The emphasis on cutting health care costs in the US -which are the highest in the world--has resulted in cutting care. The whole system is profit driven even for non-profit organizations, who rely on the revenue from billable services to keep the lights on. The least educated provide most of the essential care because they are cheaper. New rules and regulations will not fix this. Only a major overhaul of the financial infrastructure can do that and it's called single payer. And it won't happen here.
6
People who work in nursing homes are overworked and underpaid. We ask them to take care of the frailest of our elderly and disabled. They are often mandated to do double shifts. They cannot leave if their replacements do not show up for work. What does that do to a woman who worked overnight and must go home so that her children can go to school? If she leaves, that is patient abandonment. All this for $12-14 per hour? And if a CNA is overwhelmed, where does he or she turn for help or counseling? There is no where. If he or she leaves, that puts even more pressure on his or her peers. Sometimes there are language issues. This is some of the toughest work anyone will ever do. But is the work valued? No. The regulations are very tough--and they should be. But when CNAs are not properly trained (NY requires a 100-hour course for certification) and not properly updated when regulations change, you can only imagine that an overwhelmed CNA is apt for making mistakes. Turnover is rampant. I have known CNAs who are so devoted to their residents that they do all sorts of extras--do nails, hair, bring in extras, etc. Others are so busy working three jobs or overtime to make ends meet that they cannot even think straight. Let's value the work they do by paying them what they are worth. Medicare and Medicaid reimbursements, as they stand now, do not allow this. These are set by the feds and the state.
4
Does it help to hire a CNA yourself to supplement the overworked staff at a nursing home or rehabilitation center?
I work as a swallowing therapist in these kind of facilities. The problems are systemic and widespread. When staff are underpaid and overworked, everybody loses, and people like myself are leaving the industry in droves. Why would I want to work in a place that does not give me the support to do my job well?
We use a fax machine from the 80s to get critical paperwork from hospitals. I have to constantly fight with doctors, who are under enormous pressure to cut costs, about ordering necessary tests. I have to beg cranky CNAs (who are the most overworked and underpaid) to get patients out of bed for at least one meal a day. And because my company enforces ridiculous productivity requirements on therapists, I have little time to do paperwork, make phone calls to family members, or help a patient track down a nurse who is nowhere to be seen.
I do what I can, but it is never enough, and the quality of care these patients receive makes me sick to my stomach. I'm getting out of here.
We use a fax machine from the 80s to get critical paperwork from hospitals. I have to constantly fight with doctors, who are under enormous pressure to cut costs, about ordering necessary tests. I have to beg cranky CNAs (who are the most overworked and underpaid) to get patients out of bed for at least one meal a day. And because my company enforces ridiculous productivity requirements on therapists, I have little time to do paperwork, make phone calls to family members, or help a patient track down a nurse who is nowhere to be seen.
I do what I can, but it is never enough, and the quality of care these patients receive makes me sick to my stomach. I'm getting out of here.
20
Andrea, you are totally RIGHT! I also work in a nursing home facility and am also looking for a way out. I am a nurse and have worked in this facility for almost 15 years. The most disappointing thing is that there is no support for the staff but we are expected to work miracles and all these facilities are the same. The staff turnover is off the charts - on average, my facility orients a new nurse every 2 weeks and only 20% or less stay after their orientation. The working conditions are beyond appalling. We are so overworked yet underpaid. As a result, the level of care is affected (negatively) and the people who pay the price are the patients or residents.
Come State survey time; all of a sudden the staffing levels are "good" and everybody from the office helps with meals and answering of nurses' call lights. The facility passes its survey and things are back to "normal". Patient's needs are not timely met at all. That is why I will never have my loved one taken care of in any of these facilities. Patients get worse under such care and the unfortunate ones die. I understand why people are suing these facilities left, right, and center. They promise potential clients heaven on earth but never deliver. There has to be a way to ensure that care in these facilities is at least decent.
This is so sad!
Come State survey time; all of a sudden the staffing levels are "good" and everybody from the office helps with meals and answering of nurses' call lights. The facility passes its survey and things are back to "normal". Patient's needs are not timely met at all. That is why I will never have my loved one taken care of in any of these facilities. Patients get worse under such care and the unfortunate ones die. I understand why people are suing these facilities left, right, and center. They promise potential clients heaven on earth but never deliver. There has to be a way to ensure that care in these facilities is at least decent.
This is so sad!
5
Nursing homes have their own "feifdoms" wherein the "directingpPhysician" "rules the roost" and prevents other physicians access to their patients, thus increasing the "take" that the nursing home steals from Medicare. It would seem much more logical that the physicians who know most about the patient's care should have access to their patients. In several recent instances of which I'm aware, an entirely new series of diagnostic tests were preformed; in another instance, medications the patient was receiving were left out of the treatment until the patient complained.
1
This is an excellent start to examining a relationship between Medicare and nursing homes that is in the best interests of neither the patient nor of health care spending. Medicare creates the incentive to provide "therapy" when hospice is the better option for the patient. When recovery is really not a reasonable goal of care, patients are subjected to therapy for the exclusive purpose of ensuring the bed is paid for.
3
And for people who really do need rehab so they can return to their homes and normal lives, the "rehab" provided by nursing home is often substandard. People who are capable of the more comprehensive rehab provided by acute rehab facilities are routinely pushed into nursing home subacute rehab facilities by Medicare.
3
The greed in this country is one of its most disgusting features. When you allow that greed to infect the healthcare system, which it has ever since the rise of the American Medical Association (AMA) and the professionalization of what was once the province of barbers, butchers, medicine charlatans, hacks and drunks, and you have today's fee-for-service medicine, which is an expensive disgrace, costing more and providing less than the socialized medicine systems in many other developed countries in the world.
Doctors are like the car mechanics of the physical body. Yet the AMA has turned them into the deities of a hierarchical system which exploits everyone who works under them. Every decision depends on the word of the reigning doctor-in-charge, a person who shows up to talk to the patient at times of their choosing for the small duration of time possible. It is a ridiculous system, and one which needs large-scale changing. The best thing would be to put everyone in the entire country on Medicare, and create a giant insurance risk pool which covers everybody. Then, stop treating doctors like gods. They know some stuff about the human body, but there is much they don't know, but won't admit to not knowing. It is the arrogance of the system of physicians which prevents it from changing. Fee-for-service medicine with doctors at the top is a bad system.
6
What a contradictory article. Centers are upgrading facilities to attract short term medicare patients instead of long term medicaid patients - yet even the short term medicare patients receive inadequate care. The claims that things will get better because hospitals will be fined for re hospitalizations is a false claim. I observed this. When my mother in law fell and broke bones requiring surgery it took the hospital a day calling rehabilitation centers trying to find any with space willing to take her and the medicare reimbursements. The hospitals will not have a choice - they will be releasing patients to the rehabilitation centers that have space - they will have no choice. The potential fines will be absorbed as the cost of doing business and passed on to all patients. It is a sorry state. The best recourse is have relatives that have time, care and are vigilant.
8
What is needed is a mandatory set of rules relating to RN/CNA : patient ratios using an algorithm that takes acuity into account. I know from personal experience as an RN how deficient and scary these "luxury" facilities are. Don't be fooled by the "restaurant style" "dining". Nurses and caregivers are overworked and stressed by the for-profit corporate model they work within. These corporations game the system by cutting staff. If they didn't then these ventures would not be as hugely profitable...
3
Profit is the only thing that matters to the powerful who see the rest of us as nothing more than the subhuman source of ever more profit. The weak, the very old and very young, the sick, the disabled are easier to prey upon than the strong, so they naturally produce the highest profits and so attract the worst exploitation.
Compassion is not profitable, and we are taught to hate and fear those who advocate working together to solve human problems as dangerous "socialists" or "collectivists" who can only destroy liberty and recreate Stalinist Russia or Maoist China.
And yet many of the conservatives who want to cut the social safety net for the poor and give the proceeds to the rich also insist that this is a Christian nation. They seem not to understand the basic tenets of Christianity. Jesus advocated compassion for the weak, lived on alms and drove the money-changers from the temple. This seems diametrically opposed to the policies advocated by those who today claim to speak in His name.
Compassion is not profitable, and we are taught to hate and fear those who advocate working together to solve human problems as dangerous "socialists" or "collectivists" who can only destroy liberty and recreate Stalinist Russia or Maoist China.
And yet many of the conservatives who want to cut the social safety net for the poor and give the proceeds to the rich also insist that this is a Christian nation. They seem not to understand the basic tenets of Christianity. Jesus advocated compassion for the weak, lived on alms and drove the money-changers from the temple. This seems diametrically opposed to the policies advocated by those who today claim to speak in His name.
19
Reading stuff like this just convinces me more and more than if and when I get to the point where I'm too old to care for myself or even do basic tasks alone, it's time to pop the pills and call it a day. Being cared for like that is just existing...it's not living...and there isn't a wage in this world that could get someone working in a nursing home to give enough of a damn to care for these people. They're not there because they care. They're there because experience and training requirements are so pathetically low, and turnover is so high. Changing an old person's diaper is not glamorous, so of course no one but the grunts will be tasked with doing it.
For this to change, I'm certain that we will need a technological revolution to give us robots that do the caring instead of people. Robots can't cop an attitude, they won't ignore the call button, etc. Staff one for each patient and be done with it.
Pity it'll take another 50 years.
For this to change, I'm certain that we will need a technological revolution to give us robots that do the caring instead of people. Robots can't cop an attitude, they won't ignore the call button, etc. Staff one for each patient and be done with it.
Pity it'll take another 50 years.
3
There actually are some people who work as aids in nursing homes who do care and do their jobs well. Definitely not all, but some aids do care about the patients they care for and do as good a job as they can within the time constraints placed upon them. I have met some of them in the home where my mother is cared for. There will never be enough of these compassionate people to serve the people who need their care however so perhaps robots will help to relieve some of the work load in the future.
7
There are good facilities, and we used one for several weeks for my late father who couldn't be discharged home in the weeks before his death (from end stage heart failure). But, we also had private caregivers arranged long before, and that is often the only way for nursing home care to work.
Understaffing is sadly the main issue, and lousy pay for CNAs, who don't make much more, if at all, in some highly rated hospitals, either. But, my earlier question remains: how can private equity companies, or other large corporations, make a fortune on these facilities yet the govt. is unaware, and doesn't demand better staff to patient ratios? Please, can somebody explain this?
Understaffing is sadly the main issue, and lousy pay for CNAs, who don't make much more, if at all, in some highly rated hospitals, either. But, my earlier question remains: how can private equity companies, or other large corporations, make a fortune on these facilities yet the govt. is unaware, and doesn't demand better staff to patient ratios? Please, can somebody explain this?
8
Lobbying.
3
We need to return to having non-profits dominate the nursing care market. I'm sure many people in religious groups or other organizations would love to invest in such a venture, but there is a lack of know-how and a lack of oversight to make sure such plans are sound. It would be an excellent use of taxpayer dollars to set up informational sessions and training programs to non-profit leaders who want to set up nursing homes to serve their members, families and friends. We also need some non-profit staffing agencies for various skilled and unskilled helpers for seniors--both the workers and patients often receive poor value for both work and money. Most people in churches and other groups want these services for the elderly in their circle, but simply don't know where to get started. It's a good role for government to train them how to do so.
5
Unfortunately, these days non-profits act the same as for profits, sometimes worse. We no longer have the oversight from people who care at the non-profits, like when the nuns kept an eye on every penny that was spent, not because they profited but because it was their duty to do so. Not much of that going around these days.
4
Sorry, for profit health care is never going to provide quality care to anyone other than the very wealthy. Competition results in terrible care as the owners try to squeeze out every penny in profit that they can. This is bourn on the backs of the underpaid and often poorly trained staff and the people they provide very dubious "care" for in these facilities. If the physical care of the inmates - for that is the way they are treated - is miserable, can you imagine how their emotional and social needs are addressed? Is it any wonder that nobody, absolutely nobody, wants to be in a nursing home whether it is short or long term care.
15
The federal government, meaning the Congress and the president, does a terrible job of managing the payment system for healthcare and of regulating the quality of care of the inherently corrupt for-profit and not-for-profit providers. Conversely, the providers do an outstanding job of lobbying the Congress and the federal and state regulators. People are killed by the decisions the regulators and payers make, or don't make.
