Families When Love Is Exhausted

By J. MADELEINE NASH CHICAGO

It was just another Saturday night at the Coeur d'Alene Greyhound Park in Post Falls, Idaho. The dogs had returned to their kennels. The boisterous stands had nearly emptied. Custodian Lou Tonani was making his usual rounds when he happened upon an old man in a wheelchair, a bag of diapers dangling by his side. He wore a brand-new sweatsuit, blue bedroom slippers and a baseball cap emblazoned with the words PROUD TO BE AMERICAN. Twin typewritten notes, carefully taped to opposite sides of the wheelchair, identified him as "John King," a retired farmer suffering from Alzheimer's disease and requiring round-the-clock nursing care. All labels had been cut from his clothing and identifying marks scoured from his wheelchair. Who on earth, Tonani wondered, had left the man there, and why?

From the start, it seemed like a classic case of "grandpa dumping." Some stressed-out family member, experts conjectured, had suddenly broken under the pressure of caring for a confused and ailing spouse or parent. "It's shocking and terrible," says University of Chicago geriatrician Dr. Christine Cassel, "but it doesn't surprise me at all. The families of Alzheimer's patients sometimes just give up in despair." Such families have been known to drop their elderly charges off at hospital emergency rooms and then disappear. "It happens here probably once a month," says University of Chicago emergency- room physician Dr. Cai Glushak. "Before you can turn around, the person who registered the patient has gone. They've left no phone number, no address."

Some abandoned patients are merely frail and suffer from the complications of chronic diseases such as diabetes. But more are clearly demented. They show up in emergency rooms with acute problems like dehydration. Elderly people who live alone are sometimes so desperate for help that they in effect abandon themselves. Others are dumped not by relatives but by landlords and even household employees. In Greenville, N.C., a 65-year-old alcoholic woman materialized on the doorstep of the Pitt County Memorial Hospital after she was shoved out of a car by a fed-up and weary maid.

How widespread is the phenomenon of abandoned elders? The evidence is mostly anecdotal, and reliable statistics are elusive. Dr. Robert Anzinger, a past president of the American College of Emergency Physicians, estimates that between 100,000 and 200,000 such individuals show up in hospital emergency rooms every year. "These are desperate acts," says Dr. Ellen Taliaferro, an emergency-room physician at San Francisco General Hospital, "committed by desperate people."

Social workers understand that caring for an aging, infirm relative day in and day out drains families, not just financially but physically and emotionally as well. The wonder is that so many people willingly shoulder the burden with fortitude and grace. Noreen Maluchnik, head of the English department at Chicago's Resurrection High School, gets into the shower with her 77-year-old father in order to bathe him. Daily she helps her mother change his diapers, cut up his food and clean the bed linens, carpets and floors whenever there is an "accident." At times she wonders how to hold on to sanity. "Although I could never abandon my dad at a hospital or a racetrack," she says, "I can certainly understand the pressures that would lead another person to do something like this." Rather than renounce responsibility, caregivers often neglect their own health and risk ending up in hospital emergency rooms themselves.

John King turned out to be a retired autoworker named John Kingery, 82, who in early March was placed in the care of Regency Park Living Center in Portland, Ore. For a year and a half he had lived at the Laurelhurst Care Center, another Portland nursing home. His daughter, a suburban Portland resident, removed him from Laurelhurst over the protests of the staff, then reportedly checked him out of Regency Park the morning of March 21. Half a day later, he turned up more than 300 miles away at the Idaho dog track; authorities are still trying to learn exactly how he got there.

"To me, it's a sin and a crime," says Post Falls police detective Harlan Fritzsche, "but I'm left in a quandary." There is no law in Idaho against abandoning the elderly. But Oregon's Medicaid-fraud unit and the Washington County sheriff's department have launched investigations that may result in criminal charges. Among the questions under examination is why Laurelhurst did not receive Kingery's pension checks -- which partly covered the cost of his care -- for five months before his departure.

Kingery's tale is drawing the attention of policymakers to the plight of people with devastating long-term illnesses and the limited options available to their families. Medicare, for instance, will pay hospital costs for acute illnesses but not for maintaining an Alzheimer's patient in a nursing home. Many nursing homes have neither the staff nor the inclination to provide advanced Alzheimer's patients with the exhaustive services they require. For families struggling to care for their own disabled, as an impressive four out of five now do, adult day-care centers can provide well-earned relief, but there are far too few of these (2,100 nationwide) to meet the need.

Helping families care for ailing elders will not be cheap: a respite-care bill sponsored by U.S. Senator Bill Bradley carries an estimated price tag of up to $2 billion a year. But it is probably the most humane and cost-effective remedy for a growing problem. Today 4 million people in the U.S. have Alzheimer's disease. In the year 2050, there will be an estimated 14 million cases. By illuminating this frightening black hole in the nation's health-care system, John Kingery serves as a beacon in helping young and old alike search for a solution.

With reporting by Elizabeth Rudulph/New York and Lynn Steinberg/Seattle