TRIALS AT ST TIMMY'S 50 ================================================================= THE TRIALS AT ST TIMMY'S -- The Continued Saga of Paul Ess's Rehabilitation ================================================================= This is episode 50. I found out there is an organization in the San Francisco Bay area which fights the care industry on its own turf. I have a copy of their 50 best and 50 worst rest homes in California for 1996. The worst places, based on the number of deficiencies noted by the state licensing agency, tend to be in small towns and outlying areas. Inferences can be made from the ratio of deficiencies noted by state evaluators versus the number of complaints the state licensing agency received from residents and their families. When there are a lot of deficiencies and not many outside complaints, it argues the general level of resident function is low; i.e., if you're really spazzed they may mistreat you but you won't have sense enough to bitch about it or family around to see what is going on. The lesson here is, When you're looking for a place to stick grandma, look for a place with low deificiencies and ignore higher complaints. This means they are being talked about and are being kept on their toes! The use of physical restraints such as hand mittens and Posey belts is increasing. The use of psychotropic drugs such as Thorazine, Haldol, and Mellaril for control purposes is increasing at an even faster rate. The watchdog agency finds this utterly unacceptable. I've lived for eighteen months around people whose behavior prompts the use of these restraints. It seems to me the people who end up in rest homes are largely those who are in quite bad shape. I don't think anyone comes here who has any other possibilities. Consequently, a fair number of these inmates are going to be nutty, agitated, and lacking in self-control. The gutting of mental health programs has dumped people with psychiatric problems into rest homes and on the street if they are not so lucky. Because psychotropic drugs must be prescribed, this practice is good for business if you happen to be a psychiatrist with a "milk run" of rest homes as part of your weekly rounds. As you can imagine, the rest home industry calls watchdog agencies's reports on industry performance inaccurate, outdated and misleading. You can take it from me that these reports are not misleading. Political bodies such as state legislatures tend not to care what goes on so long as there isn't an outright scandal. They keep pumping money into this system which could be used to preserve people's independence instead of warehousing so many of them. The shocking fact is that even when rest homes are fined for violations, they often successfully appeal themselves right out of the need to pay! Here are some typical violations recently reported in California. Let's start with a really rotten one which ocurred in my former home, The ERR! The facility failed to keep the resident's careplan up to date, but this is a common failing. Recordkeeping is a major deficiency throughout the industry. The really outrageous part of the complaint is that they, without his knowledge or consent, put Prozac in his coffee. Now you know why I don't eat or drink anything I feel suspicious of. Just this morning I was bitching at the new male CNA that I didn't drink anything I couldn't see through, nor did I eat pudding or applesauce. These are all vehicles for getting drugs into people who don't want them. The ERR wasn't through with the Prozac dude. They also shipped his ass off to the county funny farm based on false information and then would not readmit him on the excuse that he had converted his financial plan from private insurance to the state- run MediCal insurance. The ERR is a MediCal-certified facility. As you may recall, The ERR got rid of me because the good-times money was over with. But there was a flaw in their game; they didn't keep me informed on my insurance coverage and so caused me to allegedly incur a debt to them. MediCal paid them quite a bit of it retroactively. They bill me for several thousand dollars remaining. They won't get it. I don't have it to give to them. So sue me. There are several levels of employees in a nursing home / skilled care facility / rest home / convalescent hospital / sub-acute hospital. First you have the administration and social services people along with the general office and finance drones. Next come the medical director, a doctor of medicine, and the few registered nurses the place is required to employ. Licensed vocational nurses often act as station charge nurses. The director of nursing may herself be a mere RN. LVNs are usually the med and treatment nurses. Last come the CNAs, certified nursing assistants also known as nurse's aides, nurse assistants, and now by the overblown term, patient care technician. Reports come in from time to time of which these are typical-- A resident swore at and hit another resident. Staff did nothing to restore order. A staff member was physically and verbally abusive to residents resulting in one resident suffering a broken arm. Leaky roof. Facility failed to monitor patient's condition and inform doctor of changes. Resulted in patient's return to acute hospital