July 6, 2025 • 57 mins
Alzheimer's and elder care demand our attention not just because millions endure them, but because the systems that are supposed to protect our most vulnerable are fundamentally broken. In light of the upcoming release of our documentary, No Country For Old People; a Nursing Home Exposé, August 1st on Amazon, my producing partner and today's guest host, Rick Mountcastle (whose work prosecuting Purdue Pharma was dramatized in Hulu's "Dopesick") and I are turning our focus on elder abuse.
In this powerful episode, we're joined by Richard Routman, whose 14-year career at the Department of Health and Human Services gave him a front-row seat to nursing home neglect cases, pulls back the curtain on why elder abuse persists despite seemingly robust regulations. The reality is sobering: residents fear retaliation if they report mistreatment, staff worry about losing jobs if they speak up, and facility administrators actively obstruct investigations by altering records or instructing employees to "forget" incidents when questioned by surveyors. Meanwhile, the regulatory landscape remains fragmented between federal agencies, state surveyors, Adult Protective Services, and law enforcement—creating dangerous gaps where abuse reports disappear.
Most troubling is how money influences the entire system. The nursing home industry spends hundreds of millions annually on political contributions and lobbying, effectively buying themselves protection from meaningful reform. As Richard notes, ordinary citizens advocating for better care are "fighting with sticks" while the industry fights "with guns."
Yet this conversation offers hope through specific action steps. Every county has a Commission on Aging that citizens can join to question officials and advocate for improved oversight. Families should learn their rights regarding documenting care—in many cases, they can legally record conditions despite what staff might claim. Most importantly, Richard reminds us that cultural change starts with rejecting the ageism that treats elder abuse as somehow less urgent than child abuse.
Don't miss our documentary "No Country for Old People" launching on Amazon August 1st. Until then, remember that knowledge, community action, and love remain our most powerful tools against a system that too often fails those who built our world.
Be a ROAR-ior!! JOIN THE R.O.A.R. MOVEMENT for quality long term care! Visit the No Country For Old People Website for more information.
YOU CAN ALSO SUPPORT THE ABSOLUTELY CRUCIAL PROMOTION OF OUR DOCUMENTARY "NO COUNTRY FOR OLD PEOPLE" BY MAKING A TAX DEDUCTIBLE DONATION THROUGH THE NATIONAL CONSUMER VOICE HERE
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Don Priess (00:00):
When the world has got you down, Alzheimer's sucks.
It's an equal opportunitydisease that chips away at
everything we hold dear. And todate, there's no cure. So until
there is, we continue to fightwith the most powerful tool in
our arsenal, love. This is Loveconquers alls a real and really
(00:22):
positive podcast that takes adeep dive into everything,
Alzheimer's, The Good, The Badand everything in between. And
now here are your hosts, Suziesinger Carter and me. Don
Priess,
Susie Singer Carter (00:40):
hello, everybody. I'm Susie singer
Carter, and this is loveconquers all, the podcast that
is all about Alzheimer's andelder care and extending into
long term care. Now with ourdocumentary, No Country for Old
people, which I have a verygreat announcement that we are
launching on Amazon on August 1so stay tuned, and we'll be
(01:04):
keeping you posted. If youfollow us, you'll definitely
hear more about it. And if youdon't follow us, you should be,
because it's very important, andwe're very proud of this
project, and it's informationthat everyone needs to know, and
coincidentally, we have a veryspecial episode today because,
not just because of our guest,but also because I am joined
(01:27):
today with my producing partnerfrom no country, from old
people, and my guest host todayis Rick moncastle, who you may
know already because I talkabout him all the time and or
You also might know him from aproject called dope sick, a mini
series on Hulu where his workprosecuting Purdue pharma was
(01:47):
dramatized. He's here to help melead the conversation that's
very close to both of our heartstoday. Our guest is someone
whose life's work aligns sopowerfully with the mission
behind our film. Richard routmanis a retired attorney who spent
14 years with the Department ofHealth and Human Services, where
(02:09):
he represented the government incases against nursing homes
accused of providing substandardcare. Since retiring, he's
continued to advocate for olderadults, first as a trained
volunteer ombudsman, and lateras a member of the Loudoun
County Commission on Aging inVirginia. Richard brings both
legal insight and livedcompassion to this conversation,
(02:31):
and when he's not speaking upfor better elder care, he's
enjoying time with his wife andtheir grandchildren, which,
let's be honest, is probably thebest gig of all. We truly, truly
are honored to have him herewith us today. So please help me
welcome Richard routman and ofcourse, Rick moncastle.
Rick Mountcastle (02:51):
Hey, Susie, thank you for having me. It's an
honor. I hope I can live up. Ihope, I hope I can live up to
the standards that you and donhave set for Love conquers alls,
but I'm glad I'm here, becauseRichard Rotman and I have, I
would say, Come to be friends.
Over the past two or threeyears, we've not met in person,
(03:12):
but we have talked monthly bytelephone, just trying to keep
up with what's happening inelder care and batting ideas
around about how we can makethings better in that world. So
I think it's really great tohave Richard on. And I guess I
can start off the questioning orstart off with the ball. Susie,
(03:35):
if that's okay with you.
Susie Singer Carter (03:40):
Take it away, Rick.
Rick Mountcastle (03:41):
Richard, Richard, you and I have talked
about your role on theCommission on Aging, a role you
took on after you retired fromthe Health and Human Services
assistant Regional Council. Butbefore we get into the specifics
of that, could you describe yourgeneral approach that you have
(04:03):
taken and are taking inaddressing nursing home issues?
Richard Routman (04:08):
Be happy to just before I comment on that,
Rick, I just want to thank Susiefor the lovely introduction, and
congratulate you both for thecoming of the new video, which
we're all looking forward to inAugust. It'll be a impactful
event for everybody who'sinterested in improving nursing
home care.
Susie Singer Carter (04:29):
Thank you so much. Thank you.
Unknown (04:32):
Well, the the approach to trying to deal with the
proper treatment of elders innursing homes is a complex one.
It's both federal and stateinvolved, and one of my post
retirement interests was findingout how the county of Loudoun in
(04:57):
Virginia used. Is federal money,as well as some state and local
money to promote the interestsof residents of nursing homes.
So after I spent a year being avolunteer ombudsman in a skilled
nursing facility, when we mywife and I moved here, I was
(05:21):
able to be appointed to theCommission on Aging. And let me
give just a minute or twobackground on what that means.
In 1965 Congress passed astatute called the Older
Americans Act, and that statutewas amended about 10 years
later, to provide for fundingfederal monies to go to offices
(05:49):
in counties all over thecountry. Every county in the
country has an office called theArea Agency on Aging, and that
agency receives some federalmoney and some state money. And
this is supposed to promote theinterests of seniors in that in
that county, it comes with somestrings. One of the strings was
(06:13):
that the Area Agency on Aginghad to establish what, what is
an advisory council, and inVirginia, in Loudoun County, was
called the Commission on Aging,and that was a particularly
attractive feature to thestatute, in my view, because it
allowed members of the public,ordinary folks, to be able to
(06:36):
have a seat at the table. Theyweren't they weren't empowered
to make any decisions, but theywere allowed to ask questions,
and in Loudoun County, there arenine members on the Commission
on Aging. They're appointed bythe board of supervisors, and
they're on their chairman forfour years. And what are they
supposed to do? They're supposedto educate themselves as to
(06:59):
what's going on with the elderpopulation and to make
suggestions to not onlygovernment on the state level,
but even the federal level. Inother words, they have a
portfolio. They don't have anypower, but they have the option
of educating themselves andpersuade, trying to persuade
(07:19):
people to improve the program,and that has been since we moved
here in since I became a memberof the Commission on Aging in
2016 and I that's a four yearterm. So I was on there for
until 2020 that was pretty muchwhat I tried to do. And
(07:46):
specifically, the Commission onAging is in his obligated, by
statute, to review what the AreaAgency is doing to comply with
the federal federal conditions.
One of those conditions wasestablished by statute in 2016
(08:07):
and that condition was that thearea agencies on aging and to
address the issue of thebarriers to the investigation of
elder abuse, and that includedelder abuse in nursing homes.
And as it turned out, a fewyears after that, in 2019 the
(08:33):
Office of the Inspector Generalof the Inspector General of the
Department of Health and HumanServices and the Government
Accountability Office issuedseparate reports talking about
the problems with the reportingof elder abuse or suspected
elder abuse in nursing homes.
(08:57):
There's a requirement understate law and under federal law
for staff in the nursing homesto report if there are suspected
or alleged elder abuse, and itturns out that these reports by
the Inspector General and theGAO suggested that it wasn't
(09:18):
being done very much. It wasn'tbeing honored as much as it
should be. And if there were nosufficient numbers of reports of
suspected elder abuse, thatcreates a huge problem, because
it needed to be addressed.
Attention needed to be paid toit, and that is the problem that
we're currently involved in. Itis a long term problem to try to
(09:40):
make sure that this veryvulnerable population in nursing
in skill particularly in skillednursing homes, has a voice that
we help them provide somemechanism to amplify their
issues.
Susie Singer Carter (09:57):
What you said, barriers? You. Saying, I
just want to just ask clarifywhat you meant by barriers.
Because you said there's, youknow, that was the issue is
barriers? Is that? What to whodid the barriers apply? And
then, and then, what are those?
Not all of them, but what?
Generally,
Unknown (10:17):
that's a great question. In the statute. This
is a congressional statute. Ituses the word barriers. It says
the AAA must address thebarriers to the investigation of
elder abuse. So what are thebarriers? Well, first of all,
residents in nursing homes whoare abused, and we can define
(10:41):
that independent or two have aproblem. And the problem is they
are fierce, many of them that ifthey complain, there'll be
retribution. They might bedischarged from the facility, or
the staff might be angry atthem, and they take it out on
them in different ways. There'sanother issue. If staff sees an
(11:05):
example of a resident beingabused, the staff has an
obligation to make to reportthat they're mandated reporters
under state and federal law, butthe staff is also afraid that if
they report another staffmember, they're going to be
subjected to some harassment, orthey may even be fired. So
(11:27):
that's that's a barrier thatneeds to be addressed. Sometimes
there's this perception.
Sometimes it's true. Sometimesit's not, that the resident has
cognitive issues, and we can'ttrust the resident saying what
they're saying. So if they saythey're being abused, maybe they
are, maybe they are, we can't besure. It depends on their level
(11:50):
of cognition, but that's aproblem. I'm a barrier to the
reporting. We don't have to be100% sure if the resident is
saying the CNA just slapped meor dropped me on the floor, that
ought to be the trigger for theparent, whether or not there's a
cognitive issue or not.
