|The sight of a headless bride gives residents "thoughts." But what kind of thoughts?|
When you step off the elevator onto the fourth floor of Sunrise Senior Living, and you enter the secure “Reminiscence” ward -- where dementia patients are housed -- you might well become overwhelmed with a sense of dread. The first thing you see is a large, semi-dark room – known as “the TV room” -- in which about 25 women sit virtually all day in theater-style rows, with their eyes closed and their heads either hanging down or thrown back. A couple of them gaze vacantly into the distance. There are no interactions between them, and the seating arrangement certainly isn’t conducive, even to eye contact. Is this what the website meant by "individually tailored care"?
No one is watching “Let’s Make a Deal.” They ignored "The Price is Right" as well. It would be too bad if they were interested: The sound is turned off. These women look gray and dead. They seem unreal, as if they were in Madame Tussauds’ rendition of Zombieville.
I am sick with grief and guilt as I confront the fact that my mother is moving into this $74,000 a year institution tomorrow.
|They ought to be watching "This is Your Life." And it's not "A Wonderful Life". (I have never seen the drapes open).|
A Sunrise promotional line comes to mind: “A place to tone the body, challenge the mind and lift the spirits.”
This was my first inkling that there was Darkness at Sunrise, and that before long, I would embark on a prolonged campaign to improve conditions there. Over the next five months, I wrote dozens of emails to Sunrise staff -- and letters to corporate headquarters that contained about 12,000 words total -- seeking to understand and possibly to help remedy the countless ways in which Sunrise failed to meet its contractual and legal obligations. I was ignored. They don't care. Dementia patients don't tend to complain. Their families send in their $6,000 or so checks each month, and all is well.
In this post, I will make this case about the dementia care offered by Sunrise, which operates about 300 elder-care facilities:
- Beneath the facade of cheeriness, compassion and competence is a coporation that overwhelmingly values profits over patient care. Its executive director (ED) and reminiscence director (RD) strictly enforce this facade.
- Sunrise does not provide dementia therapies. It claims to use "cutting-edge" approaches to preserve and even improve the brain function of its residents. Instead, its "activities," which most residents sullenly ignore, are straight out of a first-grade teacher's manual. Cutting-edge therapies are available, but Sunrise is content to stick with cheap, outdated methods.
- Sunrise is secretive and paranoid. It illegally prevents families from having access to all written records about their loved ones (behavioral and medical) and "serious incident" reports, which are stamped "Confidential." What drugs are you giving my mother? That's classified information.
- Its script -- and the whole operation is scripted -- obliges all staff to tell residents' families that they are having "beautiful days," are in a "great mood," are enjoying the so-called activities, and "adjusting well" -- no matter what the real truth is. Keeping families complacent is vital to the Sunrise strategy.
- Sunrise has lax security. Residents can't lock their doors. Men wander all the time into women's rooms, creating an unsafe and unsettling environment.
- Sunrise shortchanges its residents' nutritional needs. There is lots of sugar. There is very little fiber and minimal use of fresh produce or whole grains. Although virtually all of its residents are almost certainly deficient in Vitamins B12 and D -- which are vital to brain health -- it has undertaken no campaign to ensure that supplementation is provided.
- The Sunrise "medical team" is incompetent, lacking in compassion, and lazy. Residents are often told that their pain, weakness, dizziness, inflamed eyes, etc., are just "part of getting old." The residents do not feel respected or cared for.
- Most residents at Sunrise are merely vegetating, spending the vast majority of their time dozing in the "TV room." They are being cruelly warehoused.
- Sunrise claims to be aware of what I readily discovered: That its residents' dementia has not destroyed their brains. They are interesting, empathetic, observant, funny people who could greatly benefit from a decent program of affection and mental stimulation.