with kidney failure, urinary infection, and dehydration. A previously-warned staff member threw a bedpan at an 84- year old resident and twisted her nose. Staff inattentiveness resulted in a resident's fall and injury. Resident was readmitted to acute hospital for treatment. [This typically helps out the rest home because when the patient comes back, he or she re-qualifies for MediCare goodies, among other benefits.] Med nurse forced medication on a resident after resident refused such medication. After a choking incident, facility failed to revise care plan of resident. Upon second incident, resident choked to death on a slab of pizza. Facility left 80 residents in the care of two CNAs. Because of lack of supervision one resident assaulted another, breaking his fingers and bruising his face. A CNA punched a resident in the eye. Facility made several errors in administering insulin to diabetics resulting in hypoglycemic reactions and comas. Resident with Parkinson's disease was told by CNA how worthless she is and that God made her that way. Resident suffered retaliation for reporting this abuse. Facility failed to protect residents from combative and from sexually abusive residents. [Here at St Timmy's we have Old Earl who rolls up behind old ladies and nurses both and pinches their butt or feels up their crotch -- whatever he can get away with. He's so incontinent and has such wicked pee-smell you'd think they could tell he was coming...] Residents were not seen by a physician for over six months and had developed bed sores. Staff member struck resident when she asked for mustard for her food. Resident fell down a flight of stairs and suffered injuries. Staff had no clear view of the steps and the doors out were not alarmed. Physician ordered resident with a high fever to acute hospital. Facility failed to call an ambulance for over two hours. CNA answered call light by calling resident a "jackass". Unsupervised patient fell off toilet and broke her nose. Facility failed to deal adquately with a resident who wanders. She got out of the building, fell, and broke her hip. Resident was allowed to become dirty and odiferous. He was transferred to an acute hospital and was refused readmittance to the rest home upon return. CNA ignored resident's instructions about dressing her, caused her pain and ignored doing so. A male nurse probed a resident's vagina without an authorization to perform a pelvic exam. Resident was admitted to a facility in 1990 with clear skin. In 1996 was admitted to acute hospital for surgical closure of Level IV pressure sores [to the bone!]. Resident was found wandering near a busy street, confused and without an identifying arm band. Facility failed to follow care plan / doctor's orders. Patient was admitted to emergency room with fecal impaction and severe dehydration. Patient died. [Some people are so unaware or have bowels so sluggish that digital removal of feces is regularly required.] Facility left totally dependent resident unkempt and in a urine soaked bed. Patient developed skin irritations and bed sores. Facility incorrectly used blood glucose measuring device and sent various diabetic residents to acute hospital after failure to notice true hypoglycemia [possibly from insulin overdosing]. Facility failed to constantly monitor a patient who could not signal her needs with the call light. New employees were not physically examined nor tested for tuberculosis before employment, thus putting residents at risk for contagious disease. [This is a serious problem because so many CNAs are resident aleins or recent immigrants from the Third World.] Resident rolled her wheelchair down a ramp of a greater angle than that permitted by law, fell from her chair and was injured. Facility denied residents their rights (a) did not permit certain residents to use the enclosed yard, (b) disallowed access to a telephone, (c) put others on weight-reducing diets against their wishes, and (d) did not permit others to possess their own cigarettes -- all of these prohibitions without doctor's orders. This same facility was also cited for failure to protect residents against personal injury. When approached about the content of the citations, the administrator said, "I don't have to follow doctor's orders." Facility failed to provide proper oral care for patient having a nasal-gastric feeding tube. There was found dried tube feeding substance [Ensure/SustaCal-like gravy] and mucous coating the palate, teeth and tongue. Resident wandered out of the facility at five o'clock in the morning not wearing a "WANDERER" arm band and through a portal not alarmed to prevent unnoticed passage. Resident was found by fire department face-down in a nearby creek, quite dead. Staff members made inappropriate and humiliating comments about a resident's body and appearance. Resident who should have been known to be a wanderer, wheeled herself out of the facility, toppled over from her chair and broke her neck. Staff member left resident sitting in a filthy diaper after the resident asked to be changed. Staff member also made obscene gestures and derogatory comments to resident regarding the soiling. Patient was not protected from abusive CNA who kicked patient's room door and shouted vulgar words. Over a