"Hit the ball like this, Ellie," I said for the umpteenth time, demonstrating with the toy mallet. But Ellie persisted in using the mallet like a cue in shuffleboard. The shape of the mallet is similar, and it CAN work that way, maybe even better, for her, than the usual stroke. She's not being obstinate, but only responding to the signals her brain has given her, increasingly distorting her ability to learn new processes and procedures. She may never learn to do it "right," and she needs to be given huge credit for trying.
It took me a while to learn that kind of patience, even as I told myself that I'm lucky my role and Ellie's aren't reversed. I'm about ten years older than she is, and I CAN learn new things, with persistence, practice, and patience with my own gradually failing age-related powers of mind.
Ellie is smartly dressed in a tailored blue suit with a demure small gold necklace around her neck--one she is fortunate to still have, if it's real gold, in an "independent living facility" where petty theft is a common source of supplemental income for the lowly paid CNAs [Certified Nursing Assistants] and other workers. I have talked to Ellie often, and until now, she could have passed for perfectly okay. She would not have seemed out of place at the clubhouse bar. But she has a lot of trouble handling new experience of any kind--including the exceptionally simple game of Carpet Croquet.
All the facilities are operated in the same way
This facility is on the lower end of the economic spectrum, but theft happens in all of them, for the same reason, by the same kind of employees. All the care facilities compete--from one-star to five-star--by hiring employees who will take very low salaries and must augment them by stealing everything re-sellable. Locks provide no security--they're a tip-off that there's something valuable in there. It could be that Ellie wears this necklace around her neck all the time, to make sure she keeps it.
Typically, the "senior care" facilities are operated by management companies for the benefit of real estate investment firms. Top executives of those management companies never have to see the on-the-ground local operations, nor do the board members of the investment firms, who are always looking to the bottom line. If a company doesn't perform, it will be unloaded.
I know of a once-excellent assisted living facility that "sold out" to another company because it could not match its direct competitors in price, and for a very good reason: the quality care they were paying for was not visible in the lobby or on the first floor! If two facilities look the same--in the daytime, on the first floor--you would naturally choose the least expensive.
The activities director for the facility taken over by a more profitable firm told me, outraged, "They said it was going to be just the same. But it isn't, not at all. They cut every corner they could. And look at this!" Martha pointed to a half-page display in the local paper, advertising to fill all the apartments, and showed me her image--obviously kind, competent, compassionate, and high-toned--smiling from the corner of the ad: "They use my picture to sell this place!"
As in all industries, customers shop around, and managers of the profit-wise senior facility will make sure that its first floor is pristine during daytime hours, and its 9-to-5 staff bright-eyed, high-toned, and thoroughly fit for display to prospective customers. it will look exactly like a more expensive facility which actually provides better care with more and better trained nurses, around the clock and on all the floors of every wing.
What you see is not exactly what you get
The backbone of an assisted living facility is the nursing staff--the people who monitor the residents, push them around in their wheelchairs, change them, bathe them, and generally see to their health and well-being--or not. The salaries paid for those nurses can be the difference between making a hefty profit and just breaking even--which of course is not good enough for stockholders.
In Florida, you can become a Certified Nursing Assistant by taking a three-day training course and passing a test that would be a walk for the average eight-grader. Even though the salaries aren't great, such an opportunity is attractive to many Floridians, especially immigrants, who really need work. They can usually get that work, no questions asked, no resume necessary, with just a CNA certificate.
Many but not all these cheap workers belong to the notoriously over-incarcerated population that feeds the growing industry of "privatized" prisons in Florida and many other states. Many of them may have been sent to prison for nothing more than "walking while black." The real crime is not the theft, but the perpetuation of a profit-centered corporate culture that makes it necessary and actually enables it.
Could video expose and correct these problems? Yes. But no.
But there are also countless cases of unreported violent crime: physical abuse, actually beatings, and neglect: residents crying out in pain or distress and even being allowed to die, with apparently indifferent CNAs standing nearby and heedless.
And although local staff may suggest putting in video to monitor such abuses and neglect, nobody does it. Video cameras would be a useless expense. The cost of the equipment, of monitoring it, of investigating and prosecuting thieves all would be counter-productive. There's no bottom-line benefit to the company or the shareholders, so it shouldn't be done, and it won't be done.
Most of all, the corporations want to avoid legal liability of any kind, for any reason, and cameras would provide the same discomfiting level of "proof" we've seen in numerous atrocities we've watched municipal police commit this year upon minority populations, as recorded by video.
Seniors for sale in Florida!
There used to be meaningful regulation of most industries, dating back to the "New Deal" innovations of the 30s. But that was long ago. Many states, including Florida, have found ways to render meaningless many of the protections that were once actually useful.
In Florida, because of enabling legislation in 2012 (HB 787, titled "Nursing Homes") that took away regulations intended to protect Florida consumers, this truly remarkable state now allows "brokers" to prey upon seniors and their family members looking for lodgings of any kind. "Patient brokers" now legally advertise a "free service" to consumers who have no idea that they are worth thousands of dollars to these brokers, who will place them in the first senior facility who promises the best price--typically between $3,000 and $5,000 per senior.
