Archive: Opinions

Two Wallethub analyses caught my attention this week.  The first found that New York is the 6th best state to raise a family.  But the other one ranked New York 22 out of 51 (it counts the District of Columbia) in elder abuse protections.  The message is clear: come to New York to raise your family, but once your children have left the nest, get out of Dodge!

I don't think I have to convince anyone the Town and Village of Lansing is a great place to raise kids.  We have great schools, an outstanding Town Recreation Department, beautiful, family-friendly parks, and an engaged, caring community.  But I have seen for myself the impact of elder abuse here in Tompkins County, and it is not pretty.  Why should we have a great younger life and a horrific older one?

Well, part of the answer is that our bodies get older and the parts start to wear out.  No matter how many times some youthful enthusiast tells me that 60 is the new 50, or 40 is the new 30, it simply isn't true.  It is true that we live longer than our predecessors. I just read that Kane Tanaka has been confirmed as the oldest living person at 116 years old.  The truth?  116 is the new 116.  We can't do anything about that.  The problem is the part we can do something about.

My wife and I had the joy and grief of caring for my mother in her last two years of life as she descended into a hell of dementia.  We tried caring for her ourselves, and when that became undo-able, we found her a very nice spot at an assisted living facility in Cortland (I highly recommend Walden Place for their caring, above the call of duty attention, even to the most hopeless cases in their memory care unit), and finally in a nursing home (Cortland Park was also quite good).

As wonderful as these two facilities are, my mother's life went from a fairly care-free, happy one to her worst nightmare -- her dementia and hallucinations made her unable to do the things she loved doing for most of her life, including playing cards with friends, shopping, and most tragically, reading.  For most of this period she knew what was happening to her, which made her nervous and fearful, and supremely depressed.

She also began falling.  Some of her falls did damage, but most were benign.  Unfortunately New York State requires the victims of unobserved falls in assisted living facilities  to go to the hospital, and there was a period of time when I would get a call at 2am -- sometimes two or three times a week -- to go pick her up and bring her back.  The nurses at the hospital knew this was a terrible waste, because it was very clear that my mother had not been harmed in most of the falls.  She was there so much that I joked they should name one of the emergency room spaces after her.

The thing is, one of the most effective treatments for dementia is keeping to a routine, so forcing elders with dementia to go to the hospital is a pretty significant break in their routine.  So the state requirement that is meant to protect elders actually harms them in cases where it is obvious they haven't been harmed in a fall.

On two occasions the Cortland hospital staff suspected she had had a stroke.  The nearest hospital with facilities that deal with strokes was Cayuga Medical Center.  The first time it turned out she had not had a stroke, but she was referred to rehab because she was unable to function to the level required for assisted living.  After some difficulty finding a bed, the social worker at the hospital did place her at a local nursing home.

We soon learned that this facility was horrible.  Horrific.  Actually, in my opinion, damaging to its residents.

We ended up staying with my mother for the entire first weekend, and then as much as we could for the rest of her stay there.  On the one hand the Walden Place folks were determined to bring her back, making the trip from Cortland to Ithaca on three or more occasions to check in with the physical therapy folks and monitor her progress.  Also on that hand, the physical therapy people were wonderful.

On the other hand, the facility was severely understaffed and the culture of the workplace was all about what they couldn't do, not what might be done to make the residents more comfortable.  I am stating that mildly.  With us to advocate for my mother, it routinely took more than a half hour after she said the needed the bathroom for anyone to help her (she needed to be transported from her rolling bed to the toilet on a Hoyer lift).  The nurses were generally surly.  The aids tried their best, but there were simply not enough of them.

That was the good news.  You can begin to see where I am going with this... if that is the good news, what is the bad news?  We saw multiple incidents of elder abuse from nurses who should have known better.  For example, one day I witnessed one nurse was literally screaming at a dementia patient who kept getting out of her chair (and had no idea she was doing it).  I know first hand how difficult it is to deal with a person who suffers from dementia.  I am not good at it.  I am also not a trained professional.  And I also saw how successfully it could be done at Walden Place, and later at Cortland Park. 

So I was shocked at the level of abuse and neglect I was seeing at this Ithaca facility.  We worried that if we had not spent so much time there advocating for my mother that they might literally have killed her from neglect.  Indeed she couldn't walk, was all curled up, could barely speak, and when she did it was clear she was constantly hallucinating.  We tried to get her moved, but there were no beds available at the better facilities.

OK, you might say, she was at the end of the line, and she had deteriorated to this pitiful stage.  That's what I thought, too, until I visited her one week after the wonderful Walden Place staff got her back.  I had thought she would never walk again, but there she was, seemingly happy and walking with the help of a walker.  She had always been a chatty, gracious person, and even though the dementia made it impossible to know what she was talking about she was happy to talk to us.  I thought that the Walden Place staff had worked a miracle from God.

The elder care community is fairly small.  Everyone seems to know everyone else, and they know which places are good and which are bad.  Surely that extends to include the authorities who monitor such facilities.  Yet we heard that Walden Place was being fined for extending more care than they were supposed to.  And at the same time this other facility that is so horribly sub-standard continues to be allowed to exist.

In the Wallethub analysis, New York ranks 17th in prevalence of elder abuse complaints, 45th in resources, and 21st in protection.  Prevalence is the number of complaints made (and you can be sure that many are unreported).  Resources is the amount spent per resident on elder-abuse prevention.  Protection refers to the number of overseeing organizations and task forces, laws allowing camera surveillance, and quality of nursing homes.

By the way, I mentioned the first time my mother was sent to Cayuga Medical Center for a suspected stroke it turned out she had not had one.  The second time she did have a minor stroke, and this turned out to be a blessing because she was no longer aware of her mental and physical state, so she was clearly much happier.  It goes to show how everything you believe about what is good and bad about life can be upturned when dementia is involved.

Luckily for my family, my mother was only in the terrible facility for a few weeks.  The permanent residents there are not so lucky.  I tell people that nursing home is where people in the afterlife are shuttled off to when they can't even get into Hell.

By the way, if you are wondering where to retire to if you are worried about elder abuse, Massachusetts was the number one state, followed by Wisconsin, Rhode Island, Michigan, Iowa, Vermont, Pennsylvania, Louisiana, North Carolina, and West Virginia.  The bottom ten are Arkansas, Arizona, Tennessee, Nebraska, South Dakota, Nevada, Montana, California, South Carolina, and the lowest score went to New Jersey.

Isn't it interesting that the two most progressive states in the nation score so poorly, with New York in the middle, and California the third worst.

In the wake of this week's ambitious State of the State address, which set laudable goals for protecting New Yorkers from a myriad of abuses and adversity, I didn't hear much or anything about protecting the people who should be our most venerable New Yorkers.  They should be, but instead are all too often victims who are shunted out of sight until they die.

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