Summary of Robert Kane's Article 'Reimagining Nursing Homes: The Art of the Possible'

As more and more elderly Americans choose to spend their later years in assisted living facilities, FRONTLINE and ProPublica examine whether this loosely regulated, multi-billion dollar industry is putting seniors at risk? Their film “Life and Death in Assisted Living” depicts different phenomenons that occurs in assisted living that America is unaware of. A testimony provided in the film describes assisted living as being “a rock that you don’t want to look under” because of the unspoken neglect and abuse of the residents in the facilities. This film focuses on the investigation and evaluation of the care provided by Emeritus’ assisted living facilities. It provides viewers with information on what makes assisted living unique, the qualifications

Assisted living helps each person value life to its fullest potential. When it comes to making an older individual feel more at home and also be able to focus more on non-stressful activities, they need to be ensured the best care. “Families feel more confident and are less ‘protective’ when there is continuity in staff and they are deemed competent. Staff are more likely to be retained where they feel valued”2 part of the quote which is especially conducive to the argument is, “where they feel valued.” When picking and choosing a nursing home that fits individual the best, and will provide them with the care needed, it is important to make sure that everyone is valued in the process. This quote is important because if the workers are not being taken care of, then they are less enthusiastic and also less likely to give someone’s loved one the care needed and to know what is expected from them. It is assumed that when picking an assisted living home, that the well being of the person and also many other characteristics are taken into

How the Long-Term-Care Homes Act makes their goal possible is by having the participation of mutual respect for all of the residents, the resident’s families/friends,

The different places senior citizens live in is widely discussed in the first part of Being Mortal. Nursing homes are one of the most common places for seniors to end up. Based on Gawande’s descriptions and anecdotes on nursing home life, it seems that there is no autonomy when living in a nursing home. Gawande ponders current methods of handling the elderly in the following quote: “How did we wind up in a world where the only choices for the very old seem to be either going down with the volcano or yielding all control over our lives?” (68). In this quote, Gawande refers to

One thing every living organism has in common on this planet-- age. No one wants to age or face the fact that aging is inevitable. However, since it’s impossible to beat the never ending time clock that is life; everyone wants to be as comfortable as possible when age finally does catch up with them. When the majority of people think of comfortability in old age, they think of living in their own homes and being surrounded by their loved ones. Not many individuals want to be placed into a nursing home type facility because they can’t imagine themselves being comfortable that way. Nonetheless, even though being placed in a home does take away some of an elderly person’s independence, usually the independence lost is in activities that person can no longer do for themselves. Indeed, nursing homes do have their own set of scary stories behind them; life lost, independence lost, and privacy lost, yet many of those stories are outdated. Upon investigation, it would be easy for anyone to scare themselves out of a nursing facility due to the stories that are out there. Yet, upon even further research people would be able to see how far the United States has come in their development and evolution of nursing care facilities. The care of the elderly in the form of nursing homes has faced a tough evolution starting off with a harsh past, to what nursing homes are like now, and what people can expect for the future of these homes.

The long-term healthcare system has an infrastructure that is unfriendly and difficulty to navigate. With a growing number of frail older people living in the United States, the pressure to find a more affordable way to care for them will mount. Nearly 12 million people need some form of long-term care (LTC) and half are over age 65 (Wilber, 2014, Class Session 2). As mentioned in the article “Waiting in the Dark with Dad,” a large percentage of American healthcare costs fund medical procedures and medications to keep terminally ill people 65 and older alive (Lopez, 2014, p. 1). Steve Lopez experienced this with his 85-year-old father, Tony, who lived in a nursing home that was a place meant to keep his heart beating, but not actually improve his health and well-being. This is the harsh reality of the long-term care industry that many have faced, including experts in the field such as Dr. Robert Kane, author of It Shouldn’t Be This Way: The Failure of Long-Term Care. Long-term services and supports (LTSS) are supposed to maximize the quality of care and the quality of life for the individual (Kane and West, 2005, p. 169). When that focus is lost, it is the responsibility of healthcare professionals, like myself, to bring that issue back to the forefront of policy making.