Susie Singer Carter (12:13):
So airing, airing on the safe side, just if
there, there may just be so ifit's brought up, it should be
investigated, of course, ofcourse, right? Yeah,
Unknown (12:24):
The presumption bit should be that there's a problem
here, not that there's not aproblem, right? Exactly. There's
another situation where thenursing home itself doesn't want
these to be reported. Why?
Because the Centers for Medicaidand Medicaid Services is going
to send in an inspector, asurveyor, and if he finds out,
(12:45):
or she finds out that this istrue, there's a fine that's
going to be issued, or maybesomething even worse. So there's
always the possibility that thenursing home is going to tell
staff, if a surveyor comes inbecause they're interested in
knowing what happened, why don'tyou just tell them you couldn't
(13:06):
ring them. Or even worse, whydon't we remove the records of
that resident to anotherlocation so it's not easily
accessible by the surveyor. Oreven worse, why don't we alter
the records, the clinicalrecords, the nurses notes, to
make sure that this is a hardtrail to follow through. The
(13:27):
surveyor, Richard,
Susie Singer Carter (13:30):
how often does that happen? Is that? Is
that something that is regularpractice? Do you think, or, I
mean, I'm sure you can't saynationally, because you're
specific to the states that youworked in, but I don't know.
Unknown (13:45):
Well, it's a great it's a great question. Nobody knows
the answer to that question,because sometimes the facilities
get away with it. But I willtell you that I've had,
personally had a situation whereI have had a facility lie to the
surveyor, and fortunately, thesurveyor was able to determine
(14:06):
that that was a lie. It was asituation where the records were
removed so that they couldn'tfind the records. And there were
this was another situation wherethis is a chain, and the
corporate executives fromanother city were telling the
staff to lie to the surveyor, soit was a big deal. Yeah, the
(14:31):
problem is
Susie Singer Carter (14:32):
say, like with it, with my mother on her
records, you know, she hadAlzheimer's, and one of the
issues we were dealing with wasthat they had her on NPO, which
means nothing by mouth. Well, inthe records, looking back at it,
there were several entries, manyentries, where it would say
breakfast. Ate part of it,didn't want the rest, as if she
(14:53):
was eating regular food, right?
And so it was just like therewas no responsive. Little
entries. You know, there wasmany more like that, but it was
like, you know, or the patientor the resident is in denial,
she has Alzheimer's. What areyou talking about, right? Yeah,
these are but most of us don'tlook at the records. We don't
(15:15):
the nurses
Unknown (15:18):
notes are the key to the Kingdom. In my opinion, you
need to read the nurses notes.
But in any event, those areexamples of barriers to finding
out what's going on behind thecurtain in a nursing home and
another just one last item Iwant to mention, sometimes the
left hand doesn't know what theright hand is doing, which is to
say that you Adult ProtectiveServices, which is a agency of
(15:44):
the state. It's in the countythat's they also investigate
abuse in nursing homes, butthey've not there. They don't
necessarily tell the statesurveying agency what's going on
right away, the Attorney Generalof the of a state has a unit
(16:04):
called the Medicaid FraudControl Unit, and they're also
looking at abuse at nursinghomes, and sometimes there's a
lack of communication, so thatthey're not coordinated very
well, and that could be aproblem to determining whether
or not there's a, you know, hell
Susie Singer Carter (16:30):
is that by design or just by lack of
Unknown (16:39):
that's a good question.
I mean, one of the issues that Ihave always tried to grapple
with is the fact that theregulation of nursing home care
is fragmented. It's siloed. Someof it's in the state, some of
it's in the feds. Sometimes theytalk, sometimes they don't. It
has to be, there has to be ahigher level of coordination,
(17:01):
and whether that was done onpurpose, is a question that
others will have to answer. Ican't
Susie Singer Carter (17:11):
Okay, thank you. Know that that makes that
that I think that's so importantwhat you're talking about,
because most of us, as justcaregivers or even residents
don't really know how all thatworks. And, you know, we think
it's set up to take care of themost vulnerable. And then you
come to find out that it, likeyou said, it's so fragmented and
(17:35):
it becomes so complicated thatat the end of the day, many,
many family members just give upbecause it's too complicated and
it's too time consuming and it'snot fruitful.
Richard Routman (17:48):
It's very frustrating, I'm sure.
Rick Mountcastle (17:51):
So speaking of caregivers and family members, I
know some of our listeners atleast have loved ones that
they're looking out for who arein skilled nursing facilities,
and like Susie did, and asdepicted in No Country for Old
people, what would you recommendto them about becoming involved
(18:17):
in a commission or an advisorycommittee like you were involved
in advises the Commission, thelocal commission on aging.
Unknown (18:27):
They could make a phone call to the main desk of the
county office and ask for theArea Agency on Aging, and ask
for what the timetable is forapplying to be a member on the
Advisory Council. It may not becalled the Commission on Aging,
it might be, but these differfrom county to county, even if
(18:52):
they are unable to becomemembers of a Advisory Council
like the Commission on Aging,and can still go to the
meetings. These are open to thepublic. So
Rick Mountcastle (19:05):
and what would be the what would be the
benefit? How can they helpchange things by participating
in either the commission itselfor those meetings? What? What's
your what's your thoughts andyour recommendations on that
Unknown (19:19):
the Commission on Aging should be urged to educate its
members by having otherrepresentatives from other
agencies make presentations. Oneexample would be have somebody
from Adult Protective Servicestalk about how much abuse is
being discovered in the nursinghomes in that county. There,
(19:43):
there are other things that theycould do. For example, they
could ask fair law enforcementto make a presentation as to
whether law enforcement in thecounty has ever been advised to.
Within the last year or so,whether a complaint has been
(20:03):
lodged with respect to allegedor suspected elder abuse in
nursing homes, if in fact, thereis a alleged or suspected
episode that resultsparticularly in serious bodily
injury, the police have to beadvised, and if the police have
(20:24):
never received any notice, thenthe question is, is raised, why
not? And that's a proper topicfor the Commission on Aging to
bring to the attention ofelected officials, because it
should be on the top of theirlist to protect vulnerable
seniors in nursing homes. Soit's a matter of visitors. Could
(20:50):
could make recommendations. It'snot binding, of course, to say
here are a series of things todo that you could educate
yourselves and everybody else,and particularly if the visitor
has some issues with with aparticular nursing home, those
(21:10):
issues could be raised, andmaybe would not be identified by
name, but at least the issuecould be discussed
Susie Singer Carter (21:17):
also, would you say that? You know I know
that personally, I didn't knowthat there. There was an
ombudsman program available tome. I didn't know that. And I, I
would think that it would beimportant to attend these
meetings to find out, askquestions, find out, what can
ombudsmen do? What are their?
What are their you know, what'stheir job description, really,
(21:40):
and what? And what does AdultProtective Services do? Do they
talk to each other? How doesthat work? And then when you
say, police, enforcement gettinginvolved, how? When do they come
in? Is that? Is it a chain ofevents? How does that
Unknown (21:55):
work? Those are great questions. Let me take one of
take them one at a time. Okay,there are two types of ombuds.
Every state has a long term careombudsman office, and they have
paid staff, but there's notenough staff to go around to all
of the nursing homes in thestate, so they have to get
(22:16):
volunteer ombudsmen, which arefolks like what I did? You take
training, and you are requiredto go into a nursing home for
not less than four hours everyweek. And even then, not every
nursing home has even avolunteer ombudsman. But what
does the ombudsman do? TheOmbudsman has contact with elder
(22:38):
residents, and they'll say, tellme if there are any issues. And
I'm telling you that I won'ttell anybody, unless you give
any permission, this will beconfidential, so you can be free
to talk to me about it. Nowthat's a good way to elicit
information, but it is alsosomewhat frustrating because the
(23:00):
resident who may unload a burdenon the ombudsman may say, you
can't tell anybody because I'mafraid of retribution or
retaliation or being discharged.
So what's the ombudsman in adifficult spot? Well, maybe
there's a remedy for that. Maybethe Commission on Aging could
think of a way to get aroundthat problem and make a
(23:22):
suggestion to elected officials?
Susie Singer Carter (23:27):
I have a question. Wait, I just want to
say what as to that? Couldn't itbe like the way that you deal
with a whistle blower, somebodywhere you can present what's
going on without presenting thesource?
Unknown (23:40):
That would be a perfect thing to suggest, and that would
require some specific trainingof the Ombudsman. I've gone
through that training and thatthat part is not there. There
isn't there isn't a nuance.
Because you're always wanting toprotect your source, that your
source is the resident. Youdon't want to put the resident
in a period, a position of harm,sure. So that's the that's the
(24:04):
ombudsman, as far as eight ofthe Adult Protective Service,
that was your next point, adultper se, Adult Protective
Service, or APS, is a isinterested in one major goal,
and that is the safety of theresident. So if there's an
(24:27):
allegation of abuse, APS will becontacted, hopefully by the
facility, or if the resident istransferred to the emergency
room at the hospital, theadmitting doctor should notify
APS if there's some reason tobelieve that there's been abuse,
(24:52):
physical abuse, or even sexualor physical or perhaps even
emotional. All APS will send outan investigator, and if it
happens that the allegedperpetrator has been fired, that
is the staff person who wasalleged to have committed the
(25:13):
abuse, even if we don't knowthat for sure, has been fired,
air has voluntarily quit, or hasbeen moved to another form and
is no longer in proximity tothis resident. APS is
investigation is closed becausetheir mission has been
(25:34):
accomplished, they have providedsome assurance that the resident
is now safe, and they are not inthe business of determining
whether anything wrong was doneand and that's a that's a
problem, because I have talkedto APS people, and I've said,
(25:54):
Look, if you go in there and youfind out that there was abuse,
but the resident is now dead,partly because of that abuse,
you close your investigation. Myquestion is, what happens if you
(26:15):
find out if another staff memberknew of the abuse and failed to
report it. Is it part of yourduty to deal with that issue, to
report that person for failing?
If they're all mandatedreporters, what about that guy?
He failed to report? It? Myimpression of APS is that's not
(26:37):
part of their deal. All they dois find out if the resident is
safe and or dead or gone, or theperpetrators gone,
Susie Singer Carter (26:47):
right? If the problem is gone,
Unknown (26:50):
the problem still exists, because the perpetrator
is now at another facility,
Susie Singer Carter (26:56):
exactly, or on a different floor, which is
ridiculous, or a differentfloor, right?