4
Until you or a family member needs nursing home care, it may be difficult to imagine what a nightmare these places can be for its residents/patients. I could fill several pages with detailed descriptions of the daily horror and neglect suffered by my elderly mother and myself in three "highly-rated" Dutchess County facilities over several months since 2013.
Every problem we experienced was directly rooted in grossly inadequate staffing patterns resulting from the unwillingness of some owner or director to spend the money needed to hire enough trained staff to provide adequate care for all patients.
It takes a special kind of sociopath to intentionally profit from the preventable suffering of sick and elderly people.
Every problem we experienced was directly rooted in grossly inadequate staffing patterns resulting from the unwillingness of some owner or director to spend the money needed to hire enough trained staff to provide adequate care for all patients.
It takes a special kind of sociopath to intentionally profit from the preventable suffering of sick and elderly people.
9
My wife was a Physical Therapist before retiring and spent a number of years in Geriatric Care in her early days. It's better than Burn Centers but not by much. In every case where a family member was at their end we brought them home and with the aid of Hospice cared for them until the end. It's what our ancestors did and modern times are no excuse. Please support your local Hospice and the Hospice Education Institute.
5
You are 100 percent correct. And Unless you have family to visit and tend to lot of your needs you are so screwed.
3
The for-profit Assisted Living Residence "business" model is equally troubling here in NY State where the Dept of Health has been complicit in allowing unlicensed facilities such as the Prospect Park Residence in Brooklyn to have maintained operating as an unlicensed home. Dire consequences resulted to those who mistakenly thought they were protected by laws.
The urgency in view of the enormous spill-over of an aging population in NYC with the truly crummy oversight available; legislators who are NOT stepping up to mitigating obsolete or poor standards; a DOH website which is inaccurate and actually harmful for those wanting to evaluate places for their loved ones; and poor enforcement of penalties is what we and our aging loved ones face.
Look for it...These places are waiting to fatten their bottom line at your expense.
When you see a pretty lobby and the bells and whistles to allay your fears...understand that this is the Disneyfication of senior facilities which must be suspect.
125 old people at the Prospect Park Residence were dumped with a 90 day notice of eviction...they were promised to be able to "age in place"...many were forced to go to nursing homes...and to their demise.
The urgency in view of the enormous spill-over of an aging population in NYC with the truly crummy oversight available; legislators who are NOT stepping up to mitigating obsolete or poor standards; a DOH website which is inaccurate and actually harmful for those wanting to evaluate places for their loved ones; and poor enforcement of penalties is what we and our aging loved ones face.
Look for it...These places are waiting to fatten their bottom line at your expense.
When you see a pretty lobby and the bells and whistles to allay your fears...understand that this is the Disneyfication of senior facilities which must be suspect.
125 old people at the Prospect Park Residence were dumped with a 90 day notice of eviction...they were promised to be able to "age in place"...many were forced to go to nursing homes...and to their demise.
3
What many people do not realize, until after it happens, is that getting a bedsore in a nursing facility is what Medicare terms a "never event" in that it is something that should never happen. And because it should never happen Medicare will not pay for care resulting from obtaining and treating one. Leaving the patient to use his or her own supplemental insurance or own resources. Preventing bedsores is nursing 101, basic and obvious. Yet they are an all too common horror story. Too many elderly patients are left to deal with the long term and debilitating effects of serious bedsores: if they are fortunate enough to survive them. We need to do better by our elders-lets face it we will all be there soon enough.
7
My now retired wife was a Physical Therapist who had to treat these decubitus (bed sores) and held the same attitude toward them. They are a sign of neglect by nursing home staff by not turning them over to prevent the breakdown of the skin. It is also common in patients being left in wheel chairs for days on end. She has the nasty job of soaking these people in a Hubbard Tank full of Betadyne and cleaning out the infection and removing necrotic skin. It is very painful to treat and it is possible to die from sepsis.
5
My mother has been in a nursing home for two years now and from what I have seen the best way to improve nursing home care is to improve working conditions and salary and benefits for the CNAs. When the position of CNA is highly respected and adequately compensated, as it should be, care in nursing homes will improve. I am not holding my breath waiting for this to happen because it will cost too much money.
Another factor that plays into quality of care for the frail elderly is the fact that the children of these elderly often live far away and must work into their own advanced years as they cannot afford to retire. My father retired at the age of 58. For many of us baby boomers we must work well into our 60's and beyond. This leaves us with less time to care for our parents either at home or in a facility. Perhaps if greater assistance were provided for caregivers who care for elderly and disabled relatives at home this would help keep people out of nursing homes.
Another factor that plays into quality of care for the frail elderly is the fact that the children of these elderly often live far away and must work into their own advanced years as they cannot afford to retire. My father retired at the age of 58. For many of us baby boomers we must work well into our 60's and beyond. This leaves us with less time to care for our parents either at home or in a facility. Perhaps if greater assistance were provided for caregivers who care for elderly and disabled relatives at home this would help keep people out of nursing homes.
6
Thank-you Katie Thomas for this fine article. I will add: check the facility on the weekends when they are short of staff, this is when they cannot give help for bathroom needs. This can be the tip of the iceberg.
8
This country always has money for war , foreign aid (including military) and projects serving the personal interests of the rich/influential class We have a sitting president who decided roughly 5 million illegal immigrants could stay and receive various benefits while their status was reviewed, but when it comes to care of it's citizens its a different story. Those who make the decision on how our tax dollars are spent have the luxury of choices when it comes to taking care of their elderly/disabled relatives,,, they have the money and the means to see that a high quality of care is present. The same goes for the upper class which continues to get a pass on paying their fair share of taxes since our lawmakers essentially serve at their pleasure.
3
I once said I would write a book about my experiences with my mother's nursing homes once I got past it a bit. I've never gotten past it, too sad to write that book. But to everyone who is considering nursing homes for a loved one, go unannounced and sit quietly and observe--are the residents treated with respect and affection? If not, all the frills don't matter one bit.
4
The only real oversight of nursing homes is that of the patient's family and friends if they are lucky enough. Otherwise anyone who goes to a nursing home or so-called rehab facility is completely and totally at the mercy of the staff and the doctors who drop in periodically to peruse patient charts while not actually meeting with and getting to know the patients, meanwhile collecting huge fees.
They are nothing but a huge money maker for the corporate owners and,like most of medical care and the insurance industry in this country, nursing homes exist to make the most possible money and are not, on any level, about patient care. They are an outrage, are unregulated and most should be shut down.
They are nothing but a huge money maker for the corporate owners and,like most of medical care and the insurance industry in this country, nursing homes exist to make the most possible money and are not, on any level, about patient care. They are an outrage, are unregulated and most should be shut down.
5
The real problem here isn't the nursing homes. It's their underfunding by Medicaid. Under the law, folks who could pay a fair rate for nursing home care are encouraged to impoverish themselves by transferring their savings, leaving Medicaid to pay most of their long-term care costs at inadequate rates. The idea is not to defeat a lifetime of savings by spending it all on nursing home care. But if the elderly don't pay their own way and Medicaid scrimps on its payments, nursing home care will remain substandard.
1
Catholic nursing home took everything in the world I was going to inherit to pay for my suddenly crippled father who is legally blind. have had entire conversations with dad talking while sitting on the floor he fell on. can't get up until help arrives.
meanwhile, the state of Maryland, where nursing home is, refusing medicaid for his case. I live in California and am asked by facility doing his care to write letters of appeal to Maryland congress members. no offense to nursing homes of the USA, but knowing I would not get a private room, I would choose euthanasia if my fate is a nursing home.
meanwhile, the state of Maryland, where nursing home is, refusing medicaid for his case. I live in California and am asked by facility doing his care to write letters of appeal to Maryland congress members. no offense to nursing homes of the USA, but knowing I would not get a private room, I would choose euthanasia if my fate is a nursing home.
1
I have had a professional affiliation with multiple nursing homes.
A huge percentage of the patient's that receive therapy have only a marginal if any need for it. The facilities far overstate how much therapy a patient genuinely receives. And the only criteria for admission to the rehab service is that the patient has Medicare coverage.
A huge percentage of the patient's that receive therapy have only a marginal if any need for it. The facilities far overstate how much therapy a patient genuinely receives. And the only criteria for admission to the rehab service is that the patient has Medicare coverage.
2
The call for "austerity" from Republicans makes the average American believe that the non-wealthy elderly are trying to grab supposedly nonexistent federal monies for their care--pitting them against schoolchildren, non-elderly disabled people, desperate unemployed people, repairing the infrastructure, and so on.
In truth, half the nation's wealth has been siphoned up into the pockets of the ultra-wealthy, through special tax breaks, off-shore accounts that evade taxes altogether, bonuses, raises, and the like. The rest of us work harder for (inflation-adjusted) less money year after year. We're being trained to feel grateful to have a job, any job, and not to expect a living wage, the right of collective bargaining, Social Security, or a pension.
Divide-and-conquer is working quite well for right-wing politicians. By the time their voters figure out how totally they've been betrayed, they'll be too ill and desperate to fight back in any way, even at the ballot box. And the Republican propaganda machine will be blaming it all on the Democrats, as usual.
In truth, half the nation's wealth has been siphoned up into the pockets of the ultra-wealthy, through special tax breaks, off-shore accounts that evade taxes altogether, bonuses, raises, and the like. The rest of us work harder for (inflation-adjusted) less money year after year. We're being trained to feel grateful to have a job, any job, and not to expect a living wage, the right of collective bargaining, Social Security, or a pension.
Divide-and-conquer is working quite well for right-wing politicians. By the time their voters figure out how totally they've been betrayed, they'll be too ill and desperate to fight back in any way, even at the ballot box. And the Republican propaganda machine will be blaming it all on the Democrats, as usual.
16
I am always ambivalent when I read such stories. As an individual moving into retirement age, I am outraged and want all such homes to provide quality care to all. I want Medicare, Medicaid, and insurance to pay enough - and fees for the non-covered to be manageable.
That said, I worked as a nurse in a retirement home (independent living and nursing center). It was a "good" place with high end apartments with views of Lake Michigan. We generally gave good care, but working conditions were poor. Pay for nurses was very low; many of the nurses were foreigners who sent money home. Most of them worked two jobs (e.g., evenings at our facility and nights at a care home for children). That meant that they were often not interested in working any harder than they had to. The job of the nurses' aids was physically demanding and exhausting - and they too were low paid. As the evening supervisor it was common for me to get a call from the only night nurse saying that she would not be in. That meant that I had to stay all night - no sleep, no food with me to eat in those extra 8 hours.
Additionally, city and state regulations meant that we had to write a chart note on all residents once a month (even those in the apartments whom we never saw all month). All this and more for very low pay. Unless we do something different with financing elder care, the problems will continue. Government does not want to pay, often families cannot. What then?
That said, I worked as a nurse in a retirement home (independent living and nursing center). It was a "good" place with high end apartments with views of Lake Michigan. We generally gave good care, but working conditions were poor. Pay for nurses was very low; many of the nurses were foreigners who sent money home. Most of them worked two jobs (e.g., evenings at our facility and nights at a care home for children). That meant that they were often not interested in working any harder than they had to. The job of the nurses' aids was physically demanding and exhausting - and they too were low paid. As the evening supervisor it was common for me to get a call from the only night nurse saying that she would not be in. That meant that I had to stay all night - no sleep, no food with me to eat in those extra 8 hours.
Additionally, city and state regulations meant that we had to write a chart note on all residents once a month (even those in the apartments whom we never saw all month). All this and more for very low pay. Unless we do something different with financing elder care, the problems will continue. Government does not want to pay, often families cannot. What then?
44
There is no such thing as a good nursing home.
You must be constantly vigilant, fearless about asking questions and demanding that the standard of care be met at all times.
I lost a beloved aunt to the outrageous atrocities perpetrated by a private equity group that purchased the nursing home she had just moved into in Northwest Ohio and immediately cut staff and supplies to such an extant that the facility was using ace bandages instead of the very lightweight gauze required to wrap her very fragile, weeping legs from a very serious kidney condition known as nephrotic syndrome. I was appalled at the swollen, redish purple condition of her legs from the tight compression of the aces, complained to the head of the facility, who said they're hands were tied, and within two weeks, before I could get her moved to another facility, she was dead.
