Exposing Neglect in America’s Nursing Homes

There's systemic neglect and abuse occurring at far too many of America's nursing homes. Filmmaker and producer Susie Singer Carter has set out to tell this story through a powerful new documentary series, "No Country for Old People."

The three-hour, three-part docuseries, which won an Anthem Award in November, uncovers how nursing homes fail to live up to the high standards they promise, often due to chronic understaffing and other profit-driven management practices.

Carter and her team use personal accounts, expert insights and never-before-seen undercover footage to reveal the disturbing realities behind the polished facades of "five-star" facilities.

Abuse in nursing homes is more widespread than commonly known. The National Council on Aging estimates that as many as 5 million Americans experience elder abuse every year; many victims residing in nursing care facilities. Elder abuse has devastating emotional and physical effects on older adults, yet it often goes unidentified or unreported. According to one study, only 1 in 24 cases get reported.

The documentary, which will be available on a streaming service in early 2025, grew out of Carter's personal experience with her own mother, Norma, who lived with Alzheimer's disease for 16 years. Despite Carter's fierce advocacy, her mother spent her final six months in what Carter describes as a "top" facility in Los Angeles, where she suffered from numerous instances of neglect and abuse.

"This is a cautionary tale that will provide the public with critical information about the nursing home industry largely run by greedy, ruthless private-equity investors," Carter said. She added that she chose to present her case in a "personal, emotional and eye-opening way, and embolden viewers to demand that legislators, policymakers and regulators change our system into one that prioritizes people over profit," said Carter, host and producer of "Love Conquers Alz" podcast.

Like so many older adults, Carter's mother was living in a nursing home during the COVID-19 pandemic, which meant Carter couldn't visit her and check on her care. When Norma faced serious health issues and was transferred to a nearby hospital, the nursing staff discovered that she had a stage 4 bed sore, which is the most advanced stage and means muscle, bone and tendons may be visible through a hole in the skin, putting the patient at risk of serious infection, usually sepsis, which often leads to death.

"A stage 4 bedsore is a hallmark of nursing home neglect, pure and simple," added Carter. According to the Centers for Medicare and Medicaid Services (CMS), bedsores, also known as pressure ulcers, are considered a "never event" — a serious, preventable medical error that can result in death or disability.

"Of course, the nursing home denied neglect when I confronted them with this discovery," Carter said. "They said, 'It didn't happen here' and blamed the hospital." It took Carter two months of nonstop advocacy to get her mother seen by a wound specialist.

At one point, the nursing home staff moved her mother to a quarantine wing to protect her from COVID-19. However, the air conditioning was broken and her mother was left in a stifling room, sweating in the San Fernando Valley heat, with no access to fresh air or cool water. "I had to bring in five fans just to make her somewhat comfortable," said Carter.

In another instance, the nursing home staff refused to remove her mother's feeding tube and provide her with water or food for six months. "They said it was too dangerous because she was aspirating, but they never assessed her properly," Carter said. "With chronic understaffing, they did not want to spend the time feeding her by hand because feeding tubes make it easier."

She captures these heartbreaking stories that her mother faced in "No Country for Old People," weaving in more than 60 interviews with former nursing home directors, elder care attorneys, health care providers and others, including prominent advocates like New York Assemblyman Ron Kim, Ernie Tosh from Bedsore.law, gerontologist Charlene Harrington, attorney Tony Chicotel and Lori Smetanka, executive director of the National Consumer Voice for Quality Long-Term Care, which is the non-profit partner supporting the documentary.

"Unfortunately, Susie's story is all too common," said Smetanka. "Consumer Voice chose to serve as the project's sponsor to raise greater awareness about the urgent need to address the problems in our long-term care system. We hope the film series will lead to increased public demand for quality long-term care, such as through better care options, increased staffing and accountability for those providing inadequate care."

After facing numerous challenges in finding an attorney willing to take on the case due to the facility's powerful backers, Carter connected with advocate Rick Mountcastle, a former award-winning federal and state prosecutor whose work was depicted in the Emmy-nominated Hulu miniseries "Dopesick."

In addition to pursuing OxyContin maker Purdue Pharma, Mountcastle spent a significant part of his career prosecuting fraud, abuse, neglect and other crimes in the nursing home industry, but never saw any significant improvement.

Mountcastle retired in 2022 and joined forces with Carter to produce "No Country for Old People" and spotlight this rarely told story.

This is not Carter's first film about Norma and the challenges that older adults face at the end of life. Her's mother's long battle with Alzheimer's disease inspired her 2018 award-winning short film, "My Mom and The Girl," in which Valerie Harper, in her final performance, portrayed Norma.

"'My Mom and The Girl' was fueled by my desire to share a story that presented an accurate depiction of a misunderstood disease," Carter said. "A story with the potential to change the biased conversations about Alzheimer's by replacing stigma, denial, fear and grief with acceptance, understanding, appreciation and love."

Carter is also launching ROAR (Respect, Opportunity, Advocacy, Reform), a grassroots movement focused on bringing dignity, accountability and quality to long-term care. ROAR aims to address the systemic issues that the documentary is bringing to light, mobilizing the public to demand policy reforms, more transparency and greater respect for individuals in long-term care.

"It's vital that we ensure that all individuals, especially the elderly and those needing long-term care, are treated with dignity and their personal choices and values are respected," Carter said.

Paul Wynn has contributed feature and news stories to more than 65 publications throughout his career. He is a graduate of Ithaca College's Park School of Communications. He lives with his family in New York's scenic Hudson Valley. Read More