- Sunrise refuses to put anything in writing. I got accustomed to this while writing my series on Edward Jones, but that firm had the excuse of SEC scrutiny. Sunrise has none. I have submitted dozens of questions over the past five months, but both local and corporate officials insist on having meetings rather than providing written responses. I have tried to have meetings with these people, but they are a waste of time. Officials lie, digress, throw out red herrings, and make excuses that are either weak or lacking in credibility. All I asked for was that they provide their policies in written form. I got nothing. They refuse to commit.
- As a result, this should not be considered an objective work of journalism. I am describing my true, deeply felt, experiences and impressions. If you want Sunrise's side of the story, refer to the corporate website.
- It will be natural for any reader to wonder why I didn't get her out of Sunrise. I did my best to get her back home, where she wants desperately to be. I found a wonderful caregiver, with 35 years of experience as a certified nursing assistant, working with elderly and demented clients. She agreed to be a live-in housekeeper and companion. This move was blocked by a trumped-up legal action by my sisters, so she remains at Sunrise, until I muster the emotional resources to fight back.
- Now to the story:
MOVIN' ON UP -- TO THE DREADED 'LEVEL THREE'
|Sunrise Senior Living in Holladay, Utah. There's probably one near you -- maybe a cuter one!|
JUST ISOLATE HER, AND RE-EDUCATE HER, LIKE IN CHINA
|My mother's Sunrise bedroom.|
|The ward was filled with resignation and loneliness.|
TAKING YOUR COMMENTS TO AN ILLOGICAL CONCLUSION
WHAT DID THEY DO TO HER?
I was there every day for a long morning of breakfast and socializing. When I asked her why she had stopped calling me, she said, "I didn't know I ever called you. I wouldn't think of bothering you with my problems."
What total crap!
|I had taken my mother out of her home in part because it had become chaotic. Here, it was as bad as ever.|
|Her room was a mess -- and it smelled like steer manure.|
LET'S MAKE A DEAL: GIVE US WHAT WE'RE PAYING FOR
“Our dementia care program focuses on understanding the stories and details of a senior's life so we can help all experience pleasant days. Backed by the latest research and knowledge of Alzheimer's and dementia care, our professional team designs personalized programs with multi-sensory experiences, daily exercise and outings, group activities and regular contact with children and pets."
|The two house cats seem to have an instinctive understanding.|
|Your personal caregiver will bring joy to every demented day. Nope, it's not like that.|
|There are no hugs from staff, nor are their bright-eyed, stylish, healthy residents in Sunrise dementia wards.|
Here's just one: According to the New York Times,“‘Exergames’ (video games for dementia patients) have the potential to increase fitness by shifting attention away from some of the aversive aspects of working out, and toward motivating features such as competition and three-dimensional scenery. The brains of the participants remained highly plastic, and training resulted in significant neural changes that were measurable with brain imaging.”
But perhaps this exceedingly wealthy corporation finds Halloween Trivia to be more cost-effective.
|And which one has a long neck?|
Life in a TV room is not what we agreed to pay $74,000 a year for. When my mother is engaged – and they are supposed to be engaging her – she perks right up, and is delightful. When she has something to do, her energy returns. But she is wasting away in there, going downhill fast, just like everyone else.
|The web site is full of cuddling. The Sunrise isn't.|
The website appears to have been written by someone who has never spent even five minutes at Sunrise. Several top people (administrators and senior aides) at the facility have admitted to me that they have never even read the website. They would be quite unsettled if they did, by the discrepancy between the joyful life the site describes and the reality of one numbing, endless day after another. The web site is storybook fiction. Delirious dreaming. Wishful thinking.
Most importantly, it's deceptive packaging.
In 2014, Sunrise finalized a deal with Revera Inc. and Health Care REIT, Inc. (HCN). Revera, a leading provider of seniors’ accommodation, care and services, which will enhance economies of scale and buying power. The latter firm is an S&P 500 company and real-estate investment trust.
|The lobby is akin to a stage set. It provides a veneer of tasteful luxury.|
There is so much in my mother’s intake assessment that is not just off base but entirely wrong that I couldn’t conceive how it came to be. It claims she has four medical conditions, none of which is correct, and its list of her favorite activities is almost entirely fabricated. I can provide details. One particularly absurd error is “Eunice becomes irritated when asked questions.” I told the RD that she is irritated by condescending questions, but is otherwise a wonderful conversationalist, as everyone there has discovered.