Profits are all that matter to a private equity company.
I reiterate, there is no such thing as a good nursing home.
You must be constantly vigilant, fearless about asking questions and demanding that the standard of care be met at all times.
I lost a beloved aunt to the outrageous atrocities perpetrated by a private equity group that purchased the nursing home she had just moved into in Northwest Ohio and immediately cut staff and supplies to such an extant that the facility was using ace bandages instead of the very lightweight gauze required to wrap her very fragile, weeping legs from a very serious kidney condition known as nephrotic syndrome. I was appalled at the swollen, redish purple condition of her legs from the tight compression of the aces, complained to the head of the facility, who said they're hands were tied, and within two weeks, before I could get her moved to another facility, she was dead.
Profits are all that matter to a private equity company.
I reiterate, there is no such thing as a good nursing home.
62
MAW, you have my greatest sympathy. However I don't know that NO nursing homes are any good -- there are many thousands across the nation, and neither of us can know every single one. I've heard some good things about a few religious-based facilities, but I can't have personal experience with all of them. Still and all, it behooves someone to investigate on a large scale.
As per bandages: I don't understand why Medicare would not have provided gauze bandages for your aunt. My own elderly relative had ulcerations that required skilled nursing to come in and bandage her 3 times a week, and they got boxes of proper bandages and ointments from Medicare -- absolutely at no charge to my aunt. (I paid the bills, so I would have known.) That is one area I cannot fault -- Medicare -- despite complications with the various plans and Plan D drugs. The things they DO cover, they cover well and generously without giving you a hard time. Bandage supplies are one. She was provided so much of this, I had boxes of leftovers which I donated to charities.
You have a good point that private equity groups and investors have distorted this market (undoubtedly anticipating a boomer tsunami any day now). In my area, there used to be a half dozen nursing home groups. Now it is about 3. You really have little choice, despite many buidlings, because about half of them are owned by ONE huge umbrella organization.
As per bandages: I don't understand why Medicare would not have provided gauze bandages for your aunt. My own elderly relative had ulcerations that required skilled nursing to come in and bandage her 3 times a week, and they got boxes of proper bandages and ointments from Medicare -- absolutely at no charge to my aunt. (I paid the bills, so I would have known.) That is one area I cannot fault -- Medicare -- despite complications with the various plans and Plan D drugs. The things they DO cover, they cover well and generously without giving you a hard time. Bandage supplies are one. She was provided so much of this, I had boxes of leftovers which I donated to charities.
You have a good point that private equity groups and investors have distorted this market (undoubtedly anticipating a boomer tsunami any day now). In my area, there used to be a half dozen nursing home groups. Now it is about 3. You really have little choice, despite many buidlings, because about half of them are owned by ONE huge umbrella organization.
1
And the name of that private equity company is? We need to know.
We have to re-evaluate our view on keeping people "alive" and reconsider, as a society, requests for people to self-determine, including death in illness. Religious arguments of "sacred life" are fine for those believers, but leave the rest of us out of it. It should not be relied on for law here. We are dealing with the lack of progress now with my MIL. The first time I met her, 20 years ago, she said, "I have a DNR!". She loathed "mainstream" medicine, contrary to her son and I, and moved to the woods of inner PA to "die like a bear". But 10 years later, she got alzheimers instead. What's very painful to know is the contrast between what she wanted, from decades earlier, and what is happening to her now, which is the slow and painful rotting of her body and brain. She would be horrified. Livid, actually. Second on her mind, after the limits on her self-determination, would be the significant cost in all this. She shopped at thrift stores. She abhorred the senseless attempts that people made to prolong youth and life. A buddhist, a minimalist, a philanthropist, and a rational, if not equally stubborn, human being. And to kick it to the max, she wanted to leave her meager life's savings to the care of our profoundly disabled child, her grandson, instead of causing significant financial distress to my husband and I, her only child.
Its just sad. I don't want to go like this; who would?
Its just sad. I don't want to go like this; who would?
36
Then you are asking someone's relatives (usually adult children) to actively kill them. That is generally not acceptable to most people, regardless of religion. You cannot expect confused, frail Alzheimer's patients to make an informed decision about ending their life -- or even about what sort of care they want.
Even among those who are mentally quite competent, it is surprising how many people with living will and health care directions -- with DNR orders -- who have said for years "don't use excessive means to keep me alive" -- CHANGE THEIR MIND when faced with their own mortality. For all your big talk, you may well feel this way too.
It is a dangerous path to go down, to value money and inheritance over someone life, or even just a few months or weeks of life. I know you must have legitimate worries about your disabled child, but you cannot seriously think that your MIL should have been euthanized just so you could inherit more money for your child. And how about the people who want money not for a sick child, but for a European vacation? or a really fancy remodeled kitchen? Frankly, I am disturbed you would plan for your child's future based on the death of his grandmother -- what if she'd lived to 100?
Even among those who are mentally quite competent, it is surprising how many people with living will and health care directions -- with DNR orders -- who have said for years "don't use excessive means to keep me alive" -- CHANGE THEIR MIND when faced with their own mortality. For all your big talk, you may well feel this way too.
It is a dangerous path to go down, to value money and inheritance over someone life, or even just a few months or weeks of life. I know you must have legitimate worries about your disabled child, but you cannot seriously think that your MIL should have been euthanized just so you could inherit more money for your child. And how about the people who want money not for a sick child, but for a European vacation? or a really fancy remodeled kitchen? Frankly, I am disturbed you would plan for your child's future based on the death of his grandmother -- what if she'd lived to 100?
1
I agree entirely. We as a society don't respect peoples' wishes to die with dignity, especially if they get dementia after signing the DNRs. Most people, and I would wager to say practically ALL people, are terrified of getting dementia and losing control of their lives. Why we, then, insist on keeping these people alive against their will is beyond me. People should have the right to ask for euthanasia on themselves if certain conditions are diagnosed, even if the condition causes them to 'change their mind.' We know how dementia makes people live in the moment...they may not remember their lucid wishes, but I would be the last person to ask that my demented self be taken more seriously than my lucid self.
Dying in a fire is probably the only thing that could possibly be worse than dying slowly of dementia.
Dying in a fire is probably the only thing that could possibly be worse than dying slowly of dementia.
1
Yes, long term nursing home care for patients with alzheimers or dementia is especially problematic, to put it kindly. But this article is highlighting the practice of placing people who are expected to recover fairly quickly from a hospital procedure into nursing homes that are not equipped to actually provide nursing care, and in fact cause harm because of their lack of adequate staffing, while billing medicare $6000 a month for bad food, bad beds and bad care. I believe that calling these facilities nursing homes is a gross misnomer. Perhaps patient warehouse facility would be a better term.
3
We should keep in mind that no one gets out of here alive. Many want to blame the death of their loved one on the nursing home, which provides abysmal care. However, the patients have to die sometime. When? They have to die of something. What? The only answer is to take care of business before it's too late. Get "Final Exit" and read it now.
8
"Final Exit" is a highly problematic book, and you should not blithely recommend it. It is instructions, very detailed, on how to commit suicide. It can be dangerous in the wrong hands (such as a healthy but suicidal depressed person).
In any event, suicide is one thing and euthanizing a "pesky" old person is another. The post before yours is about a woman who wants her MIL to die quickly, so she can inherit money to spend on her own son. How about the person who just wants money, period? or property? or ownership of a business? Can they still kill grandma?
The author of "Final Exit", Derek Humphries, actually bullied his own in-laws into committing suicide -- they were elderly, but not senile or dying. And they were very wealthy and left the Humphries a large inheritance. Hmmm. Mrs. Humphries later recanted this position, and felt immense guilt, and wrote a tell-all book about her husband and his unethical actions. It changed my own mind about assisted suicide for the elderly or sick.
In any event, suicide is one thing and euthanizing a "pesky" old person is another. The post before yours is about a woman who wants her MIL to die quickly, so she can inherit money to spend on her own son. How about the person who just wants money, period? or property? or ownership of a business? Can they still kill grandma?
The author of "Final Exit", Derek Humphries, actually bullied his own in-laws into committing suicide -- they were elderly, but not senile or dying. And they were very wealthy and left the Humphries a large inheritance. Hmmm. Mrs. Humphries later recanted this position, and felt immense guilt, and wrote a tell-all book about her husband and his unethical actions. It changed my own mind about assisted suicide for the elderly or sick.
5
The problem is not that everyone dies sometime. The problem is that many nursing homes cause people to die unnecessarily in pain and filth and degradation. Sitting in unchanged diapers until the feces dry and stick to the skin. Left alone without turning to prevent pressure ulcers that in turn are left untreated until there is an infected and foul smelling hole in their body the size of a saucer that extends down to the bone - you can actually see the bone. Neither the family or the doctor is told about it. No one responds to a call for assistance to go to the bathroom so that a frail individual is left with the choice of sitting for hours in a foul smelling diaper or trying to go by themselves and falling, and the resulting broken hip is a death sentence. No nursing home is sued just because someone dies there, only because they have died horribly.
1
So your position is that elderly people do not deserve good care since they will die anyway. WOW !
If it isn't obvious by now it should be. These are concentration camps.
9
OK, fine. Now what is YOUR solution? My elderly relative lived on her own until age 91, though she was probably in trouble from age 88 onward -- falls, ulcerated sores ignored until infected, driving accidents.
By 91, she simply could not continue to live on her own. Where would you have her live? She had no children. She was a widow for 42 years at that point. Her closest relatives were a couple of nieces, and we had our own families and children to care for. Our homes were not suited to someone in wheelchair, and we did not have a spare bedroom. Furthermore, as an aunt, she was not our mother and we did not have that kind of intimate relationship where we COULD live together -- neither could we afford to quit our jobs, for years on end, to provide this kind of 24/7 care.
So please tell me what you suggest. The boomer generation is going to be 10 times worse, as many more of them are unmarried, divorced, loners, childless or live very far away from adult children. And it is the biggest generation in history.
By 91, she simply could not continue to live on her own. Where would you have her live? She had no children. She was a widow for 42 years at that point. Her closest relatives were a couple of nieces, and we had our own families and children to care for. Our homes were not suited to someone in wheelchair, and we did not have a spare bedroom. Furthermore, as an aunt, she was not our mother and we did not have that kind of intimate relationship where we COULD live together -- neither could we afford to quit our jobs, for years on end, to provide this kind of 24/7 care.
So please tell me what you suggest. The boomer generation is going to be 10 times worse, as many more of them are unmarried, divorced, loners, childless or live very far away from adult children. And it is the biggest generation in history.
1
Concerned: No one is expecting you to take in an extended family member, friend or anyone else and give up your life or job to take care of them. The discussion is that many care facilities are 1) dropping long term care for more lucrative short term care (like mine) which is usually paid for by private insurance. 2) put up a very attractive facade to impress others. The reality for the actual patient is vastly different. They spend money on things that don't matter like fancy brochures and websites but fail to put money into what ACTUALLY matters which is hiring sufficient staff at attractive salaries to take care of everyone. It is especially crucial for those who are incapable of taking care of themselves. All of these places really skimp on staffing. As reported elsewhere many of the staff come from foreign countries. You simply can't run a system like this. The care facilities priorities are skewed in favor of the ower/operators and against patients and staff. I need to have a knee replacement on my other knee but am putting if off as long as possible due to my previous experiences. I also want to have enough money to hire someone 20 hrs a week when I come home. Due to the fact that I was not retired and on Medicare and had private insurance I was not eligible for a home health aid provided free by the county. So I paid for my insurance, paid taxes for everyone else to have a caregiver and had to pay for my OWN home health aid as well.
Many hospitals have economic relationships with rehab ceners and will steer their departing patients to those through underhanded methods, i.e. its the only place that has a vacancy.. Also, unless you have good secondary coverage your days allowed by Medicare are only 21 and out the door you go no matter your condition or status. And the food at these places is another area where costs are cut. If you have family and friends to check up on you you are blessed. Goodness, I have seen some scenarios of patients unable to care for themselves and no one to help released to home that would break the heart of Scrooge.
