Title: Government Irrationality: Lockdowns, Mandates, and the Elderly
Original CoS Document (slug): neglect-of-the-elderly-irrational-mandates-poor-quality-of-care
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Created: 2021-11-08 12:23:55
Updated: 2021-11-17 03:00:00
Published: 2021-11-10 03:00:00
Converted: 2025-04-14T21:14:12.557620730
If you have misgivings about lockdowns and broad-brush mandates, as I do, then you’ll want to know how the the elderly in long-term care experienced them.
In early October this year, a COS volunteer called me with a harrowing story about his mother. I would say “elderly mother,” but she was only 65 when the story began, less than a year ago.
Chances are that you have a loved-one or know a family who suffered like hers and will recognize close-to-home details. I told my friends about this story. They told me of other stories like it in outline and in most of its details.
My friend has asked that I keep his family and the institutions that cared for his mother anonymous.
* * *
On December 25th, 2020, she fell in her rented home. The fall broke her femur, the largest human bone. Breaking it can cause harm throughout the body. The fracture was complex, meaning that it broke through skin and splintered along its length. It required intensive surgery, so she was taken to a Vanderbilt regional hospital.
Because of a disability, she needed special accommodation to get into and to leave her home. Her rental home was supposed to be ADA compliant. But the door she tried to enter did not have supports.
If not for her fall, she might still be alive. She died August 18 at her grandson’s house.
The rental property is owned by a corporation and is protected from full civil liability, by virtue of state action that also appears to be a clumsy over-extension of authority.
According to the act, titled “Tennessee COVID 19 Recovery Act,” anyone who files a complaint for damages “must not only prove causation by clear and convincing evidence, but also that the act or omission causing the injury and damages was gross negligence or willful misconduct.”
The burden of proof is high. From the standpoint of care providers it seems to be a necessary protection.
But this fall and the family’s emotional and financial costs are not the worst of her story.
* * *
Care at Vanderbilt was excellent, my friend said. Surgery left a long open wound about the width of a yardstick under her thigh. There were other openings for drainage. Follow up should have included intensive wound care, treatment for pain, and placement in an elder care facility capable of adequate daily care.
Between the fall, which happened on Christmas Day, 2020, and her passing away on August 18, this year she lost a hundred pounds. She became delusional, frequently lost control of her arms and hands, often lost the ability to speak. Pressure sores opened on her stomach, back, and legs.
The long wound became infected. Skin over and around it puckered, blackened, and oozed.
She was in and out of several care facilities. None of them, according to my COS colleague, provided good care. At least one of them is implicated in gross neglect, but it, too, could be protected from liability because of a state order.
* * *
From the day of her fall until December 29th, she was at a Vanderbilt hospital where the care was excellent. From the day of her discharge until she passed away, she kept saying she wanted to go back to Vanderbilt.
No wonder.
She was moved from Vanderbilt to a facility that seemed, as my friend puts it, “more intent upon keeping her than caring for her.” The major concern seemed to be revenue. She was there from December 30th until July 9th.
Her wounds opened wide, my friend learned, but he and his family were not allowed to see her. COVID restrictions were in force, staff said, and they could not or would not provide transportation to physicians’ appointments. This seemed, my friend said, to be an effort to “throw her into long term care,” which would benefit the facility.
When he finally saw her, he found her mentally “in a different world,” covered in vomited bile, and lying on a bed stained with black blood.
He doubts she had been bathed, ever. Pressure wounds had opened on her stomach. They were “huge,” he said. Care for her leg wounds was questionable, maybe non-existent, or intermittent, at best. The wound pads were to be changed every other day. The “patch” he saw was heavily stained and at least two days old.
His visit was on July 3rd. She didn't want to eat. From January until July he and the family had been barred from her room.
On July 7th, when her daughter came in response to a call from the facility at 4:30 a.m., she found her mother lethargic on the bathroom floor. She had fallen. She, too, saw the same bile-stained, blackened sheets, and when the family found out, there was a confrontation about the quality of care. Nothing changed.
On the 8th, her daughter got her to emergency care at a Southern Regional Health Center. Within two hours, physicians there discovered a severe urinary tract infection. Obviously, it developed at her care facility.
For seven months, no one at her long-term care facility had mentioned a possible UTI. To professional observers, symptoms of a very severe UTI would include delusions. Evidently, no one had taken the time to wonder whether her evident mental incoherence might be symptomatic. Or maybe they figured on a different cause for her delusions but wouldn't say.
Her physicians at the Regional Health Center diagnosed vertigo as the reason for her fall. The family urged that being delusional isn’t a symptom of vertigo.
