TRIALS AT ST TIMMY'S 50
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THE TRIALS AT ST TIMMY'S --
The Continued Saga of Paul Ess's Rehabilitation
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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agencies's reports on industry performance inaccurate, outdated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?
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