By Clifford Horwitz

The nightmare is real for the defenseless. Tens of thousands suffer physical and emotional abuse, abandonment and neglect. They face life-threatening infection (sepsis) from sores left unattended in a pool of human waste, and are intentionally over-sedated through the use of psychotropic drugs as a means to silence their despair, confusion and agony. In a great many cases, these are the conditions paid for in full by your tax dollars. It is a climate of terror in which institutional administrators and corporate leaders of long-term care facilities (nursing homes) profit enormously, while ignoring federal and state law without shame or fear of prosecution.

The untold reality is that these are not the conditions found at just a few centers for long-term care, but to some degree or another, within the majority of the state's licensed care facilities. And while legislators cite new and improved laws regarding the absolute right of aging patients to receive quality of care, few could defend the ongoing toll in human suffering. Aging and frail citizens of Illinois continue to fall prey to a system that lacks both oversight and compelling prosecution of those who injure them. Worse yet, the tactics used to silence family members who are outraged are aggressive and swift.

Faced with the difficult decision to place a loved one within a long-term care facility, many adult children or patient representatives will turn to the state's Department of Public Health website looking for information. They'll find little to help guide them however, and what is available is either old, or information that is reported not by the state, but by the facilities themselves.

In no other arena dealing with human life are the fines levied against care providers for abuse and neglect negotiated and whittled down to pennies on the dollar as those of skilled nursing facilities. Furthermore, their political power is so great that competition through the creation of new and improved facilities of care is severely restricted. With an estimated 20,000 empty beds within the state's current facilities, strategies are put into place to ensure patients who enter a facility never leave, and that future, better facilities cannot be built.

The time has come for citizens of Illinois to hold this industry of terror and those entrusted to provide oversight accountable. The time has come to recognize these factories of abuse and despair for what they are; institutional breeding grounds for crimes against persons who in most cases can no more protect or provide for themselves than infants.

Shielded from the public's eye is a system of oversight that is incapable of responding to reports of abuse and neglect. Due to a lack of funding and shrinking manpower, licensed facilities understand that control of information and site review/inspection is theirs to manipulate. Family members who provide the sole bridge between patients and the reporting of abuse most commonly find themselves punished to the point of limited access to the facility and in some cases, arrested for interfering with a facility's ability to function, however dysfunctional. Fearful that their loved ones will suffer additional abuse as a result of their demands and questions, an aging spouse without the support of adult children or access to an effective and responsive Ombudsman will suffer enormous guilt fueled by a sense of hopelessness and disempowerment.

Private sector lawsuits against a facility have become the most effective course of action available today. Litigation ensues when a family member obtains an attorney and takes matters into their own hands, as well as into the courts. For that reason, personal injury cases involving abuse, neglect or other crimes against persons within a long-term care environment are provided special consideration under the law.

These cases, however, represent preventable illness, injury and devastation after-the-fact, leaving scars that will never heal, no matter how great the verdict in dollars. It is an unfair and broken system in which justice is left to the family of an abused and neglected patient as a means to compensate for lack of oversight, or the facilities own failure to comply with state and federal laws.

Michael Carter of Horwitz, Horwitz and Associates, Ltd. has been prosecuting cases of neglect and injury within the long-term care environment for nearly a decade. 'By the time family members walk into our office, they've exhausted all the avenues and have nowhere else to turn.' According to Carter, the extent of injuries to their loved one is often far greater than the family is aware of. 'It's not unusual to find fractures that families were never told of, and for which the patient never received care for.' Says Carter, adding, 'While I'm here to help any family that needs me, I look forward to the day when I never have to prosecute these cases because they don't exist. That's absolutely possible if enough people understand the extent of abuse and get involved.'

As long as communities remain uninformed and therefore, fail to demand change within the culture surrounding the care of our most frail and aging, the rein of terror and abuse will continue. The public has the power to alter both the expectations of care and the ramifications of criminal activity that to date go without punishment under law.

There are better methods in place within a limited community of facilities, called Pioneer Practices, featuring a quality of care that supports both residents and staff members. This environment of support needs to become the model of expectation for all facilities, as it saves lives and is far more cost effective than abuse and neglect.

To better educate the public regarding the state of long-term care facilities and to promote awareness through outreach, a special online radio program featuring veteran Ombudsman, Margaret Niederer and Michael Carter was produced in partnership with Citizen Action/Illinois and the law firm of Horwitz, Horwitz and Associates. Featuring an in-depth discussion of the current crisis and the solutions that are within reach, the program can be easily accessed on-demand, 24/7 at: http://www.girlonpoint.com/citizenaction/seniorneglect/ltc.htm.

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Clifford Horwitz is a partner at Horwitz, Horwitz & Associates, a Chicago law firm.