Life with assisted living
'I was not happy,' Smith said. 'It was so bad I could barely stand it. I didn't get enough good food. The floors were never cleaned, and my sheets weren't always changed. The staff was not friendly at all.'
Smith, 73, said she was at the nursing home, which she would not name, for five weeks before her daughter had her moved to the John J. Kane Regional Center in Scott Township. She said she is pleased with the Kane center.
As the number of senior citizens grows, providing safe and comfortable living is becoming an emotional and complex issue for more people.
And the problems can be far worse than sloppy housekeeping.
In August, a 75-year-old woman who had just moved into the Lakeside Personal Care Home in Richland told manager Debbie Wiseman that a worker at the home had come into her room at night and sexually assaulted her.
Shortly afterward, Lakeside nurse's aide Christopher Michael Purdy, 24, of Hampton, was ordered by Hampton District Justice Regis Welsh to stand trial on charges of indecent assault and sexual assault.
Purdy's trial, originally set for this week, is scheduled to begin July 10 in Allegheny County Common Pleas Court.
Wiseman said that before Purdy was arrested, she would have had no reason to suspect he would be accused of attacking a resident. Wiseman said she had Purdy's record examined for any prior arrests that would indicate he could be a danger to residents. The check came back clean, she said.
'I've always tried to do the best I can,' she said. 'On several occasions, I've had the police check out people and they would tell me not to hire them and that they would be dangerous to have around.'
Nursing homes, personal care homes and assisted living facilities are required by state law to run criminal background checks on employees.
The nursing and assisted living home industry is debating further safety precautions, such as putting monitors in residents' rooms.
'It brings up a lot of issues of invasion of privacy, but all that I can do now is run the checks and pray hard that everything works out,' Wiseman said.
No residents moved out of the home when she notified them and their families of the sexual assault charge involving an aide, Wiseman said.
The Protective Services Program of the Allegheny County Agency on Aging investigates reports of abuse or neglect of the elderly.
Don Grant, manager of the program, said caseworkers investigate reports of abuse, whether the alleged victim lives in a private home or at a nursing home or personal care home.
'The trend of complaints is upward,' Don Grant, program manger said, 'I think the increase is primarily because the level of education about elder abuse and the acceptance of reporting abuse is increasing. I don't know if actual abuse is increasing but more people are filing reports.'
Most of the calls reporting abuse and neglect are regarding an older person who lives at home alone or with another person, Grant said.
In 1999, nursing homes represented about 11 percent of the reports of abuse and neglect, Grant said. Personal care homes made up 6.4 percent of cases. But reports that involved people who live alone was 43.8 percent, while cases for those living at home with another person was 38.8 percent.
Grant said 26 percent of the reports turned out to be substantiated instances of abuse.
Grant said that the 26 percent is the statewide average. The other calls are usually reports of unappetizing food being served at a nursing home or a resident not getting enough physical therapy. In these cases, a resident is not in imminent danger and the complaints are then referred to the nursing home or personal care home licensing agency who then looks into correcting the problem.
Grant said if neglect or abuse is found in a nursing or personal care home, there are several options for handling the situation.
'Sometimes the abuse may come from the person's roommate, and all it takes is to move them to another room or floor. But with each report, we notify the home's licensing agency,' Grant said.
'Our first goal is to take care of the victim and find another place for them where they will be safe. We do face situations where a person is living alone and refuses any care, and that is their right,' Grant said.
'But if we get a call of abuse at a nursing home, we will then investigate if the abuse is willful neglect on the part of the institution.'
Going hand-in-hand with the growing number of senior citizens moving into nursing homes is the growing number of lawsuits aimed at the homes.
Well-known Pittsburgh personal injury attorney Edgar Snyder said a rising number of people are coming to him to sue a facility that they think abused a relative.
'A lot has to do with the deplorable conditions of understaffing in the homes. The staff is not incompetent, but there are not enough people to properly take care the patients,' Snyder said.
Under Department of Health standards, every nursing home resident should receive 2.7 hours of specialized care from a registered nurse or licensed practical nurse per day.
Snyder said his cases run the gamut of neglect and abuse.
'We're seeing bedsore cases where the patients are not turned regularly, some of the worst kind that make you sick to look at it. Other cases include dehydration, malnourished, a lot of broken bones of people falling out of bed and people wandering out of nursing homes,' Snyder said.
But those in the nursing home industry have said many problems arise simply because people are old and sick, and that the facility is not to blame.
Dan Springer, spokesman for Beverly Enterprises, which owns more than 500 nursing homes in the country, including three in the Pittsburgh area, said sometimes symptoms of the natural aging process look like abuse.
'Bones are brittle. If a patient falls, their bones break easily. Bed sores are not always preventable,' he said. 'Older persons don't always want to eat, and they become malnourished.
'Muscles degenerate, and then the patient can't swallow a lot of food. Sometimes, lawsuits are spurred more by guilt than anything else.'
One of Beverly Enterprises' homes, Beverly Manor in Monroeville, was in the news in 1999 when a nurse's aide was arrested and charged with using residents' Social Security numbers and other personal information to set up credit card accounts.
'We have always had a no-tolerance approach for dealing with abuse, neglect or theft in our homes. We are a business of people caring for other people, but controlling people's actions is not predictable,' Springer said.
Springer said the nursing home industry is in a crisis because of a lack of adequate staffing. The jobs are not appealing, and it is hard to fill vacancies in the tight job market, he said.
Grant said that the jobs are demanding and the pay is not high.
'It is basically a very hands-on job,' Grant said. 'There are a lot of accidents such an employee hurting their back. They have to turn patients to prevent bedsores from forming. Employees have to clean up after people. These tasks are not enjoyable. You work these jobs because you care about people.'
Grant said that a person working at Home Depot or a store at the mall would make about as much as someone working in a nursing home or personal home - $7 to $11 an hour.
'I was at a conference where there was a person speaking about finding employees,' Grant said. 'He said that it is easier to be flipping burgers than flipping people.'
Richard McGarvey, spokesman for the Pennsylvania Department of Health, which licenses nursing homes, said the department is aware of the staffing shortage but first must consider the patients' needs.
'We continue to hear from the nursing home industry that there are problems with staffing of not enough nurse's aides and nurses, but we cannot ignore if a patient is being abused,' McGarvey said.
'A home needs to have a series of checks and balances to ensure that the staff is not abusing patients. They need to train staff properly and give them enough support to do their jobs.'
In 1999, the department issued 48 warnings to nursing homes, 60 fines and 15 bans on further admissions at a nursing home until problems are solved. Last year, there were 60 warnings, 67 fines, 16 bans on further admissions and three license revocations.
The need for staff members for homes is not likely to decrease.
Baby boomers are getting older, and they soon will be at an age when they will be applicants for nursing and personal care homes.
'At the last census in 1990, the population of those 65 or older was 13.5 percent. But we expect to see those numbers rise to 20 to 22 percent by 2040 and 2050,' said Joseph Yenerall, a Duquense University associate professor of sociology and a researcher on issues of aging.
'The first dramatic increases will be between 2010 to 2020, when the first group of baby boomers turn 65.'
Yenerall said this is the first time in human history when there will be such a large group of senior citizens living so long. The average life expectancy is about 76 years.
'This will put pressure on Social Security, housing matters - any sort of human services. We've termed this a quiet revolution that will force changes in all of our society. The older population seems to be more vocal about issues that effect them and tend to vote more which makes them a political force,' Yenerall said.
'They will be the ones who will shape the issues.'
Ellen James can be reached at firstname.lastname@example.org or (724) 779-7123.