RICHARD ROUTMAN: We Need to Talk About What's Happening to Our Elders

Alzheimer's and elder care demand our attention not just because millions endure them, but because the systems that are supposed to protect our most vulnerable are fundamentally broken. In light of the upcoming release of our documentary, No Country For Old People; a Nursing Home Exposé, August 1st on Amazon, my producing partner and today's guest host, Rick Mountcastle (whose work prosecuting Purdue Pharma was dramatized in Hulu's "Dopesick") and I are turning our focus on elder abuse.  

In this powerful episode, we're joined by Richard Routman, whose 14-year career at the Department of Health and Human Services gave him a front-row seat to nursing home neglect cases, pulls back the curtain on why elder abuse persists despite seemingly robust regulations. The reality is sobering: residents fear retaliation if they report mistreatment, staff worry about losing jobs if they speak up, and facility administrators actively obstruct investigations by altering records or instructing employees to "forget" incidents when questioned by surveyors. Meanwhile, the regulatory landscape remains fragmented between federal agencies, state surveyors, Adult Protective Services, and law enforcement—creating dangerous gaps where abuse reports disappear.

Most troubling is how money influences the entire system. The nursing home industry spends hundreds of millions annually on political contributions and lobbying, effectively buying themselves protection from meaningful reform. As Richard notes, ordinary citizens advocating for better care are "fighting with sticks" while the industry fights "with guns."

Yet this conversation offers hope through specific action steps. Every county has a Commission on Aging that citizens can join to question officials and advocate for improved oversight. Families should learn their rights regarding documenting care—in many cases, they can legally record conditions despite what staff might claim. Most importantly, Richard reminds us that cultural change starts with rejecting the ageism that treats elder abuse as somehow less urgent than child abuse.

Don't miss our documentary "No Country for Old People" launching on Amazon August 1st. Until then, remember that knowledge, community action, and love remain our most powerful tools against a system that too often fails those who built our world.

Chapters

• 0:00 Introduction: Fighting Alzheimer's with Love
• 1:11 No Country for Old People Documentary
• 5:18 Richard Rotman's Elder Care Background
• 13:02 Barriers to Elder Abuse Investigation
• 22:23 Advocating Through Local Commissions
• 31:30 Ombudsman Programs and APS Limitations
• 42:06 Legal Recourse and Documentation Options
• 47:38 Politics, Money and Nursing Home Oversight
• 52:06 From Advocacy to Action: Public Involvement

Transcript

Don Priess: 0:00

When the world has got you down, Alzheimer's sucks. It's an equal opportunity disease that chips away at everything we hold dear. And to date, there's no cure. So until there is, we continue to fight with the most powerful tool in our arsenal, love. This is Love conquers alls a real and really positive podcast that takes a deep dive into everything, Alzheimer's, The Good, The Bad and everything in between. And now here are your hosts, Suzie singer Carter and me. Don Priess,

Susie Singer Carter: 0:40

hello, everybody. I'm Susie singer Carter, and this is love conquers all, the podcast that is all about Alzheimer's and elder care and extending into long term care. Now with our documentary, No Country for Old people, which I have a very great announcement that we are launching on Amazon on August 1 so stay tuned, and we'll be keeping you posted. If you follow us, you'll definitely hear more about it. And if you don't follow us, you should be, because it's very important, and we're very proud of this project, and it's information that everyone needs to know, and coincidentally, we have a very special episode today because, not just because of our guest, but also because I am joined today with my producing partner from no country, from old people, and my guest host today is Rick moncastle, who you may know already because I talk about him all the time and or You also might know him from a project called dope sick, a mini series on Hulu where his work prosecuting Purdue pharma was dramatized. He's here to help me lead the conversation that's very close to both of our hearts today. Our guest is someone whose life's work aligns so powerfully with the mission behind our film. Richard routman is a retired attorney who spent 14 years with the Department of Health and Human Services, where he represented the government in cases against nursing homes accused of providing substandard care. Since retiring, he's continued to advocate for older adults, first as a trained volunteer ombudsman, and later as a member of the Loudoun County Commission on Aging in Virginia. Richard brings both legal insight and lived compassion to this conversation, and when he's not speaking up for better elder care, he's enjoying time with his wife and their grandchildren, which, let's be honest, is probably the best gig of all. We truly, truly are honored to have him here with us today. So please help me welcome Richard routman and of course, Rick moncastle.

Rick Mountcastle: 2:51

Hey, Susie, thank you for having me. It's an honor. I hope I can live up. I hope, I hope I can live up to the standards that you and don have set for Love conquers alls, but I'm glad I'm here, because Richard Rotman and I have, I would say, Come to be friends. Over the past two or three years, we've not met in person, but we have talked monthly by telephone, just trying to keep up with what's happening in elder care and batting ideas around about how we can make things better in that world. So I think it's really great to have Richard on. And I guess I can start off the questioning or start off with the ball. Susie, if that's okay with you.

