I have visited nursing homes that were good and some that were pretty awful. Now that people are living longer and many doctors have problems with letting elderly patients die, nursing homes are BIG business. I did not realize until I read an article in the 11/15/15 New York Times that nursing homes receive more money if they feed elderly patients with feeding tubes. Many of these patients have multiple medical problems, plus dementia and yet have feeding tubes to keep them alive. A living patient means more money for the nursing homes. I believe this is immoral and no doctor should authorize it. Of course, some families want their elderly relatives kept alive at any cost, but since many or probably most of these patients are on Medicare, the families are not paying for their care, but instead taxpayers are paying.
One problem also is that doctors are taught to keep people healthy and alive. Few doctors do well with dying patients, because many feel a death is a mark against them. Dying should be a part of living and if a person has multiple medical problems and dementia, they have no decent quality of life. There is a statement I have long remembered that when the pain of life outweighs the pleasure, something needs to change.
I have cared for many babies, little children, and older ones with severe, degenerative neuromuscular diseases. The most important thing I always tried to do was to support and communicate daily with the parents and talk openly with the children who were old enough to know their disorder was slowly getting much worse. Usually the one question the older patients asked was "Would they be in pain?" I always assured them that pain would be controlled if there was any and that I would be there. Only one Duchenne muscular dystrophy patient, who was developmentally delayed, ever asked to be put on life support machines. The others refused this kind of care to prolong their lives. One 22-year-old left a wonderful letter to be given to me after he died. He told me how much he appreciated my helping him to have as normal a life as possible. He was a remarkable young man who left a wealth of friends and a wonderful family behind.