What I Learned Too Late About Nursing Home Care
When a loved one entered a rehab and nursing center after a fall, no one expected what came next. She was supposed to recover, to regain strength and return home. Instead, what unfolded can be summed up in one devastating word: dehumanization.
Let these questions sink in:
How does a proud, independent woman learn on her first night that calling for help gets ignored? That being left in her own waste for hours is not an exception, but routine?
How does someone learn to stay quiet—not because they’re fine, but because they fear retaliation?
How do staff teach the "rules"? Rough handling during transfers? Cold meals delivered too late to eat? Showers that leave behind humiliation?How does a short-term rehab patient end up requesting hospice—not because they’re ready to die, but because no one helps them live with dignity?
What kind of neglect leads a person to accept silently being left sitting in filth for hours, on more than one occasion, with no accountability?
When a staff member sees the mistreatment, how do they respond? Often, it’s just a quiet squeeze on the arm. Nothing more.
And when complaints are made—Who responds? When? Does anything change?
In this case, the state inspector came, but the staff knew ahead of time. Smiles were brighter. Protocols polished. But the dignity-robbing neglect? It stayed behind closed doors.
It’s easy to be fooled by clean hallways and friendly tours. But those only go skin deep. Because when dignity disappears behind those doors, it disappears quietly—one unanswered call light at a time.
Abuse usually leaves marks. It's about what happened. Neglect is difficult to measure and document. It's about what is NOT happening. How can loved ones insure against neglect, both unintentional and/or systemic?
If CNA's have to drive more than 45 minutes each way to work the facilities will be chronically understaffed.
That said--it can't be overstated, IMO, if eldercare quality is ever to approach what we would want for elders, both present day and future--old people who have lost almost everything that makes life worth living may not be the best behaved of patients. It's really rather a Catch-22 for both care recipient and care giver. (NOT a big fan of longevity here!)
After a hospitalization in 2023, my doctor recommended rehab for me, in fact. I saw no point in it and told him so, saying no thank you. The doctor actually agreed with me and was just grasping at straws in an effort to help me with an issue that couldn't BE helped.
We all have a voice that we can use. And if dementia is involved, we hopefully have the voice of a POA to speak FOR us and get the issue resolved.
Where were you when all this dehumanization was going on? And what did you do about it at the time?
I really appreciate your perspective on the OP's situation. There were things they could have done to help their loved one's situation. Like getting them moved to a different facility, or calling APS, or having them hospitalized. Many people bring in private help in a facility also.
You can transfer, if you feel that LO needs hospitalization and the facility will not send them, you can call 911. You could removed her AMA. You would not have gotten discharge papers or prescriptions. You could have called APS. I told one person who was having problems getting a parent released, tell them there is no money. Medicare only pays 100% for 20 days. After that the patient pays 50% of the daily cost. The person did what I said and they discharged the patient.
I did this with my Mom. Told admissions, they better do what they needed to do in the 20 days because their was no money after that. Mom was out in 18 days.
In your case, speak to the administrator where your LO is and make them see you often. Be in good communication with the staff too. It doesn't hurt to get friendly with the CNA staff because they are the ones who provide most of the hands-on care in these places.
The care provided in a nursing home, memory care, or any LTC facility is usually not good because these places are profit-making and owned by shareholders. So they're going to cut every corner from food quality to staffing levels to increase profit margins. Many people hire outside help (CNA's or companions) to help their LO's in LTC facilities and rehabs because there's so much neglect.
Your idea on what is maltreatment and neglect is probably very different than what the legal industry standards and requirements are for facility care. That bar is set pretty low.
I've seen lots of LTC staff doing their level best for residents. They're working with what they have to work with. When you're responsible to wash, diaper, dress, and feed a lot of people in a set amount of time, preserving dignity is really not a priority. The CNA's have to get the work done. There isn't going to be one-on-one care where the aide can take all the time in the world with a resident they stay and visit with them in their rooms until they are ready for them to leave. That's not reality. Sure, sometimes the 'handling' can seem a bit rough to an outside observer. The aide has to get it done though. They work on facility time, not resident time.
You do know that care facility aides are required to check on room calls. In LTC especially memory care, residents will call continuously and everything is an 'emergency'. So a lot of times it's a judgment call. They can't go running every second because that encourages it. Also, they can't be seen as showing favoritism to on resident over another. That causes big problems in LTC.
This is a very hard topic and there really isn't a one-size-fits-all answer.
When state pays a visit, things improve while they're there of course. As soon as they leave, it's back to what it was.
This treatment should not be tolerated.
I agree, there are some terrible facilities that provide awful care. They hire the worst of the worst people to work for them. Rough treatment and lack of compassion is the hallmark of these god forsaken places that need to be shut down like yesterday. Residents lying in their own excrement, falls, and even sexual assaults have occurred in these places.
However, we have a responsibility to report this type of abuse and remove the loved one to a safer environment.
I would discuss your own particular complaints with the administrations involved, and would encourage you to know in your strong and loving advocacy, that the world of aging in America (and likely everywhere else) is about as imperfect as any world will ever get.