Susie Singer Carter: 3:40

Take it away, Rick.

Rick Mountcastle: 3:41

Richard, Richard, you and I have talked about your role on the Commission on Aging, a role you took on after you retired from the Health and Human Services assistant Regional Council. But before we get into the specifics of that, could you describe your general approach that you have taken and are taking in addressing nursing home issues?

Richard Routman: 4:08

Be happy to just before I comment on that, Rick, I just want to thank Susie for the lovely introduction, and congratulate you both for the coming of the new video, which we're all looking forward to in August. It'll be a impactful event for everybody who's interested in improving nursing home care.

Susie Singer Carter: 4:29

Thank you so much. Thank you.

Unknown: 4:32

Well, the the approach to trying to deal with the proper treatment of elders in nursing homes is a complex one. It's both federal and state involved, and one of my post retirement interests was finding out how the county of Loudoun in Virginia used. Is federal money, as well as some state and local money to promote the interests of residents of nursing homes. So after I spent a year being a volunteer ombudsman in a skilled nursing facility, when we my wife and I moved here, I was able to be appointed to the Commission on Aging. And let me give just a minute or two background on what that means. In 1965 Congress passed a statute called the Older Americans Act, and that statute was amended about 10 years later, to provide for funding federal monies to go to offices in counties all over the country. Every county in the country has an office called the Area Agency on Aging, and that agency receives some federal money and some state money. And this is supposed to promote the interests of seniors in that in that county, it comes with some strings. One of the strings was that the Area Agency on Aging had to establish what, what is an advisory council, and in Virginia, in Loudoun County, was called the Commission on Aging, and that was a particularly attractive feature to the statute, in my view, because it allowed members of the public, ordinary folks, to be able to have a seat at the table. They weren't they weren't empowered to make any decisions, but they were allowed to ask questions, and in Loudoun County, there are nine members on the Commission on Aging. They're appointed by the board of supervisors, and they're on their chairman for four years. And what are they supposed to do? They're supposed to educate themselves as to what's going on with the elder population and to make suggestions to not only government on the state level, but even the federal level. In other words, they have a portfolio. They don't have any power, but they have the option of educating themselves and persuade, trying to persuade people to improve the program, and that has been since we moved here in since I became a member of the Commission on Aging in 2016 and I that's a four year term. So I was on there for until 2020 that was pretty much what I tried to do. And specifically, the Commission on Aging is in his obligated, by statute, to review what the Area Agency is doing to comply with the federal federal conditions. One of those conditions was established by statute in 2016 and that condition was that the area agencies on aging and to address the issue of the barriers to the investigation of elder abuse, and that included elder abuse in nursing homes. And as it turned out, a few years after that, in 2019 the Office of the Inspector General of the Inspector General of the Department of Health and Human Services and the Government Accountability Office issued separate reports talking about the problems with the reporting of elder abuse or suspected elder abuse in nursing homes. There's a requirement under state law and under federal law for staff in the nursing homes to report if there are suspected or alleged elder abuse, and it turns out that these reports by the Inspector General and the GAO suggested that it wasn't being done very much. It wasn't being honored as much as it should be. And if there were no sufficient numbers of reports of suspected elder abuse, that creates a huge problem, because it needed to be addressed. Attention needed to be paid to it, and that is the problem that we're currently involved in. It is a long term problem to try to make sure that this very vulnerable population in nursing in skill particularly in skilled nursing homes, has a voice that we help them provide some mechanism to amplify their issues.

Susie Singer Carter: 9:57

What you said, barriers? You. Saying, I just want to just ask clarify what you meant by barriers. Because you said there's, you know, that was the issue is barriers? Is that? What to who did the barriers apply? And then, and then, what are those? Not all of them, but what? Generally,

Unknown: 10:17

that's a great question. In the statute. This is a congressional statute. It uses the word barriers. It says the AAA must address the barriers to the investigation of elder abuse. So what are the barriers? Well, first of all, residents in nursing homes who are abused, and we can define that independent or two have a problem. And the problem is they are fierce, many of them that if they complain, there'll be retribution. They might be discharged from the facility, or the staff might be angry at them, and they take it out on them in different ways. There's another issue. If staff sees an example of a resident being abused, the staff has an obligation to make to report that they're mandated reporters under state and federal law, but the staff is also afraid that if they report another staff member, they're going to be subjected to some harassment, or they may even be fired. So that's that's a barrier that needs to be addressed. Sometimes there's this perception. Sometimes it's true. Sometimes it's not, that the resident has cognitive issues, and we can't trust the resident saying what they're saying. So if they say they're being abused, maybe they are, maybe they are, we can't be sure. It depends on their level of cognition, but that's a problem. I'm a barrier to the reporting. We don't have to be 100% sure if the resident is saying the CNA just slapped me or dropped me on the floor, that ought to be the trigger for the parent, whether or not there's a cognitive issue or not.

