By Steve Moran

On the Monday before Thanksgiving, my 93-year-old retired physician father fell and broke his hip. At 93 his body is failing him, his brain is not. This turned into hip surgery on Tuesday, transfer to rehab on Wednesday evening, and the beginning of a 10-15 day rehabilitation process.

I am not going to name the rehab facility because, honestly, as California nursing homes go, Dad is in a place that is better than average. But honestly, it is not good.

The Problems

The fundamental problem is that the residents are the least important part of the equation. What is important are the regulations, the routines, not rocking the boat. Here is what I mean:

Going to The Bathroom #1

At 93, Dad’s bowels don’t work as well as they once did. Tough thing to talk about this, but I do have permission. He knows that from time to time he needs a suppository to keep things moving. He knows what works, his cognition is good. He knows more than his nurse and knows his body better than the house physician.

It has been a week and he is still in a battle to get what he needs.

Going to The Bathroom #2

New hip repair means he is not supposed to go to the bathroom unassisted. The way it is supposed to work is that he uses the call system to get assistance going to the bathroom. It turns out that NEVER once did he get help in a timely fashion. This meant either soiling himself, requiring a significant change, or going it unaccompanied, something he ended up doing most of the time.

There is no dignity in either one.


Pain mitigation is critically important, but it should serve the needs of the resident not the needs of the facility. In his case, they would bring and offer medication and he would need to either accept the medication or it was gone. What he found was that he would be offered pain medication, not need it at the time, then a few hours later need it but it was too late.

Response Time

In Dad’s facility, and way too many facilities, there seems to be near zero sense of urgency in responding to requests for help; with responses typically taking 10 to 30 minutes. This seems to be the norm rather than the exception in nursing homes, at least in California.

Dad’s roommate is a gentleman who has very limited cognitive abilities. He needed help transferring from his wheelchair to his bed. They promised to come to help him make the transfer. It took 40 minutes for it to happen. I get that other things are happening in the facility and that it was not urgent. But simple courtesy would dictate saying, “it could be 30 or 40 minutes before we get to you.”


You might be thinking . . . “just a bad facility.” But there is no reason to believe that this is not typical. Fundamentally the problem is not money or the current staffing crisis. Rather it is that we have set up a long-term-care, senior living system that operates on the premise that residents are supposed to “get with the facility, community program”. rather than the community saying through their style of operation and attitude that it is their job to figure out how to make the program flex to give the resident the greatest possible experience.

This is senior living’s greatest failure; it is also senior living’s greatest opportunity.