Rick Mountcastle (27:00):
So what's a family member or caregiver to do
in those circumstances? Is thereany recourse where they
basically want to see justicehappen? That's not justice,
right? It's not justice that anindividual has abused a person
and because that person haspassed, or the perpetrator has
(27:22):
been transferred to anotherfloor, case closed that doesn't
remedy the abuse. Is there anyrecourse for carriers or family
members?
Unknown (27:31):
Of course, is, as you well know, there's the legal
system and the that raises theissue of what happened when you
admit, when the resident wasadmitted, did the admission
papers require you to sign awhat's called a pre dispute
arbitration agreement, which isprovision in the admission
(27:53):
agreement that says, in theevent that you have a claim or
the resident has a claim againstthe nursing code, you agree now
to waive a jury and to waive alllitigation and to participate in
an arbitration with aarbitration program that the
(28:13):
facility will send up or has setup. Most people who are
confronted with that have tosign it because they don't have
much of a choice, but they don'thave a lot of confidence that
that will have the same impactas a jury trial, if they can
ever get a lawyer to take thatcase to a trial. I suppose an
(28:39):
additional feature to the answerto you Rick is that the family
or the resident could call thestate survey agency and say,
Look, do something about thefact that there was no reporting
(29:02):
of abuse here in Virginia, thereis a commissioner of aging. He
is the head, or she is the headof the Department of Aging and
rehabilitation services, and thecommissioner has the power to
have the hearing against anystaff member who fails to comply
with mandated reporting laws.
And if the staff member is foundguilty, the fee is $100 if he's
(29:27):
found guilty the second time,and the C has anywhere between
$100 and $1,000 pretty smallchange, considering the
situation,
Rick Mountcastle (29:44):
but so that's all kind of peripheral, but this
would be the time, wouldn't it?
I just make a suggestion to callthe local police department or
the sheriff's office to reportthat because Elder abuse is a
crime. Nine, and notwithstandingthe fact that APS has closed its
case because the person is nolonger in danger, either by
(30:06):
death transfer of theperpetrator or otherwise, would
that be, you know, I just mightwant to suggest that might be
the time to call the localpolice or the sheriff's office
or the Medicaid Fraud ControlUnit of the state, the local
office of that, right?
Unknown (30:25):
But you're absolutely correct. I should have added
that. So thank you for addingfor me, the federal regulation,
by the way, does say that ifthere is abuse or suspected or
alleged abuse that results orappears to result in serious
physical harm, you have twohours to report it to law
(30:48):
enforcement. If there's abusethat does not result in serious
physical harm, you have 24 hoursto report it. So there's a
specific provision, relativelynew, that points in the
direction of law enforcement. Imight add that in the past four
(31:08):
during my four year term, Iasked local law enforcement, had
they ever been notified of anypossible abuse allegations, and
the answer was no,
Rick Mountcastle (31:19):
but that's that's something that a family
member or caregiver could do noquestion, in the absence of any
kind of reporting by agovernment official or anybody
at the facility. That's anoption that's available to no
question.
Richard Routman (31:33):
You're absolutely right. I want
Susie Singer Carter (31:37):
to clarify what you said though, about the
two hour window, because what ifyou as a family member, like you
have somebody who doesn't who isnon verbal, your loved one is
non verbal, and you find outthat they've been sexually
abused, right? And they move theperpetrator to say another
floor, but you don't find outabout that for whatever a couple
weeks, it just happens to leakout and you get it now you your
(32:00):
windows passed to file a reportwith the police department or
what? Oh,
Unknown (32:05):
no, you could always file the report. The facility
has the opposite, the obligationwithin two hours. It's not you.
The facility has the obligation.
They could do it at any time.
Okay, okay,
Rick Mountcastle (32:18):
and now, and you talked about the
difficulties of the civilprocess. You know, for example,
filing a civil lawsuit againstthe facility, you mentioned that
the issue being, if you signsome sort of an arbitration
agreement, which I think, Ithink are being frowned upon by
at least some of the or were bysome of the government
(32:39):
authorities. But in the eventthat you didn't, it's often
difficult, right to even get aprivate attorney to take your
case. Do you? Can you? You haveany thoughts on why that is?
Unknown (32:51):
Well, I do have some thoughts. First of all, the
private bar claims bar, they allknow each other, not even
nationally. They know each otherbecause there's so few of them,
and then they specialize innursing home cases. So it's well
worth trying to find somesomeone. But one of the one of
the problems is that sometimesstate law has caps on the amount
(33:18):
of damages you you can get in acivil suit. I don't happen to
remember what they are inVirginia. I'm not licensed in
Virginia, but so that creates adisincentive financially for
some attorneys. And of course,historically, the notion was,
(33:38):
well, it's an 85 year old woman,she's had no earning power,
there are no damages. Thatturned out to be a complete
bogus reason, because when casesare brought and they're
compelling, the jury verdictsoften are very good. It's just
hard to get voters to do it, andit takes time
Rick Mountcastle (33:59):
well. And I think the the reason for those
compelling jury verdicts is thatthe damages component for a
nursing home resident is painand suffering. Yes, would you
agree with that? I would it'snot lost wages, it's not medical
payments, because it's usuallycovered by Medicaid or Medicare
or some insurance, but it's painand suffering. And the way kind
(34:24):
of, you know, going to aconversation that Susie and I
had long ago at the beginning ofour journey, was, hey, Susie,
you're a filmmaker. Videotapewhat's happening to your mom to
show the pain and suffering.
Now, Susie happens to be afilmmaker, but I think that the
iPhone has actually made all ofhis filmmakers, so maybe this,
would you, would Oh, would you,would you, what would be your
(34:51):
thought on advising familymembers who find themselves in a
situation where they they'refighting? And abuse and neglect
in a nursing home using theirphones to videotape what's going
on.
Unknown (35:06):
Well, that that's a great idea. Of course, it
requires them to be there.
Another option is to have asurreptitious recording device,
a video recording device, in theroom. Now, there have been
examples where the facility mayrequire you to tell them that
you're doing it. But there havebeen cases where you have done
(35:29):
they've done it without thefacility knowing.
Rick Mountcastle (35:34):
Can I, can I put a caution on that? Because
every state, there's everystate, has different laws with
regard to surreptitiouslyvideotaping someone, right? So
you must consult with your statelaw on whether you're it's legal
for you to do that. So I justput that as a caution. Some
(35:55):
states it is legal. I think onestate, and I can't remember
which one says you can do it aslong as there's not sound. And
then some states say it'sillegal to videotape someone
without their permission. So Iwould put a caution on that. I
would not I would suggest to ourlisteners, don't just do that
until you find out what yourstate law
Richard Routman (36:17):
requires. I totally agree. I just
Susie Singer Carter (36:21):
want to throw something with my own, you
know, experience, as well as,like, when, when Rick had said,
you know, start, just startmonkey, you know, taking video
of your mom so you have a recordof what's going on. And there
were, and they the frontlineproviders, a lot of the CNAs who
were, you know, didn't want tojeopardize their jobs. Clearly
they would. They got to thepoint where they were like, you
(36:43):
can't record, you can't take apicture, you can't you have to
go out. It's against our rules.
Well, I just assumed that wasright, because they were
throwing out HIPAA and all that,and saying you can't, you know,
you have to get permission.
Well, that's not true. You canfind you have to find out what
your rights are per your stateand find out if you are allowed.
(37:03):
I you know, I don't know if youknow, but I don't know if that
is even a law anywhere that youcan't take video of your own
family member.
Unknown (37:13):
I don't know the answer. I was aware of case at
least one case years ago wherethe facility did not know about
the camera. It was the film wasintroduced, and it was fine, but
that was a long time ago. One ofthe advantages of having Rick
here is that he's keeping me onthe straight and narrow with
(37:35):
respect to the law. So,
Rick Mountcastle (37:38):
yeah, well, the law is different in
different states. Be careful.
That's all right. As far asHIPAA, though that's a federal
law and so Susie, in a case of acaregiver who has power of
attorney to make medicaldecisions for their loved one,
they are actually as thoughthey're that person. So you can
film your loved one if you arethe power of attorney, right?
(38:01):
Some places they call itsomething else. What
Susie Singer Carter (38:04):
conservator person,
Rick Mountcastle (38:07):
right? Or power of attorney, you don't
need to get anybody'spermission, because you stand in
the shoes of that person thatyou want to film, right? If, if
you're not one of those in thosepower of attorney, just get your
loved one, just get your grandmaor mom or dad or whoever it is
to say to it, to say, Hey, Iagree to let you fill me yeah,
(38:29):
you have that that piece ofpaper, and it doesn't have to be
anything formal, just theiracknowledgement or their
permission and their signature.
And now you can film away, andit doesn't matter what the
facility says,
Susie Singer Carter (38:44):
right? It's important, I think, for people
to know that, yeah, because Iwas, I was afraid, so I didn't
want to get retaliation, and,you know, rock the boat anymore.
So I was trying to be, you know,not push, yeah, like, not rock
the apple cart, too much, right?
But
Unknown (39:01):
I should have done more. I totally agree with Rick.
What weather? One othercautionary note is you have to
be careful not to film the ifthere's a roommate, you have to
make sure that roommate is notfilmed because you don't have
permission there, correct? Yes.
But you know, Rick, just tofurther your point, this is such
an important device for knowingabout what's going on at night
(39:26):
in a nursing home or on theweekend in a nursing home when
it's not well staffed, that thatwould be a proper subject for an
advisory Council like theCommission on Aging to permit
this issue and commitvisibility, because there are
examples of where it has workeddramatically in litigation, and
(39:47):
it might be a long process toget that kind of acceptance for
the law to permit it, but itwould be worth at least
beginning that process. Typething.
Rick Mountcastle (40:02):
Richard, do you have any thoughts on why
these commissions on Aging,which are in every county,
right, and they're advised bycitizens of that county? Why?
Why things are not improving inthe nursing homes? The in fact,
they're getting worse. I mean,we, we have these groups to that
(40:22):
are there to to provide somesort of support for the elderly,
their government rates in everycounty, but things just seem to
be getting worse. Any, any, anyspeculation thoughts on that?
Unknown (40:41):
Well, my feeling is that the program for advisory
councils should include atraining so that people
understand we're talking aboutfolks who have some interest but
don't have much background, andit's a complicated area. There's
a lot of federal, statemishmash, so they should be
(41:02):
trained to ask the rightquestions and to demand, to talk
to agencies at meetings and getand get answers. So I think that
it's a long process to getpeople to to educate themselves
(41:23):
and to have the guts to go toelected officials and say, look,
we've got to make some changeshere. I wish I had a better
answer than that. Rick, but I'mnot. I'm afraid this is an
intractable issue.
