ARGUMENTATION Research paper AND ANNOTATED BIBLOGRAPY

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Student Research Paper

Professor Griffin

English 1302

November 18, 2019

The Broken System of Nursing Homes

Elderly care has become a huge issue to the U.S population, not only becoming a

financially conflicting matter but an ethics and safety conflict. As time goes on, nursing homes

continue to struggle with incessant problems that seem to not have an end. As young people

continue to age and grow into adults, they suddenly become more aware of their possible aging

and what they will do at that stage in their lives. Aging in the United States has changed over

time and will keep changing according to increasing population and financial status, so everyone

has to become aware of the continuous change in the U.S elderly care system. Elderly care in the

United States continues to deteriorate throughout the whole country for many reasons like a

scarcity in money that is the root of the copious amount of issues in these facilities. The picture

of elderly care in Welty’s short story “A Visit of Charity” is one of neglect and abandonment.

Over time this has become an accurate representation of what elderly care in the United States

has become day by day with the aging of America.

Nursing homes in the United States have gone through several changes, but some of the

most prominent changes pertain to hygiene related, safety hazard, and patient abuse violations. In

Welty’s short story, the reader is shown various images of an overall uncomfortable and

unhygienic environment. Welty depicts this nursing home as an environment of hazard and

unsanitary practice. “There was loose, bulging linoleum on the floor. [Marian] felt as if she were

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walking on the waves” (Welty 150). In cases like these, Environmental Health Specialists (EHS),

are set to conduct inspections throughout various nursing facilities and document any code

violations. These violations are then categorized into two main categories, these being structural

and hygiene related, or at times both can be reported in a single facility. “Structural violations

were defined as facility changes… (such as) replacing carpet, repairing walls, replacing furniture

or design issues” (Avery 16). In this case the “bulging linoleum floors” (Welty 150) would be

considered a structural violation that would be documented in the facility because of the

hazardous conditions they present. In Welty’s short story, one is also shown a scenario of a

hygiene-related violation. “There was a smell in the hall like the interior of a clock” (Welty 150),

which the reader may presume is a result of poor hygiene practice in the nursing facility. There

are multiple indications of poor hygiene and incorrect practices in Eudora Welty’s short story.

The room in which the old women resided “had altogether too much furniture. [And] everything

smelled wet” (Welty 151). These are clear examples of poor hygiene and weak structural

practices in the short story which is likewise evident in nursing home neglect has become

another big portion of the faults in the elderly care system in the United States. Patients in these

nursing homes should be “provide[d] goods and services to avoid physical harm, pain, mental

anguish, or emotional distress” (Pitman 139); yet, in Welty’s story nursing home, patients are

not provided optimum care. Nursing home abuse, whether it be emotional or physical is

something that should not be tolerated in any nursing home facility. In Welty’s short story

“[Marian] is suddenly propelled by the strong, impatient arm of the nurse,” (151) and the nurse

represents one who lacks patience, which can lead to inadequate patient care, eventually being a

gateway to future patient abuse. Abuse in nursing homes is becoming a prominent issue in many

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nursing home facilities along with various neglect cases. These cases are often a problem

correlated with inadequate environment and staffing in the facilities.

When situations of abuse and neglect come to light there has to be a way to handle these

issues, so that is why Tort law and neglect litigation have become key elements in the elderly

care system. In Welty’s short story, her readers are shown the lack of care and attention some of

these patients go through in nursing home facilities. In the short story the nurse running the front

desk of the facility seems highly uninterested and “paid no attention” (150) to her surroundings

or her patients. “In the past litigation [claims] typically involved discrete negligent acts by an

unidentifiable person” (Hoey 161). As time progresses these facilities undergo change and cases

of abuse and neglect have become more prevalent. Often cases are kept in the shadows and there

is not much legal action taken, which essentially abstains the families of the patient from

receiving justice of any sort. In some instances, nursing homes ploy against patients in order to

constrain them from taking any legal action, making it impossible for patients to sue nursing

facilities. In many cases “mandatory predispute arbitration clauses often bar a resident from

bringing lawsuits against a nursing home” (Hoey 162), which means that they take the patient’s

right away to report or file any claims against the facility. The change in nursing homes’

environment has made nursing homes a more susceptible place for neglect cases, which is often

caused by understaffing, or a lack of resources. In the short story, the inattentive “nurse [who]

was reading ‘Field & Stream’ at her desk” (Welty), was not providing the most favorable care

for her patients because she was too busy reading a book rather than caring for her patients at the

facility. In the short story it is only mentioned there being one nurse working the circulating

desk, which is usually a big red flag indicating workplace understaffing. “Studies show that 90

percent of skilled nursing facilities are routinely understaffed, which has direct correlation with

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patient neglect” (Hoey 168). Often these minor neglect cases begin to develop into more serious

cases of abuse towards patients and even workplace staff at times. As these patient neglect cases

continue to carry on, which is common, in most of these cases “litigation is often the only

effective method of recovery available to victims and their families.” (Hoey 170).