My friend's mother wanted to be moved to Vanderbilt for observation of her wounds, but was refused transport. She was discharged from emergency care with words that became all too familiar to her: “There is nothing else we can do.”
Her pressure wounds, my friend said, were then so bad that bare bone was visible on her backside. The surrounding tissue was black, necrotic, with a green tinge. Two large holes, in addition to drainage openings, appeared at either end of the still open surgical incision site, and the canal along the wound would open, close, then open, and green fluid would flow out of it. Her wound care clearly had been neglected for a long time.
On July 9th, she moved to a different regional health center where she was treated until the 26th for dehydration, malnutrition, and the UTI. She had been taking Oxycodone since her discharge from Vanderbilt in December. That, or the infection, or both, or possibly other drugs, made her hallucinate.
On the 26th, she moved to yet another hospital in Tennessee and stayed there till the 30th for tests.
When her son and daughter tried to find a fourth care facility for her, they were told that she was “too acute to be admitted.”
Indeed.
There seemed nowhere to go, certainly not back to the facility that had so badly neglected her after surgery.
Eventually, taken to yet another regional health center, she was admitted and stayed five days from July 25th till July 30th. This center failed to see evidence of sepsis, despite delusions, obvious necrotic tissue, and gangrene. She was “forced to leave.”
From July 30th till August 4th, she was at her grandson’s house, where he prepared a room for her, furnishing it with air conditioning and the comforts of family visits, and close, attentive care. She was comfortable, eating and talking. Her family came and went as they pleased until she again appeared to deteriorate.
So on the 4th she went to an Alabama regional heath care center. Physicians diagnosed sepsis and indicated on the record that it had infected her brain, but, curiously–and sadly–no one informed the family of this fact. They learned of it after her death when they logged in to their mother’s MyHealth account.
On August 11 she was diagnosed with COVID at that health center, which is odd, since she he had been given the Moderna vaccine in February. Between February and August, that particular vaccine still offered a high degree of protection.
At this final care facility, my colleague found his mother with knotted and matted hair. He says that “she stank.” He doubts that she had been bathed, perhaps for weeks, maybe months, and the family had not been allowed to intervene.
Here, she was going to be locked down, again—the COVID diagnosis.
She began to say again and again that she was just giving up.
My friend brought her home, back to her grandson's house, on the 13th.
She passed away the 18th.
The family asked for an autopsy, but was refused; the stated cause of death was COVID.
There were other possible explanations, clearly—sepsis, cranial inflammation, the UTI, the massive open wounds, loss of the will to live. Despite the family’s almost constant contact with her when she was at her son’s house, no one in the family ever contracted Covid-19. So much for the COVID diagnosis.
* * *
Broad-brush mandates, like the lockdowns during the pandemic, are irrational.
We were told by knowledgeable authorities that they were to “flatten the curve,” the ascending graph line showing increasing deaths from COVID patients. The point was to reduce the number of deaths and hospitalizations so that the graph line would trend flat or downward.
That made sense, right? But what of the infinitely various individuals whose destinies were represented in the dull abstraction of a line on a graph? There were understaffed nursing homes to consider, and the sometimes abysmal quality of care, and the damaging effect of lockdowns on the elderly in isolation, not to mention the extremely complex variety and severity of their medical histories. How could a broad mandate help clinicians sort them out? Would they even be allowed to sort them out?
Did the issuers of the mandates take into account this dizzying complexity? Did they take good health into account?
Did they consider that simply being good to the elderly was important?
How about the bad behavior of caregivers who knew they were not being observed because family members were kept outside? Would they be good?
Did a mandated lockdown take into account likely morbidity from other causes, possibly the mandated lockdowns themselves: suicide, abused prescription drugs, alcohol abuse, despair from loss of basic life-functions and loss of sound health because of sheer loneliness?
No, the lockdowns did not take any of that into account. It all happened.
* * *
Ironically, mandates have become heavier as the pandemic winds down. Important facts keep getting left out of consideration, among them the elephant in the room whenever public health officials speak, natural immunity of now over 100 million people.
And there are the now well known side effects of vaccination, stubborn phenomena that federal officials set aside: the deadly effects of myocarditis following vaccination of young men; clotting in women; severe strokes following vaccination; paresthesia, i.e., numbness, usually of the arms; worse, Guillain Barre Syndrome; pericarditis; and the myriad preconditions and side effects peculiar to and consequential among the medical histories of the over 350 million Americans.
It seems that when the government has acted, it has done so without forethought, without nuance, and without enough intelligent consideration of the conceivable ill effects of broad government actions in and of themselves, especially when they are harshly enforced.
