Elizabeth Newman

Two incidents featured recently in the New York Times have provoked thought about inclusion in long-term care settings.

The first, an op-ed by popular author Jennifer Weiner, is about mean girls at her grandmother’s independent living facility. The second, in Paula Span’s New Old Age blog, is about an Alabama continuing care retirement community resident who was excluded from bingo once she moved to skilled care.

Both are seriously depressing when we consider how much our industry promotes the concept of community.

While Weiner’s piece ultimately ends on a hopeful note, there’s no happy ending for Ann Clinton, a resident at Redstone in Huntsville. She enjoyed playing bingo and after back surgery had to relocate to the skilled nursing wing. She was told she couldn’t come to the independent living area to play her favorite game. A few years ago, when her husband was moved to assisted living, the couple was told they couldn’t come into the main dining room, which their son told the paper was hurtful. No kidding.

All of this is not infrequent in continuing care retirement communities. It’s a sign that the halcyon days of a decade ago, when a facility with a continuum of care was touted as the future, in part relied on two ideas. One, that seniors would willingly move floors, rooms or units as they grew sicker. Second, those paying a premium to living in a high-end CCRC would be the type of folks who believed in the concept of being neighborly and friendly. In both cases, conventional wisdom failed.

I’m sympathetic to CCRC administrators and directors. (I asked a few of them this week about how to deal with the problem of SNF residents feeling a part of the larger CCRC. While they all demurred in speaking on the record, previously many have said independent and assisted living residents don’t want to hang with the very old and/or sick.) It seems ludicrous on the surface that someone who is 85 with a walker would look down on someone who is 92 and in a wheelchair, but it happens. It’s also true, as Weiner points out in her grandmother’s case, that there are mean girls everywhere: They are in fourth grade taunting someone’s new haircut, in a college sorority, at the playground, or in online comment sections.

The bingo debacle reflects larger-scale issues in long-term care, but still has the vein of meanness at its core.

Personally, while I try to have empathy for all residents, it was hard for me to do that with the resident who said Clinton “broke at least three rules in order to come to an independent living activity to which she was not invited” or the residents who walked out of bingo when Clinton said she was staying. Plus, while there are always two sides to a story, the administrator trying to use patient privacy laws to give non-answers to Paula Span’s questions also isn’t doing that facility any favors.

None of this is easy to handle: No administrator in the world can change people into being kinder or more charitable. But we should realize it makes a difference in attracting new customers. A CCRC that allows those in skilled nursing to be kicked out of activities they enjoy, or be segregated from their friends, is not one where I’d want to bring a family member, or ever live myself. 

Elizabeth Newman is Senior Editor at McKnight’s. Follow her @TigerELN.