Dementia Care (Or "Shouldn't Dad really be in a Nursing Home?")

James K. Curto, CMDCP

James K. Curto, CMDCP

The Birches Assisted Living, sailor, jazz fan, LTHS, Denison, Kellogg NU grad, and a White Sox fan. The spark of an idea for the Birches Assisted Living and Memory Care began when I heard about this new “assisted living movement” back in the mid-90. I found and purchased the land in 1997, and we began construction a year later... I grew up in La Grange and am a proud graduate of Lyons Township High School. My wife, Mary, and I have lived in Western Springs since 1992. I spent much of my career in hospital management, after receiving training in that field at the Kellogg School at Northwestern University.

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A Frontline documentary/expose on assisted living was shown on PBS. It featured one of the biggest assisted living companies in our industry, Emeritus. The piece, Life and Death in Assisted Living raised some significant issues about the safety and appropriateness of assisted living for people with dementia. 

Three people who died were featured. One was former Chicago Bear Hall of Famer George McAfee, who played for our team before and after World War II service in the Navy. He died a horrible death at age 90 after drinking a caustic cleaning chemical he found in Georgia Assisted Living Community where he lived. Someone (it was not detailed) failed to lock a door, and he couldn't judge or sense that this was not something to drink. Dementia can take away our senses.

Another death was from a fall from a second-story window. The windows in her Mississippi assisted living apartment was supposedly blocked from opening more than 12 inches, but Merle Fall, a new resident who had packed her bag to go 'home,' figured out how to open it. This may or may not have been negligence, but it illustrates that judgment can be severely impaired due to dementia. These two tragic deaths could have happened in a nursing home or a private home. 

Joan Boice, who had nine undetected advance stage bed sores, was the third person who died. The report showed a physician who testified that these decubitus ulcers did not cause the woman's death, but the jury thought otherwise and awarded the family almost $23 million. 

The son, on camera, grieved, saying that he wished he would have thought to look under his Mom's bedclothes to check her skin. Someone was grossly negligent here, and it was not the son. At least one staffer, who was shown, was aware of the bedsores. She was not a nurse and said that she did not know what she was doing while she was treating the wounds. 

A theme of the hour-long show was inadequate training, failed systems, and a drive to maximize profits – profits that come from accepting and keeping people who should be in nursing homes. Severe charges and heartbreaking stories that suggested more regulation were the answer. Perhaps, but perhaps not. 

I don't think this story necessarily reveals any truths as to whether assisted living or nursing home is the better choice for caring for each person living with dementia. There are certainly good and bad of each. Each family needs to gather information from multiple sources to make the right choice for "their person." 

All the providers in our industry need to work harder to provide our staff members the necessary training, to retain our exemplary staff, promptly get rid of the bad, to develop and constantly improve systems, and generally take the best care possible of our valued elders.