This “individualized service plan” is supposed to “provide peace of mind for residents and their families that such detailed understanding creates personalized care and services necessary for the best quality of life.” It doesn’t. It just helps to expose the fraud that “the Sunrise experience” is all about.
|In her dreams, she's "free as a bird." / by SubCowpur|
The incident brought out the “full metal jacket” approach to Covering Your Ass, as the institution promptly destroyed potential forensics evidence, belittled my mother’s sobbing assertions, and waited five hours to call me. They said, “She feels fine this morning, so do you think we need to call the police?” This episode – particularly the delay in notifying law enforcement -- “meets all the criteria of elder abuse,” according to a Salt Lake County detective.
The bag with my mother’s sheets in it remained in a large dog bed in his office, a well over a month after the incident. Oddly, the stained bedskirt and carpet were left as they were for more than two weeks. I have photos of them, taken 10 days after I discovered them.
And even more odd: I saw the sheets on my mother’s bed from about the waist area upward. There were no stains. When George said, “Oh there were stains, all right," he must have been referring to the ‘below-the-waist’ area. For some reason, it hadn't occurred me to pull the bedspread all the way down. The evidence I'd already documented seemed sufficient for conclusive testing.
We are paying to have aides either help her or prompt her to maintain her hygiene, but many of them seem to have given up, because she is “resistant.” (They are also overburdened by large caseloads, which the facility could remedy by forking out a tiny fraction of its gross profits to give the aides some breathing room.) Many if not most dementia patients are resistant, but an “expertly trained” staff should know how to address this behavior out of respect for her and for her family.
My mother is not getting the “continuity of care” that Sunrise acknowledges is so important to the resident’s welfare: “The designated care manager is a role unique to Sunrise. A serving heart, the designated care manager is a compassionate and trained caregiver who consistently cares for the same residents in their suites and throughout the community,” the website says. This is pure bunk. A total lie!
|"Fantasyland" / by Melanie Taylor|
I don't recall seeing even one instance of a caregiver sitting down with a resident to chat or just enjoy looking out the window. I also don't recall ever seeing physical affection being shown by an aide, despite all the cuddly photos on the website. While I can imagine that there are complexities regarding this, I have hugged and kissed pretty much every lady there, and they seem to melt with pleasure. I believe they are desperate for human touch.
JUST GO RIGHT IN AND DO WHAT YOU PLEASE: THAT’S THE SUNRISE DIFFERENCE
|Give her a lock and key, you fools.|
There are two men who I have found repeatedly in my mother’s room when she was not there. Both have several times forcefully tried to follow us into her room. I tell them firmly to leave – that “this is for women only.”
THE ROVING PERILS OF TESTOSTERONE
|It's not his fault. He doesn't even know where or who he is.|
|And it burns, burns, burns: The ring of fire.|
My response was: I have no sex life, and haven’t for decades. If I did, I wouldn’t discuss it loudly anywhere -- certainly not in a medical facility. And why the hell would families write to McLean, Va., to report this, instead of coming straight to you, Mr. fancy-pants ED? Isn’t that insulting to you? I asked him to provide me with redacted copies of these so-called missives, but he refused to let me see them. The reason is obvious: They don’t exist.
|Dear Sunset honchos: What are you hiding?|
I mentioned to one aide the refusal of Sunrise to let me review the aides’ notes regarding my mother, and her reply was that “all the notes about everyone are mixed together in a jumble. We don’t, like, have a page about each resident.”
|"Falling" by GodSlayer.|
In some cases, residents’ families are notified about these “occurrences,” but the institution minimizes their severity. For example, when I was notified that my mother fell in her closet in the middle of the night, I wasn’t informed that she had lain there for some time, collapsed on top of hangers, shoes and a laundry basket. Her legs were severely bruised, and she re-injured a shoulder that had been wrenched in an earlier collapse, which I would never have known if an aide hadn't whispered it to me. In the closet, she was crying and calling out for help, but no one heard her.
