Pleasant Springs

August 10

The building was brick, single story with nothing much to recommend it. Kitschy stuff like the foil star or flower garlands found at local hobby stores as well as cards, lots of cards were hung in the windows. Some fake potted flowers dotted the sills.

We walked into the room my mother was to occupy. It was bare. She had just been admitted to Pleasant Springs Home. I was moving her clothing in and placed it in the tiny closet made from pressed wood. I brought the few pictures of people she still recognized to sit on her sills. The room was bare and depressing even to me and I didn't have to live in it. Did all these facilities have the same pale lifeless walls, I thought to myself,

My mother Emily sat in her wheelchair near me while I worked. She had that apathetic face that revealed little. But it was early in the day, and she did not get agitated until about five o'clock. Then she might hit someone or pinch them if they got too close and mumble gibberish.

It would be impossible to care for her at home anymore. It was a full-time job. She required assistance with dressing, toileting and was frequently incontinent. She did feed herself... mostly finger foods. No utensils.

I was exhausted, she was up most of the night and I had no money to pay for additional help. At eighty two, we had hit the end of the road. Alzheimer Disease had won.

" Mom, how do you like your new room," I asked in that slightly high pitched sing song voice used with the sick, elderly and cognitively impaired. I hated myself.

" Oh, this will be lovely when it is all fixed up," I imagined her saying. But there was no reply.

The nurse aide stood by ready to assist. Happy smile on her face.

"Maybe you would like to go to the dining room?" she asked, same voice. Same answer.

July 14

"We are having an inspection by the state, they just walked in," Karen Laughton states. She is the facility administrator.

"Send out an all e-mail alert. Let everyone know," she continues to her assistant before entering the room where the two administrators sit.

Then settles the two state inspectors into the free conference room. And they begin.

"As you know we are here to investigate several patient and family care complaints and a major incident that occurred at your facility.

The families have complained that their parents are not being cared for appropriately resulting in weight loss and sores from their incontinence," states Arlene. She uses an almost conciliatory tone. Good cop.

"And of major concern of course is that one of the residents eloped from the building in their wheelchair. In this heat and with the high traffic road out front this is a major concern for us. And should be for you as well," Karla finishes. Stern faced, bad cop state reviewer.

"Of course. We have done our own internal investigations on all of these matters. We have provided you with all the information to complete your review," Karen tells them. Let me know if you need anything else. We have coffee and snacks for you as well."

Karen leaves them to their work. Gathers her assistant, director of nursing Lisa and a small handful of others.

"This is a problem. We have provided as much information as is possible under the circumstances. We have had cutbacks in staff due to finances and some minor adjustments in wound supplies and in the dietary department," Karen states in summary but all around the table there are slight head nods and no one too vocal on this.

Lisa the nursing director says, "We interviewed families but, we just don't have the staff....." She trails off.

The reviewers are present for two days. The exit interview brief and includes the directors of dietary, and nursing, the administrative assistant, as well as the director of finance and of course Karen, the administrator.

Arlene, starts, good cop. We have found some reasons to believe the staff are not answering call lights for toileting in appropriate time frames. So, some of our observations are that people are sitting in urine once they have been incontinent. This could lead to skin breakdown. Also, the patients' meals sit on bedside trays and are cold by the time staff is available to feed them. She did not state that some patients had even reported the staff being rough with them. This they would have to investigate further.

Then it is Karla's turn. Stone faced and giving away little. "The elopement of a patient with late-stage dementia is a serious citation. We have found no specific cause for this so we will bring this back for further review and let you know our decisions."

After they leave, there is no collective sigh of relief. If these issues are corroborated there are fines, not to mention the state's postings on the internet. Public viewing. Poor business. Pleasant Springs is already suffering financially.

It will be weeks before they hear anything. The state is notoriously slow as they review and deliberate.

July 20

At the Bureau of HealthCare, Arlene, and Karla make their report to their superiors. It is not good but also not definitive.

"There is not much in the records to say negligence for the elopement, but we are sure that is the cause. They are short staffed as many of the facilities are," Karla maintains.

Arlene adds, " We are sure there is negligence we just can't prove it."

Their director, " Well is a citation and fine sufficient? Or are you in the belief that something more has to be done?" This means possibly initiating criminal action. For profit facilities making money while cutting back on services. These actions result in patient harm.

"Not without more proof," the corporate attorney says dryly.

Well, let's move on then with that in mind," says the director.

September 10

My mother has been in Pleasant Springs one month now. I push her in the wheelchair daily, making rounds to the therapy department, kitchen, community areas for dinning and activities. My mother is silent, she doesn't participate. We just watch together.

She has been good since entering the facility, her behavior has improved, and she needs only her blood pressure medication.

I tell the nursing staff that in two days I am taking my mother for an outing. She needs some fresh air, and activity that may stimulate her.

September 12

Arlene and Karla are again seated in the conference room at Pleasant Springs. The administration of the facility is gathered around the table. Half consumed and cold cups of coffee sit in front of them along with documents provided by the Bureau of HealthCare.

A well-dressed dry little man accompanies them. Gray and balding, clear blue eyes behind spectacles and unsmiling, this man shuffles some pages, and it is he who begins.

"This is a court order that will close your facility issued by the District Court. This is based on multiple findings of negligence."

Karen begins to speak but is immediately silenced by this man who was not part of the investigation.'

" I am the attorney for the state and represent the state in this matter. You will find all the formal documentation you need in the documents that sit in front of you."

"We also have firsthand corroboration of this," Karla states. She remains stone-faced throughout. " These accounts were provided to the judge in the district court as we requested the court order for closure.

The administration was stunned. The finance director was responsible for many of the cuts made to the facility, but ultimately decisions reside with the administrator.

"I don't understand how this could be." Karen asks.

"Emily can you please come in. With your daughter of course," the attorney states.

I walk in first, all eyes on me. I carry a binder. Emily, "my mother" walks in behind me. No wheelchair, the blank apathy gone. Beautifully dressed.

The attorney continues in his dry tones, "Emily and Lucy work for the Bureau, part time for these types of investigations." They agreed to serve as the eyes and ears of the Bureau and enclosed in the binder that Lucy is carrying are their observations. It includes names, dates and times of staff interactions. It includes response time to call bells, assistance at meals. But most importantly it provides documentation of physical abuse as well as the general neglect.

I place the binder on the table. I look from person to person in the room and wonder how they could make the decisions that jeopardize so many vulnerable people.

The attorney says, " You may be able to get an injunction on this. You can certainly try."

Emily unsmiling lifts the sleeves of her shirt. On the upper parts of her arms are the fingerprints of staff who had "assisted" her to the bathroom and into bed. Bruises that had been photographed.

Unsmiling, Emily says, "It was not a pleasure doing business with you. I think we are done here."

November 22

The last resident of Pleasant Springs is moved to their new home. New facilities that have been identified as providing good care.

Emily and I are present for this though it is not required.

There was personal satisfaction for both of us as we watched them be rehomed.

Emily waved to the woman leaving, it was someone she had become friends with during her stay. At eighty two she could still contribute but only marginally for the Bureau. But that was enough.