Rick Mountcastle (41:39):
No, that makes, that that makes perfect
sense. So would you recommendthat you know people like our
listeners on this, this program,or people who are caregivers for
elderly folks that are inskilled nursing facilities?
Would you recommend that theyget involved in these advisory
committees that advisecommissions on
Unknown (41:59):
aging? I absolutely would recommend it. And I also
have another recommendation thatSusie singer Carter and Rick
moncast will come up with atraining program in addition to
their film that could be used byevery county commission in the
country. And actually, I'mpretty serious about that.
Susie Singer Carter (42:23):
Well, we're hoping that the film is, you
know, will help that and be ablepeople will be able to use parts
of the film as training and useit as education, you know, and
also this podcast and where, youknow, we're specifically talking
about these, these subjects indetail, you know, because it,
(42:45):
that's what's important, becauseknowledge, knowledge is power.
And that's, that's, yeah, we'rewith you. That's, that's one of
our goals, right? Rick, toeducate.
Unknown (42:57):
There's also, absolutely, if I may add one
large one another point, thereis a political feature to this
issue. If it is true, which Ibelieve it is, that nursing home
chains and nursing homes makepolitical contributions to
legislators. They have a greatdeal of influence on the kind of
(43:19):
oversight that actually occurson nursing homes. Why not
require nursing home chains todisclose the amount and
recipients of their politicalcontributions? I think that
would be an important thing forthe people to know, because
(43:39):
there have been plenty of peoplewho've tried to make changes in
the system, and it's very hardto do
Susie Singer Carter (43:46):
absolutely and it goes beyond that. It's
the contributions to ourpolitical candidates and things
like that, right? So, so, youknow, I've seen so many groups
now in the past three years thatI've watched them work so hard
on getting bills, you know,recognized and then into the
system, and then they're killed.
You know, the American arrival,yeah,
Unknown (44:11):
the American Healthcare Association is the lobbying of
arm for the nursing homeindustry. What are their
political contributions? Isuspect they're substantial.
Rick Mountcastle (44:24):
Well, if you go to you can find the a lot of
the federal information onopensecrets.org and if you go to
opensecrets.org you'll see thatthey spend hundreds of millions
of dollars annually on campaigncontributions and lobbying. And,
(44:49):
you know, I think there was areport that was generated out
specifically about the nursinghome industry's contributions
and involvement in politicaland. Is lobbying that they
issued a few years ago that youcan find on that website. So
it's open secrets.org It showsthat, in fact, it is true,
(45:10):
Richard, that the AmericanHealthcare Association and its
state affiliates contributehundreds of millions of dollars
a year to campaign contributionsand lobbying.
Unknown (45:24):
Well, if that is true, and I have no doubt that Rick is
correct, people like the rest ofthe ordinary folks in
commissions on aging arefighting with sticks and the
other side are fighting withguns. 100%
Susie Singer Carter (45:41):
that's why we need to have a movement.
That's why you're validatingeverything that we're we've been
trying to to communicate. Yeah,and
Rick Mountcastle (45:49):
by the way, just so people know, most of
that money that they're usingfor those political
contributions and lobbying isour tax money, because Medicare
and Medicaid substantially fundmake up the most of the revenue,
80% 8080 to 90% of the nursinghomes revenue comes from
(46:10):
Medicare and Medicaid, our taxmonies, which they turn around
and put into politicalcontributions and lobbying to
make sure that we keep gettingthe crappy care in nursing homes
that we've been getting for 50years. So that's my soapbox.
Susie Singer Carter (46:26):
Let me, let me jump on that soapbox when I
just one thing to add is thatnot only are they spending our
money, they are also buyingthemselves seats at the table in
our legislation. So they alsosit there as advisors and advise
when to pass on something, evenif it gets to that far. So
that's there's that too,
Unknown (46:49):
I think. So I'll give you an example. I'm not sure
that this is fair, but I'm goingto say it anyway. Under state
law in Virginia, there's arequirement, as in most all
states, for mandated reporting.
But there's a provision in thelaw, which is unusual. Maybe
Rick knows about it, and itsays, essentially, that if a
(47:11):
person acquire if a staff personat a nursing home acquires
information involving abuse,that person can simply tell the
person in charge of theinstitution that would be the
administrator of the nursinghome, who then has the
responsibility to report it. Thefirst person doesn't have to
(47:35):
report it. He just has to tellhis boss or her boss, and then a
boss that makes a separatedetermination whether there is
sufficient suspicion to reportit. When I was at the
commission, I called up stateofficials and said, Is this a
problem? Are you having an issuehere with this problem? And they
(47:56):
said, Yes, but it's never beenchanged, and it's been a subject
of frustration for me
Susie Singer Carter (48:05):
see that, yeah, that's so to it's so
obvious and so and so egregiousat the same time, right? Because
I went and reported everythingthat I thought was wrong with
going with my mom, just fromwhat the CNAs were telling me.
And I would go to theadministrator that, you know,
(48:27):
the director, and they wouldsay, Nope, we're fine. We're not
understaffed. Nope, no, we gotplenty of help. Nope, don't
worry about it. It's all good.
You know, nothing was reported,and they weren't going to report
it there. Why would they?
Richard Routman (48:43):
Well, they should, because it's the law.
They
Susie Singer Carter (48:46):
should, but they don't. They don't, right?
Well,
Unknown (48:50):
somebody's got somebody, somebody's got to pay
attention to this with greaterintensity than they had been.
Susie Singer Carter (48:57):
Yes, Rick, that's why we're doing No
Country for Old people. Yes,
Rick Mountcastle (49:05):
we the public, needs to be educated about all
of this, all of the failings ofthe system, so that the public
can know and become activated todemand change, because that's
the only way we're going toovercome the hundreds of
millions of dollars in moneythat the industry puts into
keeping things the same.
Richard Routman (49:26):
I think that's true, and we and we may be on
the brink of a time where thereare fewer government employees,
and it's going to put a greaterburden on ordinary citizens to
step up to the plate and takeaction and be proactive about
doing something, even if it'sonly providing a voice that's at
(49:50):
least something, and hopefully,in the course of time, elected
officials will pay attention.
Susie Singer Carter (49:59):
You know.
It's, it's, it's really tellingthat we, you know, having both
of you who have had so much, somany years experience in this
field of trying to bring qualitycare, and you know, less than
substandard care, to to our mostvulnerable, and you've spent so
many decades trying to do it,and what your conclusion is that
(50:19):
it's on us as a collective,because, and it really, you
know, and it if we don't, if wedon't listen to that people as a
community, then, then we arefailing as human beings. I mean,
it's, it's a human This is ahuman rights situation, and we
need to step up. We have to,because that's what that's
(50:40):
that's the only power we haveright now. It's obvious both of
you have spent your livesworking within that system, and
this is the conclusion. So itreally speaks volumes to what
we're trying to say through thedocumentary as well.
Unknown (50:58):
If people weren't as concerned about seniors and the
possibility that seniors sufferfrom abuse as they are about
babies who might also sufferfrom abuse. We wouldn't have
this conversation.
Susie Singer Carter (51:13):
But there's a I just had a conversation with
my another colleague of minewho's in the health system, and
she said, Well, babies are cute.
Well, you know, cute is in theeye of the beholder. Some babies
aren't that cute. No. I mean,you know, listen, my mom was
adorable, and I in my mind shewas the best. So, I mean, we
(51:34):
have to get up, you know, weThat's true. I mean, babies are
we treat babies different,
Rick Mountcastle (51:43):
but just from a human, if you're a human
being, you don't want to seesomeone suffering. I don't care
who they are, how they are,someone suffering from a stage
four pressure ulcer, sufferingfrom sepsis, suffering from
dehydration. Just as a as humanbeings, it shouldn't matter how
(52:05):
cute they are or howcomparatively cute they are. It
should matter that you seesuffering and you want to change
that. You want to make itbetter. You want to make it go
away. That should be enough,100%
Susie Singer Carter (52:19):
100% but why is why? But you're right,
Richard, it's like, why we've,we've had that conversation, you
know, one of our, one of ourinterviewees, who used to work
for Adult Protective Services,and you know, was very active in
in the caregiving community andelder care rights. And you know,
(52:40):
she would say to her colleagues,I need somebody over here.
There's some abuse going on.
Okay? We'll make a report andwe'll, we'll check it out
tomorrow. No, someone needs tocome now. But it doesn't happen
like that. But if it but inchildren, for the children's
Protective Services, it does. Ithappens right there. So it's,
it's built into our system, tobe to have this ageism, to have
(53:02):
this ableism, it's built intoit.
Unknown (53:08):
And I think it's a cultural thing. I don't think, I
don't think this is truenecessarily in other countries,
for example,
Susie Singer Carter (53:16):
I think it's becoming worse and worse,
though, honestly, it's becominga worldwide phenomenon of this
individualistic kind of societythat we have created. And
Unknown (53:26):
I think that's right, but historically correct me, if
I'm wrong, Japan didn't havenursing homes, but if you grow
old in Japan, this is years ago,you were with the family, only
in recent years have beennursing homes in Japan.
Susie Singer Carter (53:40):
And now that's not it's actually worse.
They're having a crisis nowwhere they are basically sending
the elders out to the to thesecommunities of homes where
they're just left on their ownto to take care of themselves
and with no oversight. And it'sbecause the population and
because of this, the way thatsociety now is looking at the
(54:03):
elder generation. It's so easyto look at them through, you
know, a lens, as if you'rethey're othered, as one of our
experts says, they're othered.
And, you know, we, we will bethat other in a sec, in a blink
of an eye, we are all there.
Unknown (54:22):
Well, with the demographics of our population,
this is going to just get worseand worse in this country,
because the seniors are probablythe predominant feature of the
of the population, or they willbe fairly soon.
Susie Singer Carter (54:36):
They are.
It's their call. It a graytsunami. That's the term and
and, you know, there's so muchvalue in that population, no
matter what, and that's theproblem. We need to really shift
that, that that perspective toto a more healthier perspective,
because we're missing, we'relosing out on on some
(54:58):
incredible. Double, you know,value that comes from that, from
our elder generations. And youknow, I only get smarter I hope,
and I only get more valuable asa person. I hope. As I grow so I
and I see that in the peopleabove me, ahead of me, I look to
my elders as mentors and guides,that they are they should be
(55:19):
revered. That's the way I lookat it.
Unknown (55:25):
Well, let's hope that No Country for Old people is
required viewing by everybody atschools and medical schools and
nursing schools,
Susie Singer Carter (55:33):
from your mouth to God's ears. Thank you.
