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Editor's Note: If you or someone you know may be considering suicide, contact the National Suicide Prevention Lifeline at 1-800-273-8255 (En Español: 1-888-628-9454; Deaf and Hard of Hearing: 1-800-799-4889) or the Crisis Text Line by texting HOME to 741741.
By 2030, 20 percent of Americans will be senior citizens. Many will eventually enter long-term care, a move that presents tough choices and challenges for seniors and their families -- including risks of depression and suicide. In partnership with Kaiser Health News, special correspondent Cat Wise reports on how families and facilities are struggling to understand and manage these risks.
By the year 2030, one in five Americans will be a senior citizen. And, as baby boomers age, many will eventually enter long-term care.
That move brings difficult choices and challenges for both seniors and their families. Among the less discussed is an increased risk of both depression and suicide for those moving into or living in long-term care.
Special correspondent Cat Wise reports on this difficult topic. It's part of a partnership with Kaiser Health News. And a warning: This story contains graphic references to suicide.
He was fit and physically just on track to just living this long, long life.
Roland Tiedemann was a lifelong outdoorsman, a hiker, skier, a member of the Forest Service who taught his daughter, Jane Davis, to love the outdoors as well. But after so many years of pushing himself, traveling the world, and serving as a surrogate father to his granddaughter, Jayna, after her father died, both his and his wife's health began to fail in 2014.
He contracted a vicious case of shingles. His wife, Mary, took a fall while caring for him, breaking her back. She was subsequently diagnosed with dementia.
So, we made the decision to put them both together in a facility where, in my opinion, I thought that would be the safest place, that they would get the care they needed.
How did he handle the transition into long-term care facility?
Good question. He — he didn't. He struggled with it, but he also recognized it was the only option.
I didn't have the space. I built a place with no bedrooms on the bottom floor, and neither of them could do stairs. He had his hands tied. And for a man that had made so many decisions and been able to be so free, now he was confined to this space where he didn't have a voice.
In early 2018, facing his third move to another long-term care facility, one that would accept Medicaid, as the family's resources dwindled, the 89-year-old locked his door at his nursing home in Wenatchee, Washington, and jumped to his death from his fourth-floor window.
Him being a big writer, I knew he wouldn't have left without leaving a note. And a note was found. And he couldn't write. Remember, he had shaky letters.
And it just said, "Sorry, everybody."
That must have been so difficult. It's been about a year since he passed. How are you doing now?
It', every day, a different journey. I miss him. He was my anchor. And he was my daughter's anchor. When Jayna's dad died, he became her pop-pop. And she misses him.
Davis lived close to the nursing home, and found it painful to drive by, so she and her daughter recently moved to Colorado.
But in the wake of her father's death, a new program is being developed to prevent this from happening again.
So, vision loss leads to social isolation, which then concurs into depression.
Julie Rickard is a psychologist at Parkside Mental Health in Wenatchee, a 28-bed crisis stabilization center.
She's also the founder of the Suicide Prevention Coalition of North Central Washington, which she started in 2012 after a rash of suicides, mostly among young people.
Prior to that, we kind of averaged between 10 and 13 any given year, but as long as the youth didn't die, the community wasn't saying anything about it.
Then, in 2018, Roland Tiedemann's death led her to start asking questions at his facility of the residents, staff and administrators.
What I heard was that there were other residents that were now considering the same method. And the administration really wasn't on board. Like, they had no idea, because the staff hadn't communicated to administration that there were these other five residents that were now considering the same method.
And what they said was, you know, I always wondered if that would work, but now I know.
The risk is elevated for up to eight months after transitioning to a long-term care facility.
Sitting in on Dr. Rickard's staff training was Kaiser Health News reporter JoNel Aleccia. For the past six months, she and her reporting partner, Melissa Bailey, have been examining records of over 500 attempted and completed suicides from across the country in long-term care settings.
And she was surprised to find that the rates of suicide among residents in these facilities don't differ from seniors living on their own.
One of the things that I think most people think is that, when you send your loved one to a long-term care facility, in part, what you want is supervision.
And from the data that have been available, it looked like the rates of suicide in long-term care and in the larger community with no monitoring were about the same.
Is it your sense from your reporting that this is an issue that is front and center for many long-term care facilities? I mean, are they really tracking the mental well-being of their residents?
We found that it's a pretty big problem. From the research that we did, up to a third of the people who are living in long-term care centers have suicidal behavior, either suicidal thoughts or attempts. And we found that about half of the people have been reported to be depressed.
Had a home, a new car.
Now I ain't got nothing.
A year-and-a-half ago, 84-year-old Jim Ellis moved from a facility in Arizona to Kadie Glen, a 60-bed long-term care facility in East Wenatchee. He'd already lost his leg to a medical complication, and says losing his mobility and independence have been hard.
He says other residents feel the same way.
Has anyone here that you know ever talked about or said that they're thinking about suicide here?
Oh, you hear it. You hear it practically every day.
You hear other residents talking about…
Certainly. And I have probably said it myself. But that's talk.
Julie Rickard is working with management at Kadie Glen, which hasn't had a suicide, to try to prevent one from happening by screening residents for depression and suicidal thoughts, teaching staff to recognize warning signs, and then intervening when necessary.
Some families watching this might start to feel a bit guilty for having their loved ones go into long-term care facilities. What would you say to them?
I would say, you know, there's lots of reasons that people go into long-term care. This isn't about whether it's a right decision or a wrong decision. What it's about is, what are we doing on the backside to make sure that the person is transitioning well when they are going into long-term care, that we are doing the things to support them and stay connected.
A big part of that means pairing people who are not adjusting well with those who are to help them reconnect and reengage with the community.
For Jane Davis, that mentoring piece is key.
I think the biggest thing is connection. If you have no connection, if your voice is no longer heard, why? What's the why for life?
And just having someone to listen to you, to tell your story to — my dad had a great story. He loved to tell it, but no one was listening anymore.
For many families evaluating long-term care options for their loved ones, just learning the history of a facility can be challenging.
Kaiser Health News reporter JoNel Aleccia says there are no federal requirements to report suicides in long-term care, and most states either don't track these numbers or wouldn't divulge them.
You would think that somebody would be watching. And what we found is, it is very difficult to tell which long-term care centers have had suicides, how your loved one — whether your loved one is in a place where that might have occurred.
She recommends that families ask what suicide prevention and mental health protocols are in place. But she cautions that the work being done in Wenatchee is one of the only programs she was able to find across the country.
For their part, Julie Rickard and Jane Davis say we need to do better as a country of valuing the elderly and to reduce stigma around depression and suicide.
I don't want this to happen to anyone else. It haunts you. So, to be able to talk about suicide, to talk about depression and anxiety and all those issues that stem from long-term stuff that just isn't addressed, we need to get rid of the stigma. We need to understand that a person is a person and talk about it.
For the "PBS NewsHour," I'm Cat Wise in Wenatchee, Washington.
If you or anyone you know is feeling depressed or suicidal, please call the National Suicide Prevention Lifeline at 1-800-273-8255.
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Frank Carlson is a general assignment producer at the PBS NewsHour, where he's been making video since 2010. @frankncarlson
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