11
Medicare is not “the health insurance program for older adults.” Medicare covers only hose who have paid into Social Security or are the survivors of those who have.These individual may be adults who have paid into Social Security themselves, who have reached a certain age,adults of any age who have have become disabled after having worked for a sufficient number of work quarters and qualify for Social Security Disability qualify for Medicare Benefits after two years.They may be the survivors of those who have paid into Social Security for sufficient quarters including widows ,children, & Disabled Adult Child Survivors (“DACS”) who have become completely disabled prior to the age of 22. Those who have been divorced may qualify for Medicare Benefits under the Social Security Benefits of their former spouses f the marriage was at least 10 years in duration.
Older patients who are covered by Medicare will not “transition into lower
paying Medicaid” unless they qualify for SSI ,which is based on income and assets, Those who have been covered under Medicare who do not qualify for SSI based on low income and extremely limited assets,will be required to pay out of pocket,or go through every asset they have,until they qualify for SSI,in order that they be covered under Medicaid.
Older patients who are covered by Medicare will not “transition into lower
paying Medicaid” unless they qualify for SSI ,which is based on income and assets, Those who have been covered under Medicare who do not qualify for SSI based on low income and extremely limited assets,will be required to pay out of pocket,or go through every asset they have,until they qualify for SSI,in order that they be covered under Medicaid.
10
Virtually all Americans qualify for Medicare. I am not sure what group you are referring to that has no Medicare. If you cannot afford Medicare premiums, you'd go onto MedicAID, which covers the poor. Under Obamacare, this program has been greatly expanded.
The greatest expense that Medicaid pays for each year is not poor families or children. It is the elderly who have used up all their assets in nursing homes or Assisted Living, and are forced onto Medicaid. At that point, they have zero assets, and it is relatively easy to get SSI at that point. This is a bankrupting cost to the system of Medicaid and the primary reason it runs in the red each year.
We are fools, as a nation, not to tackle this problem head on and instead leave families and the elderly in misery and confusion and bankrupting costs.
The greatest expense that Medicaid pays for each year is not poor families or children. It is the elderly who have used up all their assets in nursing homes or Assisted Living, and are forced onto Medicaid. At that point, they have zero assets, and it is relatively easy to get SSI at that point. This is a bankrupting cost to the system of Medicaid and the primary reason it runs in the red each year.
We are fools, as a nation, not to tackle this problem head on and instead leave families and the elderly in misery and confusion and bankrupting costs.
1
Forget the home's ratings- ask how much they pay the staff, and check patient-to-staff ratio. In most nursing homes, you'll find that low-skilled people being paid the at or near the minimum wage are the ones who will actually be caring for patients. "Nurse Aide, Orderly, or Attendants in the United States take home approximately $10.06 per hour on average." (see: http://www.payscale.com/research/US/Job=Nurse_Aide,_Orderly,_or_Attendan... ) Expecting attentive, compassionate care from people who are working at poverty wages in difficult, unpleasant jobs (probably because they have few alternatives) is bound to lead to neglect, abuse and misery.
27
They will not tell you this, based on HIPPA regulations -- they use that to excuse nearly everything they won't tell you. They even bully the RESIDENTS about discussing such issues amongst THEMSELVES. Virtually anything can be claimed to be a "violation of HIPPA", just as government loves to claim "homeland security" about everything.
However, I can tell you that turnover in such jobs (aides, attendants) is very high. It is stressful, miserable work. And it pays roughly minimum wage to start, though after several years you can work your way up to about $12 an hour. Meanwhile, such aides from agencies charge $20-$22 an hour in my area -- with the AGENCY taking more than half. This makes in-home care virtually unaffordable for anyone but the very rich -- do the math. At $22 an hour, a 24 hour aide would cost a single patient about $15,000 a month or $180,000 a year -- double the cost of even a nursing home.
However, I can tell you that turnover in such jobs (aides, attendants) is very high. It is stressful, miserable work. And it pays roughly minimum wage to start, though after several years you can work your way up to about $12 an hour. Meanwhile, such aides from agencies charge $20-$22 an hour in my area -- with the AGENCY taking more than half. This makes in-home care virtually unaffordable for anyone but the very rich -- do the math. At $22 an hour, a 24 hour aide would cost a single patient about $15,000 a month or $180,000 a year -- double the cost of even a nursing home.
2
I don't think you'd get better care from these people even if you doubled their income. The work is grueling and practically thankless, especially if patients are crotchety, demented, or nonverbal. I wouldn't work in a nursing home for $50/hr, and that's a fact.
I don't think pay equates to giving good care.
There seems to be a disconnect between what is considered low Medicaid reimbursement rates, yet the obviously high profits of nursing homes, if they indeed sell at over 75K per bed, and corporations are snatching them up. Can anyone intelligent explain the high profits of many nursing homes? If so, why can't the state and federal governments be stricter about staffing ratios? Perhaps each patient without family or good friends needs somebody from the outside to keep track of his/her progress, or lack of, and a place to call when the care isn't good. In contrast, better nursing homes should be rewarded, and Medicare and Medicaid need to know about this more often.
12
Most places do not take Medicaid -- only the low level, run-down facilities do (and a few religious ones). And it involves a SHARED bedroom, with at least 2 residents, and a shared or public bathroom. Many such Medicaid facilities are dirty and have low staff ratios and terrible food.
Anyone with ANY money would spend every nickel to get the better care usually available in for-profit nursing homes and Assisted Living residences -- but this costs from $5000 to $10,000 a month. For most people, this means using up 100% of their savings, including the sale of their home. But before that happens, the nursing home/facility gets all your money. That is a pretty sweet deal, if you think about it -- you scrimp and save for decades, only to turn over the entirety of your assets to the nursing home, for roughly 2 years of care at the very end.
Patients without families do have access to social workers, but they are overworked and underpaid. Even WITH a family that is close by -- loving and involved -- it is virtually impossible to protect a frail elderly person with dementia from the poor care at most nursing homes or AL facilities.
Anyone with ANY money would spend every nickel to get the better care usually available in for-profit nursing homes and Assisted Living residences -- but this costs from $5000 to $10,000 a month. For most people, this means using up 100% of their savings, including the sale of their home. But before that happens, the nursing home/facility gets all your money. That is a pretty sweet deal, if you think about it -- you scrimp and save for decades, only to turn over the entirety of your assets to the nursing home, for roughly 2 years of care at the very end.
Patients without families do have access to social workers, but they are overworked and underpaid. Even WITH a family that is close by -- loving and involved -- it is virtually impossible to protect a frail elderly person with dementia from the poor care at most nursing homes or AL facilities.
1
Can it be explained?
From a corporate balance-sheet perspective it's a profit generator, or had better be. The fictional character Gordon Gecko probably probably said it best in the not-so-fictional movie "Wall Street": "greed is good."
From an underpaid hospital/home staffer's operational perspective it's easy to objectify and dehumanize terribly needy people barely able to function during their few remaining days before returning to nothingness, many trapped inside ruined bodies. For casual observers it's frightening. "Today you, tomorrow me." So they lash out. "Man's inhumanity to man (and woman)" also covers it. Some staffers are closet sadists. After all, "so many bedpans to change today ....
From a corporate balance-sheet perspective it's a profit generator, or had better be. The fictional character Gordon Gecko probably probably said it best in the not-so-fictional movie "Wall Street": "greed is good."
From an underpaid hospital/home staffer's operational perspective it's easy to objectify and dehumanize terribly needy people barely able to function during their few remaining days before returning to nothingness, many trapped inside ruined bodies. For casual observers it's frightening. "Today you, tomorrow me." So they lash out. "Man's inhumanity to man (and woman)" also covers it. Some staffers are closet sadists. After all, "so many bedpans to change today ....
Look, also, at nursing home regulations. What they have to provide; number of times they need to do huge assessments; etc., etc. This is often driven by professional organizations that want to make sure their members have jobs. They can always find some horror story or some stats that justify it, but it ends up generating costs that are contributing to the problem and perhaps don't do what they promise, anyway.
I have been through this with 4 parents over the course of the last few years. In each case, the biggest problem was that the hospital discharged the patient before the patient was capable of assisting in their own care, in one case while she was still hallucinating from the excessive amounts of morphine given her in the hospital. It appears hospitals try to discharge when the Medicare stops, regardless of the condition of the patient. Rehab facilities are intended to transition the patient to daily life, whether it be assisted living, home care or whatever, but frequently they are asked to be "hospital light" for people who are just not ready to leave full-time hospital care.
23
You've hit the nail on the head. Hospitals are way over-compensated, and non-profits aren't much better. Look at the administration compared to what it was years ago. When DRGs came in, the numbers people came in to optimize revenue. The 350 bed hospital I worked at in the early 1970's had 2 administrators and a secretary - two bare bones offices and a small reception area. Not carpeted. I don't know what their compensation was - I doubt it was equivalent to what is earned today.
Aren't or weren't there a few people in Congress who made their fortunes by for-profit hospital chains and nursing home chains?
Guess we won't expect any help in improving conditions from that front.
Guess we won't expect any help in improving conditions from that front.
14
They represent those industries. Their purpose there is to block regulation and reform.
1
So true. My mother was in what was supposed to be a high-quality nursing home after she fractured her shin. I spent all day with her several days in a row and observed that no one was turning her to help prevent bed sores (eventually I did it myself). When I asked a nurse rather gently what the plan was for preventing bed sores, she accused me of insulting her; I'm sure she was afraid for her job, and she had too many patients to take care of. Mom has recovered but says she will never go back there again. But what other options are there?
18
If you were there all day, the staff might've been discouraged from coming to do their work. I've seen lots of folks who insist on caring for their elderly in spite of being in the center...they're basically only there because they need a bed.
As a single person who has had 3 joint replacements and spent time in *skilled nursing* for rehab (both before and after I turned 65 and was forced onto medicare), the situation is not as simple as described.
Medicare rates may be higher than Medicaid, but they barely cover the costs of high quality nursing and rehab.
The first time, the nursing home got patients our of their rooms and into a small dining room for their noon meal and those who could make it on their own could have dinner there. I think that the morale boost of having meals with companionship in a pleasant environment rather than a bed tray was easily worth the additional cost, and probably promotes healing.
However, these places are designed to please relatives rather than patients. When I came back the dining space had been converted to other use, and I left as quickly as I could. There was a place for visitors to eat with patients, but nothing for those on their own.
Because nursing homes can't *balance bill* for additional amenities, the choice is between a depressing environment for rehab or cutting costs on care.
The third time, I arranged for 3 weeks rehab in a modest assisted living facility at my own expense. It was far from luxurious, but I could not face another stay in a nursing home. But I did want more in the way of P.T. than I could get at home as well as have someone else responsible for meals and housekeeping.
Medicare rates may be higher than Medicaid, but they barely cover the costs of high quality nursing and rehab.
The first time, the nursing home got patients our of their rooms and into a small dining room for their noon meal and those who could make it on their own could have dinner there. I think that the morale boost of having meals with companionship in a pleasant environment rather than a bed tray was easily worth the additional cost, and probably promotes healing.
However, these places are designed to please relatives rather than patients. When I came back the dining space had been converted to other use, and I left as quickly as I could. There was a place for visitors to eat with patients, but nothing for those on their own.
Because nursing homes can't *balance bill* for additional amenities, the choice is between a depressing environment for rehab or cutting costs on care.
The third time, I arranged for 3 weeks rehab in a modest assisted living facility at my own expense. It was far from luxurious, but I could not face another stay in a nursing home. But I did want more in the way of P.T. than I could get at home as well as have someone else responsible for meals and housekeeping.
10
You could have supplemented the assisted living with home care services paid by Medicare. That could have provided PT - sometimes that's a better option for the reasons you so richly described.
I have had first hand experience with 3 different short term rehab facilities and I can tell you they are all the same fancy or not. Thay are all totally UNDERSTAFFED when it comes to the people who matter - the CNA's. They are the primary care givers in the place. They bath you, get you to the toilet, get your food, make your bed, come whenever you need them. It is a terrible disgrace. No I am not retired or eldely, I have committed the sin of being single with no family near by. My friends are all busy with their lives and were unable to care for me 24/7. The first place was horrible and I worked really hard to get out of there fast. It contributed to my having complications with my total knew replacement surgery later. The second place had the fancy lobby but was no better with the daily care than the first place. They had just opened a new wing for short term rehab paitients like myself and were throughly understaffed and unprepared for the influx of new people. The final place was an older faciility but seem to have the best staff who cared but they too were understaffed. In my case I couldn't reserve a space beforehand. I had to give the hospital 3 choices but there was no guarantee I would get any of them as there has to be an opening there. It was on a 1st come 1st serve basis. You only occasionally see an actual RN and a bonafide DR even less of the time. Physical therapy 1 hour or less a day the same goes for rehab.