Well, thank you today forcoming. Is there anything else
we you wanted to say that wasburning and that I missed, or
Rick missed and that, oh,
Unknown (55:45):
it's hard, it's hard to think of, it's hard to think of
anything that either of youmissed. So I'm appreciative of
your filling the gaps when Iwhen I forgot a few things. But
anyway, no, I appreciate, Iappreciate, I appreciate the
opportunity to have thisconversation with you. It's very
important again. Congratulationson your work. We're going to
look forward to August and allof the publicity that comes with
(56:09):
your film.
Susie Singer Carter (56:10):
Well, thank you. We loved having you and and
as you might know, this show isall about love. It's in the
title, and the reason is becauselove is powerful, love is
contagious, and love conquersalls and, and that's, and I,
that's what I feel. And I'm notchanging my mind. So I think
love is our, is our, is it's,it's the big, greatest tool in
(56:33):
our arsenal. So thank you,Richard. You're full of love,
and we really appreciated havingyou today. You, you know how I
feel about you. So anyway, ifyou like this show, please, you
know, earmark it and share itwith everybody and talk about
it. Give us good reviews, comeback and listen again, and keep
(56:56):
an eye out for no country, forold people, and have a wonderful
time until we're together again,take care.
Richard Routman (57:04):
Bye, see you both. Bye, bye, thank you. You.
When the world has got you down, Alzheimer's sucks.
It's an equal opportunitydisease that chips away at
everything we hold dear. And todate, there's no cure. So until
there is, we continue to fightwith the most powerful tool in
our arsenal, love. This is Loveconquers alls a real and really
(00:22):
positive podcast that takes adeep dive into everything,
Alzheimer's, The Good, The Badand everything in between. And
now here are your hosts, Suziesinger Carter and me. Don
Priess,
Susie Singer Carter (00:40):
hello, everybody. I'm Susie singer
Carter, and this is loveconquers all, the podcast that
is all about Alzheimer's andelder care and extending into
long term care. Now with ourdocumentary, No Country for Old
people, which I have a verygreat announcement that we are
launching on Amazon on August 1so stay tuned, and we'll be
(01:04):
keeping you posted. If youfollow us, you'll definitely
hear more about it. And if youdon't follow us, you should be,
because it's very important, andwe're very proud of this
project, and it's informationthat everyone needs to know, and
coincidentally, we have a veryspecial episode today because,
not just because of our guest,but also because I am joined
(01:27):
today with my producing partnerfrom no country, from old
people, and my guest host todayis Rick moncastle, who you may
know already because I talkabout him all the time and or
You also might know him from aproject called dope sick, a mini
series on Hulu where his workprosecuting Purdue pharma was
(01:47):
dramatized. He's here to help melead the conversation that's
very close to both of our heartstoday. Our guest is someone
whose life's work aligns sopowerfully with the mission
behind our film. Richard routmanis a retired attorney who spent
14 years with the Department ofHealth and Human Services, where
(02:09):
he represented the government incases against nursing homes
accused of providing substandardcare. Since retiring, he's
continued to advocate for olderadults, first as a trained
volunteer ombudsman, and lateras a member of the Loudoun
County Commission on Aging inVirginia. Richard brings both
legal insight and livedcompassion to this conversation,
(02:31):
and when he's not speaking upfor better elder care, he's
enjoying time with his wife andtheir grandchildren, which,
let's be honest, is probably thebest gig of all. We truly, truly
are honored to have him herewith us today. So please help me
welcome Richard routman and ofcourse, Rick moncastle.
Rick Mountcastle (02:51):
Hey, Susie, thank you for having me. It's an
honor. I hope I can live up. Ihope, I hope I can live up to
the standards that you and donhave set for Love conquers alls,
but I'm glad I'm here, becauseRichard Rotman and I have, I
would say, Come to be friends.
Over the past two or threeyears, we've not met in person,
(03:12):
but we have talked monthly bytelephone, just trying to keep
up with what's happening inelder care and batting ideas
around about how we can makethings better in that world. So
I think it's really great tohave Richard on. And I guess I
can start off the questioning orstart off with the ball. Susie,
(03:35):
if that's okay with you.
Susie Singer Carter (03:40):
Take it away, Rick.
Rick Mountcastle (03:41):
Richard, Richard, you and I have talked
about your role on theCommission on Aging, a role you
took on after you retired fromthe Health and Human Services
assistant Regional Council. Butbefore we get into the specifics
of that, could you describe yourgeneral approach that you have
(04:03):
taken and are taking inaddressing nursing home issues?
Richard Routman (04:08):
Be happy to just before I comment on that,
Rick, I just want to thank Susiefor the lovely introduction, and
congratulate you both for thecoming of the new video, which
we're all looking forward to inAugust. It'll be a impactful
event for everybody who'sinterested in improving nursing
home care.
Susie Singer Carter (04:29):
Thank you so much. Thank you.
Unknown (04:32):
Well, the the approach to trying to deal with the
proper treatment of elders innursing homes is a complex one.
It's both federal and stateinvolved, and one of my post
retirement interests was findingout how the county of Loudoun in
(04:57):
Virginia used. Is federal money,as well as some state and local
money to promote the interestsof residents of nursing homes.
So after I spent a year being avolunteer ombudsman in a skilled
nursing facility, when we mywife and I moved here, I was
(05:21):
able to be appointed to theCommission on Aging. And let me
give just a minute or twobackground on what that means.
In 1965 Congress passed astatute called the Older
Americans Act, and that statutewas amended about 10 years
later, to provide for fundingfederal monies to go to offices
(05:49):
in counties all over thecountry. Every county in the
country has an office called theArea Agency on Aging, and that
agency receives some federalmoney and some state money. And
this is supposed to promote theinterests of seniors in that in
that county, it comes with somestrings. One of the strings was
(06:13):
that the Area Agency on Aginghad to establish what, what is
an advisory council, and inVirginia, in Loudoun County, was
called the Commission on Aging,and that was a particularly
attractive feature to thestatute, in my view, because it
allowed members of the public,ordinary folks, to be able to
(06:36):
have a seat at the table. Theyweren't they weren't empowered
to make any decisions, but theywere allowed to ask questions,
and in Loudoun County, there arenine members on the Commission
on Aging. They're appointed bythe board of supervisors, and
they're on their chairman forfour years. And what are they
supposed to do? They're supposedto educate themselves as to
(06:59):
what's going on with the elderpopulation and to make
suggestions to not onlygovernment on the state level,
but even the federal level. Inother words, they have a
portfolio. They don't have anypower, but they have the option
of educating themselves andpersuade, trying to persuade
(07:19):
people to improve the program,and that has been since we moved
here in since I became a memberof the Commission on Aging in
2016 and I that's a four yearterm. So I was on there for
until 2020 that was pretty muchwhat I tried to do. And
(07:46):
specifically, the Commission onAging is in his obligated, by
statute, to review what the AreaAgency is doing to comply with
the federal federal conditions.
One of those conditions wasestablished by statute in 2016
(08:07):
and that condition was that thearea agencies on aging and to
address the issue of thebarriers to the investigation of
elder abuse, and that includedelder abuse in nursing homes.
And as it turned out, a fewyears after that, in 2019 the
(08:33):
Office of the Inspector Generalof the Inspector General of the
Department of Health and HumanServices and the Government
Accountability Office issuedseparate reports talking about
the problems with the reportingof elder abuse or suspected
elder abuse in nursing homes.
(08:57):
There's a requirement understate law and under federal law
for staff in the nursing homesto report if there are suspected
or alleged elder abuse, and itturns out that these reports by
the Inspector General and theGAO suggested that it wasn't
(09:18):
being done very much. It wasn'tbeing honored as much as it
should be. And if there were nosufficient numbers of reports of
suspected elder abuse, thatcreates a huge problem, because
it needed to be addressed.
Attention needed to be paid toit, and that is the problem that
we're currently involved in. Itis a long term problem to try to
(09:40):
make sure that this veryvulnerable population in nursing
in skill particularly in skillednursing homes, has a voice that
we help them provide somemechanism to amplify their
issues.
Susie Singer Carter (09:57):
What you said, barriers? You. Saying, I
just want to just ask clarifywhat you meant by barriers.
Because you said there's, youknow, that was the issue is
barriers? Is that? What to whodid the barriers apply? And
then, and then, what are those?
Not all of them, but what?
Generally,
Unknown (10:17):
that's a great question. In the statute. This
is a congressional statute. Ituses the word barriers. It says
the AAA must address thebarriers to the investigation of
elder abuse. So what are thebarriers? Well, first of all,
residents in nursing homes whoare abused, and we can define
(10:41):
that independent or two have aproblem. And the problem is they
are fierce, many of them that ifthey complain, there'll be
retribution. They might bedischarged from the facility, or
the staff might be angry atthem, and they take it out on
them in different ways. There'sanother issue. If staff sees an
(11:05):
example of a resident beingabused, the staff has an
obligation to make to reportthat they're mandated reporters
under state and federal law, butthe staff is also afraid that if
they report another staffmember, they're going to be
subjected to some harassment, orthey may even be fired. So
(11:27):
that's that's a barrier thatneeds to be addressed. Sometimes
there's this perception.
Sometimes it's true. Sometimesit's not, that the resident has
cognitive issues, and we can'ttrust the resident saying what
they're saying. So if they saythey're being abused, maybe they
are, maybe they are, we can't besure. It depends on their level
(11:50):
of cognition, but that's aproblem. I'm a barrier to the
reporting. We don't have to be100% sure if the resident is
saying the CNA just slapped meor dropped me on the floor, that
ought to be the trigger for theparent, whether or not there's a
cognitive issue or not.
Susie Singer Carter (12:13):
So airing, airing on the safe side, just if
there, there may just be so ifit's brought up, it should be
investigated, of course, ofcourse, right? Yeah,
Unknown (12:24):
The presumption bit should be that there's a problem
here, not that there's not aproblem, right? Exactly. There's
another situation where thenursing home itself doesn't want
these to be reported. Why?
Because the Centers for Medicaidand Medicaid Services is going
to send in an inspector, asurveyor, and if he finds out,
(12:45):
or she finds out that this istrue, there's a fine that's
going to be issued, or maybesomething even worse. So there's
always the possibility that thenursing home is going to tell
staff, if a surveyor comes inbecause they're interested in
knowing what happened, why don'tyou just tell them you couldn't
(13:06):
ring them. Or even worse, whydon't we remove the records of
that resident to anotherlocation so it's not easily
accessible by the surveyor. Oreven worse, why don't we alter
the records, the clinicalrecords, the nurses notes, to
make sure that this is a hardtrail to follow through. The
(13:27):
surveyor, Richard,
Susie Singer Carter (13:30):
how often does that happen? Is that? Is
that something that is regularpractice? Do you think, or, I
mean, I'm sure you can't saynationally, because you're
specific to the states that youworked in, but I don't know.