Susie Singer Carter: 12:13

So airing, airing on the safe side, just if there, there may just be so if it's brought up, it should be investigated, of course, of course, right? Yeah,

Unknown: 12:24

The presumption bit should be that there's a problem here, not that there's not a problem, right? Exactly. There's another situation where the nursing home itself doesn't want these to be reported. Why? Because the Centers for Medicaid and Medicaid Services is going to send in an inspector, a surveyor, and if he finds out, or she finds out that this is true, there's a fine that's going to be issued, or maybe something even worse. So there's always the possibility that the nursing home is going to tell staff, if a surveyor comes in because they're interested in knowing what happened, why don't you just tell them you couldn't ring them. Or even worse, why don't we remove the records of that resident to another location so it's not easily accessible by the surveyor. Or even worse, why don't we alter the records, the clinical records, the nurses notes, to make sure that this is a hard trail to follow through. The surveyor, Richard,

Susie Singer Carter: 13:30

how often does that happen? Is that? Is that something that is regular practice? Do you think, or, I mean, I'm sure you can't say nationally, because you're specific to the states that you worked in, but I don't know.

Unknown: 13:45

Well, it's a great it's a great question. Nobody knows the answer to that question, because sometimes the facilities get away with it. But I will tell you that I've had, personally had a situation where I have had a facility lie to the surveyor, and fortunately, the surveyor was able to determine that that was a lie. It was a situation where the records were removed so that they couldn't find the records. And there were this was another situation where this is a chain, and the corporate executives from another city were telling the staff to lie to the surveyor, so it was a big deal. Yeah, the problem is

Susie Singer Carter: 14:32

say, like with it, with my mother on her records, you know, she had Alzheimer's, and one of the issues we were dealing with was that they had her on NPO, which means nothing by mouth. Well, in the records, looking back at it, there were several entries, many entries, where it would say breakfast. Ate part of it, didn't want the rest, as if she was eating regular food, right? And so it was just like there was no responsive. Little entries. You know, there was many more like that, but it was like, you know, or the patient or the resident is in denial, she has Alzheimer's. What are you talking about, right? Yeah, these are but most of us don't look at the records. We don't the nurses

Unknown: 15:18

notes are the key to the Kingdom. In my opinion, you need to read the nurses notes. But in any event, those are examples of barriers to finding out what's going on behind the curtain in a nursing home and another just one last item I want to mention, sometimes the left hand doesn't know what the right hand is doing, which is to say that you Adult Protective Services, which is a agency of the state. It's in the county that's they also investigate abuse in nursing homes, but they've not there. They don't necessarily tell the state surveying agency what's going on right away, the Attorney General of the of a state has a unit called the Medicaid Fraud Control Unit, and they're also looking at abuse at nursing homes, and sometimes there's a lack of communication, so that they're not coordinated very well, and that could be a problem to determining whether or not there's a, you know, hell

Susie Singer Carter: 16:30

is that by design or just by lack of

Unknown: 16:39

that's a good question. I mean, one of the issues that I have always tried to grapple with is the fact that the regulation of nursing home care is fragmented. It's siloed. Some of it's in the state, some of it's in the feds. Sometimes they talk, sometimes they don't. It has to be, there has to be a higher level of coordination, and whether that was done on purpose, is a question that others will have to answer. I can't

Susie Singer Carter: 17:11

Okay, thank you. Know that that makes that that I think that's so important what you're talking about, because most of us, as just caregivers or even residents don't really know how all that works. And, you know, we think it's set up to take care of the most vulnerable. And then you come to find out that it, like you said, it's so fragmented and it becomes so complicated that at the end of the day, many, many family members just give up because it's too complicated and it's too time consuming and it's not fruitful.

Richard Routman: 17:48

It's very frustrating, I'm sure.

Rick Mountcastle: 17:51

So speaking of caregivers and family members, I know some of our listeners at least have loved ones that they're looking out for who are in skilled nursing facilities, and like Susie did, and as depicted in No Country for Old people, what would you recommend to them about becoming involved in a commission or an advisory committee like you were involved in advises the Commission, the local commission on aging.

Unknown: 18:27

They could make a phone call to the main desk of the county office and ask for the Area Agency on Aging, and ask for what the timetable is for applying to be a member on the Advisory Council. It may not be called the Commission on Aging, it might be, but these differ from county to county, even if they are unable to become members of a Advisory Council like the Commission on Aging, and can still go to the meetings. These are open to the public. So

Rick Mountcastle: 19:05

and what would be the what would be the benefit? How can they help change things by participating in either the commission itself or those meetings? What? What's your what's your thoughts and your recommendations on that

