By: David A. Smith
A society of robots for humanity’s physical needs, dogs for our emotional ones
He stayed close to the wall to keep out of people’s way, headed for a chair in one corner. He sat down and huddled back, forcing his body deep into the cushions, watching the milling humanity. Strangers-every one of them. Not a face he knew. People going places. Heading out. Anxious to be off. Worried about last details. Rushing here and there.
– Clifford D. Simak, Huddling Place, 1952
As we’ve seen in the preceding two parts, the older one gets, the less one wants to travel physically, and the more one wants to remain alert and active mentally, but safe and secure and in a familiar environment – a place, in fact, envisioned at least in spirit by Clifford D. Simak, whose haunting novel City imagines a future in which humanity has ceded control over its physical environment to perfectly protective robots, and of its emotional environment to the faithful dogs.
The doctor’s simulacrum will see you now
As technology revolutionizes how we age and how we live the extra decades technology is giving us, it is time to reinvent what we mistakenly call the nursing home around five core elements that arise as themes within these updated regulations: freedom, choice, security, quality, and redress.
Sources used in this post
Even if a person is impaired, dependency in one aspect of daily living shouldn’t invalidate the resident’s right to freedom and independence in other things, such as who she sees:
1.A. Residents deserve freedom to host whom they want, when they want
Those of us who live independently take for granted that we can admit into our home anyone we choose, at any time of day or night, for any purpose that doesn’t violate the law or ruin the neighbors’ quiet enjoyment. In a hospital, that notion of privacy is one of the first rights we lose, as people come and go at all hours, with lights and sounds and traffic in the corridor.
It’s out there, it’s loud, and I’m afraid of it
The regulations strengthen residents’ control over certain decisions important to their daily lives. For example, the rules allow people to receive any visitor they choose (not just relatives) whenever they choose, without restricted hours, as long as visitors don’t disturb other residents.
That change is also important because twenty-first century relationships come in many more varieties than they did a quarter-century ago. Even as gay relationships have normalized, the nuclear family has undergone household fission.
Nuclear era, nuclear family
Just having family members around in the evening, when homes have fewer staff members, might improve attention and care, Dr. Castle pointed out.
We’re all so cool our kids fold their arms to show their self-satisfaction
Likewise, with ubiquitous cell phones, broadband, and increasingly cheap and high-quality videoconferencing, strong and meaningful friendships can be formed between people who live far away from each other – and with Facebook and similar social-media networks, people can find good friends they lost decades earlier.
A toast to the choice of power relationships
Choice is an illusion, created between those with power and those without.
The Merovingian, The Matrix Reloaded
When you take away my choice, I lose some of my humanity, so as long as I can choose, I should be able to choose – and among the most fundamental rights of being at home is choosing with whom one is at home.
2.A Choice of roommate
The requirements also allow residents to choose their roommates when both parties agree, making it easier for friends, siblings or same-sex couples to share living quarters.
It’s a measure of my naivete that I didn’t know nursing home residents could have a roommate foisted upon them without their consent. Thank goodness this was added.
2.B Choice of schedule
I choose to like olives … what do you choose?
Adults choose when and what they eat; those whose meals are chosen for them, we call children.
You’re violating my autonomy!
The regulations require facilities to make meals and snacks available when residents want to eat, not only at predetermined mealtimes.
Again my ignorance is showing; I’d never given thought to when and how residents in a nursing home should be able to eat, but certainly few thing are more frustrating, even humiliating, than being hungry or thirsty while unable to provide for oneself.
Among the core benefits of home (whether ownership or rental) is physical security, for ourselves, our possessions, and our loved ones. Patients don’t have such rights; residents do.
AHI multi-part posts on unusual emerging housing tenures
May 18, 2009: Outlaw in-laws (accessory dwelling units, 2 parts)
January 6, 2016: Sprouting innovation (co-living; 3 parts)
Indeed, unless the regulatory changes merely codify what has already become standard in the industry, then nursing homes must be dismal places where residents have little security over the most basic decencies of life.
3.A. Security from contagion through carelessness
The rule requires a nursing home to designate an infection-control officer and to establish a system to monitor antibiotic use.
3.B. Security of personal possessions
For the first time, nursing homes must take “reasonable care” of residents’ personal belongings and can’t shrug off responsibility for theft or loss by requiring residents to sign waivers. “That’s been a big complaint,” Ms. Grant said.
That such basics of proper accommodation weren’t required is further evidence nursing home regulations were horribly out of date.
I mean, horribly out of date
Times author Mr. Span adds this poignant note:
Moving into a nursing home already requires giving up so many possessions that “losing something can be devastating” — especially when eyeglasses, hearing aids or dentures go missing.
While some people in a nursing home will have all their faculties intact, some – perhaps many – will not, and I’ve experienced at first hand that when someone’s mind goes, he or she can no longer distinguish one door from another, one pair of glasses, one hearing aid.
3.C. Security from abuse
Worse, demented patients are emotionally fragile, and for those who take care of them, few things are more upsetting than being shrieked at by an incoherent, undersized, and yet furiously aggressive oldster.
The regulations call for expanded staff training in preventing elder abuse and in caring for patients with dementia. Dr. Phillips calls the latter critically important; most residents have moderate or severe dementia, Medicare statistics show.
Just as parents lose patience with their children, it’s easy enough to understand staff losing patients with their residents – but it’s still wrong, and it’s still elder abuse.
There’s one more bit of insecurity:
I mean, the worst
3.D. Security of tenure
This last element of insecurity is the worst:
Long-term-care ombudsmen report frequent complaints of “dumping”.
Too bad about Mildred, but somebody’s got to go
The existing regulations provide a lot of protection against being bounced from nursing homes.
But there is a loophole:
A nursing home sends a resident, often someone whose dementia causes problematic behavior, to a hospital.
The ‘health care system’ (a misnomer as triply wrong as the Holy Roman Empire) functions as an assembly line operating in the dark, staffed by workers with attention deficit disorder and neuromuscular decay, and overseen by an addled bureaucracy.
After she is discharged, the home won’t readmit her.
Yes, you’re located somewhere in the system
“Once they’re out the door, it’s a lot easier to just evict someone,” Ms. Grant said.
It certainly is, and it has all the earmarks of corner-cutting shenanigans.
The new rule extends those protections to someone who’s been hospitalized but intends to return.
“That resident has all the rights that go with discharge and can appeal the decision.” Nor can the facility transfer the resident while she is appealing.
Thank goodness – though of course, residents whose faculties are dimming will need their relatives to defend them as energetically as if in a case of mistaken identity, grandma had been taken into protective custody by the inept constabulary of Information Retrieval.
Whoever she is, she’s never getting out
[Continued tomorrow in Part 4.]