How do we fix the apathy in nursing home staffs?

My grandmother’s room is silent, save for the plucks of sitar strings and Pixar movie soundtracks I try to stimulate her with. Instead of books, we fill the shelves around her bed with mouth swabs, drab hospital gowns and vials of baby powder. My grandmother — who walked an hour every day, who thrashed me in gin rummy, who rose before sunrise every morning to read — now lies bedridden and mute in a nursing home, courtesy of vascular dementia.

My mother and I kept her at home as long as possible. Finality slapped me in the face as I wheeled her out to the van that waited to take her to her new residence. She was fast asleep and unconscious of the fact that she was leaving us behind, at least partly. I would no longer be able to wake up, trudge down the stairs to her room and see her crack into a smile upon seeing me. Her eyes would crinkle into thin lines, her grin stretching her face like it was made out of Play-Doh.

At first, I was relieved that she would be placed in a “skilled nursing facility” to get quality care and health monitoring. Now, it feels like we’re trapped in a cage, my grandmother and I in her cramped room, and the administration and staff on the outside. They’re the classic complaints: she isn’t repositioned often enough and gets bedsores as a result, aides disappear once you let them out of your sight, her diapers are left soiled all night, etc. Far more disconcerting is the negative atmosphere that pervades the building, a depressing mixture of apathy and “Monday Morning syndrome.”

The nurses and aides are vocal about their hatred of their career paths, and their quality of care reflects it. To make sure my grandmother is turned on time, I hound the aides and drag them to her room to change and reposition her. The big green sign above her bed reminding them to put Nystatin powder on her three times a day and keep her feet elevated is ignored. It’s become a game of “incentivize the staff.” How can I get them to come in and turn my grandmother when I’m not there? I’ve found leaving bags of goodies next to my grandmother’s bed works. I also nominate as many aides as possible for the home’s various employee awards with my grandmother’s name printed in bright red Sharpie as the nominator.

After leaving my grandmother’s room one evening, I passed a resident in a wheelchair begging an aide to re-inflate her air mattress so she could go to sleep. I waited for the aide to step-in and help her. But she just stood there back half-turned away and stared back at the resident, vile disgust plastered on her face. I quickly helped the resident into her room and adjusted her bed.

I’ve never seen a more raw expression of apathy. I’ve taken to helping residents with minor requests, but there’s an obvious limit to what I can do for them.

Mind you, the U.S. News and World Report rated our nursing home at 4.5 out of 5 stars.

My stories are mild compared to what I’ve heard and read. Deceased patients left lying on the floor for hours. Infections left untreated. The scariest thing: evictions. Families can choose to give their loved ones inadequate care at home and bear the full brunt of care or hand their loved ones into the cold hands of indifferent nursing homes. Many who would complain to the nursing facility administrators muzzle themselves out of the fear that their loved ones will be evicted.

I feel like I’m fighting an uphill battle against those who should be my grandmother’s allies. And my grandmother, despite her condition, can be considered lucky because she has me to advocate on her behalf. Many of her neighboring residents have no one. They’re closed off from the world outside, trapped in an amalgam of the green coloring of the tapestry, the navy and brown scrubs of the staff, and the harsh yellow light illuminating the halls. The local ombudsmen, a small group of individuals dedicated to nursing home quality, can only do so much.

Of all places, one who would think the Golden Rule, or at the very least stricter enforcement of legislation, would inspire nursing home staff to better care for their residents, realizing they will one day inherit the same beds and, if nothing changes, the same apathetic culture. Yet, this doesn’t happen.

This is a failing of human prospection. As Harvard psychologist Daniel Gilbert writes in his best-seller “Stumbling on Happiness,” humans fail to envision the details of their futures as they will likely be. Instead of looking for the empirical evidence found in the lives of those around us, we tend to envision a future based on our individual present lives. It seems that many nurses and aides employed in nursing homes have become numb to the reality that they’re aging and will likely live in nursing homes themselves. This lack of prospection leads to a lack of empathy for those under their care.

As a pre-med student at UT Dallas, I will soon (hopefully) join the health care system of America. It’s no secret that we’ll have to adapt to the aging population. For the first time in human history, people aged 65 and older will outnumber children under age five. According to the U.S. Census Bureau, this demographic swap will occur before 2020. Despite the immediacy of this demographic transition, I’m appalled by the swaddling pace of nursing home reforms. Policy officials need to step back from the economic consequences of the aging population and focus on the more fundamental issue at hand: How will we care for the elderly themselves?

Ajay Dave is a premedical student.

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