PBS: Risk Aversion Trumps Compassion in Elder Care

The health care regulatory system keeps senior care employees from providing the best care possible, writes PBS media partner Next Avenue in a recent column

“America’s elder care system is not a caring system,” writes Dr. Robert L. Kane in the column. “It is driven by caution instead of imagination. Safety is an overvalued commodity. As a result of risk aversion, older people are deprived of many activities and subjected to unnecessary suffering.

Kane, who holds an endowed chair in Long-term Care and Aging at the University of Minnesota School of Public Health, describes some of the challenges he and his family faced when trying to find a senior living community for his mother who had suffered a stroke and had dementia.


While he doesn’t blame the employees themselves, he says it’s the overall health care system that contributes to the senior care system’s inefficiencies.

When in an assisted living community, the provider’s inability to treat minor injuries his mother sustained on campus led to a number of trips to the emergency room (ER) — causing increased distress for both the resident and loved ones.

“If she injured herself in any way, the risk-averse staff would call the EMTs, lest they be accused of neglect,” Kane says, adding that after each visit to the ER it took several days for his mother to recover her cognitive function back to baseline.


“We approached the assisted living facility and offered to sign a waiver of liability to avoid calling the EMTs unless there was evidence of a serious problem like a fracture,” he says. “They said they could not do that because they would still be at risk and would be criticized by external regulators. So our mother became a frequent flyer to the ER, and we watched hopelessly.”

At another full-care facility, when it was discovered his mother was prone to choking staff altered her diet to consist of thickened liquids.

“This meant that one of her few remaining pleasures was removed,” he says. “Food is rendered both physically and taste-wise unpalatable. We can and should be able to do better.”

The article is part of Twin Cities Public Television Next Avenue’s year-long project about aging well, planning for the changes aging brings and shaping how society thinks about aging. 

Read the full column here

Written by Cassandra Dowell

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