How Marion Died Illustrates Problems of Nursing Homes

It wasn’t the hard times that finally broke Marion Heide. Not the death of her beloved husband, nor the days of hard work and little money, nor the fire that took her home.

She survived all that and lived to a ripe old age.

But her life ended at 88, with Marion bruised and bleeding, curled into a ball in a nursing home bed, so scared of the nurses who were supposed to help her that she cried when they came near.

Her decline began with a scraped leg. Without the care she needed, the scrape turned into a sore. The skin around it turned black, and infection sank to the bone. Finally doctors cut off her leg.

Marion died three months later.

Jurors understood that she was near the end of her life, sick with diabetes and a bad heart. That didn’t excuse her final 11 months.

They slapped the nursing home’s owner and its operator--a corporation that runs more than 100 nursing homes across the Southeast--with a negligence verdict and $6.5 million in compensatory damages. When the jurors said they wanted to consider punitive damages too, the defendants’ lawyers settled for an even $10 million and ended the case there.

Despite federal and state laws, hundreds of inspectors across the country and years of newspaper and TV horror stories, neglect and abuse of the elderly remain cruel realities.

One nursing home in four has severe deficiencies that endanger people’s health or their lives, according to a recent federal study. Advocates for reform say that figure is low, and they note that the aging of the baby-boom generation promises to exacerbate the problem.

Why is it so difficult to solve these nagging problems, to stop these tragedies? The answer is complicated, but part of it may be found in Marion Heide’s story.

*

She could be bullheaded, Marion could.

She wouldn’t change the channel on her TV set. She liked only ABC, especially “Jeopardy” and “Wheel of Fortune.”

She liked her beer, but not cold. Let it sit until it got to room temperature, she’d say.

A stout woman with frizzy hair and sensible dresses, she spent two decades working at a Salvation Army store after her second husband, George Heide, a cabdriver, died of a heart attack. She wouldn’t leave the little house on Marion Street in Brooklyn where they lived.

She was going to die in that house, she’d say.

In her 70s, her eyesight failing, she ended up a widow alone with a worn, hand-painted portrait of George beside her bed. Few relatives came to visit.

On Halloween 1993, a fire burned her out. Grandson Brian Schroeder took Marion to his home on Long Island and got her an apartment.

Marion had been unwilling, yet suddenly she had family again--dinners, great-grandchildren, birthday parties.

“You saved my life,” she wrote to Brian and his wife that year, her script slow and careful but the words tumbling together. “I know I’m a hindrance to you I will try to do everything you both think I should do I thought I was going to end my life. . . .

“I love my home,” she said.

When Schroeder decided to move to Florida a year later, stubborn Marion didn’t want to go. He packed the car, told her he was taking her to the store and headed south. She figured it out by the time they were crossing into New Jersey.

In Florida, another grandchild, Barbara Meley, took Marion into her home in New Port Richey.

Marion adjusted. She liked to sit by a slow-moving creek behind Meley’s house where trees hang over the water. She liked to hold Stormy, a little poodle. She’d talk about George, her home that burned, Brooklyn. “I want to go back,” she’d say.

Then the ailments came. She had a mini-stroke and began to fall. Some nights she couldn’t make it out of bed to get to the bathroom.

At 87, she fell and cut her head against a glass table.

Meley, who worked during the day, realized she could no longer care for Marion. “I was afraid leaving her at home all day.”

Complaints of Abuse, Neglect Abound

Americans 65 and older number 34 million, and that figure is expected to reach 90 million in 40 years. Nearly half of those over 65 will spend at least a little time in a nursing home, and one in four will spend one year or more in one, demographers predict.

Right now, about 1.5 million people, largely the World War II generation, live in nursing homes. That could grow to 5 million by 2040.

It is big business. There are some 17,000 nursing homes, and large corporations dominate the industry. Nursing home care cost $78 billion in 1996, with more than half paid by the federal and state Medicaid and Medicare systems.

There are many choices for the elderly who remain independent: assisted living facilities, adult day care, home health care. But for the frailest, those who are bedridden or need constant supervision, the nursing home can be the only option.

The modern nursing home industry was born in the mid-1960s with Medicaid and Medicare. What followed was a cycle of abuse and reform, repeated over three decades.

In the 1970s there were widespread reports of fraud and abuse, including a scathing study from Ralph Nader. Government hearings brought new regulations. The cycle returned in the 1980s. A 1986 law strengthened protection, but problems remain.

A stream of complaints of neglect and abuse has prompted a U.S. Senate committee to order investigations and begin hearings.

“Considering the vast amount of money that Congress pays on Medicare and Medicaid,” said Sen. Charles E. Grassley, an Iowa Republican who is the panel’s chairman, “we haven’t done an adequate job of oversight.”

Chronic Complaints of Understaffing

Heather Hill Nursing Home won superior ratings from Florida’s inspectors for several years running. The low building has a welcoming lawn, cheerful plants out front and chairs for residents and guests to sit in the sun. Schoolchildren visit. It was clean and bright when Barbara Meley toured the home.

Marion Heide arrived at Heather Hill after three months at an assisted living facility. She’d grown to like it there but fell and broke her hip. After surgery, she needed rehabilitation.

Problems began almost immediately: Marion was so sleepy she couldn’t keep her head up. Meley questioned nurses about the medication, and soon Marion was again alert and able to eat with the others.