period of several months, a CNA used a female resident for "show and tell" to other CNAs by fondling the sexual parts of the resident. Med nurses used uncalibrated measuring devices resulting in various over- and under-dosings and used out-of-date and expired medicines. Facility cited for inadequate stock of clean linens and for call light system which was inoperable in six rooms. Resident was sent out for a blood-in-urine test. Facility never obtained results of this test and did not forward them to the resident's physician. Resident's health failed to the point where she was admitted to acute hospital and was found to have a migrating bladder cancer. Facility failed to protect residents from a CNA who punched, slapped, threatened and teased residents while other CNAs looked on. CNA pushed residents in wheelchairs at unsafe speeds and maneuvered them in unsafe ways. Other CNAs failed to report these abuses according to the state and federal laws pertaining to elder abuse. Nursing home administrators have the reputation of not caring about residents who have no friends or family to look out for them. In some homes, one CNA is assigned 15 to 20 residents to wash, clothe, feed and care for through the shift. In my experience, one CNA can adequately perform these tasks for not more than seven patients. Here at St Timmy's they are assigned at least eight and as many as twelve residents. If you have an emergency and your CNA is not available, you can just go ahead and shit your pants or whatever it is that is bugging you because none of the others is going to step in to help. You can press the call button and be told to turn it off because your nurse is coming -- when you know for a fact that no such thing is about to happen. For the pay CNAs get, they can do as well breaking their backs at a fast food joint. As much as I disliked life at The ERR, I will give their director of nursing this much: She saw to it that all day and evening CNAs had "in-service" training for a half hour at least two times a week. I gave an in-service twice at The ERR on the changes in one's living habits diabetes makes. The CNAs had no clue about sensitive feet, nerve sensation loss, vascular issues, etc. Here at St Timmy's they've had an in-service once or twice in not much of anything -- and it shows. I have trained CNAs here on how to assist someone who gets in and out of bed to wheelchair. They don't know how to actually help yet not be a hindrance until I get to them! LVNs -- licensed vocational nurses -- have the hardest jobs of any "real" nurse outside of an emergency room. They often have to dose 50-70 patients in an eight-hour shift. Each patient will need from one to a dozen pills or other doses. The LVN typically spends ten to twenty minutes with each patient. They have to make time for their breaks, lunch, and for the incessant record keeping ("charting"). In some places, the med nurse doubles as the treatment nurse and must take care of bandaging and wound care as well. One RN who has worked in nursing homes in five states says California has the worst, so don't send grandma here. In 1995, 19 people died as a direct result of unsafe practices in rest homes. Another 45 died as an indirect result of bad practices. About 45 percent of California homes were cited in 1995 for failure to provide care which enhances dignity and 40 percent were cited for failure to accomodate residents's reasonable needs. About 16 percent were cited for privacy violations. Food service issues were a matter of contention in 43 percent of homes. Infection control was lax in 25 percent of homes. Unnecessary drug administration was found in 30 percent of homes. Over 70 percent of nursing home residents are female, are admitted by transfer from regular (acute) hospitals, are over 75 years of age, and are white. I am surrounded by LOLs, half of whom are precariously ill or dotty. Nine percent of all nursing home residents have bedsores, an indwelling urinary catheter, or a nasal-gastric feeding tube. Over 20 percent died in a nursing home. Another 33 percent go back to an acute hospital and presumably croak there. Twelve percent get "dumped" -- sent to another long-term care facility. Dumping is common over financial and behavior issues. When the good money stops or you become a management problem, they dump you into another home which will take lower-grade patients. Last year over 1700 nursing home patients went AWOL! They left to live on the street, or however else they might, instead of remaining in one of these places. There is no figure for the number who may have committed a covert suicide. The real Nurse Mengele works in San Jose. A resident was given an insulin injection against his wishes and after having told the med nurse it was his rommmate who is the diabetic. Another resident was restrained by staff for the unwilling insertion of a urinary catheter during which procedure they broke the man's leg. A resident in a cowtown facility had a leg amputated because the facility failed to manage her health correctly. She was send to the county hospital in her underwear because nobody could find her clothes. Residents will be held down and slapped and will have towels stuffed in their mouths to shut them up. Others will have their