With 3 out of 4 Americans insisting they would prefer to age in place at home, senior care institutions already face stiff headwinds. But an investigation by two media organizations paints a glum picture of a little discussed aspect of elder life: the “lethal planning” some older residents make in nursing homes, assisted living centers, and adult care facilities — to end their own lives.
The exact suicide toll among the 2.2 million elderly Americans who live in long-term care settings is poorly tracked and difficult to quantify, reported the independent, nonpartisan Kaiser Health News (KHN) service and PBS NewsHour (see the broadcast report by clicking here). But the two news organizations found:
[An] analysis of new data from the University of Michigan suggests that hundreds of suicides by older adults each year — nearly one per day — are related to long-term care. Thousands more people may be at risk in those settings, where up to a third of residents report suicidal thoughts, research shows. Each suicide results from a unique blend of factors, of course. But the fact that frail older Americans are managing to kill themselves in what are supposed to be safe, supervised havens raises questions about whether these facilities pay enough attention to risk factors like mental health, physical decline and disconnectedness — and events such as losing a spouse or leaving one’s home. More controversial is whether older adults in those settings should be able to take their lives through what some fiercely defend as ‘rational suicide.’
Nursing home operators and those who run assisted living and adult care facilities defended their elder care, noting that residents rarely take their lives and each incident is tragic and likely difficult to avert. Still, the problem exists, the news organizations reported:
KHN examined over 500 attempted and completed suicides in long-term care settings from 2012 to 2017 by analyzing thousands of death records, medical examiner reports, state inspections, court cases and incident reports. Even in supervised settings, records show, older people find ways to end their own lives. Many used guns, sometimes in places where firearms weren’t allowed or should have been securely stored. Others hanged themselves, jumped from windows, overdosed on pills or suffocated themselves with plastic bags. (The analysis did not examine medical aid-in-dying, a rare and restricted method by which people who are terminally ill and mentally competent can get a doctor’s prescription for lethal drugs. That is legal only in seven states and the District of Columbia.) Descriptions KHN unearthed in public records shed light on residents’ despair: Some told nursing home staff they were depressed or lonely; some felt that their families had abandoned them or that they had nothing to live for. Others said they had just lived long enough: ‘I am too old to still be living,’ one patient told staff. In some cases, state inspectors found nursing homes to blame for failing to heed suicidal warning signs or evicting patients who tried to kill themselves. A better understanding is crucial: Experts agree that late-life suicide is an under-recognized problem that is poised to grow.
Experts said seniors can struggle with deep mental health problems that may intensify when they move in and among caregiving facilities. They may become unrooted when they are diagnosed with disease, when spouses or dear friends die, or if they fail to feel that caregiving staff and families give them the love and attention they need.
By the way, if you or someone you know has talked about or is contemplating suicide, consider calling the National Suicide Prevention Lifeline at 1-800-273-8255, or use the online Lifeline Crisis Chat, both available 24 hours a day, seven days a week. People 60 and older can call the Institute on Aging’s 24-hour, toll-free Friendship Line at 800-971-0016. IOA also makes ongoing outreach calls to lonely older adults.
Dr. Yeates Conwell, director of the Office for Aging Research and Health Services at the University of Rochester, told the media organizations that long-term care staff and facilities need to be aware of and to deal with four crucial warning signs in seniors who may take their lives. He calls them “the four D’s”: depression, debility, access to deadly means, and disconnectedness.
Nursing homes, assisted living centers, and adult care facilities can face fines and other regulatory penalties for failing to prevent older residents from taking their lives. They charge some nose-bleed prices, more than $90,000 annually on average for a private room. Still, with operators seeking to maximize profits by minimizing their caregiving personnel, the facilities can fall short of the optimal staffing needed to give residents the highest level of sustained attention and treatment they need, especially to maintain their mental health and prevent the depression and anxiety that may end in suicide.
In my practice, I see not only the harms that patients suffer while seeking medical care, but also their struggles to access and afford safe, efficient, and excellent medical care, especially in staying away from nursing home neglect and abuse. As the nation grays, KHN and the PBS NewsHour emphasized, the challenges will only rise, as likely will the toll, of senior, long-term care residents taking their lives. At the same time, more Americans than now may expect to may find themselves spending time in nursing homes and other long-term care settings, the independent, nonpartisan RAND Corporation has found.
Suicide, of course, is both a complex and individual problem that isn’t easily addressed, no matter the person’s age. We have work to do to erase the silence and shame surrounding suicide, so we can help support our loved ones and friends and keep them from taking their own lives. We also need to figure better how we can ensure that we all maintain our dignity, purpose, and meaning as we grow older. Life is too precious and rare for us to demean or throw away with any of the isms, including and especially ageism. As the media organizations’ investigation reported:
Most suicide prevention funding targets young or middle-aged people, in part because those groups have so many years ahead of them. But it’s also because of ageist attitudes that suggest such investments and interventions are not as necessary for older adults, said Jerry Reed, a nationally recognized suicide expert with the nonprofit Education Development Center. “Life at 80 is just as possible as life at 18,” Reed said. “Our suicide prevention strategies need to evolve. If they don’t, we’re going to be losing people we don’t need to lose.”