I was determined to see the aide’s report, despite the strict “confidentiality” rule.
|The Sunrise atmosphere makes you wonder where you are and what you did
to deserve this isolation. At least the fish in the aquarium are real. Sunrise is unreal.
It is a highly stylized, expertly manipulative “luxury” environment, until you go upstairs to the Crazy House, which, more than anything, is a velvet-gloved meat grinder: You plop in, money pours out.
|Stepford wives are obliged to sustain a cheerful demeanor and not to question authority.|
Sunrise is described as a “cult” by many of the aides who post comments on message boards about this multinational corporation, which is so well-rehearsed in putting up a fabulous façade to prospective customers. Their clear goal is to relieve families of their guilt over institutionalizing a parent or spouse by presenting life there as full of pleasure, safety, luxury, variety and companionship.
|One lady has a baby doll --- her only consolation, except for ice cream.|
It takes only the slightest “tone” in your voice to get his upper lip spouting perspiration and his hissing mode to take over. A simple, genuine question can cause you to be accused of “sarcasm.”
She is drenched in makeup, fabulous clothes and blinding jewelry. Her tone is soothing, and she oozes understanding and tenderness. I think she probably does have quite a bit of understanding and tenderness, just as her boss does, but in both of them, their loyalty to the corporation, and to keeping their jobs, are paramount. The RD makes you feel that you are being "heard" and respected when you talk to her. It is only later, when you learn what she has said about you, or what she has promised but failed to do, or what she has done but will firmly deny, that you realize what a villainess she is. She has a Manchurian Candidate mode of operation.
My mother once told me, “I think they have spies here,” which sounds like a typical remark that a dementia patient might make – but I agree with her. Sunrise is a huge corporate entity, which is run like a totalitarian regime, with much whispering and subtle manipulation. I believe the RD is the overlord of this spy network, which enlists every aide to report whatever snatch of conversation she hears that might prove "problematic" or "not helpful." I believe the RD maintains a dossier, even if it's only in her head.
I told them I was hatching a plot to “spring” them from this joint in the dark of night, enlist muscular young hunks to carry them to a barge, and float down whatever river we could find to reach our own island, where we could live freely. "Let's be naked!" one of them suggested. They were psyched. “Count me in,” the irascible one said seriously. The others added: “Me too!”
TAKING SWEETNESS WAY TOO FAR
When I asked about all that sugar, the ED said most patients need to gain weight. I agree: they are frail. But there are empty calories (sugar) and nutritious calories (nuts, avocados, olive oil, goat cheese, bran muffins). I guess they must cost too much. Coffee refills are not offered, except when I irritate the staff and carry the pot around myself. Almost everyone wants more coffee. (Sunrise serves decaffeinated coffee, even though caffeinated coffee has shown “breathtaking” potential for staving off dementia in healthy adults, and for slowing the progression of cognitive impairment, according to studies cited by the New York Times on June 6, 2013. The statistical results, based on consumption of at least three cups of coffee daily, "show the kind of effectiveness you rarely see in any pharmacological agent of any kind.")
My first of a bazillion complaints about Sunrise was that the menu called for fresh fruit, and all they served was canned fruit. The ED was livid when I mentioned this.
“We do not serve canned fruit!” he said. “There is no canned fruit in this institution!”
I went back upstairs and filled a cloth napkin with the canned pears and grayish-yellow slices of pineapple and mandarin oranges that residents had left on their plates. I put it on his desk.
