Joshua D. Schor - The Nursing Home Guide: A Doctor Reveals What You Need to Know about Long-Term Care

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Table of Contents

For Lori... Some luck lies...

Acknowledgments

In writing this book, I hope I have spoken for the many patients and their families I have come to know. It is to them that I owe sincere thanks. For those who I have not met, I hope this book can be a useful guide. My agent, Susan Cohen, has been patient and encouraging. Seeing her and her son, Julian, is always a special treat. My editor, Denise Silvestro, is an expert at her craft, and only because she is so tactful and genuine was I able to restrain myself and write more guide than memoir. I also thank Denises assistant, Meredith Giordan, who has been especially helpful.

I have had wonderful colleagues and friends in the long-term care world: first and foremost those on the staff of my own home away from home, Daughters of Israel in West Orange, New Jersey. Larry Gelfand has always been a supportive, warm, and wise director and in no small way inspired me to commit my thoughts to paper. Mary Spielvogel has been the biggest-hearted director of nursing and has earned a good retirement. Both Susan Grosser and Susan Harris are carrying on the challenge and are models of hard work, intelligence, and grace. In no particular order, I owe great thanks to Adena Twersky, Lisa Verdon, Muriel Bradshaw, Chris Mooney, Sandy Shore, Tom Tierney, Barbara Quinlan, Colleen Thompson, Rabbi Zvi Karpel, Barbara London, Pat Watson, Lydia Stanislaus, Dawn Thompson, Argenett Anderson, Sharon Glaser, Eve Goldberg, Li Schuman, Karen Callahan, Jennifer Rutberg, Joann Digiovanni, Mark Sapoznick, Sylvia Goodman, Joyce Silverman, Sophia McGhee, Anne Berry, Steven Finkler, Gary Beinhacker, Jan Ball, and the Daughters of Israel Board of Governors.

My chief mentors in geriatrics, Drs. Lewis Lipsitz, Kenneth Minaker, and Ed Kaminskas, were unstinting in their time and infallible in their advice. Dr. Phil McCarthy was the most inspiring and dedicated resident a medical student could wish for. My colleagues at Evercare have taught me how to put good care and good ideas into good practice; their nurse practitioners and clinical service managers are transforming the face of long-term care.

With great family, I have been greatly rewarded. My parents, Joe and Sandy, took wonderful care of their parents and my extended sibling clan, Starry, Walter, Gideon, Beth, Freddie, and Marcie Lee, have done nothing less with ours. Thanks to Rita and Laura for love and support. If a book on nursing homes could have a muse, it is surely my wife, Lori. She has a sensitive ear and a charitable and loving soul. With each successive birth of our three daughters, Lori and I recognized that we were increasingly blessed. Noemi, Shayna, and Rafaella: Thank you for lots of love and loads of laughs, but do what you have to do. Mom and I will be proud to be your parents in whatever nursing home you choose for us. But choose well!

Introduction

Several years ago, I read a newspaper story that has stuck with me. It concerned an elderly Arizona gentleman who had been a felon for much of his life. For some years he had gone straight, but owing to desperate finances, very bad health, and perhaps an unflagging criminal bent, he held up a convenience store from his wheelchair at age ninety-two. His getaway was none too swift and as he exited the wheelchair ramp the police apprehended him. He was soon convicted and a wise judge deliberated on the sentence. The judge observed that the man was not a flight risk and that he badly needed care. The judge offered him a choice between seven to ten years in prison or admission to a local nursing home. The felon responded that hed rather take his chances in prison because hed never get out of a nursing home alive.

We have probably all thought about having to put a parent, an uncle, an aunt, or someone dear to us in a nursing homeand like the felon, would prefer just about any other option. For instance, what about assisted living or foster care for seniors? I will explore those, too, but what if you conclude that a nursing home is necessary? Some of us have promised (as have I and my siblings) not to put a father or mother in a nursing home. These promises are often made toward the end of a holiday meal like Thanksgiving. After everyone has finished the main course, sipped plenty of wine, and dessert is about to begin, the topic arises. It is usually one of the elders in our midst: Do you remember Aunt Gussie? Her son Irving just put her in a nursing home. Silence, and then the other shoe drops. Promise me, youll never stick me in some godforsaken place like that. Another pregnant pause and then, Sure, Mom. Pass the rice pudding.

As a geriatrician in the practice of long-term care, Ive heard this story a hundred times. Because I specialize in this field, I know that almost everyone sees long-term care as a last resort. Many of us have made promises that we cannot keep. It can break our hearts to have to put someone we love and who more than likely raised us and sacrificed for us into a nursing home.

So whats a child to do? Is a good nursing home really that hard to find? This book will help guide you in your search for a good home. And it will help you make the most of that home after your loved one has moved in. I will try to paint an accurate picture of the state of long-term care and how to be sure the resident of the home gets the best treatment available.

The cast of characters on a nursing home staff is large and deserves discussion, too. You have limited amounts of time, and being a caring and devoted family member or friend will require time to visit, to call, and to advocate for your loved one. I hope to help you understand who is who in a nursing home so you can avoid the runaround and instead share time with your loved one.

I have learned to place myself in the shoes of my patients whenever I can. One of my most memorable was a gentleman named Harry who was 104 when we first met. He had been a tailor and still threaded a needle with ease. I had just been introduced as the new doctor on the unit. He recently had prostate problems and had been to a urologist (a mans best friend, my cousin the urologist tells me) who had ordered some lab tests. Sensing he might get more information from me than from the last doctor, he swept up to me like a middle linebacker. I checked with the lab and was told that the results were not ready. I told Harry there was nothing to report but every half hour he approached me while I was working to ask again. I then made the mistake of saying something like, Harry, whats the rush? Youve lived one hundred and four years. What difference would a day or two make? Harry grabbed me by the lapel of my bright white lab coat and said, Doc, you dont understand. Im one hundred and four. Every minute counts.

I adore my work. Ive done many other things in medicine, from working in emergency rooms to reviewing insurance applications, but Ive never done anything as fulfilling as the work I perform as medical director of a three-hundred-bed nursing home. I tell the students who work with me that long-term care is an acquired taste; they quickly understand what I mean. Its not for everyone. But then many of you never thought youd need to read a book like this. We make the best of the situation in which we find ourselves.

Im anxious to tell the good, the bad, and the ugly. And I hope youll come to see that it is not all ugly out there. Ive witnessed some moving and beautiful moments in my work and I hope to share these with you, too. I admire many of my medical colleagues. Great doctors have inspired me and I carry their stories and wisdom and bits of their bedside manner with me every day. However, I cant help but see some of my colleagues failings, too. My aim is not to be harsh but to be helpful and if I appear to go overboard at times, I take responsibility and apologize.

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