clothes ripped off them or threatened that, Some day I will kill you! At a state hospital for the insane, a caregiver screamed at an inmate, Fucking bitch! -- You don't deserve to live! -- and then slapped her. Another charming disciple of de Sade made an old lady eat her bowel movement. In some homes you aren't permitted visitors or will be permitted to troop through the halls stark naked in front of Glub, visitors, and everybody. You can be made to sit in your own piss and shit until they get good and ready to do something with you such as shower you in cold water -- or scalding. Instead of segregating agitated or noisy residents so they can be monitored and do not become a disturbance to others, these places continually mix the daft with the intelligent. If you can't sleep they will drug you so you do if you complain about the noise. You stand a chance of getting a double dose of something such as Haldol and ending up a drooling, incontinent fool. Sometimes it scares me to think what might happen if St Timmy's found out what I have been writing. Miss Ralph and I are sistah- girlfrens, but I won't even tell "her" what I'm up to. There are associations of health facility operators who spend big bucks in Washington and in state capitals to see that regulations pertaining to them are not tightened and, if possible, get even more watered down. I've avoided citing dollar amounts in this episode because I have nothing with which to put them into a perspective. Suffice it to say that in 1995 the nursing care industry in California was never more robust. It's a multi- billion dollar industry with a record year in stock gains and industry profits. CEOs of the big chains of nursing homes in California made at least US$400,000 last year with the head of the notorious Hillhaven system making over a million. The only people who didn't overwhelmingly benefit are the ones living in the beds. So, why am I still here? Good question. I want my life back. Whenever I get another list of ADA-compliant apartment house operations, I call up the person in charge and ask if they have a vacancy. They never do. I ask if they have a waiting list. They always do. The next question is whether the waiting list is open. Often it is not. Waiting lists are years long for what I need. I even explored the possibility of combining resources with another young man who is living here at St Timmy's. We would not be friends and we would get into each other's way in some things. But together we might be able to afford the rent on a market-rate two-bedroom place and combine entitlements sufficiently to get assistive technology retrofitted to the place such as bars, ramps and a bench shower. So I live at St Timmy's and watch the last four hundred dollars in my checking account run out in twenties and hundreds for phone line, internet connection, a jar a week of jam, storage for my household goods, and an ocassional toy. Maybe I'll make it last until I can file for my income tax withholding. Maybe the administrative law judge who's deciding my appeal on the cutting of my pension will come down on my side. Maybe maybe maybe. The complete text of my ERR and Timmy's tales is on deposit with three friends, Boogie Man, Demon, and Miss Kooky. The whole text has been broadcast worldwide on the Internet. Everybody says I should write a book. I have. The ERR and this are it. Suggested combined title: God's Waiting Room. The only thing which needs to be done is to make footnotes about obscure words such as 'spoo', 'choad', and 'grogan'. I suppose I ought to rewrite some sections and eliminate some repetitiousness. But I don't want to go back over what I've set down. Like Pontius Pilate, I have written what I have written. Going over it is too much reliving it. Sometimes I wonder what the point is or was of even starting this stuff. It began as the ObTs -- Obligatory Tastelessnesses -- to posts in Usenet newsgroup alt.tasteless in order to conform to the customs among its adherents. Then it took on a life of its own. It gave me a way to cry out about the confusion and frustration I've put up with. Concurrently I could be entertaining to those who have an appreciation for the ribald, nasty, and ironic. I hope I have pointed up how easy it is to fall into the cracks and how a few hours can change your life unbelievably. What you do with grandma matters. What happens to productive people who had a devastating illness matters. When these things and predicaments no long matter we have lost a large part of what makes us human or at least humane. Under the current system both of us get the shaft because the resources are going down the wrong holes. You on the outside have to change that. None of us are getting good value for the money. Corporate fat cats and unresponsive administrators are getting rich off misery and the waste of human resources. My work pointing this up is finished. I'm about finished. Every morning I wake up to another finger stick and an uninteresting breakfast eaten in social silence. Every morning I wake and wait. Wait for what? I don't know any more. Does anybody have Dr Jack's phone number? ================================================================= T H E E N D =================================================================