The regulation of nursing homes: a case study.

Abstract

The high point of a Copenhagen bus tour is a visit to what in America might be called a cross between a home for the aged and a nursing home. These homes are-without exception-clean, cheerful, well-run and happy places, operated with the sole and undeviating purpose of providing the kind of care and attention that tells the elderly that they matter-that someone cares about them-and that they continue to be a worthwhile part of their society. The elderly can live in these homes full time if they choose or visit them as they wish during the day while living elsewhere-alone or with their families. If they live away from the home, they can receive minor health care in their own residences from a visiting nurse. The outstanding characteristic of the entire program is freedom for the elderly to choose the life-style they prefer without selling their souls or their estates, secure in the knowledge that their basic needs will be fulfilled-and their dignity as human beings left intact. One has difficulty picturing a similar tour conducted in most of America's large cities. What would it show to a foreign visitor? The ancient Greeks judged whether other nations were civilized by the quality of treatment they provided for their elderly. But institutionalized neglect and abuse of old people and profiteering from their misery have become a hallmark of American life and a force that threatens to tear apart the very fabric of this society. Civilization is a bonding together of men and women for the common good within a framework-however loose-of order and justice. The purpose of this framework is to protect the weak from the whimsical depredations of the strong. The weakest have always been the elderly, both rich and poor. Today, America is losing the fight to provide its aged citizens with the opportunity to play meaningful roles in society free from fear. They fear robbery, murder, rape, and assaults from street criminals. They also fear suffering mentally, physically, and spiritually through illness, undernourishment, and