Unknown (13:45):
Well, it's a great it's a great question. Nobody knows
the answer to that question,because sometimes the facilities
get away with it. But I willtell you that I've had,
personally had a situation whereI have had a facility lie to the
surveyor, and fortunately, thesurveyor was able to determine
(14:06):
that that was a lie. It was asituation where the records were
removed so that they couldn'tfind the records. And there were
this was another situation wherethis is a chain, and the
corporate executives fromanother city were telling the
staff to lie to the surveyor, soit was a big deal. Yeah, the
(14:31):
problem is
Susie Singer Carter (14:32):
say, like with it, with my mother on her
records, you know, she hadAlzheimer's, and one of the
issues we were dealing with wasthat they had her on NPO, which
means nothing by mouth. Well, inthe records, looking back at it,
there were several entries, manyentries, where it would say
breakfast. Ate part of it,didn't want the rest, as if she
(14:53):
was eating regular food, right?
And so it was just like therewas no responsive. Little
entries. You know, there wasmany more like that, but it was
like, you know, or the patientor the resident is in denial,
she has Alzheimer's. What areyou talking about, right? Yeah,
these are but most of us don'tlook at the records. We don't
(15:15):
the nurses
Unknown (15:18):
notes are the key to the Kingdom. In my opinion, you
need to read the nurses notes.
But in any event, those areexamples of barriers to finding
out what's going on behind thecurtain in a nursing home and
another just one last item Iwant to mention, sometimes the
left hand doesn't know what theright hand is doing, which is to
say that you Adult ProtectiveServices, which is a agency of
(15:44):
the state. It's in the countythat's they also investigate
abuse in nursing homes, butthey've not there. They don't
necessarily tell the statesurveying agency what's going on
right away, the Attorney Generalof the of a state has a unit
(16:04):
called the Medicaid FraudControl Unit, and they're also
looking at abuse at nursinghomes, and sometimes there's a
lack of communication, so thatthey're not coordinated very
well, and that could be aproblem to determining whether
or not there's a, you know, hell
Susie Singer Carter (16:30):
is that by design or just by lack of
Unknown (16:39):
that's a good question.
I mean, one of the issues that Ihave always tried to grapple
with is the fact that theregulation of nursing home care
is fragmented. It's siloed. Someof it's in the state, some of
it's in the feds. Sometimes theytalk, sometimes they don't. It
has to be, there has to be ahigher level of coordination,
(17:01):
and whether that was done onpurpose, is a question that
others will have to answer. Ican't
Susie Singer Carter (17:11):
Okay, thank you. Know that that makes that
that I think that's so importantwhat you're talking about,
because most of us, as justcaregivers or even residents
don't really know how all thatworks. And, you know, we think
it's set up to take care of themost vulnerable. And then you
come to find out that it, likeyou said, it's so fragmented and
(17:35):
it becomes so complicated thatat the end of the day, many,
many family members just give upbecause it's too complicated and
it's too time consuming and it'snot fruitful.
Richard Routman (17:48):
It's very frustrating, I'm sure.
Rick Mountcastle (17:51):
So speaking of caregivers and family members, I
know some of our listeners atleast have loved ones that
they're looking out for who arein skilled nursing facilities,
and like Susie did, and asdepicted in No Country for Old
people, what would you recommendto them about becoming involved
(18:17):
in a commission or an advisorycommittee like you were involved
in advises the Commission, thelocal commission on aging.
Unknown (18:27):
They could make a phone call to the main desk of the
county office and ask for theArea Agency on Aging, and ask
for what the timetable is forapplying to be a member on the
Advisory Council. It may not becalled the Commission on Aging,
it might be, but these differfrom county to county, even if
(18:52):
they are unable to becomemembers of a Advisory Council
like the Commission on Aging,and can still go to the
meetings. These are open to thepublic. So
Rick Mountcastle (19:05):
and what would be the what would be the
benefit? How can they helpchange things by participating
in either the commission itselfor those meetings? What? What's
your what's your thoughts andyour recommendations on that
Unknown (19:19):
the Commission on Aging should be urged to educate its
members by having otherrepresentatives from other
agencies make presentations. Oneexample would be have somebody
from Adult Protective Servicestalk about how much abuse is
being discovered in the nursinghomes in that county. There,
(19:43):
there are other things that theycould do. For example, they
could ask fair law enforcementto make a presentation as to
whether law enforcement in thecounty has ever been advised to.
Within the last year or so,whether a complaint has been
(20:03):
lodged with respect to allegedor suspected elder abuse in
nursing homes, if in fact, thereis a alleged or suspected
episode that resultsparticularly in serious bodily
injury, the police have to beadvised, and if the police have
(20:24):
never received any notice, thenthe question is, is raised, why
not? And that's a proper topicfor the Commission on Aging to
bring to the attention ofelected officials, because it
should be on the top of theirlist to protect vulnerable
seniors in nursing homes. Soit's a matter of visitors. Could
(20:50):
could make recommendations. It'snot binding, of course, to say
here are a series of things todo that you could educate
yourselves and everybody else,and particularly if the visitor
has some issues with with aparticular nursing home, those
(21:10):
issues could be raised, andmaybe would not be identified by
name, but at least the issuecould be discussed
Susie Singer Carter (21:17):
also, would you say that? You know I know
that personally, I didn't knowthat there. There was an
ombudsman program available tome. I didn't know that. And I, I
would think that it would beimportant to attend these
meetings to find out, askquestions, find out, what can
ombudsmen do? What are their?
What are their you know, what'stheir job description, really,
(21:40):
and what? And what does AdultProtective Services do? Do they
talk to each other? How doesthat work? And then when you
say, police, enforcement gettinginvolved, how? When do they come
in? Is that? Is it a chain ofevents? How does that
Unknown (21:55):
work? Those are great questions. Let me take one of
take them one at a time. Okay,there are two types of ombuds.
Every state has a long term careombudsman office, and they have
paid staff, but there's notenough staff to go around to all
of the nursing homes in thestate, so they have to get
(22:16):
volunteer ombudsmen, which arefolks like what I did? You take
training, and you are requiredto go into a nursing home for
not less than four hours everyweek. And even then, not every
nursing home has even avolunteer ombudsman. But what
does the ombudsman do? TheOmbudsman has contact with elder
(22:38):
residents, and they'll say, tellme if there are any issues. And
I'm telling you that I won'ttell anybody, unless you give
any permission, this will beconfidential, so you can be free
to talk to me about it. Nowthat's a good way to elicit
information, but it is alsosomewhat frustrating because the
(23:00):
resident who may unload a burdenon the ombudsman may say, you
can't tell anybody because I'mafraid of retribution or
retaliation or being discharged.
So what's the ombudsman in adifficult spot? Well, maybe
there's a remedy for that. Maybethe Commission on Aging could
think of a way to get aroundthat problem and make a
(23:22):
suggestion to elected officials?
Susie Singer Carter (23:27):
I have a question. Wait, I just want to
say what as to that? Couldn't itbe like the way that you deal
with a whistle blower, somebodywhere you can present what's
going on without presenting thesource?
Unknown (23:40):
That would be a perfect thing to suggest, and that would
require some specific trainingof the Ombudsman. I've gone
through that training and thatthat part is not there. There
isn't there isn't a nuance.
Because you're always wanting toprotect your source, that your
source is the resident. Youdon't want to put the resident
in a period, a position of harm,sure. So that's the that's the
(24:04):
ombudsman, as far as eight ofthe Adult Protective Service,
that was your next point, adultper se, Adult Protective
Service, or APS, is a isinterested in one major goal,
and that is the safety of theresident. So if there's an
(24:27):
allegation of abuse, APS will becontacted, hopefully by the
facility, or if the resident istransferred to the emergency
room at the hospital, theadmitting doctor should notify
APS if there's some reason tobelieve that there's been abuse,
(24:52):
physical abuse, or even sexualor physical or perhaps even
emotional. All APS will send outan investigator, and if it
happens that the allegedperpetrator has been fired, that
is the staff person who wasalleged to have committed the
(25:13):
abuse, even if we don't knowthat for sure, has been fired,
air has voluntarily quit, or hasbeen moved to another form and
is no longer in proximity tothis resident. APS is
investigation is closed becausetheir mission has been
(25:34):
accomplished, they have providedsome assurance that the resident
is now safe, and they are not inthe business of determining
whether anything wrong was doneand and that's a that's a
problem, because I have talkedto APS people, and I've said,
(25:54):
Look, if you go in there and youfind out that there was abuse,
but the resident is now dead,partly because of that abuse,
you close your investigation. Myquestion is, what happens if you
(26:15):
find out if another staff memberknew of the abuse and failed to
report it. Is it part of yourduty to deal with that issue, to
report that person for failing?
If they're all mandatedreporters, what about that guy?
He failed to report? It? Myimpression of APS is that's not
(26:37):
part of their deal. All they dois find out if the resident is
safe and or dead or gone, or theperpetrators gone,
Susie Singer Carter (26:47):
right? If the problem is gone,
Unknown (26:50):
the problem still exists, because the perpetrator
is now at another facility,
Susie Singer Carter (26:56):
exactly, or on a different floor, which is
ridiculous, or a differentfloor, right?
Rick Mountcastle (27:00):
So what's a family member or caregiver to do
in those circumstances? Is thereany recourse where they
basically want to see justicehappen? That's not justice,
right? It's not justice that anindividual has abused a person
and because that person haspassed, or the perpetrator has
(27:22):
been transferred to anotherfloor, case closed that doesn't
remedy the abuse. Is there anyrecourse for carriers or family
members?
Unknown (27:31):
Of course, is, as you well know, there's the legal
system and the that raises theissue of what happened when you
admit, when the resident wasadmitted, did the admission
papers require you to sign awhat's called a pre dispute
arbitration agreement, which isprovision in the admission
(27:53):
agreement that says, in theevent that you have a claim or
the resident has a claim againstthe nursing code, you agree now
to waive a jury and to waive alllitigation and to participate in
an arbitration with aarbitration program that the
(28:13):
facility will send up or has setup. Most people who are
confronted with that have tosign it because they don't have
much of a choice, but they don'thave a lot of confidence that
that will have the same impactas a jury trial, if they can
ever get a lawyer to take thatcase to a trial. I suppose an
(28:39):
additional feature to the answerto you Rick is that the family
or the resident could call thestate survey agency and say,
Look, do something about thefact that there was no reporting
(29:02):
of abuse here in Virginia, thereis a commissioner of aging. He
is the head, or she is the headof the Department of Aging and
rehabilitation services, and thecommissioner has the power to
have the hearing against anystaff member who fails to comply
with mandated reporting laws.