Unknown: 19:19

the Commission on Aging should be urged to educate its members by having other representatives from other agencies make presentations. One example would be have somebody from Adult Protective Services talk about how much abuse is being discovered in the nursing homes in that county. There, there are other things that they could do. For example, they could ask fair law enforcement to make a presentation as to whether law enforcement in the county has ever been advised to. Within the last year or so, whether a complaint has been lodged with respect to alleged or suspected elder abuse in nursing homes, if in fact, there is a alleged or suspected episode that results particularly in serious bodily injury, the police have to be advised, and if the police have never received any notice, then the question is, is raised, why not? And that's a proper topic for the Commission on Aging to bring to the attention of elected officials, because it should be on the top of their list to protect vulnerable seniors in nursing homes. So it's a matter of visitors. Could could make recommendations. It's not binding, of course, to say here are a series of things to do that you could educate yourselves and everybody else, and particularly if the visitor has some issues with with a particular nursing home, those issues could be raised, and maybe would not be identified by name, but at least the issue could be discussed

Susie Singer Carter: 21:17

also, would you say that? You know I know that personally, I didn't know that there. There was an ombudsman program available to me. I didn't know that. And I, I would think that it would be important to attend these meetings to find out, ask questions, find out, what can ombudsmen do? What are their? What are their you know, what's their job description, really, and what? And what does Adult Protective Services do? Do they talk to each other? How does that work? And then when you say, police, enforcement getting involved, how? When do they come in? Is that? Is it a chain of events? How does that

Unknown: 21:55

work? Those are great questions. Let me take one of take them one at a time. Okay, there are two types of ombuds. Every state has a long term care ombudsman office, and they have paid staff, but there's not enough staff to go around to all of the nursing homes in the state, so they have to get volunteer ombudsmen, which are folks like what I did? You take training, and you are required to go into a nursing home for not less than four hours every week. And even then, not every nursing home has even a volunteer ombudsman. But what does the ombudsman do? The Ombudsman has contact with elder residents, and they'll say, tell me if there are any issues. And I'm telling you that I won't tell anybody, unless you give any permission, this will be confidential, so you can be free to talk to me about it. Now that's a good way to elicit information, but it is also somewhat frustrating because the resident who may unload a burden on the ombudsman may say, you can't tell anybody because I'm afraid of retribution or retaliation or being discharged. So what's the ombudsman in a difficult spot? Well, maybe there's a remedy for that. Maybe the Commission on Aging could think of a way to get around that problem and make a suggestion to elected officials?

Susie Singer Carter: 23:27

I have a question. Wait, I just want to say what as to that? Couldn't it be like the way that you deal with a whistle blower, somebody where you can present what's going on without presenting the source?

Unknown: 23:40

That would be a perfect thing to suggest, and that would require some specific training of the Ombudsman. I've gone through that training and that that part is not there. There isn't there isn't a nuance. Because you're always wanting to protect your source, that your source is the resident. You don't want to put the resident in a period, a position of harm, sure. So that's the that's the ombudsman, as far as eight of the Adult Protective Service, that was your next point, adult per se, Adult Protective Service, or APS, is a is interested in one major goal, and that is the safety of the resident. So if there's an allegation of abuse, APS will be contacted, hopefully by the facility, or if the resident is transferred to the emergency room at the hospital, the admitting doctor should notify APS if there's some reason to believe that there's been abuse, physical abuse, or even sexual or physical or perhaps even emotional. All APS will send out an investigator, and if it happens that the alleged perpetrator has been fired, that is the staff person who was alleged to have committed the abuse, even if we don't know that for sure, has been fired, air has voluntarily quit, or has been moved to another form and is no longer in proximity to this resident. APS is investigation is closed because their mission has been accomplished, they have provided some assurance that the resident is now safe, and they are not in the business of determining whether anything wrong was done and and that's a that's a problem, because I have talked to APS people, and I've said, Look, if you go in there and you find out that there was abuse, but the resident is now dead, partly because of that abuse, you close your investigation. My question is, what happens if you find out if another staff member knew of the abuse and failed to report it. Is it part of your duty to deal with that issue, to report that person for failing? If they're all mandated reporters, what about that guy? He failed to report? It? My impression of APS is that's not part of their deal. All they do is find out if the resident is safe and or dead or gone, or the perpetrators gone,

Susie Singer Carter: 26:47

right? If the problem is gone,

Unknown: 26:50

the problem still exists, because the perpetrator is now at another facility,

Susie Singer Carter: 26:56

exactly, or on a different floor, which is ridiculous, or a different floor, right?

Rick Mountcastle: 27:00

So what's a family member or caregiver to do in those circumstances? Is there any recourse where they basically want to see justice happen? That's not justice, right? It's not justice that an individual has abused a person and because that person has passed, or the perpetrator has been transferred to another floor, case closed that doesn't remedy the abuse. Is there any recourse for carriers or family members?