24
As a home health nurse I saw the "best" and the worst. I wanted to report the worst but morally I had to consider-where would these folks go. The wait is too long and the cost too high for these poor folks. What would you have done?
7
A lawyer in the video explains that psychotropic drugs are used in nursing homes. The purpose of these drugs is to keep patients immobile and under control (i.e. tranquilized) in order to reduce the amount of labor needed to operate a nursing care facility. Since the cost of labor is likely the largest single operating cost of running a nursing home, and since the facilities are mostly owned as investments, it is reasonable to assume that the management does everything possible to minimize labor costs, including employing as few workers as possible, and paying them low wages. The result is low-quality, minimal "care" for the patients and maximum profits for the owners/shareholders.
49
When in doubt, privatize!
Ain't this the American way of all things that require, at minimum, strict public oversight, if not non-profit community-based operation. Just as with schools and pre-school day care, when the bottom line is measured in dollars for other people, it's the target service populations that get short-changed.
Ain't this the American way of all things that require, at minimum, strict public oversight, if not non-profit community-based operation. Just as with schools and pre-school day care, when the bottom line is measured in dollars for other people, it's the target service populations that get short-changed.
12
Ah, yes. The joy of having all important functions privatized, operating to maximize profit and minimize care.
Meanwhile, Republican leaders work long hours getting ALEC's new rules into law--trying to rid every company of the oh-so-burdensome regulations and inspections that might, if enforced, make the lives of ordinary people far safer and healthier.
Meanwhile, Republican leaders work long hours getting ALEC's new rules into law--trying to rid every company of the oh-so-burdensome regulations and inspections that might, if enforced, make the lives of ordinary people far safer and healthier.
10
"Strict oversight" by government is anti-American and not "exceptional." The story here is just the same ol', same ol' of the new plantation economy fostered by kleptocracy and legislative and corporate corruption.
"Healthy citizens are the greatest asset any country can have." - Winston Churchill
Our country, for which we are ultimately responsible (but haven't been), should be ashamed of itself.
"Healthy citizens are the greatest asset any country can have." - Winston Churchill
Our country, for which we are ultimately responsible (but haven't been), should be ashamed of itself.
1
This is all quite distressing but as the article points out, increased government oversight is helping to improve a situation that has been bad for a long time. If people want to know why government has to be so intrusive and have so much "red tape", here is some compelling data.
Many people respond that the only answer is to get rid of the profit motive. I would claim that a nonprofit organization isn't all that much different as a for-profit one, as it still has to break even. I don't think the country as a whole is even remotely ready to nationalize the entire industry, so advocating that is not a useful response for a problem that is causing many helpless people to suffer right now.
I would suggest that a greater tolerance for governmental "red tape" and intervention may be the only short-term remedy. In order to keep that from getting out of hand, we all need to keep monitoring the outcomes and reporting abuses in public forums like this. That's part of democracy.
Many people respond that the only answer is to get rid of the profit motive. I would claim that a nonprofit organization isn't all that much different as a for-profit one, as it still has to break even. I don't think the country as a whole is even remotely ready to nationalize the entire industry, so advocating that is not a useful response for a problem that is causing many helpless people to suffer right now.
I would suggest that a greater tolerance for governmental "red tape" and intervention may be the only short-term remedy. In order to keep that from getting out of hand, we all need to keep monitoring the outcomes and reporting abuses in public forums like this. That's part of democracy.
36
While it is true that not-for-profit facilities also must break even to survive, there is pretty good empirical evidence that not-for-profit nursing homes tend to deliver higher quality care (obviously, there are some lousy not-for-profits and some very good for-profits -- we're talking about central tendency of the two categories).
1
I cannot tell you what a fight it is to find competence at any level in the hospital/acute rehab/secondary rehab and then at-home system. The advocacy and the struggles do not stop. I can vouch for secondary rehab as an especially weak link, especially if the secondary rehab takes place in a facility that also offers long-term care as the efforts to see that a patient never leaves are never-ending. An especially valuable resource throughout the process is the Center for Medicare Advocacy. Of course, the search for competent aides, invaluable as they are, once a patient is home is never-ending. The good ones leave the field because they become too attached to their clients. The bad ones can do a great deal of harm.
22
Thanks for busting Kaiser on its "high standards of care" claim. In the Northwest, it won't say which homes are under contract. Our experience a few years ago involved a choice of three homes for a relative -- none good. The one we chose left her overnight, fully clothed, on top of her bed one night. She couldn't get up or turn over on her own. They didn't answer her bathroom calls that night. Her diabetic diet? Ha ha ha. And the so-called KP doctor and staff to treat patients? A nurse who ignored her chart on a medication she wasn't supposed to get, causing serious side-effects. A miserable experience all the way around.
14
An excellent story about a significant, under-reported trend. Thank you for your deep, insightful reporting.
24
A few words of advice from someone who has worked in health care:
1. Hospitals will discharge your loved one very quickly these days. As soon as the person is admitted for an acute stay, they are already planning discharge to either your relative's home (sometimes with assistance), a nursing home, or intensive rehab (called acute rehab.)
2. When your loved one is hospitalized, get in contact with the social worker as soon as possible to discuss discharge planning. Don't wait.
3. If you are given a list of nursing home options by the hospital, please go visit and look on line for reviews of the facility written by actual people - those who have either stayed in the facility or the families of the patient residing there. Reviews by government agencies won't give you the real picture. And don't take the hospital's word that it's a good place.
4. Most importantly, if your loved one is in a nursing home, make every effort to be present if not once a day then several times a week. You know your relative better than any care provider and they will receive better care if you are there consistently.
5. If you feel comfortable doing this, check their heels and buttocks for skin breakdown. These are common areas that develop sores from laying in bed. It is best that any skin breakdown is caught early.
1. Hospitals will discharge your loved one very quickly these days. As soon as the person is admitted for an acute stay, they are already planning discharge to either your relative's home (sometimes with assistance), a nursing home, or intensive rehab (called acute rehab.)
2. When your loved one is hospitalized, get in contact with the social worker as soon as possible to discuss discharge planning. Don't wait.
3. If you are given a list of nursing home options by the hospital, please go visit and look on line for reviews of the facility written by actual people - those who have either stayed in the facility or the families of the patient residing there. Reviews by government agencies won't give you the real picture. And don't take the hospital's word that it's a good place.
4. Most importantly, if your loved one is in a nursing home, make every effort to be present if not once a day then several times a week. You know your relative better than any care provider and they will receive better care if you are there consistently.
5. If you feel comfortable doing this, check their heels and buttocks for skin breakdown. These are common areas that develop sores from laying in bed. It is best that any skin breakdown is caught early.
84
Excellent advice. I would add to ask any doctor if your relative has any condition that would make acceptance (yes, a nursing home can and will reject someone) difficult. My father was on peritoneal dialysis and after an infection, given only a couple days' notice to find a nursing home. The vast majority can't handle this care. What's worse, at those that claim they do, the staff is unlikely to be trained for it. I saw the look of abject terror on my father's face as he watched them being trained, as it was clear not one of them had a clue. I LITERALLY prepared my father's dialysis for him and trained the staff (medicare requires a quickie training, but it takes more than a few hours one afternoon to get the hang of it). Then, after I had the staff trained, this place's therapist claimed my dad had "plateaued" in his therapy (which medicare was sued for) and booted him with only a couple days' notice. (I suspect that they were more concerned with the low profit margin he probably was, given the amount of care he needed.) A very, very, very aggravating experience. Mind you, the first place had all the bells and whistles of a hotel, complete with a lovely pool that was not used. Not even once. Do yourself a favor and start the hunt well before the crisis, and ignore the ambience of a place. Look for caring staff.
3
I was hoping to see another nurse post accurate advice. I am a hospital nurse who moved into discharge planning. As is evident in many comments here, there is a passivity which must change. An "expectation" that things "should be" a certain way. Wake up, every one of us! These are BUSINESSES. You have a CHOICE.
Every day when I meet patients and families on day one of admission, I am met with hostility and comments about being pushed out. Some refuse to accept or look at the extensive list of rehab facilities we have. All I want to do is to help them. They need to take role and responsibility to determine the next setting. Pick a home care agency and a skilled nursing facility. That way, depending on your level of function at discharge, you will have a bed of choice. If you don't like it, you can switch. BTW, dragging your heels doesn't delay your discharge-you end up with less choice because you are forced to take any open bed.
One thing needs to be made more clear to readers: We have NO ties with these places. This list is for convenience and families are asked to visit any and all they may be interested in. I don't care which one you choose, and we don't have any ratings on our list. Not only do we not have a financial interest in your choice, we cannot recommend a place. We are absolutely NOT ALLOWED to steer you. So, learn the way I did: Get in the car, drive around to local places, popping in unannounced and ask for a tour. They are NOT all equal.
Every day when I meet patients and families on day one of admission, I am met with hostility and comments about being pushed out. Some refuse to accept or look at the extensive list of rehab facilities we have. All I want to do is to help them. They need to take role and responsibility to determine the next setting. Pick a home care agency and a skilled nursing facility. That way, depending on your level of function at discharge, you will have a bed of choice. If you don't like it, you can switch. BTW, dragging your heels doesn't delay your discharge-you end up with less choice because you are forced to take any open bed.
One thing needs to be made more clear to readers: We have NO ties with these places. This list is for convenience and families are asked to visit any and all they may be interested in. I don't care which one you choose, and we don't have any ratings on our list. Not only do we not have a financial interest in your choice, we cannot recommend a place. We are absolutely NOT ALLOWED to steer you. So, learn the way I did: Get in the car, drive around to local places, popping in unannounced and ask for a tour. They are NOT all equal.
Item (2) Get in contact with your social worker? What are you writing about? We have trouble finding physican's and homes wiling to take my elderly mother-in-law. Social workers are no where to be found and are of no help or assistance.
But yet the wealthy continue to divest their money so ultimately taxpayers can pick up the Medicaid nursing home fees when these people go on Medicaid. Very unfair.
Medicare only pays the first 20 days, then the partial payment down to no Medicare reimbursement gradually. Also, Medicare does not pay for nursing home fees after a hospital "observation" stay - a stay which does not meet inpatient criteria. In addition, Medicare does not pay for nursing home fees when a patient has stayed less than three nights in the hospital.
These rules infuriate patients and infuriate patients' families when they find out the patient's own money needs to be used to pay for nursing home fees - if they do not qualify for Medicaid.
So be it - care for our elderly. A day in the life of a hospital case manager.
Medicare only pays the first 20 days, then the partial payment down to no Medicare reimbursement gradually. Also, Medicare does not pay for nursing home fees after a hospital "observation" stay - a stay which does not meet inpatient criteria. In addition, Medicare does not pay for nursing home fees when a patient has stayed less than three nights in the hospital.
These rules infuriate patients and infuriate patients' families when they find out the patient's own money needs to be used to pay for nursing home fees - if they do not qualify for Medicaid.
So be it - care for our elderly. A day in the life of a hospital case manager.
16
Then you need to be a highly-paid government employee in a not-for-profit facility and institutional health care needs to be single payer, not-for-profit, period.
Years ago, I worked as an assistant nurse at an expensive assisted living facility. There was a book in the nurses' office that indicated which medications should not be taken together. Out of curiosity, I checked a few of the patient's meds to see if there were bad combinations and was shocked to find countless meds being administered that the book described as having the highest level of risk I pointed this out to the head nurse, who rolled her eyes at me and said, "Don't worry about it".
I used to spend time with each resident when I dropped off the meds because I felt that one of the biggest problems there was loneliness. The nurses laughed at me and said I was wasting time and shouldn't be with each resident any extra time beyond what was needed to give the meds.
The activities done with the seniors were demeaning, as though they were in kindergarten.
The care of the elderly in the US is often heartless and shameful. I think this has to do with a youthful culture that doesn't want to face mortality. Seniors' years of experience and wisdom are too easily brushed aside, which is an enormous loss to us all.
I used to spend time with each resident when I dropped off the meds because I felt that one of the biggest problems there was loneliness. The nurses laughed at me and said I was wasting time and shouldn't be with each resident any extra time beyond what was needed to give the meds.
