At first, when we left him, Dad would grasp our hands and beg us not to go, to take him along to Pittsburgh, one of the few words he could still say with utter clarity. But in time, he settled in—to even enjoy the regular Sunrise events. The staff offered singalongs, clowns, comedians, and similar evening treats. There was a Christmas party with presents from Santa. Those who were able could go on field trips to parks and to lunch. Sunrise, we decided, would be a fine place.
Things fall apart
But he became harder and harder to handle. Though the nurse aides would crush his 11 or 12 doses of pills each day and mix them in with yogurt and ice cream, he would frequently detect the medicine and spit it out. Eating was a trial as well, since he started refusing to open his mouth. Jack began to visit at breakfast and dinner, to feed him and to make sure the pills went down. Still, at 95 pounds, he now weighed about half of what he had before his decline. His mood began swinging wildly.
The impression we had was that Sunrise was doing the best possible job under difficult circumstances. But we observed that aides regularly worked overtime, and the nurse aides responsible for much of the hands-on resident care seemed to come and go. Outside the building, a large sign always advertised for help. Kathleen Koch, Sunrise of Fox Chapel's director of community relations, tells me that staffers often like to work overtime for the extra money and says, "We don't have as much turnover as some of the other places do because it takes a special person to work in this type of environment." She notes that "the reason we have that sign is we hire a lot of people part time, and we're always looking for volunteers as well."
But I've since discovered that high nursing staff turnover is not unusual for long-term care facilities. According to a 2008 survey by the American Health Care Association, a yearly turnover rate above 70 percent in certified nurse assistants is common in rural nursing homes, for example. Nurse turnover rates are also high-50 percent annually or more.
After Dad developed a staph infection from an open sore on his elbow, his downward spiral accelerated. Dressing the wound daily required sedating him, but afterward he would be even more agitated than before. He started to bother other residents, trying to shake hands with them and reaching out to grab them. Finally, on March 19, 2008, Dad hit a nurse who had begun to work on his bandage—by her account, a glancing blow. A superior, who witnessed the incident, insisted that she file a complaint with the Allegheny County Health Department, which immediately sent out two representatives to interview Dad. Jack was called and informed that Dad had been reported for aggressive behavior and that Sunrise had recommended to the county officials that he be sent to a nearby inpatient psychiatric facility to have his medications regulated. She assured Jack that Dad could return in a few days once a doctor had evaluated him.
Jack met up with Dad once the ambulance had delivered him to the psychiatric hospital (cost to Mom for transportation: $603). For five hours, the two sat in a waiting room, watching an assortment of troubled people parade through the doors. But no doctor arrived, and there was no room with a bed. Finally, around 10 p.m., Jack was told Dad would be sent to another psychiatric hospital, where, when Dad awoke the next morning, he was placed in a sort of adult highchair that only allows for arm movement. The nurses set him down in front of the nursing station, telling Jack they were afraid someone would hurt him if he were free to move around. The doctor never did come to evaluate his medicine that day, and Jack grew nervous. This is insane, he thought—why send an 88-year-old man with advanced Alzheimer's to such a place? Distraught, he announced to the nurses that he was taking Dad out of there. No, he was told, "you can't."