Unknown: 27:31

Of course, is, as you well know, there's the legal system and the that raises the issue of what happened when you admit, when the resident was admitted, did the admission papers require you to sign a what's called a pre dispute arbitration agreement, which is provision in the admission agreement that says, in the event that you have a claim or the resident has a claim against the nursing code, you agree now to waive a jury and to waive all litigation and to participate in an arbitration with a arbitration program that the facility will send up or has set up. Most people who are confronted with that have to sign it because they don't have much of a choice, but they don't have a lot of confidence that that will have the same impact as a jury trial, if they can ever get a lawyer to take that case to a trial. I suppose an additional feature to the answer to you Rick is that the family or the resident could call the state survey agency and say, Look, do something about the fact that there was no reporting of abuse here in Virginia, there is a commissioner of aging. He is the head, or she is the head of the Department of Aging and rehabilitation services, and the commissioner has the power to have the hearing against any staff member who fails to comply with mandated reporting laws. And if the staff member is found guilty, the fee is $100 if he's found guilty the second time, and the C has anywhere between$100 and $1,000 pretty small change, considering the situation,

Rick Mountcastle: 29:44

but so that's all kind of peripheral, but this would be the time, wouldn't it? I just make a suggestion to call the local police department or the sheriff's office to report that because Elder abuse is a crime. Nine, and notwithstanding the fact that APS has closed its case because the person is no longer in danger, either by death transfer of the perpetrator or otherwise, would that be, you know, I just might want to suggest that might be the time to call the local police or the sheriff's office or the Medicaid Fraud Control Unit of the state, the local office of that, right?

Unknown: 30:25

But you're absolutely correct. I should have added that. So thank you for adding for me, the federal regulation, by the way, does say that if there is abuse or suspected or alleged abuse that results or appears to result in serious physical harm, you have two hours to report it to law enforcement. If there's abuse that does not result in serious physical harm, you have 24 hours to report it. So there's a specific provision, relatively new, that points in the direction of law enforcement. I might add that in the past four during my four year term, I asked local law enforcement, had they ever been notified of any possible abuse allegations, and the answer was no,

Rick Mountcastle: 31:19

but that's that's something that a family member or caregiver could do no question, in the absence of any kind of reporting by a government official or anybody at the facility. That's an option that's available to no question.

Richard Routman: 31:33

You're absolutely right. I want

Susie Singer Carter: 31:37

to clarify what you said though, about the two hour window, because what if you as a family member, like you have somebody who doesn't who is non verbal, your loved one is non verbal, and you find out that they've been sexually abused, right? And they move the perpetrator to say another floor, but you don't find out about that for whatever a couple weeks, it just happens to leak out and you get it now you your windows passed to file a report with the police department or what? Oh,

Unknown: 32:05

no, you could always file the report. The facility has the opposite, the obligation within two hours. It's not you. The facility has the obligation. They could do it at any time. Okay, okay,

Rick Mountcastle: 32:18

and now, and you talked about the difficulties of the civil process. You know, for example, filing a civil lawsuit against the facility, you mentioned that the issue being, if you sign some sort of an arbitration agreement, which I think, I think are being frowned upon by at least some of the or were by some of the government authorities. But in the event that you didn't, it's often difficult, right to even get a private attorney to take your case. Do you? Can you? You have any thoughts on why that is?

Unknown: 32:51

Well, I do have some thoughts. First of all, the private bar claims bar, they all know each other, not even nationally. They know each other because there's so few of them, and then they specialize in nursing home cases. So it's well worth trying to find some someone. But one of the one of the problems is that sometimes state law has caps on the amount of damages you you can get in a civil suit. I don't happen to remember what they are in Virginia. I'm not licensed in Virginia, but so that creates a disincentive financially for some attorneys. And of course, historically, the notion was, well, it's an 85 year old woman, she's had no earning power, there are no damages. That turned out to be a complete bogus reason, because when cases are brought and they're compelling, the jury verdicts often are very good. It's just hard to get voters to do it, and it takes time

Rick Mountcastle: 33:59

well. And I think the the reason for those compelling jury verdicts is that the damages component for a nursing home resident is pain and suffering. Yes, would you agree with that? I would it's not lost wages, it's not medical payments, because it's usually covered by Medicaid or Medicare or some insurance, but it's pain and suffering. And the way kind of, you know, going to a conversation that Susie and I had long ago at the beginning of our journey, was, hey, Susie, you're a filmmaker. Videotape what's happening to your mom to show the pain and suffering. Now, Susie happens to be a filmmaker, but I think that the iPhone has actually made all of his filmmakers, so maybe this, would you, would Oh, would you, would you, what would be your thought on advising family members who find themselves in a situation where they they're fighting? And abuse and neglect in a nursing home using their phones to videotape what's going on.

Unknown: 35:06

Well, that that's a great idea. Of course, it requires them to be there. Another option is to have a surreptitious recording device, a video recording device, in the room. Now, there have been examples where the facility may require you to tell them that you're doing it. But there have been cases where you have done they've done it without the facility knowing.

