trenches.

It is not about political power brokers balancing guns against butter.

It is about us. And about whether we love and cherish our elderly enough to pay to treat them tenderly.