The woman wrapped her frail fingers around her front door’s rusty bars and glared at the outside world. Then she waited. She waited for, ten, 15, then 20 minutes until her visitor arrived, passed a brown paper bag through bars—likely a snack—before shuffling back to the community TV room. Here, the group neither communicated nor watched TV. They stared blankly at the walls, at each other, at the food in front of them, waiting.
Social solitude, decrepit buildings and physical inactivity are just a few of the various issues plaguing some of Buenos Aires’ better nursing homes. In worse cases, rats, abysmal hygiene and even physical abuse have been reported by witnesses who are not able to provide for better care of their loved ones. And experts say that more often than not, the city government is either unable or unwilling to do much to help.
According to Dr. Adriana Alfano, geriatrician and secretary general of Argentina’s Society of Gerontology and Geriatrics (SAGG), there are three tiers of quality in Buenos Aires’ 560 public and private nursing homes, or geriátricos. Around 60% fall in the “good” category, 33% in the “medium,” and the remaining 7% in the “bad”.
In the nursing home visited by Argentina Independent reporters, tiles were missing in every room in the building, and country-shaped chunks of paint had peeled off of the walls. The nurse leading the tour stopped only to coax a confused octogenarian back into her seat in the dingy TV room before continuing on her way, leaving the ten or so residents unattended.
She admitted that there were only two nurses on duty to care for 40 residents. No doctors, no psychologists, no planned activities.
“The elderly need special care,” says Alfano. “You have to stimulate the eyes, the ears and the brain, with memory tests, for example. You have to organise activities to keep them active.”
Ambitious Guidelines, Scant Enforcement
It wasn’t until 2001 that the Buenos Aires government imposed any regulations on the quality of life in nursing homes.
At that point, three separate entities were established to oversee the different facets of the homes. The health ministry grants official registration, while the Directorate General of Inspection and Control (DGFyC) is responsible for the safety and upkeep of the buildings. The third, The Management Unit of Control and Registration of Residential Facilities for the Elderly (UGCOR), now requires that each nursing home must have doctors, psychologists, social workers, nutritionists and occupational therapists on staff.
Alfano says that despite the government’s efforts, the law is not fully defined or enforced. Policy force regulations were never established for the UGCOR, and there are no specific sanctions for the social and health irregularities it refers to. Only a pitiful array of official measures is in place to give the appearance of control, and no actual recourse is taken against owners who fail to comply.
“If this [UGCOR] unit finds a problem, they can only give the owners recommendations to change in 30 days.” If the owner fails to take action by that time, Alfano says the UGCR will present the home with an official document to “insist” that changes be made.
“But the document is powerless,” she adds.
Finally, if still nothing has changed, the UGCR will send an “invitation” for the owner to “get out of office,” which also has little to no actual power. In fact, there are still many homes that are accepting new residents after everything.
“However,” says Alfano, “If the building inspector team finds a problem, they can charge a fine, and if that fine isn’t paid, the building can be shut down.”
Yet even this thin veneer of control in the city is more than is afforded elsewhere in Argentina.
“This is just the law for Buenos Aires City,” said Alfano. “The rest of the provinces only have building regulations.”
Roxana, who preferred not to give her last name, says she used to work in one of the city’s under-regulated nursing homes.
“The patients wouldn’t be bathed, and their sheets wouldn’t be changed,” she describes. “You knew that hygiene wasn’t being taken care of,” she says of the residents’ diapers, “you could smell it.”
Even though the government supplied diapers to registered nursing homes for free, they would frequently go missing. Roxana says incidents of staff pocketing supplies were not uncommon.
“It got to be where I couldn’t take it anymore, and I quit,” she says. “I’m a ‘patient person,’ [working for the wellbeing of the patients], but a lot of my coworkers weren’t. I couldn’t stand to see it.”
Some of the worst cases of abuse and mistreatment often go unreported by well-intentioned staff and patients’ family members. In one extreme case, a nursing home owner shot a Bromatologia inspector when he tried to enter. More often, lawsuits are filed.”
“The problem comes back against the family,” Alfano says. “They don’t know what to do.”
The city’s best private nursing homes can charge $6,000 or more per month, and the public ones are nearly always at capacity. Lacking other options, families unable to afford private care often send their loved ones to unregistered but inexpensive nursing homes known as ‘truchos‘, local slang meaning ‘fakes’.
Experts estimate that there are currently around 900 of these trucho homes in the city, some of them run by former nurses out of their homes.
Since these residences only hold about six or seven elderly patients, owners are able to evade official inspections, claiming they are simply caring for several family members. And because they are private residences, inspectors are only allowed access if a complaint is made.
Alfano says without even the appearance of an official watchdog, these homes can be the most dangerous for their residents. Patients have been known to be strapped down to beds, drugged to sleep throughout the day, and owners have been suspected of stealing medication. Without formal inspections, it is difficult for officials to estimate the scope of the problematic homes.
“My mother-in-law had an uncle who was in an unregistered nursing home,” says Liliana Díaz, an employee of SAGG. “He was mistreated, and died within. I wanted to denounce the fact, but she was afraid of the owners.”
Alfano says the low-level nursing homes will continue to exist until specific measures are taken.
“For example, families could be given some economic subsidies to afford better [registered] nursing homes for their relatives,” she says. “That way, the ‘truchos‘ would naturally disappear.”
However, if these places are simply closed down, and the family is not able to afford better housing, there is still the problem of providing public places to care for the elderly. The city’s five public nursing homes are able to fill from 300 to 800 beds each, and are all at capacity.
“As much as you control or have complaints, if there are no alternative public beds, people will return to the underground system,” said Eugenio Semino, ombudsman for the elderly of the city, in a recent article by La Opinión. “If you close a place down, where else are they going to go?”
Despite all of the industry’s failures, both Alfano says there are plenty of good people caring for the country’s elderly, and families can help ensure the safety of their loved ones by asking questions and taking interest in the quality of the homes.
She says that families should ask what type of professionals are on staff, and if they can visit their relatives at any point in the day. If there are only specified visiting hours, families should be suspicious of what’s going on behind closed doors.
She also advises concerned families to check that the home’s residents are awake during the day. If several are asleep, there is a good chance they have been sedated to ease the caretakers’ workload.
“We have the theory—and it’s a beautiful theory—about the profession,” says Alfano. “But in practice you have nothing. You don’t have the force to compel people to make social and sanitary regulations.”
“You have good people working in these nursing homes, and there are several challenges they are facing. But they go on and fight.”