I recently had a conversation with a friend of mine about the last few months of her mother’s life, which were spent in a local, community-based not-for-profit skilled nursing facility. The conversation came up because her husband’s mother is at the stage where she needs 24-hour care or supervision, with the choice being at home care or an assisted living/Alzheimer’s facility. My friend had some strong opinions of the way to go, and about where her mother spent her last weeks. This facility enjoys a tremendous local reputation and has even won a few national awards for some innovative design concepts. It also has an unusually high number of volunteers, from high school kids to retired adults living in the community, and is always at the top of everyone’s list of where they would place their parent when and if the time comes.
But this friend of mine spent many hours at the facility, often late at night or early in the morning, when the staffing tends to be light and the managers tend to be home. In one situation, her mother’s feeding tube had become dislodged, and after her long-time friend and local doctor re-inserted it, she asked the nurse to help and clean her mother’s stomach area, which was covered with a variety of things that had oozed out of the hole when the tube popped out. The response, and one she will never forget, was “I’m already late for my one-hour break, so it will have to wait.” My friend had to clean up the mess herself, rightfully deciding that to leave all the fluids on her mother’s already raw skin would certainly not be in the patient’s best interests. Too bad the nurse did not have her patient’s best interests in mind as well.
In another situation, my friend’s mother had to go to the bathroom late at night. She rang the call button and explained the situation to the nurse on duty. The response? “It’s not the scheduled time to do that, you will just have to wait.” This temporary employee was from an outside agency, which was promptly notified, and she was not allowed to work at the facility again. The problem, however, is that she will be in someone else’s facility, doing and saying the same thing to someone else’s mother (perhaps yours).
After listening to her stories, and squirming a bit in my seat, I tried to point out that even the best assisted living and skilled nursing facilities in the country run into quality of care problems from time to time and that mistakes will always happen, as unfortunate, and unacceptable as that may be. That was not a good enough answer. One company that has been criticized by some of its competition (and the media) for keeping residents in place beyond its ability to “adequately” take care of them is Sunrise Senior Living. But Sunrise views the situation as one of patient choice, and if the resident, and the family want “mom” to spend her last months at the Sunrise facility, so be it, as long as there is a coordinated care plan regarding additional help and aids. A few years ago, Sunrise initiated a hospice program in its facilities, whereby the company contracted out hospice care to an outside firm that does nothing but hospice care, both to allow the resident to receive the most appropriate care, but also to allow her to stay where she wanted to. We have been surprised that more of this has not occurred in the industry, as we believe the hospice program has been successful at Sunrise.
So with all the consolidation occurring in the industry, will quality of care suffer or improve? Will being part of a large company mean that uniformity of care will prevail, with expectations spelled out from headquarters? Or as the front lines are further removed from the decision makers, will day-to-day problems go unnoticed, and uncorrected until a disaster happens? To my knowledge, there have been no reliable studies or statistics concluding one way or the other. But my friend with the dying mother will never be convinced that small and local means high quality of care, no matter how good the intentions. The problem, however, is that she does not have any answers, or solutions. Unfortunately, neither did I.
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