Politics has become a huge and essential part of how our healthcare system works. These

have total control over the funding of the elderly care facilities. If the Federal government

decides to cut down on funding, then state governments have no choice but to cut down on

elderly care facilities expenses as well, whether that means cutting down on staff or medical

supplies. In Welty’s short story the reader is shown a disregarded facility, which the reader can

only assume is because of a lack of funding and resources. But not only is this an issue for the

current elderly population, this will soon become an issue to individuals who will require these

facilities in the future. The Medical Trust Fund has been an ongoing concern in the eyes of many

Americans, but the main concern is essentially running out of this much needed resource.

“Although the Medical Trust Fund has declared the solvency of the trust fund until 2015… there

is abiding interest in emerging health care needs and issues” (Takamura 233). The need for

medical funding has increased due to the highly increasing population in the United States.

“Although the percentage of older adults in the United States has tripled since 1900, the elderly

population is expected to double [by year] 2030” (Takamura 234). This ongoing concern of

whether these resources will become scarce should also be a worry for the future elderly

populations. “It is [also] predicted that nearly 40 percent of all adults will enter a nursing home at

some point in their lives” (Hoey 168), meaning that a large majority of U.S citizens will enter a

nursing home during their elderly life. In the short story “[Marian]… wondered for a moment as

though there was nothing else in the world to wonder about” (Welty 153), at this moment in the

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story Marian becomes aware of the possible consequences that aging will bring her. Just like

Marian, many Americans will one day become aware of their aging and become concerned for

their possible retirement and care. Yet medical spending will differ from state to state, but some

states will choose to cut the spending because they deem other expenses more essential than

those regarding healthcare and elderly care at that. “The Medicaid budget competes with other

state spending priorities, such as education, pensions, and welfare” (Blankart 171). In Welty’s

short story the reader can see one of the older women cry and whine to Marian “have you a

penny to spare for a poor old woman that’s not got anything of her own? —not a penny for

candy — not a thing! Little girl, just a nickel- a penny” (154). This pleading by the nursing home

resident to Marian seems to show how much need and despair some of these patients experience

because of a lack of money and resources. “U.S health care expenditures represent a substantial

portion of public spending and are therefore likely to be affected by partisan political control”

(Blankart 171). Although the Federal government has a huge influence over the percentage of

Medicare spending, the state government is who will have a final say as to who is eligible and

can receive certain benefits and reimbursements. Medicaid is a joint federal-state program that is

administered by the states “with increasing state discretion… state governments are now the

most important decision makers with regard to eligibility” (Blankart 173) meaning that states are

the ones who influence major decisions.

As in Welty’s short story “A Visit of Charity,” there is plenty of room for improvement

in care facilities for elderly in the United States. As the population ages, and more people

become dependent on the services of nursing homes, particularly those which are not private pay,

the issue of care for the elderly demands more attention. Welty’s short story paints an accurate

image of what many nursing home facilities have become over the years. These facilities should

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be a safe home for those who are in need of care because of their old age. The problems of abuse,

neglect, malpractice, and hygiene violations which have been documented should be fixed, even

if it means increasing the budget for Medicare and Social Security at a Federal level. Elderly care

is not only a problem just for those who are currently receiving these services; rather, care for

this segment of the population represents a problem for all people, because most everyone will

one day become old or have a family member who ages, especially with expanding longevity.

Most people will likely one day need the services of nursing home facilities, which is why the

demand should be made to enhance immediately the resources necessary for appropriate care for

the burgeoning elderly population.

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Works Cited

Avery, Chris, et al. “Evaluation of Five Years of Nursing Home Inspection Forms: Structural and

Hygiene-Related Violation Trends.” Journal of Environmental Health, vol. 77, no. 4,

Nov. 2014, pp. 14–18. EBSCOhost, search.ebscohost.com/login.aspx?direct=true &db

=a9h&AN=98897998&site=ehost-live&scope=site. Accessed 9 Nov. 2019.

Blankart, Carl Rudolf, et al. “The Effect of Political Control on Financial Performance,

Structure, and Outcomes of US Nursing Homes.” Health Services Research, vol. 54, no.

1, Feb. 2019, pp. 167–180. EBSCOhost, doi:10.1111/1475-6773.13061. Accessed 9 Nov.

2019.

Hoey, David J. “The Intersection of Tort Law and Nursing Home Abuse and Neglect

Litigation.” NAELA Journal, vol. 14, Fall 2018, pp. 155–171. EBSCOhost,

search.ebscohost.com/login.aspx? direct=true&db=a9h&AN=133626064&site=ehost-

live&scope=site. Accessed 9 Nov. 2019.

Pitman, A., and Katherine E. Metzger. “Nursing Home Abuse and Neglect and the Nursing

Home Reform Act: An Overview.” NAELA Journal, vol. 14, Fall 2018, pp. 137–

154. EBSCOhost, search.ebscohost.com/login.aspx?direct=true&db=a9h&AN

=133626063&site=ehost-live&scope=site. Accessed 9 Nov. 2019.

Takamura, Jeanette C. “Getting Ready for the 21st Century: The Aging of America and the

Older Americans Act.” Health & Social Work, vol. 24, no. 3, Aug. 1999, pp. 232–

239. EBSCOhost, doi:10.1093/hsw/24.3.232. Accessed 9 Nov. 2019.

Welty, Eudora. “A Visit of Charity.” Arguing about Literature: A Guide and Reader, edited by

John Schilb and John Clifford, 2nd ed., Bedford/St. Martin’s, 2017, pp. 150-154.