And if the staff member is foundguilty, the fee is $100 if he's
(29:27):
found guilty the second time,and the C has anywhere between
$100 and $1,000 pretty smallchange, considering the
situation,
Rick Mountcastle (29:44):
but so that's all kind of peripheral, but this
would be the time, wouldn't it?
I just make a suggestion to callthe local police department or
the sheriff's office to reportthat because Elder abuse is a
crime. Nine, and notwithstandingthe fact that APS has closed its
case because the person is nolonger in danger, either by
(30:06):
death transfer of theperpetrator or otherwise, would
that be, you know, I just mightwant to suggest that might be
the time to call the localpolice or the sheriff's office
or the Medicaid Fraud ControlUnit of the state, the local
office of that, right?
Unknown (30:25):
But you're absolutely correct. I should have added
that. So thank you for addingfor me, the federal regulation,
by the way, does say that ifthere is abuse or suspected or
alleged abuse that results orappears to result in serious
physical harm, you have twohours to report it to law
(30:48):
enforcement. If there's abusethat does not result in serious
physical harm, you have 24 hoursto report it. So there's a
specific provision, relativelynew, that points in the
direction of law enforcement. Imight add that in the past four
(31:08):
during my four year term, Iasked local law enforcement, had
they ever been notified of anypossible abuse allegations, and
the answer was no,
Rick Mountcastle (31:19):
but that's that's something that a family
member or caregiver could do noquestion, in the absence of any
kind of reporting by agovernment official or anybody
at the facility. That's anoption that's available to no
question.
Richard Routman (31:33):
You're absolutely right. I want
Susie Singer Carter (31:37):
to clarify what you said though, about the
two hour window, because what ifyou as a family member, like you
have somebody who doesn't who isnon verbal, your loved one is
non verbal, and you find outthat they've been sexually
abused, right? And they move theperpetrator to say another
floor, but you don't find outabout that for whatever a couple
weeks, it just happens to leakout and you get it now you your
(32:00):
windows passed to file a reportwith the police department or
what? Oh,
Unknown (32:05):
no, you could always file the report. The facility
has the opposite, the obligationwithin two hours. It's not you.
The facility has the obligation.
They could do it at any time.
Okay, okay,
Rick Mountcastle (32:18):
and now, and you talked about the
difficulties of the civilprocess. You know, for example,
filing a civil lawsuit againstthe facility, you mentioned that
the issue being, if you signsome sort of an arbitration
agreement, which I think, Ithink are being frowned upon by
at least some of the or were bysome of the government
(32:39):
authorities. But in the eventthat you didn't, it's often
difficult, right to even get aprivate attorney to take your
case. Do you? Can you? You haveany thoughts on why that is?
Unknown (32:51):
Well, I do have some thoughts. First of all, the
private bar claims bar, they allknow each other, not even
nationally. They know each otherbecause there's so few of them,
and then they specialize innursing home cases. So it's well
worth trying to find somesomeone. But one of the one of
the problems is that sometimesstate law has caps on the amount
(33:18):
of damages you you can get in acivil suit. I don't happen to
remember what they are inVirginia. I'm not licensed in
Virginia, but so that creates adisincentive financially for
some attorneys. And of course,historically, the notion was,
(33:38):
well, it's an 85 year old woman,she's had no earning power,
there are no damages. Thatturned out to be a complete
bogus reason, because when casesare brought and they're
compelling, the jury verdictsoften are very good. It's just
hard to get voters to do it, andit takes time
Rick Mountcastle (33:59):
well. And I think the the reason for those
compelling jury verdicts is thatthe damages component for a
nursing home resident is painand suffering. Yes, would you
agree with that? I would it'snot lost wages, it's not medical
payments, because it's usuallycovered by Medicaid or Medicare
or some insurance, but it's painand suffering. And the way kind
(34:24):
of, you know, going to aconversation that Susie and I
had long ago at the beginning ofour journey, was, hey, Susie,
you're a filmmaker. Videotapewhat's happening to your mom to
show the pain and suffering.
Now, Susie happens to be afilmmaker, but I think that the
iPhone has actually made all ofhis filmmakers, so maybe this,
would you, would Oh, would you,would you, what would be your
(34:51):
thought on advising familymembers who find themselves in a
situation where they they'refighting? And abuse and neglect
in a nursing home using theirphones to videotape what's going
on.
Unknown (35:06):
Well, that that's a great idea. Of course, it
requires them to be there.
Another option is to have asurreptitious recording device,
a video recording device, in theroom. Now, there have been
examples where the facility mayrequire you to tell them that
you're doing it. But there havebeen cases where you have done
(35:29):
they've done it without thefacility knowing.
Rick Mountcastle (35:34):
Can I, can I put a caution on that? Because
every state, there's everystate, has different laws with
regard to surreptitiouslyvideotaping someone, right? So
you must consult with your statelaw on whether you're it's legal
for you to do that. So I justput that as a caution. Some
(35:55):
states it is legal. I think onestate, and I can't remember
which one says you can do it aslong as there's not sound. And
then some states say it'sillegal to videotape someone
without their permission. So Iwould put a caution on that. I
would not I would suggest to ourlisteners, don't just do that
until you find out what yourstate law
Richard Routman (36:17):
requires. I totally agree. I just
Susie Singer Carter (36:21):
want to throw something with my own, you
know, experience, as well as,like, when, when Rick had said,
you know, start, just startmonkey, you know, taking video
of your mom so you have a recordof what's going on. And there
were, and they the frontlineproviders, a lot of the CNAs who
were, you know, didn't want tojeopardize their jobs. Clearly
they would. They got to thepoint where they were like, you
(36:43):
can't record, you can't take apicture, you can't you have to
go out. It's against our rules.
Well, I just assumed that wasright, because they were
throwing out HIPAA and all that,and saying you can't, you know,
you have to get permission.
Well, that's not true. You canfind you have to find out what
your rights are per your stateand find out if you are allowed.
(37:03):
I you know, I don't know if youknow, but I don't know if that
is even a law anywhere that youcan't take video of your own
family member.
Unknown (37:13):
I don't know the answer. I was aware of case at
least one case years ago wherethe facility did not know about
the camera. It was the film wasintroduced, and it was fine, but
that was a long time ago. One ofthe advantages of having Rick
here is that he's keeping me onthe straight and narrow with
(37:35):
respect to the law. So,
Rick Mountcastle (37:38):
yeah, well, the law is different in
different states. Be careful.
That's all right. As far asHIPAA, though that's a federal
law and so Susie, in a case of acaregiver who has power of
attorney to make medicaldecisions for their loved one,
they are actually as thoughthey're that person. So you can
film your loved one if you arethe power of attorney, right?
(38:01):
Some places they call itsomething else. What
Susie Singer Carter (38:04):
conservator person,
Rick Mountcastle (38:07):
right? Or power of attorney, you don't
need to get anybody'spermission, because you stand in
the shoes of that person thatyou want to film, right? If, if
you're not one of those in thosepower of attorney, just get your
loved one, just get your grandmaor mom or dad or whoever it is
to say to it, to say, Hey, Iagree to let you fill me yeah,
(38:29):
you have that that piece ofpaper, and it doesn't have to be
anything formal, just theiracknowledgement or their
permission and their signature.
And now you can film away, andit doesn't matter what the
facility says,
Susie Singer Carter (38:44):
right? It's important, I think, for people
to know that, yeah, because Iwas, I was afraid, so I didn't
want to get retaliation, and,you know, rock the boat anymore.
So I was trying to be, you know,not push, yeah, like, not rock
the apple cart, too much, right?
But
Unknown (39:01):
I should have done more. I totally agree with Rick.
What weather? One othercautionary note is you have to
be careful not to film the ifthere's a roommate, you have to
make sure that roommate is notfilmed because you don't have
permission there, correct? Yes.
But you know, Rick, just tofurther your point, this is such
an important device for knowingabout what's going on at night
(39:26):
in a nursing home or on theweekend in a nursing home when
it's not well staffed, that thatwould be a proper subject for an
advisory Council like theCommission on Aging to permit
this issue and commitvisibility, because there are
examples of where it has workeddramatically in litigation, and
(39:47):
it might be a long process toget that kind of acceptance for
the law to permit it, but itwould be worth at least
beginning that process. Typething.
Rick Mountcastle (40:02):
Richard, do you have any thoughts on why
these commissions on Aging,which are in every county,
right, and they're advised bycitizens of that county? Why?
Why things are not improving inthe nursing homes? The in fact,
they're getting worse. I mean,we, we have these groups to that
(40:22):
are there to to provide somesort of support for the elderly,
their government rates in everycounty, but things just seem to
be getting worse. Any, any, anyspeculation thoughts on that?
Unknown (40:41):
Well, my feeling is that the program for advisory
councils should include atraining so that people
understand we're talking aboutfolks who have some interest but
don't have much background, andit's a complicated area. There's
a lot of federal, statemishmash, so they should be
(41:02):
trained to ask the rightquestions and to demand, to talk
to agencies at meetings and getand get answers. So I think that
it's a long process to getpeople to to educate themselves
(41:23):
and to have the guts to go toelected officials and say, look,
we've got to make some changeshere. I wish I had a better
answer than that. Rick, but I'mnot. I'm afraid this is an
intractable issue.
Rick Mountcastle (41:39):
No, that makes, that that makes perfect
sense. So would you recommendthat you know people like our
listeners on this, this program,or people who are caregivers for
elderly folks that are inskilled nursing facilities?
Would you recommend that theyget involved in these advisory
committees that advisecommissions on
Unknown (41:59):
aging? I absolutely would recommend it. And I also
have another recommendation thatSusie singer Carter and Rick
moncast will come up with atraining program in addition to
their film that could be used byevery county commission in the
country. And actually, I'mpretty serious about that.
Susie Singer Carter (42:23):
Well, we're hoping that the film is, you
know, will help that and be ablepeople will be able to use parts
of the film as training and useit as education, you know, and
also this podcast and where, youknow, we're specifically talking
about these, these subjects indetail, you know, because it,
(42:45):
that's what's important, becauseknowledge, knowledge is power.
And that's, that's, yeah, we'rewith you. That's, that's one of
our goals, right? Rick, toeducate.