Rick Mountcastle: 35:34

Can I, can I put a caution on that? Because every state, there's every state, has different laws with regard to surreptitiously videotaping someone, right? So you must consult with your state law on whether you're it's legal for you to do that. So I just put that as a caution. Some states it is legal. I think one state, and I can't remember which one says you can do it as long as there's not sound. And then some states say it's illegal to videotape someone without their permission. So I would put a caution on that. I would not I would suggest to our listeners, don't just do that until you find out what your state law

Richard Routman: 36:17

requires. I totally agree. I just

Susie Singer Carter: 36:21

want to throw something with my own, you know, experience, as well as, like, when, when Rick had said, you know, start, just start monkey, you know, taking video of your mom so you have a record of what's going on. And there were, and they the frontline providers, a lot of the CNAs who were, you know, didn't want to jeopardize their jobs. Clearly they would. They got to the point where they were like, you can't record, you can't take a picture, you can't you have to go out. It's against our rules. Well, I just assumed that was right, because they were throwing out HIPAA and all that, and saying you can't, you know, you have to get permission. Well, that's not true. You can find you have to find out what your rights are per your state and find out if you are allowed. I you know, I don't know if you know, but I don't know if that is even a law anywhere that you can't take video of your own family member.

Unknown: 37:13

I don't know the answer. I was aware of case at least one case years ago where the facility did not know about the camera. It was the film was introduced, and it was fine, but that was a long time ago. One of the advantages of having Rick here is that he's keeping me on the straight and narrow with respect to the law. So,

Rick Mountcastle: 37:38

yeah, well, the law is different in different states. Be careful. That's all right. As far as HIPAA, though that's a federal law and so Susie, in a case of a caregiver who has power of attorney to make medical decisions for their loved one, they are actually as though they're that person. So you can film your loved one if you are the power of attorney, right? Some places they call it something else. What

Susie Singer Carter: 38:04

conservator person,

Rick Mountcastle: 38:07

right? Or power of attorney, you don't need to get anybody's permission, because you stand in the shoes of that person that you want to film, right? If, if you're not one of those in those power of attorney, just get your loved one, just get your grandma or mom or dad or whoever it is to say to it, to say, Hey, I agree to let you fill me yeah, you have that that piece of paper, and it doesn't have to be anything formal, just their acknowledgement or their permission and their signature. And now you can film away, and it doesn't matter what the facility says,

Susie Singer Carter: 38:44

right? It's important, I think, for people to know that, yeah, because I was, I was afraid, so I didn't want to get retaliation, and, you know, rock the boat anymore. So I was trying to be, you know, not push, yeah, like, not rock the apple cart, too much, right? But

Unknown: 39:01

I should have done more. I totally agree with Rick. What weather? One other cautionary note is you have to be careful not to film the if there's a roommate, you have to make sure that roommate is not filmed because you don't have permission there, correct? Yes. But you know, Rick, just to further your point, this is such an important device for knowing about what's going on at night in a nursing home or on the weekend in a nursing home when it's not well staffed, that that would be a proper subject for an advisory Council like the Commission on Aging to permit this issue and commit visibility, because there are examples of where it has worked dramatically in litigation, and it might be a long process to get that kind of acceptance for the law to permit it, but it would be worth at least beginning that process. Type thing.

Rick Mountcastle: 40:02

Richard, do you have any thoughts on why these commissions on Aging, which are in every county, right, and they're advised by citizens of that county? Why? Why things are not improving in the nursing homes? The in fact, they're getting worse. I mean, we, we have these groups to that are there to to provide some sort of support for the elderly, their government rates in every county, but things just seem to be getting worse. Any, any, any speculation thoughts on that?

Unknown: 40:41

Well, my feeling is that the program for advisory councils should include a training so that people understand we're talking about folks who have some interest but don't have much background, and it's a complicated area. There's a lot of federal, state mishmash, so they should be trained to ask the right questions and to demand, to talk to agencies at meetings and get and get answers. So I think that it's a long process to get people to to educate themselves and to have the guts to go to elected officials and say, look, we've got to make some changes here. I wish I had a better answer than that. Rick, but I'm not. I'm afraid this is an intractable issue.

Rick Mountcastle: 41:39

No, that makes, that that makes perfect sense. So would you recommend that you know people like our listeners on this, this program, or people who are caregivers for elderly folks that are in skilled nursing facilities? Would you recommend that they get involved in these advisory committees that advise commissions on

Unknown: 41:59

aging? I absolutely would recommend it. And I also have another recommendation that Susie singer Carter and Rick moncast will come up with a training program in addition to their film that could be used by every county commission in the country. And actually, I'm pretty serious about that.

Susie Singer Carter: 42:23

Well, we're hoping that the film is, you know, will help that and be able people will be able to use parts of the film as training and use it as education, you know, and also this podcast and where, you know, we're specifically talking about these, these subjects in detail, you know, because it, that's what's important, because knowledge, knowledge is power. And that's, that's, yeah, we're with you. That's, that's one of our goals, right? Rick, to educate.

