The state of eldercare: from bad to better, but there's much room for improvement

Dear readers: A lot has gone wrong in eldercare over the years.

On June 5, I spoke at the annual conference of the Washington Association of Homes and Services for the Aging (primarily nonprofit eldercare providers), outlining what we need to do to dramatically change this. Today and in some upcoming columns I'll provide selected excerpts. The solutions won't be easy, but we must begin. I started my career in aging during what I call the "mean old days" of the nursing-home industry — it was the mid-1970s when I was appointed director of a nationwide investigation of the nursing-home industry for the federal government. For those of you too young to remember, there were newspaper headlines in virtually every state describing gut-wrenching, deplorable care. Since we've just had our breakfast, I'll spare you the graphic details. Suffice to say, there was profound corruption and frequent images of unimaginable human suffering splashed across the front pages, and it was happening nationwide.

The source of these problems, in my mind, was extraordinarily weak federal regulations governing quality and fiscal accountability. Under Medicare and Medicaid, which started in the mid-1960s, the federal government threw money at nursing-home operators who quickly learned how to milk the system. As a result, the industry attracted thugs and sharks, people who couldn't care less about frail, old people — they just wanted the money. The quality of care was unbelievably awful, while many bad operators went to the bank laughing. Some of them are still here.

Common characteristics of many nursing homes in the "mean old days" of the '70s and '80s include:

• Constant, rapid staff turnover; a revolving door.

• Poor pay, nonexistent benefits, no career ladders, no future for the people who did the work.

• Inadequate staffing, too little training.

• Poor-quality management.

• Too many regulations — the worse nursing homes became, the more regulations were thrown at them.

• Boring, lonely lives for residents, living two to four to a room. No privacy. No place for their belongings.

• No alternatives. If your mom broke her fingernail and needed care — into a nursing home! There were no other options except what families could provide.

No wonder most older people today, and even boomers, are scared to death of growing old, becoming frail and needing care — many remember visiting their grandmothers in nursing homes and being horrified at what they saw. I've long wondered what might have happened to our country's attitude about aging if, instead of starting with wretched care, we'd started with wonderful care. Would we go into the last phases of our lives with more optimism and anticipation, planning the ingredients that help us control our last days? We'll never know. That genie's out of the bottle.

Fast forward to today. There's good news: The quality of long-term care has improved.

For one thing, there are alternatives to nursing homes — home care, retirement communities, assisted-living communities and adult family homes.

For another: There are no longer headlines in state after state describing deplorable conditions. Those days, at least for now, are gone.

The bad news is, from my perspective, most long-term care today is just plain mediocre. A few providers still offer bad care, a few offer exceptional care, but most offer poor to mediocre care. And it's happening throughout all care settings.

My dad lived in a profoundly mediocre nursing home for two years. I visited him daily, and when you visit a nursing home daily, you get a good picture of reality. Here's what I saw:

• Constant, rapid staff turnover — the exodus of really good caregivers was rampant. Nationally, the turnover rate of caregiving aides in nursing homes is 70 percent, for nurses it's 50 percent. Home care has similar numbers.

• Poor pay, almost nonexistent benefits.

• Inadequate staffing — too few aides for too many residents. I'd walk in and the call bells would be ringing incessantly while residents waited for long stretches for help getting to the bathroom. The nurses would be standing at their stations pushing pencils across forms, ignoring the bells, while the few aides who showed up would run from room to room. No wonder my dad was incontinent; no wonder he was at risk for falls, because, pretty soon, he'd try to get to the bathroom himself.

• Poor-quality management.

• Too many regulations.

Hmmm, sounds like the bad old days, except a few steps better.

The truth is, I don't think we've made a lot of progress in long-term care over the past 40 years. Gone are the really horrible providers, but they've been replaced by the merely mediocre, and I have a feeling many of their owners are still going to the bank laughing.

When it comes to finding care for our parents, our spouses, our clients — or us someday — mediocre as a norm doesn't cut it. We want better.

Next week: The quiet revolution that's transforming the quality of eldercare.

Liz Taylor's column runs on Mondays. With 30 years experience in the field, she writes and lectures on a host of aging topics. E-mail her at growingolder@seattletimes.com or write to P.O. Box 11601, Bainbridge Island, WA 98110.