The plight of elderly Americans has been a top concern of the Center for a Just Society since our inception in 2005, and as senior citizens comprise an ever increasing percentage of our nation's population, the need is greater than ever to draw attention to a little discussed, little known epidemic in American health care. According to a new study released this month by the American Association for Justice (AAJ), eldercare abuse in America has escalated from a shameful problem to a full-blown humanitarian crisis. As the report illustrates, our nation's looming demographic boom will pose more than a financial challenge for our society – it will pose a moral challenge that is just as important: What kind of care and treatment does our society consider appropriate for its most vulnerable members?
As an attorney I have spent decades representing elderly men and women who have endured unspeakable abuse and neglect in nursing homes. Often, these conditions were so reprehensible and so degrading that – were they unearthed at daycare centers or even federal penitentiaries – members of Congress and the media would be crusading for reform. The AAJ's report is rife with illustrations: A nursing home resident whose leg was amputated after becoming infested with maggots; an Alzheimer's patient who died trapped in a freezer; a Florida nursing home resident who suffered from multiple falls, severe weight loss, multiple pressure sores, infections, dehydration, and eventually death by starvation; patients at a home in Illinois who were given antipsychotic drug injections "assembly-line style" as a means of "chemical restraint;" and an elderly nursing home resident who was sexually assaulted in the middle of the night at the hands of an orderly who was an ex-con.
If something major doesn't change, and change soon, this is the kind of fate that awaits multitudes of Americans expected to join the ranks of the institutionalized elderly in the coming decades.
One of the major reasons why these reprehensible acts occur is because a culture of ruthless profiteering pervades much of the eldercare industry. Many nursing home operators are little more than real estate developers posing as health care providers. Large publicly owned companies and a consortium of private equity groups are finding the industry increasingly attractive. Their "rental units" are beds rather than apartments or condominiums or offices, and their "rental stream" is guaranteed by the federal government through the Medicare and Medicaid programs. Patients with many needs (typically Medicare patients who have been just discharged from the hospital) are their target "market" because Medicare provides a higher reimbursement than other government entitlement programs. A filled bed represents a guaranteed income stream. An empty bed generates no revenue. Hence, the facilities engage in aggressive marketing campaigns to ensure high "occupancy levels." And since labor accounts for the largest expense in the nursing home budget, operators often understaff their facilities in order to maximize profits. While these practices may be good for the bottom line, they are devastating for the patients. From the AAJ report:
For-profit nursing homes have on average 32 percent fewer nurses and 47 percent higher deficiencies than their non-profit counterparts. . . . This increased emphasis on profits has led to a distressing rise in neglected and abused seniors. Between 2000 and 2008, instances of "immediate jeopardy" – violations likely to result in serious harm or even death – rose 22 percent. More than 90 percent of all nursing homes were guilty of at least one violation.
How have we allowed this to happen? In addition to the demographic and economic factors at play – the ranks of the elderly are swelling, the birthrate is declining, and our entitlement programs are on the brink of collapse – there is an underlying cultural component to the elder abuse crisis in America. Over the last several decades American society has gradually shifted from a "sanctity of life" to a "quality of life" ethic. Increasingly obsessed with youth and utility, we have come to evaluate the net worth of human beings based on cost-benefit ratios and quality of life calculus. And not surprisingly, the elderly (who cost more to maintain than they produce, whose functional capacities have deteriorated because of old age or illness, and who serve as unwelcome reminders of our own mortality) do not score well using these standards. In the next 20 or 30 years, when our expanding elder cohort is consuming valuable resources and is no longer deemed "useful," one shudders to imagine what "solutions" might be devised to deal with the growing problem of eldercare.
The crisis of eldercare abuse, then, is one that begs for our attention and demands a solution. First and foremost, it is critical that the American people begin to view eldercare as one of the great moral problems of our generation. For too long we have viewed the coming Senior Tsunami solely in abstract economic terms while ignoring the "human factors" at stake. For the younger generations in particular – those expected to bear the fiscal brunt of replenishing our anemic entitlement infrastructure – it is easy for a sentiment of bitterness to prevail. However, we must remember that the elderly – no matter how disabled or helpless – are human beings who deserve to be treated with the full measure of dignity and respect. America's senior citizens should not become victims of a sliding scale that erodes their humanity as their faculties decline. Those of us who care about the creation of a just society must be willing to defend the rights of the elderly no less vigorously than the rights of the unborn.
For Christians, the Bible is quite clear on this point. Most folks know that the Ten Commandments call upon us to honor our parents, but the Scriptures also tell us that we have a responsibility to care for our elders with willing hearts, in gratitude for the care they showed to us. St. Paul's first letter to Timothy tells us that children and grandchildren "should learn first of all to put their religion into practice by caring for their own family and so repaying their parents and grandparents, for this is pleasing to God." (1 Tim. 5:4) Paul is adamant on this point: "If anyone does not provide for his relatives, and especially for his immediate family, he has denied the faith and is worse than an unbeliever." (1 Tim. 5:8)
The Apostle Paul’s message runs against the grain of modern American culture, which places a significant value on the immediate family but focuses little on the moral and civic obligations we have to our extended family and community elders (so few of us, after all, even identify with a discrete community anymore!). All the more reason, then, why a targeted campaign to ensure justice for the infirm and the elderly is critical. Next to the battle to secure the rights of the unborn, protecting the rights of the elderly in America may well turn out to be the most important civil rights movement of the 21st century.