Humanity is living longer these days creating the need for long-term care facilities. Today’s families need to work outside the home forcing their loved ones to enter the dependency of the extended care and long-term care facilities. More and more of the retirees are seeking better facilities for themselves because there are more options. There are more than meets the eyes in the nursing and long-term care that involves families and personnel in the decision making for their loved ones.

When presented with the word “elderly,” a twenty-year-old might begin to think of the joys of retirement when an older person has spent their life building a comfortable bank account; they then get to reward themselves by journeying around the world with their near and most dear companion. When reality sets in, that person may realize that a lot of today’s elderly are living in nursing homes or living week-by-week not knowing if they are going to be able to leave their hospital bed just to go relax in their recliner at home. While it is true that some elderly enjoy their last twenty or thirty years on earth, a lot of the elderly in America are struggling to hang on to life while being abused every day by healthcare workers or even loved ones. While many people have been working endlessly to put a stop to elder abuse, not everyone can say the same.

In this interview, Thompson voices concern for the future of assisted living. The PBS interview supports my claim that there is an inability to properly take care of patients in living facilities, and that it is dangerous to elderly people or those with disadvantages. One way in which Thompson strengthens my claim is through his use of the word “pattern.” This word shows how common these problems are across the country in assisted living facilities. These problems that he witnessed are dangerous and, as he put it,

In Being Mortal, Atul Gawande painted a little depressing picture of the realities faced by the elderly in the US nowadays: declining health status, economic insecurity, and loss of independence. It seems once the older people move into nursing homes or assisted living facilities, they lose autonomy, dignity and privacy as the institutions are not able to fully individualize care. Even though the situation has been improving, it still shocks me to see how unhappy some of the elderly are in these circumstances. Realizing senior care facilities often fail to address all aspects of well-being, I would like to explore the issues of promoting both objective and subjective component in quality of care for the older people.

Care homes should provide a quality of service meeting the needs of the residents as in a normal setting. However, the institutionalised nature of the care has many negative impacts on the residents’ as they perceive it is as negative form of care and a service denying independence, autonomy, privacy, power and other principle of human rights. Elderly are abused and neglected in some care homes while large proportions of staff caring for them are untrained and incompetent in caring. Funding for elderly care is major issue, on one extreme elderly are being forced to pay for care and on the other local authorities struggle to manage service within their budget.#

Both of the gentlemen stated they had been in other homes and that this was the nicest home they had been in. Kenneth complained of his first home ¡°smelling more like a zoo than a nursing home.¡± John told me that his last home was on the South Side and that the neighborhood was filled with gang bangers and hoodlums. When his family visits here though, they wheel him through the Lincoln Park neighborhoods and it¡¯s nice. For all of the questions that I asked these two men, they had just as many questions for me. Heading in to this assignment, I hadn¡¯t really considered that someone would be asking ME questions. In the midst of all that happens in nursing homes, it¡¯s important to remember that these residents aren¡¯t just dependent, older people, but that they are still people just like you and I.

I conducted interviews with individuals from the Department of Health and Human services that focused on the aging population, vulnerable adults and their residency in long term care facilities. The DHS has different branches that cater to the needs of older adults as well as regulations and laws aimed at protecting residents in long-term care facilities. The regulations include, the Adult protection statute, and general statutory guidelines for home and community-based services under Medicaid. Minnesota and the federal government share responsibility for enforcing the “Nursing Facility Bill of Rights” which explains the rights afforded to residents of nursing facilities.

The book As We Are Now, written by May Sarton, targets those concerned with the care of elderly individuals in nursing homes. In the book, Sarton artistically highlights the plethora of ongoing issues social workers face in their work as they attempt to provide quality care to the elderly population. The book is written as the memoirs of a very thoughtful elderly woman, Caroline Spenser, as she spent part of her life in a nursing home; and brings to light the lack of quality of care that elderly individuals received when living in such a facility in the 1970’s.

The film portrays light as wayfinding elements that are highly desirable in residential facilities. The understanding that most older adults will live in long-term residential facilities is imperative to enhance the distorted public knowledge about long-term residential facilities and what they think could be, so that they make better decisions about their future, safety, and