The activities done with the seniors were demeaning, as though they were in kindergarten.
The care of the elderly in the US is often heartless and shameful. I think this has to do with a youthful culture that doesn't want to face mortality. Seniors' years of experience and wisdom are too easily brushed aside, which is an enormous loss to us all.
108
And it'll only get worse as the boomers start to need care.
20
Everything you say is absolutely correct. There were a very few nurses like yourself who were honest and ethical, but the majority were bored -- under paid -- hostile to the elderly they worked with -- very eager to get them drugged up (and passive). We had awful experiences with them. Sometimes they were outright rude and dismissive to my elderly aunt, treating her like a simpleton or a child.
Furthermore, oversight of the nursing staff by management is very spotty.
Furthermore, oversight of the nursing staff by management is very spotty.
7
It's true. Many nurses and aides so not have a caring bone in their body. I've seen it with my own eyes. The callousness is shocking.
2
What kind of society have we become when nobody wants to help us care for the elderly unless they can make a buck off of them?
116
Greed, Linda. Greed. The owners of private nursing homes make big dollars.
10
What kind of society? A materialistic one that values money over everything else. It's not just nursing homes, it'e EVERYWHERE...schools, churches, justice system (remember the judges that were sending kids to juvenile prison for cash kickbacks?), government, art, medicine, etc.. EVERYWHERE.
14
Ask Gov. Bruce Rauner (R-IL).
His hedge fund profited enormously from warehousing thousands of elderly Americans whose crime was to be ill and helpless; more profitable than warehousing thousands of convicted felons in hell-holes we euphemistically call "private" or "for-profit" prisons; although the two are basically the same. Hellholes are hellholes, after all.
Not that he'd ever tell you, of course. He wants to be president.
His hedge fund profited enormously from warehousing thousands of elderly Americans whose crime was to be ill and helpless; more profitable than warehousing thousands of convicted felons in hell-holes we euphemistically call "private" or "for-profit" prisons; although the two are basically the same. Hellholes are hellholes, after all.
Not that he'd ever tell you, of course. He wants to be president.
Mixing high profits with care for old people - what could go wrong? a bit like industrialized farming- the premium is dollars per square inch, not health. You are talking 2 value systems at loggerheads.
In the Real World, getting an elderly person's teeth brushed, looking at their skin, getting them dressed and toileted and takes time. In America time=$$$.
Some families never visit. People wait at a table for an hour before each meal while everyone is wheeled into a dining room. Plus old folks are set in their ways and are not much on communal living. Assisting families to creatively care for an elderly person should be something creative people work on, not just the profiteers.
In the Real World, getting an elderly person's teeth brushed, looking at their skin, getting them dressed and toileted and takes time. In America time=$$$.
Some families never visit. People wait at a table for an hour before each meal while everyone is wheeled into a dining room. Plus old folks are set in their ways and are not much on communal living. Assisting families to creatively care for an elderly person should be something creative people work on, not just the profiteers.
36
Again, very correct. I put my elderly relative into a facility -- not a good one -- but close to my house. Therefore, I was able to visit her about 3 times a week. That was vastly more than most people visited their own mothers! the average was probably once a week or every other week. You cannot imagine the boredom and loneliness. As you correctly state, these are often people who had just recently lived in their own homes or apartments, with dignity and autonomy -- reduced to the status of a child in a very badly run day care facility (that you can never leave, even at night).
The food service was especially wretched. As you say, it takes nearly an hour to get a bunch of frail elderly people in wheelchairs or walkers to the table. By that point, the steam table food is often not hot anymore. Our facility had a completely incompetent system of delivering the food -- one plate at a time, meaning the 2 aides running meal service (who had to set the tables, clean up, wash dishes and linens, SERVE the meals, bus tables, etc.) would literally take one plate at a time, to random tables, in no order. Needless to say this took FOREVER and resulted in mostly cold or tepid food. Suggestions to do one table at a time, or use a cart, were shrugged off. They often forgot individuals meals, served people the wrong things (dangerous with diabetics!) and the food was horribly unappetizing. Each meal took 90 minutes or more! and was exhausting.
The food service was especially wretched. As you say, it takes nearly an hour to get a bunch of frail elderly people in wheelchairs or walkers to the table. By that point, the steam table food is often not hot anymore. Our facility had a completely incompetent system of delivering the food -- one plate at a time, meaning the 2 aides running meal service (who had to set the tables, clean up, wash dishes and linens, SERVE the meals, bus tables, etc.) would literally take one plate at a time, to random tables, in no order. Needless to say this took FOREVER and resulted in mostly cold or tepid food. Suggestions to do one table at a time, or use a cart, were shrugged off. They often forgot individuals meals, served people the wrong things (dangerous with diabetics!) and the food was horribly unappetizing. Each meal took 90 minutes or more! and was exhausting.
4
I've been in a lot of nursing homes, and I've yet to see one where the staff actually brushes the resident's teeth more than once a week. The aides hate to brush people's teeth, they just don't do it.
5
I am a therapist who has worked in 15 different nursing homes in 3 different states. When I first started out, I would work at 2-3 in any given week because it was hard finding employment where I lived. Sadly, they are all pretty much the same; they are all severely understaffed. Nurses have anywhere from 14-18 patients each and many of them come from places like the Philippines. The companies that own these facilities have brought them here and they are working to get their green card/permanent residency so they're not going to say anything about the poor working conditions. Because compared to the country they came from, the conditions in these nursing homes are the lap of luxury. The home health aides have the hardest job and are the lowest paid. Imagine lifting, toileting, and cleaning heavy people for 8-12 hours straight for $8 or $9/hr. 5-6 days per week. It is back breaking work. IMO, the aides should make at least $50K per year, but of course they don't. Because the job is so hard, many aides call out sick on a moments notice contributing to further short staffing. And the therapists are under unrealistic productivity standards where they must see a certain amount of patients per day and bill a certain amount of hours. With very few exceptions, these places are factories meant to turn a profit. There are good people working at these facilities but they are hampered by the monetization of our health care system. These places are all about the $$$, not good care.
130
I agree the pay is very poor, for what is hard and stressful work. However, the costs are ALREADY astronomical and bankrupting to the patients. If you doubled the pay of the aides, the costs would double. Because this is a totally labor-intensive business. The facilities themselves are nothing special -- just small apartments or single rooms. They don't have many amenities (like an apartment for young renters), because they don't have to -- they have a captive population of seniors with few choices.
So right NOW, with badly underpaid and overworked aides and CRAs -- the cost is at least $5000 a month in Assisted Living and $10,000 a month in a nursing home or dementia facility. And you want to double that. So what will happen to people who cannot pay $20,000 a month? or $240,000 a year, PER PERSON?
So right NOW, with badly underpaid and overworked aides and CRAs -- the cost is at least $5000 a month in Assisted Living and $10,000 a month in a nursing home or dementia facility. And you want to double that. So what will happen to people who cannot pay $20,000 a month? or $240,000 a year, PER PERSON?
The use of minimal wage immigrant nursing aides is pervasive. Most of them take these jobs (which involve less pleasant things like cleaning up vomit) solely to get a green card. Very few view these jobs as the first step to a better jobs in health care.
I wish there were a way to redirect immigrants to different fields in which they have an interest and train them. Instead we have exploitation, which results in poor care.
I wish there were a way to redirect immigrants to different fields in which they have an interest and train them. Instead we have exploitation, which results in poor care.
1
Absolutely, dead on! Good care starts with qualified, competent, caring staff. Pay, benefits (if any) and working conditions for assistants and aides is atrocious while the administrators and owners line their pockets. Agreed there are many good people trying to work and survive financially in this field as the actual caregivers, but more and more I see drug addicts, people with criminal backgrounds, and inexperienced and incompetent people hired simply because they are the ones willing to try it for the 10.00 to 11.00 per hour that is routinely paid.
2
The average monthly charge for nursing home care, at least in NC, is $6000, whether you're in an excellent facility with a private room or in a pure dump sharing a tiny room with, well, you never who is going to be sharing the room with your loved one.
When my mother first left the hospital in Charlotte we found a top rated facility that agreed to take her. Once admitted, they totally ignored my mother's condition, allowing her to become totally dehydrated to the point she began coughing up blood. Only then would they agree to send her back to the hospital. We filed a complaint with the state which negatively impacted their rating.
The home she passed in was better, but I still wonder how much longer she would have lived if the first nursing home had done their job correctly. I also think I should have taken them to court for negligence.
When my mother first left the hospital in Charlotte we found a top rated facility that agreed to take her. Once admitted, they totally ignored my mother's condition, allowing her to become totally dehydrated to the point she began coughing up blood. Only then would they agree to send her back to the hospital. We filed a complaint with the state which negatively impacted their rating.
The home she passed in was better, but I still wonder how much longer she would have lived if the first nursing home had done their job correctly. I also think I should have taken them to court for negligence.
28
North Carolina, then, is on the low end of costs. In my Rustbelt Midwest town, most ordinary AL facilities (not the super fancy ones) cost about $4500 to $6000 a month -- this is NOT skilled nursing care nor even dementia care. This is for mostly competent seniors who need assistance with basics like showering, dressing, etc. and the majority are in walkers or wheelchairs. Once you exhibit serious signs of dementia, you are pushed forcefully into a dementia unit -- and the cost goes up to around $7500 a month. This will look similar (chandeliers) but have more staff (not much, but some) and be a "locked down" unit -- so your senior is basically a prisoner.
If they are combative or hard to handle, they can be thrown out of even there. Then the next step is A. psychotropic drugs to make them zombies and B. skilled nursing. The cost of skilled nursing care is bankrupting to nearly any family -- $9000 to $12,000 a month. By this point, the chandeliers and any pretense at gracious living are long gone. The rooms are doubles, with a hospital bed and a stranger sharing it.
The methodology is basically to separate the senior and their family from the savings of a lifetime -- it is a rare person who can pay for this for even a year. Two to three years, and nearly anyone who is not a millionaire is tapped out, and then you go on Medicaid. Only a few facilities will take this (it's much, much less money) and they are not the nice ones.
If they are combative or hard to handle, they can be thrown out of even there. Then the next step is A. psychotropic drugs to make them zombies and B. skilled nursing. The cost of skilled nursing care is bankrupting to nearly any family -- $9000 to $12,000 a month. By this point, the chandeliers and any pretense at gracious living are long gone. The rooms are doubles, with a hospital bed and a stranger sharing it.
The methodology is basically to separate the senior and their family from the savings of a lifetime -- it is a rare person who can pay for this for even a year. Two to three years, and nearly anyone who is not a millionaire is tapped out, and then you go on Medicaid. Only a few facilities will take this (it's much, much less money) and they are not the nice ones.
3
Up north, $6,000/mo is cheap, and all of the facilities are the same: poor.
1
My wife and her best friend are Physical Therapists and have worked at most of the nursing homes in a 3 county area. Many of the older homes are now owned by Carolinas Health Care and Novant Health. Being owned by huge hospital corporations are no better than when they were privately owned. My wife's favorite description for some of them? "It's better than living under an overpass and eating from dumpsters."
My mother suffered a long steady decline over 10 years before she died. We were regulars at the hospital ER, and she was in and out of nursing homes for rehab multiple times after her many hospitalizations.
The Achilles heel of all facilities that care for the elderly is staffing. Even the good ones don't have enough staff, because the business people at the top believe cutting staff is the way to cut costs.
Nursing homes care for people who often can do very little for themselves, especially if they just got out of the hospital. Many families do not have family members who can sit there 24/7 and fill in the gaps, when the staffers don't respond to the call button.
For the most part, I do not blame the actual staffers--in the good facilities, these people were hustling as fast as they could to care for too many people who had too many needs. (Logistically, think about how many people it would take to give baths to hundreds of patients who can't bathe themselves…every day. Or to sit with patients who can't feed themselves, and don't have family able to leave work at mealtimes, three times a day.)
I blame the people in the front office, far from the action, who decide that they need to cut costs by cutting people out on the nursing home floor.
Most of us don't find out what a mess this is until we have an emergency situation on our hands. It's time to deal with this as a society. And ignore the chandeliers, ask about staffing when you have to find a nursing home.