The unforeseen can be foreseen with imagination and foresight and by giving the obvious its due. Yet even now the current mandates leave out of consideration the widely known, top-of-mind fact that mandates do harm.
Mandates, especially the nursing home lockdowns, left out a first order personal value—responsibility, especially that of family for their elderly—and insert cold bureaucratic responsibility first.
They omit emphasis on credible, unbiased scientific advisories and insert instead politically motivated information that mixes truth with falsehood, the most dangerous kind of half-truth.
They should, by contrast, assume that American families are responsible and take into account the multitude of good faith and morally prudent exceptions to broad mandates that American families can present.
The premise of the mandates that we have duly observed and obeyed is flawed by these sins of omission. To the extent that they are forced and peremptory, they tend toward oppression. Lost livelihoods are the cost of resistance. Being forced out of lawful means of support by irrational mandates, and the potential loss of home, and food, and sustaining labor, is oppressive.
As some might urge, we are not in shackles. But oppression takes many forms. Ask the parents of any family whose breadwinners have been forced out of work for refusing to be vaccinated, even though he or she has natural immunity. Ask any child of an elderly parent who has been neglected and abused during a lockdown.
Mandates?
Simple advisories are best, supported by honest, tactful, and reasonable persuasion. Politics and prejudicial policies were best set aside.
* * *
Ten years ago, an Ohio native, Steve Piskor, suspected that his mother was being violently abused in a Cleveland nursing home. Her name was Esther. When he saw suspicious marks on her—dementia prevented her from explaining what was happening—he placed a camera in her room. As it turned out, the camera revealed abuse so violent that the images led to prison for two of his mother’s aides.
The premise of regulations controlling elder care apparently didn’t take well enough into account the irony of caregivers who inflict intentional harm.
Since then, Mr. Piskor has led efforts to institute what the Ohio legislature calls “Esther’s Law.” It allows cameras in clients’ rooms to offer protection until now denied vulnerable people in elder care facilities. The law provides safeguards against misuse.
That law was passed in the Ohio House this week (October 28, 2021.) It exemplifies one needed, humane correction, late coming indeed, to the irrationality of much government regulation.
Now it is the business of other states to bring a much needed corrective to neglect of the elderly and exploitation by caregiving institutions.
Tennessee needs Esther’s Law. Every state needs an Esther’s Law.
* * *
On March 13, 2020, “the Centers for Medicare & Medicaid Services (CMS) issued its lockdown order, banning everyone but essential personnel from entering nursing homes.” In September 2020 the limitations eased and “residents and families could see each other in-person” again, as a report by The Consumer Voice for Quality Long Term Care observes.
Leadership of that organization began hearing from “family members that their loved ones were almost unrecognizable because of physical and mental decline. Families shared stories about residents who had lost extreme amounts of weight, not been washed, developed pressure ulcers, and suffered significant cognitive decline.”
Consumer Voice conducted a national survey to assess the degree to which their concerns were widespread.
“The results confirmed our concerns,” the report says. “Of the 191 respondents from across the United States, an overwhelming majority indicated that they had seen decline in both physical and mental conditions. Additionally, families reported that their loved ones were missing possessions ranging from glasses and hearing aids to wedding rings and clothes. Family members repeatedly noted the same issues - residents were unkempt, clearly had not been bathed or groomed in months, had lost significant weight, and were significantly depressed-even suicidal.”
The president of Consumer Voice, Lori Smetanka, wrote me in an email that “We had many of the same stories from ombudsmen and other advocates from around the country.“ She is concerned, in addition, about the use of antipsychotic drugs, which are “often used as chemical restraints, and [subsequent] increases in new schizophrenia diagnoses among nursing home residents.” She says those diagnoses are “suspect because schizophrenia does not present itself for the first time in a person’s later years, but the diagnosis is a reason for prescribing antipsychotic drugs.”
My friend’s mother was delusional when in long term care, and normal in her few days at home. Suspicious indeed.
The country needs, as my friend puts it, “Nancy’s Law,” as he calls it, a requirement that at least one family member be given, by statute, free access to enter the rooms of his or her elderly relative in long-term or intensive care, regardless of a declared state of emergency.
He is lobbying hard for that law after his mother’s story came to its sad end.
We should all lobby hard against irrational and oppressive government action. We have seen too much.
The best way, I believe, is by a Convention of States that brings amendments to The Constitution limiting the jurisdiction of the federal government and limiting, as well, the number of terms federal officials, including unelected bureaucrats, can serve.
Then none of the federal agencies now in the news–neither OSHA, nor the Department of Labor, nor the CDC, nor the NIH, nor the CMS, nor the DOJ and FBI–could impose at will so much harm upon us or those we love because lifelong, unelected officials would be gone.