Because Sunrise failed from Day One to respond to my pleas for a urinalysis, the delirium continued. Ultimately she wound up in the emergency room, where a urinalysis was obtained in about 15 minutes. She did indeed have a UTI -- the most common cause of delirium. If Sunrise medical personnel were even marginally competent, this could have been resolved within 8-12 hours by administering an antibiotic. Instead, she spent six days in the hospital, after her agonizing week of suffering at Sunrise. She had to be transfused from the blood loss. And then, two weeks after it this whole mess began, she was sent to a rehab facility. All because of clueless, arrogant, lazy Sunrise personnel. (http://kronstantinople.blogspot.com/2014/11/malpractice-and-malfeasance-ignore-her.html .)
|An air of warm elegance characterizes the dining room where the "real people" have a choice of entrees and side dishes.|
Or, you might prefer to peruse the bounteous buffet, which offers a choice of entrees & coffees, a fabulous array of high-quality, fresh tropical fruits, silver trays of unhealthy but enticing muffins and pastries, a selection of yogurts, a compote of stewed prunes…….I could go on. When I boldly walked in and liberated a few bananas and muffins and carried them to “those other people” upstairs, festivity erupted and management exploded.
"If we left it out for them, they might drink too much," the RD told me. Too much for what? Like they're going to succumb to "water intoxication"?
(The ED admitted to me that the vast majority of dementia residents are chronically dehydrated. The visual cue of chilled, streaming fluid would surely be a prudent move. The vast majority are also deficient in Vitamin D and B12, but these supplements -- which nourish the brain, are not provided.)
|The downstairs ambiance reinforces well being, while the upstairs has a Crazy Town atmosphere. Note the fake flowers.|
These people have memory problems, to be sure, but they aren’t animals, and they aren’t stupid. I do think that living there is likely to make them become stupid, though, because the life there is truly spirit-killing.
|The explanation: She fell. On the tops of her arms?|
“Wouldn’t the case managers’ log indicate if she had fallen?” I asked the aide. “Maybe – I’ll look,” she responded. I never heard anything more about it.
|My tiny mother's legs were hugely swollen from vascular insufficiency.|
“She doesn’t pee out of her calves,” I retorted. It was not urine. Her diaper was dry. I get exhausted arguing with skeptical, somewhat resentful employees about issues that ought to be non-issues, just problems to be professionally resolved.
|Sunrise nurses check vital signs once a month.|
One assessment said there had been changes in my mother’s skin, but didn’t say what they were, or if any treatment or “watchful waiting” was called for (I discovered for myself that my mother’s chronic dehydration – which also is not being addressed – had caused such dry skin that it was cracking and bleeding on her neck, back and sides.) The more recent report states that there has been no change in my mother’s weight, and then lists a seven pound weight gain. WTF? The assessments also indicate that my mother’s blood pressure has gone from her usual 114 to 134 to 167. This was merely noted, and filed away. No follow-up has been undertaken.
From now on, I would have to take my mother out of the facility – to my house or to a restaurant – to visit her.
One Sunrise resident confided that she copes with being confined there by “living inside my head.” My mother is using the same tactic.
In her mind, she lives at home, in the tasteful, sun-splashed world she spent 50 years perfecting. She fantasizes, dreams and talks incessantly about what she’s accomplished that day at home. Her dozing hours are filled with sunny images of working in the garden, cooking delicious meals and maintaining the living spaces that she loves so much. She asks her bewildered tablemates how their gardens are doing. “If you need any greens, let me know – I’ve got plenty!” she says joyfully. She believes that the Sunrise “restaurant” provides free food for old people. “I bet it was Michelle Obama’s idea,” she says. “That cute thing is brilliant.”
As promised above, here are a few alternatives to using a first-grade teacher's manual to prevent or slow the progression of dementia. I found these well over a year ago. I'm sure much progress has been made since then:
The same could be said for coffee, which has shown breathtaking potential for staving off dementia in healthy adults and for slowing the progression of cognitive impairment, according to studies cited by the New York Times on June 6, 2013. The statistical results, based on consumption of at least three cups of coffee daily, "show the kind of effectiveness you rarely see in any pharmacological agent of any kind."