The Achilles heel of all facilities that care for the elderly is staffing. Even the good ones don't have enough staff, because the business people at the top believe cutting staff is the way to cut costs.
Nursing homes care for people who often can do very little for themselves, especially if they just got out of the hospital. Many families do not have family members who can sit there 24/7 and fill in the gaps, when the staffers don't respond to the call button.
For the most part, I do not blame the actual staffers--in the good facilities, these people were hustling as fast as they could to care for too many people who had too many needs. (Logistically, think about how many people it would take to give baths to hundreds of patients who can't bathe themselves…every day. Or to sit with patients who can't feed themselves, and don't have family able to leave work at mealtimes, three times a day.)
I blame the people in the front office, far from the action, who decide that they need to cut costs by cutting people out on the nursing home floor.
Most of us don't find out what a mess this is until we have an emergency situation on our hands. It's time to deal with this as a society. And ignore the chandeliers, ask about staffing when you have to find a nursing home.
70
You can ask all you want, but chandeliers or not, very few places have adequate staffing. Those that do, are crazy expensive -- they require "buy ins" of $100,000 or more (up front!) and THEN ON TOP OF THAT, $5000-$10,000 a month.
The vast majority of elderly cannot remotely afford this. Even the chandeliered Assisted Living homes are for the solidly middle class -- those who have savings or a house to sell to pay the astronomical costs ($50,000 at the low end, and $75,000 a year average). If that is too costly, you must go to a "residential home" -- a low end conversion of a house or apartment, run by a few individuals or a family. These are nearly always shabby beyond belief, usually have shared or very tiny rooms and shared bathrooms. Needless to say, NONE of these has what you'd call "adequate staffing".
A frail senior needs the level of care of an infant or toddler -- meaning maybe 1 caretaker for every 4-6 seniors. And NO facilities have this level of care that I have ever seen. That's why you see people neglected, bedsores, patients who fall -- because the staffing level is more like one aide per every dozen seniors. Even that is generous. Some places are much worse.
The vast majority of elderly cannot remotely afford this. Even the chandeliered Assisted Living homes are for the solidly middle class -- those who have savings or a house to sell to pay the astronomical costs ($50,000 at the low end, and $75,000 a year average). If that is too costly, you must go to a "residential home" -- a low end conversion of a house or apartment, run by a few individuals or a family. These are nearly always shabby beyond belief, usually have shared or very tiny rooms and shared bathrooms. Needless to say, NONE of these has what you'd call "adequate staffing".
A frail senior needs the level of care of an infant or toddler -- meaning maybe 1 caretaker for every 4-6 seniors. And NO facilities have this level of care that I have ever seen. That's why you see people neglected, bedsores, patients who fall -- because the staffing level is more like one aide per every dozen seniors. Even that is generous. Some places are much worse.
2
The sad thing is that it will be patients and families who suffer. The people who run these places hire poorly qualified attendants and paid the nurses they hire a pittance. This is what for profit health care looks like its no care at all. What a sad thing for Dr. Hamerman to go through. I wish here a quick and complete recovery.
9
As with most other parts of the American healthcare system, nursing homes are structured for maximum profit. Operators focus on fancy chandeliers, drapes and other amenities because the nice surroundings help to assuage the guilt children feel over leaving their parents in these facilities. The same is true in assisted living places. As a result, there is less money left for the main purpose of the institution: appropriate care.
I can remember having to put my father in an assisted living home that looked like a fancy hotel, but where I found him one evening, slumped in his wheelchair and overdue for a trip to the hospital. None of the staff even noticed or appeared to care. When we moved him in to the facility, administrators insisted he receive the highest level of care at the highest prices, but I later discovered he was not given the promised two aides to help him for the top rate that we paid.
You can count on the American health-industrial complex to monetize to the hilt anything that moves, over-delivering when it comes to profits and under-delivering when it comes to care or outcomes.
I can remember having to put my father in an assisted living home that looked like a fancy hotel, but where I found him one evening, slumped in his wheelchair and overdue for a trip to the hospital. None of the staff even noticed or appeared to care. When we moved him in to the facility, administrators insisted he receive the highest level of care at the highest prices, but I later discovered he was not given the promised two aides to help him for the top rate that we paid.
You can count on the American health-industrial complex to monetize to the hilt anything that moves, over-delivering when it comes to profits and under-delivering when it comes to care or outcomes.
99
You are quite right about the whole chandelier thing. It's to assuage guilt. It's also a sales tool. I have toured dozens of local facilities in the last couple of years, and I've seen places that looked so wonderful, I'd happily move in myself -- they look like fancy hotels or spas -- but of course, I am a healthy, active middle aged adult. I am not a frail, senile senior in a wheelchair who is TRAPPED in such a facility and dependent on the good graces of staff to care for me.
What is sad is how much money goes into the chandeliers and art on the walls, and fancy furniture -- it is costly and all money that DOES NOT go to the aides or nursing staff.
I also object to the advertising, which makes it SEEM like people in their 60s and 70s in relatively good health CHOOSE such places, so they can have "active lifestyles". What a crock. Nobody would ever go here, or pay these obscene prices if they were not desperate and too frail to live on their own! It is rare to see anyone under 78, and the average age is mid-80s to 90s.
The cost is designed to be bankrupting -- it is a clever methodology to separate the senior from a lifetime of savings and thrift, from a house or condo and transfer 100% of that wealth to the nursing facility. Then the patient becomes a conduit for Medicaid funds. It's an unbelievable racket.
What is sad is how much money goes into the chandeliers and art on the walls, and fancy furniture -- it is costly and all money that DOES NOT go to the aides or nursing staff.
I also object to the advertising, which makes it SEEM like people in their 60s and 70s in relatively good health CHOOSE such places, so they can have "active lifestyles". What a crock. Nobody would ever go here, or pay these obscene prices if they were not desperate and too frail to live on their own! It is rare to see anyone under 78, and the average age is mid-80s to 90s.
The cost is designed to be bankrupting -- it is a clever methodology to separate the senior from a lifetime of savings and thrift, from a house or condo and transfer 100% of that wealth to the nursing facility. Then the patient becomes a conduit for Medicaid funds. It's an unbelievable racket.
3
Is it overstating the obvious to point out that this article is located in the Business section of the newspaper? Today's nursing home industry often seems to practice more profit care than health care and this is repeatedly (and sadly) demonstrated in the Times' reporting on the industry.
92
Whether we like it or not, healthcare is a business in the U.S. Vast sums of money are involved. The competition between providers is intense. Financial incentives play a huge role in the care people receive. All this requires the kind of reporting we find in this article, to make sense of the forces at work and their impact. Pretending that healthcare isn't a business (or merely wishing it weren't so) won't change a thing. Change becomes possible with information and insight of the kind presented here. It isn't just nursing homes that are profiting from healthcare. Hospitals, doctors, imaging centers, laboratories -- everyone has their finger in this enormous pot of potential profits and money is a key driver of the system.
11
That's where most of the coverage for health care now resides. Because, that's the way Wall Street likes it. And the Times is all about the Wall Street.
5
Judith E Graham: Laura isn't denying reality. She's bemoaning as the fact that the U.S. is the only country in the world that allows needless middlemen to profit off the sick.
Hospitals, doctors, imaging centers, laboratories (you forgot nurses!) all provide actual needed services.
What service, exactly, do the corporations, which now own hospitals and nursing homes, provide the elderly? Other than sucking money out of the system, that is?
Hospitals, doctors, imaging centers, laboratories (you forgot nurses!) all provide actual needed services.
What service, exactly, do the corporations, which now own hospitals and nursing homes, provide the elderly? Other than sucking money out of the system, that is?
2
justofy how you have overworked staff in snf's with owners walking away with literally millions in profits. How owners will state they don't have enough money for raises but manage to eke out $800,000 in profits for themselves
47
I live in AZ and am terrified of being hospitalized, let alone sent to a short-term facility for "rehab". No one seems to come out of those places in better shape than they went in. So to C. Mark Hansen, the president and chief executive of Santé Partners, I can say I have just told my power of attorney to NEVER EVER send me to a Sante Partners facility. Arizona's state motto should be "Winning the Race to the Bottom".
27
Advised by an attorney friend when I told him what had happened to a former childhood neighbor: when your elderly loved one is admitted into a hospital and it is certain that outside nursing care will be next, get a GUARDIANSHIP ASAP, as your POA will be worthless. (Former article in January here in NYT on this topic). The neighbor was placed in a local nursing home after being released from the hospital and frequently--when residents are difficult--they are shipped to a nursing home further away for "medication". That institution placed the resident under it's guardianship by an attorney, with whom it most obviously colludes. The daughter could not move her mother closer to her in a major metropolitan area, because the attorney said that the mother "had to be near to a hospital" in that regional rurally located nursing home. The mother died as the daughter was in process of wrestling the guardianship away from that corrupt attorney who represents the interests of the nursing home for the difficult.
2
Many of these nursing homes are the equivalent of high priced mini-storage facilities. We fret over such things as puppy mills but are content to ignore the elderly and those in need of rehab or medical care even though that is generally the inevitable fate many or most will face.
We are rushed out of the hospital so fast today it is a wonder that surgeons aren't stitching the sutures as the patient is being wheeled out to the parking structure.
We are rushed out of the hospital so fast today it is a wonder that surgeons aren't stitching the sutures as the patient is being wheeled out to the parking structure.
82
When it became clear to me that my beloved and now deeply missed mother could no longer really be by herself or manage her affairs, I understood that the only chance for her to have a loving and happy final time was for me to make it so.
And so I gave up everything, moved to the City she was in (so that she could remain close to her sisters), moved her into independent living and rented an apartment a half block away.
I never lived in my little apartment. For five years, I lived with her, sub rosa (so to speak) in her retirement community. It was a full time job, I devoted myself to her because she was such a wonderful mother, because I loved her and refused to see her abused or neglected in any way. After a while I became an "inmate" myself, and was pretty much accepted as such.
But I watched, and saw everything. Had I not been there 24/7, she would have ended up ignored, bed-sored, her dignity and will to live until it was time to die, taken.
It was a huge price to pay....I could never have abandoned her...it simply was not possible.
But I know that what I did is neither reasonable or right for others...and as I write this I know beyond all doubt, that there are thousands, perhaps millions of suffering elderly...locked down and essentially warehoused and ignored in places with white shutters, pink wallpaper and extensive dinner menus.
And so I gave up everything, moved to the City she was in (so that she could remain close to her sisters), moved her into independent living and rented an apartment a half block away.
I never lived in my little apartment. For five years, I lived with her, sub rosa (so to speak) in her retirement community. It was a full time job, I devoted myself to her because she was such a wonderful mother, because I loved her and refused to see her abused or neglected in any way. After a while I became an "inmate" myself, and was pretty much accepted as such.
But I watched, and saw everything. Had I not been there 24/7, she would have ended up ignored, bed-sored, her dignity and will to live until it was time to die, taken.
It was a huge price to pay....I could never have abandoned her...it simply was not possible.
But I know that what I did is neither reasonable or right for others...and as I write this I know beyond all doubt, that there are thousands, perhaps millions of suffering elderly...locked down and essentially warehoused and ignored in places with white shutters, pink wallpaper and extensive dinner menus.
128
Bless you - may you have someone to take as good care of you when you'll need it.
I wonder then, why you maintained a separate apartment at all? Why not just rent a place for yourself and your mother, with the hiring of a part time aide to help inbetween? An independent living apartment would not be the best fit, and how did you get your meals? They won't feed you for free in such a place (assuming meals were provided).
In the "olden days", what you describe was the norm. A child -- usually an adult daughter -- literally would give up her life to care for aging parents. The only reward (if there was one) was that perhaps she ended up with their assets or a house at the end-- but it was often 10 years or more of brutal work without reprieve or gratitude.
But that was in a era when most women did not work outside the home. And parents did not get generous Social Security or Medicare. So things have changed, and it is a rare adult who can give up career, marriage and a life to care for elderly parents 24/7.
In the "olden days", what you describe was the norm. A child -- usually an adult daughter -- literally would give up her life to care for aging parents. The only reward (if there was one) was that perhaps she ended up with their assets or a house at the end-- but it was often 10 years or more of brutal work without reprieve or gratitude.