Meley had other complaints: The food was often cold; she found her grandmother naked in her bed; and sometimes Marion had soiled herself and no one had cleaned her.

But there was more, according to nursing home documents presented at trial.

Meley’s lawyers argued that the nursing home operator--National Health-care Corp.--knowingly left the home understaffed on nights and weekends.

Aide after aide testified about the workload, how they were told when they began working that they would care for 15 residents but that often became 20 or 30, occasionally 60. Residents would go without spoon-feeding or a bath. They would not get turned in bed, the surest way to prevent bedsores.

“I always worked short, short-handed, you know, not enough help, and I couldn’t give my patients the care that they deserved,” Marcia Wakefield, a former nurse’s aide at the home, testified at the March trial.

The home ignored repeated complaints from workers that they were overloaded, aides testified. A former administrator at an NHC-run home testified that superiors repeatedly refused her requests for more staff.

Three months after Marion entered Heather Hill, a nurse recorded a “small abrasion” on her shin. Though bedsores are a significant danger for the bedridden and elderly, nobody contacted a doctor for six weeks, according to the home’s records.

By then the shin was badly infected. Nursing home documents show sporadic treatment. Over 5 months, the sore grew 20 times in size, eating into Marion’s body until her ankle bones disintegrated.

The records also showed that months went by with no indication that she got medicine prescribed for her depression, and that she received only half her doses of narcotic pain medication, despite screams of pain.

On April 3, Marion’s right leg was amputated at the hospital. She died on July 17, 1997.

In court, lawyers for operator NHC and owner York Hannover Nursing Centers argued that Marion’s poor health, including a circulatory disorder, prevented her leg from healing. She refused to eat and drink, they said. Their lawyers argued that care was provided even if it was not documented. That was an argument jurors rejected.

“There was gross negligence,” said juror William Tingley. “It’s a pity we have our senior citizens taken care of this way at nursing homes.”

“This woman came into the nursing home and she was walking, she was talking, she was mentally OK except for she didn’t want to go in,” said a juror who spoke about the verdict on condition her name not be used. “And when she left, she was screaming and saying she wanted to die, in a state of severe depression and in severe pain.”

Lawsuits Result in Huge Damage Awards

In Texas, an 80-year-old man starved to death in a nursing home, and a jury last year awarded $250 million to his family. In California, a worker dropped a nursing home patient and broke her hip, and jurors awarded $94 million.

Lawyers say the growing number of lawsuits and the high damage awards reflect a frustration with lax government oversight.

Jim Wilkes, whose firm handled Meley’s case, said suits hit the corporations where they understand, the bottom line.

“I’ll break them eventually if they do it enough. And we’ll get justice,” Wilkes said.

But even when government oversight is in place, it does not necessarily stop problems. Two recent studies by the General Accounting Office, Congress’ investigative arm, found:

* Even after sanctions, 40% of homes with the most severe deficiencies were in violation again three years later.

* The most prevalent of the serious problems are bedsores, letting people go hungry and failing to care for the incontinent. Advocates say all are the outcome of simple neglect, not physical beatings or sexual assaults that draw headlines.

* Pressure sores are the biggest of the serious problems nationwide, with 2,809 homes cited from January 1997 to October 1998.

President Orders Random Inspections

Federal investigators are studying whether the government should, for the first time, mandate specific per-patient staffing ratios of nurses and aides. Research by several academics and consumer advocates has concluded that staffing levels are often too low to let nurses and aides do their jobs.

Congress is considering establishing a national criminal background check for every nursing home employee.

“We are failing our parents and we must do more,” President Clinton said last summer, ordering random inspections so nursing homes can’t hide their problems and faster punishment for repeat serious violators.

The nursing home industry agrees abusive homes should be punished.

Only the worst homes cut back staff for profits, and they should and will be caught by the state and federal oversight system, said Tom Burke, a spokesman for the American Health Care Assn., which represents 11,000 care facilities.

Still, even the best homes struggle with a tight labor market and staffing needs that change according to the health of residents, he said.

Lawyers for Heather Hill acknowledged there were times when the home was not fully staffed but denied that was corporate policy. Officials with NHC did not return repeated phone calls.

Some in the industry say extra regulatory paperwork takes time away from residents, and closing down homes simply limits options for the elderly.

“I don’t need the state, I don’t need the ombudsman, I don’t need a reporter, and I don’t need an attorney to tell me to do a good job,” said Roy Meredith, the administrator of another NHC-run home in Clearwater, Fla. The home has had 10 years of superior state ratings for being clean of violations.

Much of the so-called neglect is just aides failing to write down the care they provide, he said. Sympathetic jurors respond to the horror stories.

“If a person falls, fractures their hip--which is what old people do--we lose,” he said.

Marion’s Final Resting Place

The house at 338A Marion St. is gone. An apartment building stands in its place now.

Fifteen blocks away is a cemetery, lush and green with oak trees and quiet, except for the passing hum of a tractor-trailer on the Interborough Parkway.

There are purple cloth flowers, faded in the sun, next to the granite tombstone bearing the inscription: George Heide, 1898-1964. Marion’s name is not here, but this is her resting place.

“She’d always say, ‘I want to be with Grandpa,”’ Meley said.

And so Meley drove from Florida to New York, dug a hole next to the grave for Marion’s ashes, and returned her grandmother to her beloved Brooklyn.