For the elderly and their children, no two words unleash such a flood of emotions: terror, dread, bitterness, anger, anguish, anxiety.
Mention "nursing homes," and the horror stories quickly follow. You'll hear about filthy conditions, isolation, improper medication, neglect, verbal -- and occasionally even physical -- abuse.
But while a few county nursing homes have consistently fallen far short of state and federal standards, cases of neglect or serious abuse remain the exception at most.
Much more widespread are persistent staff shortages, sometimes forcing nurses and aides to work double shifts, and extraordinarily high burnout and turnover rates, says Dorothy Drummond, the long-term care ombudsman at the county Department of Aging.
Hospital placement specialists, the elderly and their relatives often struggle even to find a bed in an Anne Arundel County nursing home.
Meanwhile, the nursing homes themselves struggle to find staff to care for the influx of new patients.
Hoping to attract -- and retain -- good staff, nursing homes have gone so far as offering incentives such as free college education and a full week's pay for a weekend's work.
But such perks, along with tireless recruiting efforts, have done little to ease the shortages at most county nursing homes, Drummond says.
The work is hard, dirty and low-paid, particularly for unskilled nurses' aides, most of whom come to the job with a high school education and little or no formal training. With the population rapidly graying and insurance regulations sharply limiting hospital stays, staffers at the homes must care for more older, frail and chronically ill patients.
In Anne Arundel, it's even tougher than elsewhere to find good help.
The county's low unemployment rate, a dearth of affordable housing and the lack of public transportation combine to make unskilled, low-paid help among the hardest to find. Thus, nursing homes must compete with other employers for scarce applicants.
"In nursing homes, the work is hard physically, and it's hard emotionally, and people know they can get jobs that pay more without having to invest nearly that much emotionally," says Drummond, who investigates complaints and inspects county nursing homes.
Rapid turnover and shortages of competent staff, more than any other factors, lead to most complaints, Drummond says.
"It all comes down to retaining staff," she says. "People are just overworked and overreacting in situations because they're worn out and burned out and just at the end of their rope."
As a result, the number of complaints is growing.
Drummond says she is now looking into almost 90 complaints. They range from cold food and slow responses when patients press a call button to more serious complaints such as improper medication and verbal or physical abuse.
She resolves most without referring them to the state Department of Health and Mental Hygiene, which can impose sanctions such a ban on new admissions. Drummond says she calls in the state only in the more serious cases, or after a pattern of repeated violations of state or federal regulations.
Carol Benner, acting director of licensing and certification for the state Health Department, says state intervention usually brings quick compliance to correct deficiencies. Inspections of most Arundel nursing homes rarely reveal serious deficiencies, such as abuse or violations that could endanger patients.
But, Benner says, three Arundel homes have consistently failed inspections during the past three years: Fairfield Nursing Center in Crownsville, North Arundel Nursing and Convalescent Center in Glen Burnie and Pleasant Living Convalescent Center in Edgewater. All three have submitted required "correction plans" after inspections, Benner said.
* At the 142-bed Fairfield, Arundel's only non-profit nursing home, state officials temporarily banned new admissions in April for the third time since 1988. Officials also briefly stripped the home of its power to admit Medicare and Medicaid patients last year and the year before.
The sanctions came after investigators found a wide range of management and patient care deficiencies that endangered patients and even led to "life-threatening" situations seven times last year and once this year.
* North Arundel, a private, 121-bed nursing home, has repeatedly failed state inspections over the past two years. In October, investigators documented a pattern of violations, including improper medication, inadequate supervision and patient neglect. The nursing home could lose its Medicare and Medicaid support unless an unannounced visit shows significant improvements.