But that was in a era when most women did not work outside the home. And parents did not get generous Social Security or Medicare. So things have changed, and it is a rare adult who can give up career, marriage and a life to care for elderly parents 24/7.
2
It wasn't that I "could" do it...I made the choice to do it.
In fact, it was the decision not to allow my mother to suffer.
The corporation that owned the retirement community also owned the apartment complex that abutted it.
They never would have allowed me to "visit" for any serious length of time with my mother unless I essentially paid them to do it...I paid the significant monthly rent on "my apartment" but slept on the living room floor of my mother's one bedroom apartment in the retirement community. Her apartment had a kitchen...she was entitled to dinner meals in the "dining room"....but I was not. She would not have gone without me, and could not have maneuvered it on her own. She was , in addition to all else, legally blind and profoundly deaf. It was a complex juggling act.
In fact this was the "best" (of a worse) arrangement but nerve wracking for me and exhausting. My little place did gave me a private space to breathe from time to time (to "escape" for an hour or two so that I could remain balanced.) My mother never knew or even suspected how difficult it was...all of it. But I kept her happy and engaged until the end.
Count up the costs...they were staggering. My mother's board, my own room and board, plus a deluge of "extras"....nothing in these places ever, ever comes included.
After her death I was broke...but not broken.
I still am broke...but know that I made the kind of sacrifices that she and my father made for me all their lives.
In fact, it was the decision not to allow my mother to suffer.
The corporation that owned the retirement community also owned the apartment complex that abutted it.
They never would have allowed me to "visit" for any serious length of time with my mother unless I essentially paid them to do it...I paid the significant monthly rent on "my apartment" but slept on the living room floor of my mother's one bedroom apartment in the retirement community. Her apartment had a kitchen...she was entitled to dinner meals in the "dining room"....but I was not. She would not have gone without me, and could not have maneuvered it on her own. She was , in addition to all else, legally blind and profoundly deaf. It was a complex juggling act.
In fact this was the "best" (of a worse) arrangement but nerve wracking for me and exhausting. My little place did gave me a private space to breathe from time to time (to "escape" for an hour or two so that I could remain balanced.) My mother never knew or even suspected how difficult it was...all of it. But I kept her happy and engaged until the end.
Count up the costs...they were staggering. My mother's board, my own room and board, plus a deluge of "extras"....nothing in these places ever, ever comes included.
After her death I was broke...but not broken.
I still am broke...but know that I made the kind of sacrifices that she and my father made for me all their lives.
2
I have left clear instructions that I am not to be put in any nursing home. Happily for me, my state allows me to evaluate my condition and make an exit when my personal cost/benefit ratio is exceeded. I have been to visit nursing homes and believe me, death is better. I believe that our sentimental society needs to confront these issues, and I'm hopeful that younger generations will be clear-eyed enough to realize that death with dignity usually means death before you've lost the ability to move and are covered in bedsores.
Sadly, we are warehousing thousand of patients who have no quality of life remaining, especially the long-term ventilator patients whose families insist that they be kept alive. I'm sorry, but this is people-abuse. And horribly costly.
Sadly, we are warehousing thousand of patients who have no quality of life remaining, especially the long-term ventilator patients whose families insist that they be kept alive. I'm sorry, but this is people-abuse. And horribly costly.
81
I'm not aware of any state that allows assisted suicide for anything but a terminal illness with expected death within six months, which would not cover most chronic illnesses such as Alzheimer's. So you would have to turn to plain old non-assisted suicide and do it while you are still able to carry out an effective plan. Not so easy to do. Please check your states laws carefully before assuming that simply stipulating that you refuse to go into a nursing home will prevent that from happening.
20
Good luck with that. No doubt, your instructions will not be followed if you truly become incapacitated.
12
You're fooling yourself, Avocats. Even in Washington, the law doesn't allow you to avail yourself of assisted suicide in all such situations, and the people to whom you've given your "instructions" probably won't want to go to jail just to oblige you.
One of the biggest problems with end-of-life dilemmas if that most people rely more on fantasy than fact in their planning. We desperately need better laws and better care facilities, and we have to be realistic about how horrible our last years are apt to be if we don't start working now to get those laws and facilties. It won't happen without a fight.
One of the biggest problems with end-of-life dilemmas if that most people rely more on fantasy than fact in their planning. We desperately need better laws and better care facilities, and we have to be realistic about how horrible our last years are apt to be if we don't start working now to get those laws and facilties. It won't happen without a fight.
5
My father spent 9 months in a nursing home with a great local reputation. However the quality of medical care was a serious disgrace. I doubt that most people are aware of what is really going on or not. He complained for two weeks about his black stools. They never checked (unfortunately he never told me). One day his blood pressure dropped very low and instead of calling an ambulance they called for a not to rush carrier. He was having a serious heart attack and no one noticed. It ultimately killed him. This is what they call care?
61
I have been in this facility over four months. They tell me it's osteoarthritis, and maybe it is. In this time I have seen the doctor abut three times. He has listened to my heart and lungs and told me I should elevate my legs for two hours twice a day. He has neither provided a means of elevation or a suggestion. He has pumped 12 pills into me daily until I rebelled. I am 92 and have come through a serous illness only because I am a fighter.Something should be done to protect us and correct these conditions. Medicare is wasting money--penny wise and pound foolish.
4
My elderly aunt just passed away in an Assisted Living facility two weeks ago. She had dementia, but was physically OK for her age (93) and had just had a full physical with a gerontology practice 3 days earlier.
She came down with some massive sepsis infection during the night -- didn't come down to breakfast -- finally another resident came to look for her (the staff was nonplused and incurious -- she was comatose and lying in her own vomit. This was about 8AM. It took them ANOTHER FOUR HOURS to find a nurse (!!!) and have the nurse call me. Then instead of an ambulance, they used their own transport van to take her to the doctor.
She may well have died anyways -- maybe it was "her time" -- but their callous indifference to her condition simply shocked me to the core. And this was after several years of my complaining about the facility, staff, nursing and so on. Maybe it was even a kind of payback (because I'd complained). I'll never know.
She came down with some massive sepsis infection during the night -- didn't come down to breakfast -- finally another resident came to look for her (the staff was nonplused and incurious -- she was comatose and lying in her own vomit. This was about 8AM. It took them ANOTHER FOUR HOURS to find a nurse (!!!) and have the nurse call me. Then instead of an ambulance, they used their own transport van to take her to the doctor.
She may well have died anyways -- maybe it was "her time" -- but their callous indifference to her condition simply shocked me to the core. And this was after several years of my complaining about the facility, staff, nursing and so on. Maybe it was even a kind of payback (because I'd complained). I'll never know.
6
"Maybe it was even a kind of payback (because I'd complained). I'll never know." I am very sorry they made you wonder about this after you have lost a loved one on their watch. I would have complained, too, because there seems to be no other way of keeping alive one's conscience in the face of a cruel and predatory system.
Sad, but predictable (and predicted by many) situation.
As long as our health care system remains overwhelmingly profit-driven, we will roll from crisis to crisis. Especially as the Boomer generation ages and overwhelms the existing system.
It doesn't take a rocket-scientist to predict that as health insurance increasingly favors nursing home settings (because they are cheaper) for rehabilitation services and tightens reimbursements on in-hospital programs (resulting in total or partial shut-down of many superb programs), the trend of rehab moving to nursing homes will continue. Many nursing homes will not be able to meet demands, and patient care will suffer. Many in health care have personally weathered these changes in their careers, and witnessed the demise of excellent in-hosital programs.
The article is timely, and pertinent. It could be improved by taking a longer view of the factors behind the changes in provision of rehab services. It could also be improved--and better balanced--by reporting on the many satisfactory to good experiences some are having with short-term nursing home rehab.
As long as our health care system remains overwhelmingly profit-driven, we will roll from crisis to crisis. Especially as the Boomer generation ages and overwhelms the existing system.
It doesn't take a rocket-scientist to predict that as health insurance increasingly favors nursing home settings (because they are cheaper) for rehabilitation services and tightens reimbursements on in-hospital programs (resulting in total or partial shut-down of many superb programs), the trend of rehab moving to nursing homes will continue. Many nursing homes will not be able to meet demands, and patient care will suffer. Many in health care have personally weathered these changes in their careers, and witnessed the demise of excellent in-hosital programs.
The article is timely, and pertinent. It could be improved by taking a longer view of the factors behind the changes in provision of rehab services. It could also be improved--and better balanced--by reporting on the many satisfactory to good experiences some are having with short-term nursing home rehab.
25
You know what would cure all of this? If the U.S. gave up its for-profit health care model -- which only enriches those superfluous middlemen who cut care in order to make a profit -- and we all, rich or poor, young or old, moved to a Medicare for all plan.
For the past couple of decades we've seen hospitals and nursing homes being bought up by for-profit corporations and cutting care and jacking up prices. It is incredible that those who wrote the Affordable Care Act didn't know that this would happen. ACA naively expected those profit-grubbing middlemen to give up their profits and accommodate government cuts. When have capitalists ever been willing to give up THEIR own profits? Of course they're going to take it out of someone else's hide!
A for-profit health care system will never never result in an affordable, effective, and humane system.
For the past couple of decades we've seen hospitals and nursing homes being bought up by for-profit corporations and cutting care and jacking up prices. It is incredible that those who wrote the Affordable Care Act didn't know that this would happen. ACA naively expected those profit-grubbing middlemen to give up their profits and accommodate government cuts. When have capitalists ever been willing to give up THEIR own profits? Of course they're going to take it out of someone else's hide!
A for-profit health care system will never never result in an affordable, effective, and humane system.
113
Remember that the ACA set up the insurance companies as the biggest profit-takers in the new system. There is no need for them. Medicare for all.
28
"For profit" is the key phrase here. Visualize the Wall Street operators putting together their clever, very well paid lawyers and MBA's with the mandate of how do we squeeze money from a business like this. Even a few years ago there was an analysis that may have appeared in the N.Y.Times about the corporate structure of nursing homes that made it next to impossible to access liability for poor care. Until the "for profit" disappears there are going to be clever operators seeking large profits, and I would guarantee that they are more clever than the checks and balances that could be put in place.
7
What you are describing would be hospital a nd short-term rehab only. Long term residence in nursing homes is an entirely separate issue. This article weaves the Medicaid issues in and out but reAlly does not address them or the quality issues therein. The types of efforts under the ACA on permissions will likely mostly affect Medicare patients and not address the very real issues for long term residents which the article hints at.
4
Rehab/long-term care is a whole other world. We had very little time to become an informed consumer between the time it was announced that my mother was being discharged from the hospital (in her current unwell state) and the actual discharge. When the rehab facility that the discharge worker had identified as appropriate declined to take my mother, late on a Friday afternoon, the worker suggested my mother just go home. I said no, in that case we need to identify another facility (and the medical personnel backed me up, that in medical terms, my mother needed the care of rehab). The worker eventually named a few. One she said she would not begin a referral for until I had driven to the place and scoped it out, apparently because its physical plant is often deemed wanting by patients and families. We went with Plan C, a family-owned facility nearby. It had a reputation for cleanliness. They were willing to take my mother the next day. It worked out. Medicare only covered about a week of her stay, the other 5 weeks, until she died, ended up being private pay, with Medicare paying for hospice care. Between advocating for my mother's care, spending time with her, emptying her apartment, buying her supplies, etc. etc., I did not have time to do any comparison shopping. I tried to find personnel there who would listen and get things done -- they were not on every shift or always on site. I tried to work with what we had. I had little context to put our experience in.
57
You were quite lucky. Also your poor mother did not have to suffer there very long -- six weeks overall, that is a VERY short stay. The average senior spends the last TWO YEARS of their life in some kind of facility.
And Medicare pays for nursing rehab (up to a limited number of days, I think 100 a year) and they do pay for a BRIEF hospice stay, but they do NOT cover long term nursing care nor Assisted Living -- at all.
And Medicare pays for nursing rehab (up to a limited number of days, I think 100 a year) and they do pay for a BRIEF hospice stay, but they do NOT cover long term nursing care nor Assisted Living -- at all.
1
Concerned Citizen,
Are you referring in your second paragraph to when a hospice patient qualifies briefly for General In-Patient care due to a temporary need for an increased level of medical attention?
Are you referring in your second paragraph to when a hospice patient qualifies briefly for General In-Patient care due to a temporary need for an increased level of medical attention?