Unknown (42:57):
There's also, absolutely, if I may add one
large one another point, thereis a political feature to this
issue. If it is true, which Ibelieve it is, that nursing home
chains and nursing homes makepolitical contributions to
legislators. They have a greatdeal of influence on the kind of
(43:19):
oversight that actually occurson nursing homes. Why not
require nursing home chains todisclose the amount and
recipients of their politicalcontributions? I think that
would be an important thing forthe people to know, because
(43:39):
there have been plenty of peoplewho've tried to make changes in
the system, and it's very hardto do
Susie Singer Carter (43:46):
absolutely and it goes beyond that. It's
the contributions to ourpolitical candidates and things
like that, right? So, so, youknow, I've seen so many groups
now in the past three years thatI've watched them work so hard
on getting bills, you know,recognized and then into the
system, and then they're killed.
You know, the American arrival,yeah,
Unknown (44:11):
the American Healthcare Association is the lobbying of
arm for the nursing homeindustry. What are their
political contributions? Isuspect they're substantial.
Rick Mountcastle (44:24):
Well, if you go to you can find the a lot of
the federal information onopensecrets.org and if you go to
opensecrets.org you'll see thatthey spend hundreds of millions
of dollars annually on campaigncontributions and lobbying. And,
(44:49):
you know, I think there was areport that was generated out
specifically about the nursinghome industry's contributions
and involvement in politicaland. Is lobbying that they
issued a few years ago that youcan find on that website. So
it's open secrets.org It showsthat, in fact, it is true,
(45:10):
Richard, that the AmericanHealthcare Association and its
state affiliates contributehundreds of millions of dollars
a year to campaign contributionsand lobbying.
Unknown (45:24):
Well, if that is true, and I have no doubt that Rick is
correct, people like the rest ofthe ordinary folks in
commissions on aging arefighting with sticks and the
other side are fighting withguns. 100%
Susie Singer Carter (45:41):
that's why we need to have a movement.
That's why you're validatingeverything that we're we've been
trying to to communicate. Yeah,and
Rick Mountcastle (45:49):
by the way, just so people know, most of
that money that they're usingfor those political
contributions and lobbying isour tax money, because Medicare
and Medicaid substantially fundmake up the most of the revenue,
80% 8080 to 90% of the nursinghomes revenue comes from
(46:10):
Medicare and Medicaid, our taxmonies, which they turn around
and put into politicalcontributions and lobbying to
make sure that we keep gettingthe crappy care in nursing homes
that we've been getting for 50years. So that's my soapbox.
Susie Singer Carter (46:26):
Let me, let me jump on that soapbox when I
just one thing to add is thatnot only are they spending our
money, they are also buyingthemselves seats at the table in
our legislation. So they alsosit there as advisors and advise
when to pass on something, evenif it gets to that far. So
that's there's that too,
Unknown (46:49):
I think. So I'll give you an example. I'm not sure
that this is fair, but I'm goingto say it anyway. Under state
law in Virginia, there's arequirement, as in most all
states, for mandated reporting.
But there's a provision in thelaw, which is unusual. Maybe
Rick knows about it, and itsays, essentially, that if a
(47:11):
person acquire if a staff personat a nursing home acquires
information involving abuse,that person can simply tell the
person in charge of theinstitution that would be the
administrator of the nursinghome, who then has the
responsibility to report it. Thefirst person doesn't have to
(47:35):
report it. He just has to tellhis boss or her boss, and then a
boss that makes a separatedetermination whether there is
sufficient suspicion to reportit. When I was at the
commission, I called up stateofficials and said, Is this a
problem? Are you having an issuehere with this problem? And they
(47:56):
said, Yes, but it's never beenchanged, and it's been a subject
of frustration for me
Susie Singer Carter (48:05):
see that, yeah, that's so to it's so
obvious and so and so egregiousat the same time, right? Because
I went and reported everythingthat I thought was wrong with
going with my mom, just fromwhat the CNAs were telling me.
And I would go to theadministrator that, you know,
(48:27):
the director, and they wouldsay, Nope, we're fine. We're not
understaffed. Nope, no, we gotplenty of help. Nope, don't
worry about it. It's all good.
You know, nothing was reported,and they weren't going to report
it there. Why would they?
Richard Routman (48:43):
Well, they should, because it's the law.
They
Susie Singer Carter (48:46):
should, but they don't. They don't, right?
Well,
Unknown (48:50):
somebody's got somebody, somebody's got to pay
attention to this with greaterintensity than they had been.
Susie Singer Carter (48:57):
Yes, Rick, that's why we're doing No
Country for Old people. Yes,
Rick Mountcastle (49:05):
we the public, needs to be educated about all
of this, all of the failings ofthe system, so that the public
can know and become activated todemand change, because that's
the only way we're going toovercome the hundreds of
millions of dollars in moneythat the industry puts into
keeping things the same.
Richard Routman (49:26):
I think that's true, and we and we may be on
the brink of a time where thereare fewer government employees,
and it's going to put a greaterburden on ordinary citizens to
step up to the plate and takeaction and be proactive about
doing something, even if it'sonly providing a voice that's at
(49:50):
least something, and hopefully,in the course of time, elected
officials will pay attention.
Susie Singer Carter (49:59):
You know.
It's, it's, it's really tellingthat we, you know, having both
of you who have had so much, somany years experience in this
field of trying to bring qualitycare, and you know, less than
substandard care, to to our mostvulnerable, and you've spent so
many decades trying to do it,and what your conclusion is that
(50:19):
it's on us as a collective,because, and it really, you
know, and it if we don't, if wedon't listen to that people as a
community, then, then we arefailing as human beings. I mean,
it's, it's a human This is ahuman rights situation, and we
need to step up. We have to,because that's what that's
(50:40):
that's the only power we haveright now. It's obvious both of
you have spent your livesworking within that system, and
this is the conclusion. So itreally speaks volumes to what
we're trying to say through thedocumentary as well.
Unknown (50:58):
If people weren't as concerned about seniors and the
possibility that seniors sufferfrom abuse as they are about
babies who might also sufferfrom abuse. We wouldn't have
this conversation.
Susie Singer Carter (51:13):
But there's a I just had a conversation with
my another colleague of minewho's in the health system, and
she said, Well, babies are cute.
Well, you know, cute is in theeye of the beholder. Some babies
aren't that cute. No. I mean,you know, listen, my mom was
adorable, and I in my mind shewas the best. So, I mean, we
(51:34):
have to get up, you know, weThat's true. I mean, babies are
we treat babies different,
Rick Mountcastle (51:43):
but just from a human, if you're a human
being, you don't want to seesomeone suffering. I don't care
who they are, how they are,someone suffering from a stage
four pressure ulcer, sufferingfrom sepsis, suffering from
dehydration. Just as a as humanbeings, it shouldn't matter how
(52:05):
cute they are or howcomparatively cute they are. It
should matter that you seesuffering and you want to change
that. You want to make itbetter. You want to make it go
away. That should be enough,100%
Susie Singer Carter (52:19):
100% but why is why? But you're right,
Richard, it's like, why we've,we've had that conversation, you
know, one of our, one of ourinterviewees, who used to work
for Adult Protective Services,and you know, was very active in
in the caregiving community andelder care rights. And you know,
(52:40):
she would say to her colleagues,I need somebody over here.
There's some abuse going on.
Okay? We'll make a report andwe'll, we'll check it out
tomorrow. No, someone needs tocome now. But it doesn't happen
like that. But if it but inchildren, for the children's
Protective Services, it does. Ithappens right there. So it's,
it's built into our system, tobe to have this ageism, to have
(53:02):
this ableism, it's built intoit.
Unknown (53:08):
And I think it's a cultural thing. I don't think, I
don't think this is truenecessarily in other countries,
for example,
Susie Singer Carter (53:16):
I think it's becoming worse and worse,
though, honestly, it's becominga worldwide phenomenon of this
individualistic kind of societythat we have created. And
Unknown (53:26):
I think that's right, but historically correct me, if
I'm wrong, Japan didn't havenursing homes, but if you grow
old in Japan, this is years ago,you were with the family, only
in recent years have beennursing homes in Japan.
Susie Singer Carter (53:40):
And now that's not it's actually worse.
They're having a crisis nowwhere they are basically sending
the elders out to the to thesecommunities of homes where
they're just left on their ownto to take care of themselves
and with no oversight. And it'sbecause the population and
because of this, the way thatsociety now is looking at the
(54:03):
elder generation. It's so easyto look at them through, you
know, a lens, as if you'rethey're othered, as one of our
experts says, they're othered.
And, you know, we, we will bethat other in a sec, in a blink
of an eye, we are all there.
Unknown (54:22):
Well, with the demographics of our population,
this is going to just get worseand worse in this country,
because the seniors are probablythe predominant feature of the
of the population, or they willbe fairly soon.
Susie Singer Carter (54:36):
They are.
It's their call. It a graytsunami. That's the term and
and, you know, there's so muchvalue in that population, no
matter what, and that's theproblem. We need to really shift
that, that that perspective toto a more healthier perspective,
because we're missing, we'relosing out on on some
(54:58):
incredible. Double, you know,value that comes from that, from
our elder generations. And youknow, I only get smarter I hope,
and I only get more valuable asa person. I hope. As I grow so I
and I see that in the peopleabove me, ahead of me, I look to
my elders as mentors and guides,that they are they should be
(55:19):
revered. That's the way I lookat it.
Unknown (55:25):
Well, let's hope that No Country for Old people is
required viewing by everybody atschools and medical schools and
nursing schools,
Susie Singer Carter (55:33):
from your mouth to God's ears. Thank you.
Well, thank you today forcoming. Is there anything else
we you wanted to say that wasburning and that I missed, or
Rick missed and that, oh,
Unknown (55:45):
it's hard, it's hard to think of, it's hard to think of
anything that either of youmissed. So I'm appreciative of
your filling the gaps when Iwhen I forgot a few things. But
anyway, no, I appreciate, Iappreciate, I appreciate the
opportunity to have thisconversation with you. It's very
important again. Congratulationson your work. We're going to
look forward to August and allof the publicity that comes with
(56:09):
your film.
Susie Singer Carter (56:10):
Well, thank you. We loved having you and and
as you might know, this show isall about love. It's in the
title, and the reason is becauselove is powerful, love is
contagious, and love conquersalls and, and that's, and I,
that's what I feel. And I'm notchanging my mind. So I think
love is our, is our, is it's,it's the big, greatest tool in
(56:33):
our arsenal. So thank you,Richard. You're full of love,
and we really appreciated havingyou today. You, you know how I
feel about you. So anyway, ifyou like this show, please, you
know, earmark it and share itwith everybody and talk about
it. Give us good reviews, comeback and listen again, and keep
(56:56):
an eye out for no country, forold people, and have a wonderful
time until we're together again,take care.
Richard Routman (57:04):
Bye, see you both. Bye, bye, thank you. You.
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