Recently a wonderfully attractive actress named Jane Wyatt passed away. Movie buffs would recognize her as the flower of Shangri-La in the 1930s film Lost Horizon. Probably more people, though—at least those of a certain vintage—would remember her as Margaret Anderson, the pleasant, gentle wife who put up with the would-be perfect husband in the 1950s TV series Father Knows Best.
Played by the hearty Robert Young in his pre–Marcus Welby, M.D. days, Jim Anderson's foibles were dealt with gently by the series, as was the wont of the time. In the end, Anderson had maintained his dignity, and really did emerge with a solution or a comment just right for his family's situation (and the situations those kids got into made The Adventures of Ozzie and Harriet look wild). Today, Jim Anderson's parental persistence comes to mind frequently as I think about nursing homes.
Why would that be? I think that it's the paternalistic relationship that nursing homes have with the federal government. There's no need to belabor the point about the amazingly detailed regulations with which nursing homes must comply—regulations that not only set end points, but lay out, step by step, how to attain them. And sometimes (although not always), missing a step can be quite costly.
I often wonder how nursing homes got themselves into this situation. What was it about them that made reformers think it was required to spell out their day-to-day work? Was it a belief that properly caring for the elderly in an institution was something that people had to be forced to do—that not having a direct personal relationship with the resident meant that money-grubbing neglect was sure to rule the day? What did nursing homes do to work themselves into such a demeaning position?
Whatever it was, today it is, with some disgusting exceptions, history. Nevertheless, today's facilities have to live with the results. And the practical impact of this is the “schizoid approach” described by long-term care analyst V. Tellis-Nayak, PhD, in the current installment of his new column, “Moving Toward Evidence-Based” (p. 24). You need not agree with every point to get the gist of Dr. Tellis-Nayak's argument: In long-term care, a paternalistic system has split off the regulators of facilities from the residents and families who use them and created two quite different caregiving value sets.
There doesn’t seem to be much that nursing homes can do about it; regulatory intensity via citation of deficiencies shows no signs of abating. But eventually, even Jim and Margaret Anderson had to let their kids go and make it as adults on their own (although, as far as I recall, this wasn’t documented cinematically). Maybe someday nursing homes will provide their federal fathers with evidence of sufficient maturity to be set free to care for their residents in the ways that residents really want to be cared for.
RICHARD L. PECK, EDITOR-IN-CHIEF
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