There has been a growing movement in favor of in-home or community-based care, in which a patient avoids the bureaucracy and potential neglect that can come with a nursing home stay, and instead receives more personalized and human care in the comfort of their own home. This can often be with the direct care of indirect support from loved ones.
Real World Examples
There was a recent case profiled in The Atlantic that combines the idea of care from one’s family member along with neglect and exploitation that has resulted in a long prison sentence. In California, an 85 year old woman had resided in a nursing home because she could not care for herself even on the most basic level. Eventually her daughter, who was homeless and lived in her car, convinced her to move into an apartment, which the daughter paid for by tapping into her mother’s social security money. The daughter moved in and assumed responsibility for her mother’s care.
The daughter, however, proved to be a terrible caregiver, and appears to have never intended to truly provide the assistance her mother needed. According to police and court documents, she took her mother for only one document visit in the course of two years, and effectively ignored the advice of a visiting nurse on how to prevent her mother from contracting bedsores, which is common with the bedridden elderly at nursing homes or elsewhere.
Keeping patients routinely bathed and clean and constantly monitoring their bodies to ensure sores do not develop is crucial; otherwise sores are not only significantly uncomfortable but can also lead to infections and then possibly death. A common occurrence for those with bedsores is septic shock, which results from bacteria that develops with the bed sores, and can cause tissue damage, low blood pressure, failing organs, and possibly blood clots. Septic shock causes death, and this is exactly what happened with the elderly patient in this case because her daughter failed to take care of her bedsores and prevent further sores and infection. This gross negligence on the part of the daughter led to her mother’s death. Or to put it more simply, it appears she simply let her die.
Notably, prior to the mother’s death the daughter had actually became her official caregiver under the California in-home care program administered for the poor. This state program pays caregivers (with taxpayer money) to take care of poor elderly patients like the mother in this situation. The daughter was reportedly paid about $900 per month to “take care” of her mother. Thus in addition to free residence at the apartment, she made an income in spite of doing nearly nothing for which the money was meant to compensate. All in all this was a case of apparent financial exploitation, fraud against the state, and worst of all gross neglect of an elderly patient in need of serious care, resulting in her death. The daughter pleaded guilty to elder abuse several months ago, and will serve 11 years behind bars.
While the in-home movement is a positive one, it is not necessarily a complete solution to avoiding abuse and neglect, as in-home caregivers, including family and friends, can take advantage and that neglect can lead to death. Such programs like California’s, which is funded by taxpayer dollars to the tune of $7.3 billion and serves approximately 490,000 poor Californians, are meant to decrease costs and give patients greater comfort, but as reported many caregivers receive payments yet are not properly trained or supervised, and provide poor care and may even abuse patients. Thus in-home programs anywhere must still have adequate oversight just as nursing homes have.
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