With million-dollar budgets provided by giant firms from out of state, these "brokers" can and do cast a very large net, largely shutting out free counseling and referral services already available to the same customers by trained professionals who place seniors on the basis of real compatibility, instead of their cash per capita value. They do nothing useful. They make things worse. And they make lots of money.
Florida is often and justly called "God's waiting room," and the senior care industry is prepared to keep a client as long as that client can pay....and only until then. Evictions are messy, but perfectly legal, in all the states. And most of these facilities are fully prepared to move a customer from "Independent Living" to "Assisted Living" in another wing or a different building, and then onto the "Nursing Home," and then.... (In the REI corporate board room, I think they refer to that kind of efficiency as "vertical integration." But I might have it confused with "horizontal integration" which, of course, also works.)
Scott's campaign said the Governor had "no direct knowledge" of the fraud, and that Scott had nevertheless "taken responsibility" and resigned his CEO position soon after the biggest case of Medicare fraud in US history became public. Scott's free-enterprise example has been an inspiration to aspiring entrepreneurs of every stripe, the embodiment of the new American dream: getting rich by rigging the system, working it, and getting off "Scott-free."
Even though the Affordable Care Act (aka "Obama Care") was passed with the enthusiastic support of the medical and pharmaceutical lobbies because it promised to provide even greater profit for those industries, millions of people in the United States do not have health insurance of any kind. In Palm Beach County alone, fully a quarter of the population (250,000) are uninsured.
So who is REALLY responsible?
But there's always government regulation, you might say. Yes, there is, and it is typically written by lobbying firms working for vested-interest corporations who provide the bulk of the funds the politicians need to be elected and re-elected.
Nothing, it seems, can be done to correct this. And that is especially dispiriting to the genuinely caring and motivated staff of these facilities. The good and compassionate nurses, increasingly unable to find high-quality facilities ethically operated, are dropping out of the profession, leaving the field open to the predators and the equally victimized, underpaid and exploited class of workers they hire.
The true meaning of "American Exceptionalism"
I asked an exceptionally competent and caring activities director with a 9-to-5 job why she stays in the job. What she said reminded me of my own answer when I ask myself, "Why am I doing this volunteer work? I'm just helping the corporation make profits!" Phyllis said, "My son asks me the same question, and I've asked it of myself many times. The truth is, I feel I actually CAN brighten the lives of those people while I'm there, five days a week, just a little, and I have to do that. We can do fun things together. I can't let myself just abandon the most vulnerable people to be preyed upon by...them."
By "them," she means the system. Phyllis and I and many generous and talented staff and volunteers have thus been taken hostage by the system. We confront disturbing images and hear upsetting stories almost every day. We are constantly outraged. We see no possibility of escape. All we can do it try to make a tiny, local difference. All we can do in the face of the system is to gesture.
Also taken hostage by the system are many of the concerned relatives of residents who require, ideally, a high level of institutional care. Typically, they come in to visit their friend or relative many times a week, not just to make sure they're taken care of and properly socialized, but to let the staff know--for what it's worth--that someone who cares is aware of how well or how poorly that resident is being attended to.
You may be able to handle a small, local problem. But for now, nothing can be done to fix the system. This is the system we have and the one that we deserve. As long as we continue to enable with our votes the kind of "free enterprise" system bent on widening the gap between the very rich and the very poor, the very poor will be exploited and finally wasted by profit-making corporations, and the very rich can spend their billions on exotic medical procedures and round-the-clock home care in their private mansions whenever they need it.
A good life is what you make it
At the same time, it must be said and I will say it now: Many residents in these facilities manage to make good lives for themselves. I put this down to their own human qualities, not the quality of care delivered by the corporation and its staff. Roommates and neighbors and buddies look out for each other. The residents celebrate birthdays and exchange "get well" cards, and sometimes include staff members as well.
And some of the staff are just normally kind and caring human beings, willing to be responsible for the atmosphere around them. But how is, I wonder, that so many people have lived for so long and failed to discover what I call "the irresistible physics of the smile"? (When I smile at you in a friendly way for no particular reason, you smile back, and our smiles energize us and animate our shared surroundings with a contagious atmosphere of good will and cordiality.) Many residents and staff at senior homes influence the shared reality of their institutions by generating vibes that are invariably positive.
So even though there are residents who insist on being victims of the system and of their relatives (one woman tells me almost every week, bitterly, "My son stuck me in this place") others in exactly the same circumstances participate in every activity available, take all the shopping and adventure excursions done almost daily in the bus or van, and offer a friendly smile to one and all, routinely. How could they not have good lives?
Perhaps they don't even care that we have all become creatures of the military/industrial/scientific/corporate/political establishment, whether we like it or not. Why should they object when a fully-paid-for politician tells us, "What's good for General Bullmoose is good for the country"?
Theirs could be the healthiest individual response to the overweening reality of life in America in the year 2015, where the "free market" system is well on the way to turning everything--including health care and senior care--into commodities to be bought and sold for profit in a truly exceptional country.
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