Unknown: 42:57

There's also, absolutely, if I may add one large one another point, there is a political feature to this issue. If it is true, which I believe it is, that nursing home chains and nursing homes make political contributions to legislators. They have a great deal of influence on the kind of oversight that actually occurs on nursing homes. Why not require nursing home chains to disclose the amount and recipients of their political contributions? I think that would be an important thing for the people to know, because there have been plenty of people who've tried to make changes in the system, and it's very hard to do

Susie Singer Carter: 43:46

absolutely and it goes beyond that. It's the contributions to our political candidates and things like that, right? So, so, you know, I've seen so many groups now in the past three years that I've watched them work so hard on getting bills, you know, recognized and then into the system, and then they're killed. You know, the American arrival, yeah,

Unknown: 44:11

the American Healthcare Association is the lobbying of arm for the nursing home industry. What are their political contributions? I suspect they're substantial.

Rick Mountcastle: 44:24

Well, if you go to you can find the a lot of the federal information on opensecrets.org and if you go to opensecrets.org you'll see that they spend hundreds of millions of dollars annually on campaign contributions and lobbying. And, you know, I think there was a report that was generated out specifically about the nursing home industry's contributions and involvement in political and. Is lobbying that they issued a few years ago that you can find on that website. So it's open secrets.org It shows that, in fact, it is true, Richard, that the American Healthcare Association and its state affiliates contribute hundreds of millions of dollars a year to campaign contributions and lobbying.

Unknown: 45:24

Well, if that is true, and I have no doubt that Rick is correct, people like the rest of the ordinary folks in commissions on aging are fighting with sticks and the other side are fighting with guns. 100%

Susie Singer Carter: 45:41

that's why we need to have a movement. That's why you're validating everything that we're we've been trying to to communicate. Yeah, and

Rick Mountcastle: 45:49

by the way, just so people know, most of that money that they're using for those political contributions and lobbying is our tax money, because Medicare and Medicaid substantially fund make up the most of the revenue, 80% 8080 to 90% of the nursing homes revenue comes from Medicare and Medicaid, our tax monies, which they turn around and put into political contributions and lobbying to make sure that we keep getting the crappy care in nursing homes that we've been getting for 50 years. So that's my soapbox.

Susie Singer Carter: 46:26

Let me, let me jump on that soapbox when I just one thing to add is that not only are they spending our money, they are also buying themselves seats at the table in our legislation. So they also sit there as advisors and advise when to pass on something, even if it gets to that far. So that's there's that too,

Unknown: 46:49

I think. So I'll give you an example. I'm not sure that this is fair, but I'm going to say it anyway. Under state law in Virginia, there's a requirement, as in most all states, for mandated reporting. But there's a provision in the law, which is unusual. Maybe Rick knows about it, and it says, essentially, that if a person acquire if a staff person at a nursing home acquires information involving abuse, that person can simply tell the person in charge of the institution that would be the administrator of the nursing home, who then has the responsibility to report it. The first person doesn't have to report it. He just has to tell his boss or her boss, and then a boss that makes a separate determination whether there is sufficient suspicion to report it. When I was at the commission, I called up state officials and said, Is this a problem? Are you having an issue here with this problem? And they said, Yes, but it's never been changed, and it's been a subject of frustration for me

Susie Singer Carter: 48:05

see that, yeah, that's so to it's so obvious and so and so egregious at the same time, right? Because I went and reported everything that I thought was wrong with going with my mom, just from what the CNAs were telling me. And I would go to the administrator that, you know, the director, and they would say, Nope, we're fine. We're not understaffed. Nope, no, we got plenty of help. Nope, don't worry about it. It's all good. You know, nothing was reported, and they weren't going to report it there. Why would they?

Richard Routman: 48:43

Well, they should, because it's the law. They

Susie Singer Carter: 48:46

should, but they don't. They don't, right? Well,

Unknown: 48:50

somebody's got somebody, somebody's got to pay attention to this with greater intensity than they had been.

Susie Singer Carter: 48:57

Yes, Rick, that's why we're doing No Country for Old people. Yes,

Rick Mountcastle: 49:05

we the public, needs to be educated about all of this, all of the failings of the system, so that the public can know and become activated to demand change, because that's the only way we're going to overcome the hundreds of millions of dollars in money that the industry puts into keeping things the same.

Richard Routman: 49:26

I think that's true, and we and we may be on the brink of a time where there are fewer government employees, and it's going to put a greater burden on ordinary citizens to step up to the plate and take action and be proactive about doing something, even if it's only providing a voice that's at least something, and hopefully, in the course of time, elected officials will pay attention.

Susie Singer Carter: 49:59

You know. It's, it's, it's really telling that we, you know, having both of you who have had so much, so many years experience in this field of trying to bring quality care, and you know, less than substandard care, to to our most vulnerable, and you've spent so many decades trying to do it, and what your conclusion is that it's on us as a collective, because, and it really, you know, and it if we don't, if we don't listen to that people as a community, then, then we are failing as human beings. I mean, it's, it's a human This is a human rights situation, and we need to step up. We have to, because that's what that's that's the only power we have right now. It's obvious both of you have spent your lives working within that system, and this is the conclusion. So it really speaks volumes to what we're trying to say through the documentary as well.

