Soumya Madam,

You must publish this in your blog or in your website. This is my personal experience I am sharing to highlight the unsavoury conditions of our care facilities and the plight of our elders who are destined to get inferior care in such facilities. I could go on and on from pages to pages but let me start the story about the last ‘Care’ home I got into before I met you. The meeting between changed my perception all together and that’s why this letter. I marvel at the acquisition of the vast knowledge and experience you have in the field of ageing and social gerontology. Here is the story!

I am not saying that everything in US is hunky-dory in elder care settings, there also there are a lot of shortcomings but there is a ‘system’ which routinely check for the quality of services. What I learnt is that here we don’t have any mandatory or independent body to oversee the expected and  necessary standards. 

When we arrived, no one there to receive us and we almost waited half an hour to get the gate opened. There was an overall atmosphere of a haunted place with unkempt grass and the building looks untidy. Ideally, their existence should not be necessary. This is the seventh ‘Care home’ that we visited past one week. An exploration to find the ‘right place’ to keep my mom and dad. It was a real sad experience to find how pathetic is the old age home (Care home) situation in India. 

In brief these were the standards I was looking for :

• Dignity and respect to each inmate.
• A detailed involvement of the family in care and good communication.
• The right care, treatment and support that meets individual needs.
• A safe and hygienic environment.
• Staff to have the right skills and attitude to do their jobs properly.
• Adherence to protocols.
• Regular checks for the quality of the services.

It was obvious that many of these standards were in short supply at all the places, including the nutritious food and medication management. Many of the elders showed dramatic weight loss and most of them not bathed for may days together. I knew many conditions especially dementia itself can cause weight loss, on the contrary, in these cases, there was more than one cause. One lady had false teeth that whirled round her mouth alarmingly when she spoke and you can imagine how she can struggle with food. Many of them complained about the food.

Even though they objected to speak to the Inmates, in one, residents told me of strange food combinations and stale food. The portions seemed inadequate for some of the men and second helping is not provided. Food that should have been hot was often cold. Menus were often not compatible with what was served and much of the food was bought in, rather than home-cooked on site. Food that had not been eaten was often left on bedside tables with flies and ants swarming, when I visited in the mid-afternoon. As most of these facilities follow strictly vegetarian food, protein content of meals seemed low.

I could gather lot more information which are true concerns, such as no trained nursing staff being available at weekends other Holidays; night staff slept when supposedly on duty and most time spend on mobile phones! There appeared to be no regular assessment or monitoring of residents – a doctor was called when necessary. Because of the understaffing in almost all facilities, residents were left to empty their bowels and bladder in their beds, even though they could have walked the short distance to their en suite lavatory with help. I can smell urine in every bed ridden patient because no timely change of diapers. This is what one lady told me, when I popped my head round her open door and her helplessness made me cry thinking is this my future too. “I’ve had to pee on the pad every time  – I complained the pad is not fitting properly and trickles down my leg and onto the bed – it’s wet and cold. No one bothers and this is what they tell me to do – I hate it – I just need help to get to the toilet, that’s all”.

As a visitor, though I am a stranger, I promised to get her help and found a carer, filling out paperwork.“I have to wait till the other carer has finished taking the tea round”, she responded. I said the lady was very upset. “ Madam,She’s a nagging patient and never listens. She will have to wait”, came the answer.Interaction between care staff and residents was often minimal and unfriendly. Having said that, in their defence, there were staff shortages. And the result is  low level motivation.

I could go on.

Management is not liking my way of  finding answers and may not be used to this in-depth ‘probe’. In spite of this, I was subjected to a five-minute monologue about the medication management and emergency protocols  – the message was clear – “mind your own business”! 

Understandably, it was not very comfortable for them. But I was adamant to find appropriate answers because after all  I was seeking admission for my Mom and Dad.  So, why I rejected all the seven places? Poor management and lack of staff training were at the root of many of their deficiencies. I am sorry for the residents who were placed here and getting inferior care.” Kirthana Jagannathan ended her letter abruptly citing her experience of finding a well run care home.

Kirthana’s observation is right. Inadequacies in the quality of care provided in elder care facilities is a matter of concern but no one is bothered to bell the cat. Common causes include inadequate or unhygienic infrastructure; lack of competent, motivated staff; inadequate nutrition; medication mismanagement; poor compliance to evidence-based clinical interventions and practices; lack of emergency protocols and poor documentation and use of information. Improving quality of care and patient safety are therefore critical if we want to accelerate reductions in  morbidity and mortality. Quality of care is also a key component of the right to better health, and the route to equity and dignity for elders at the fag end of life. In order to achieve this, health care must be safe, effective, timely, efficient, equitable and people-centred.

We, suggest the following to a prospective buyer of institutional care:

1. Does the Owner/Director have formal geriatrics training and expertise. Better training naturally translates to a greater passion and oversight.
2. What is the rate of turnover for staff and how long have the leaders ( Medical Director, Nursing Director, Nursing Staff, and Administers) been in the current position. The lower the turnover and higher the tenure says a lot about the quality of care.
3. What is the staff to patient ratio? Prefer a better ratio than the mandatory rule demands. 
4. How does the facility look and smell when you walk around. A foul smell or untidy appearance of the facility will tell a great deal about management attitude and quality of care provided. 
5. Why not ask questions because you have a right to know even the minute details. 
6. Finally don’t rely too heavily on google reviews. “Star-based” rating systems don’t correlate well to ‘quality’ care. Most are fake reviews. Sieve the chaff. Old birds are not to be caught with chaff.