The story of Joel Marrable, an Air Force veteran who died recently at a US Department of Veterans Affairs assisted-living facility hit a nerve with me as I’ve spent considerable time over the past year taking care of my elderly mom in various settings, including hospitals, skilled nursing facilities, and home. I write this column in honor of Marrable, a Vietnam veteran who should have been allowed to die with dignity and respect.

Marrable was found twice by his visiting daughter, covered in ants.


Pictures by his daughter show his body covered by hundreds of ant bites. One has to ask how such a thing can happen. Obviously, the staff at the facility were not checking on him. Second, how could this happen twice? And what happens to people who don’t have relatives to look after them and advocate for their care?

My mom, who lives in another state, recently spent two weeks in one of the best rehabilitation and skilled nursing centers in her state. Yet, her five children were sure to take turns to be with her so that she would receive appropriate care, so she would not sit in a wet bed or chair for hours, so that she would get the help she needed to eat, so that we could take her to the bathroom when she had to go without waiting 15 minutes for someone to assist her.

One day, I needed help to get my mom, who was recovering from back surgery, to the bathroom. We pressed the call button for help. In the hallway, her name then appeared on a screen outside her door for all the staff to see up and down the hall. Numerous staff walked by her room without even asking if there was an emergency or what the situation was. Thank goodness no one was choking or having a heart attack.

The nurse on duty was very nice. But she had an entire floor of 14 elderly people in various stages of rehabilitation to care for. The entire rehabilitation center had one physician assistant on duty. Did I say that this was one of the best facilities in the state?

My mom had a “discharge meeting” at 2 pm on a Thursday. Her discharge was approved by the team, including me, who believed I could take better care of her in her home with my siblings. How silly we were to believe that my mom would get to sleep in her bed that evening. In fact, the physician assistant was not available to sign the discharge papers and would not be available until noon the following day. I finally wheeled my mom out of the facility at 2 pm the following day; 24 hours after her team approved her discharge. According to the nurse, this was “normal.” My mom took up space in an expensive skilled nursing facility for 24 hours of unnecessary “care.” And this is “normal.”

I have been in the field of direct care for my entire 45-year career.

I have worked in state facilities and community-based programs, and everything in between. I know that staffing — appropriate staffing — is the number one issue regarding inpatient care. You can have all the fancy technology in the world and the most beautiful facility in the world, but if you don’t have enough staff to provide basic care for your patients, you have nothing.

The facility my mom stayed at for two weeks was located on prime, beach-front property. The dining room, facing the beach, had to be rated five-star and the interior decoration and décor would easily put any high-priced hotel to shame. But no matter the location, view, or décor, when you are sitting in your own waste waiting for help, none of that matters.

We need to get back to basics when it comes to patient care and put our money into our primary mission — patient care — not fancy buildings and décor. Yes, I understand the marketing elements involved with promoting these facilities today. But I also know I’m not the only one who would vote for more staffing, better patient care, and less granite.

By the way, this is not a statement against the employees of my mother’s rehabilitation facility; most were hard-working and nice. But they were overworked and too busy to do the job that attracted them into the field of patient care. Something is wrong with our system when a nurse has to spend 50 percent of his/her time at a nursing station typing on the computer instead of at the bedside of his/her patients.

When providing care for our elderly, let's get back to basics.

Tom Zirpoli writes from Westminster. He is program coordinator of the Human Services Management graduate program at McDaniel College. His column appears Wednesdays. Email him at