Unknown: 50:58

If people weren't as concerned about seniors and the possibility that seniors suffer from abuse as they are about babies who might also suffer from abuse. We wouldn't have this conversation.

Susie Singer Carter: 51:13

But there's a I just had a conversation with my another colleague of mine who's in the health system, and she said, Well, babies are cute. Well, you know, cute is in the eye of the beholder. Some babies aren't that cute. No. I mean, you know, listen, my mom was adorable, and I in my mind she was the best. So, I mean, we have to get up, you know, we That's true. I mean, babies are we treat babies different,

Rick Mountcastle: 51:43

but just from a human, if you're a human being, you don't want to see someone suffering. I don't care who they are, how they are, someone suffering from a stage four pressure ulcer, suffering from sepsis, suffering from dehydration. Just as a as human beings, it shouldn't matter how cute they are or how comparatively cute they are. It should matter that you see suffering and you want to change that. You want to make it better. You want to make it go away. That should be enough, 100%

Susie Singer Carter: 52:19

100% but why is why? But you're right, Richard, it's like, why we've, we've had that conversation, you know, one of our, one of our interviewees, who used to work for Adult Protective Services, and you know, was very active in in the caregiving community and elder care rights. And you know, she would say to her colleagues, I need somebody over here. There's some abuse going on. Okay? We'll make a report and we'll, we'll check it out tomorrow. No, someone needs to come now. But it doesn't happen like that. But if it but in children, for the children's Protective Services, it does. It happens right there. So it's, it's built into our system, to be to have this ageism, to have this ableism, it's built into it.

Unknown: 53:08

And I think it's a cultural thing. I don't think, I don't think this is true necessarily in other countries, for example,

Susie Singer Carter: 53:16

I think it's becoming worse and worse, though, honestly, it's becoming a worldwide phenomenon of this individualistic kind of society that we have created. And

Unknown: 53:26

I think that's right, but historically correct me, if I'm wrong, Japan didn't have nursing homes, but if you grow old in Japan, this is years ago, you were with the family, only in recent years have been nursing homes in Japan.

Susie Singer Carter: 53:40

And now that's not it's actually worse. They're having a crisis now where they are basically sending the elders out to the to these communities of homes where they're just left on their own to to take care of themselves and with no oversight. And it's because the population and because of this, the way that society now is looking at the elder generation. It's so easy to look at them through, you know, a lens, as if you're they're othered, as one of our experts says, they're othered. And, you know, we, we will be that other in a sec, in a blink of an eye, we are all there.

Unknown: 54:22

Well, with the demographics of our population, this is going to just get worse and worse in this country, because the seniors are probably the predominant feature of the of the population, or they will be fairly soon.

Susie Singer Carter: 54:36

They are. It's their call. It a gray tsunami. That's the term and and, you know, there's so much value in that population, no matter what, and that's the problem. We need to really shift that, that that perspective to to a more healthier perspective, because we're missing, we're losing out on on some incredible. Double, you know, value that comes from that, from our elder generations. And you know, I only get smarter I hope, and I only get more valuable as a person. I hope. As I grow so I and I see that in the people above me, ahead of me, I look to my elders as mentors and guides, that they are they should be revered. That's the way I look at it.

Unknown: 55:25

Well, let's hope that No Country for Old people is required viewing by everybody at schools and medical schools and nursing schools,

Susie Singer Carter: 55:33

from your mouth to God's ears. Thank you. Well, thank you today for coming. Is there anything else we you wanted to say that was burning and that I missed, or Rick missed and that, oh,

Unknown: 55:45

it's hard, it's hard to think of, it's hard to think of anything that either of you missed. So I'm appreciative of your filling the gaps when I when I forgot a few things. But anyway, no, I appreciate, I appreciate, I appreciate the opportunity to have this conversation with you. It's very important again. Congratulations on your work. We're going to look forward to August and all of the publicity that comes with your film.

Susie Singer Carter: 56:10

Well, thank you. We loved having you and and as you might know, this show is all about love. It's in the title, and the reason is because love is powerful, love is contagious, and love conquers alls and, and that's, and I, that's what I feel. And I'm not changing my mind. So I think love is our, is our, is it's, it's the big, greatest tool in our arsenal. So thank you, Richard. You're full of love, and we really appreciated having you today. You, you know how I feel about you. So anyway, if you like this show, please, you know, earmark it and share it with everybody and talk about it. Give us good reviews, come back and listen again, and keep an eye out for no country, for old people, and have a wonderful time until we're together again, take care.

Richard Routman: 57:04

Bye, see you both. Bye, bye, thank you. You.