More and more of us will be single, with no children and no one to check on us in the nursing homes or even our own homes. There are many places to store advance directives in "the cloud" of the Internet so our wishes could be followed even if an advocate doesn't appear. And we absolutely, positively need assisted dying and more options for right-to-die.
2
There are a number of "virtual villages" which help seniors who are living, often alone, in their homes, connect to other similar seniors and senior services. The one in Boston called Beacon Hill I believe was the first. The outlook does not have to be bleak if you take the effort to get and stay connected.
These are good changes. The last time my mother was in a nursing home (for profit) recovering from surgery, we encountered the following problems:
She immediately developed a urinary tract infection, which was dismissed as age-related incontinence.
She was given cognitive tests (not necessarily a bad idea under better circumstances) while she was in a state of confusion from her infection and while her hearing aids were placed out of her reach.
A socially-inept male aide made sexually inappropriate remarks while changing her, leaving her in tears and recalling all of those abusive incidents that most women have experienced in the course of a lifetime. After she complained, the aide disappeared for a week, but returned, making a joke of her reaction, as her only night-time help, meaning that she was left unchanged until the next day.
She was immediately put on opioid painkillers. At her discharge interview, there was some objection to discharging her while she was still taking them (fortunately she hadn't been taking them). I wondered if they wanted to keep her as long as possible.
Whenever I came to visit her I ran a gauntlet of inmates stretching out their arms and crying "help me, help me."
This was not the worst of places. It was staffed (understaffed) with good people. But when a resident is helpless, a few mistakes, one nurse turning rough from impatience and overwork, a little neglect, can be fatal.
She immediately developed a urinary tract infection, which was dismissed as age-related incontinence.
She was given cognitive tests (not necessarily a bad idea under better circumstances) while she was in a state of confusion from her infection and while her hearing aids were placed out of her reach.
A socially-inept male aide made sexually inappropriate remarks while changing her, leaving her in tears and recalling all of those abusive incidents that most women have experienced in the course of a lifetime. After she complained, the aide disappeared for a week, but returned, making a joke of her reaction, as her only night-time help, meaning that she was left unchanged until the next day.
She was immediately put on opioid painkillers. At her discharge interview, there was some objection to discharging her while she was still taking them (fortunately she hadn't been taking them). I wondered if they wanted to keep her as long as possible.
Whenever I came to visit her I ran a gauntlet of inmates stretching out their arms and crying "help me, help me."
This was not the worst of places. It was staffed (understaffed) with good people. But when a resident is helpless, a few mistakes, one nurse turning rough from impatience and overwork, a little neglect, can be fatal.
4
I have been trying to get CLOSURE for my mom's death at the hands of Forestville and Heartland Nursing Facilities, for three years till this day. My family is desperately in need of an transparent and thorough investigation into her Death. We were prevented by The Department Of Health And Equality from telling our side of what we observed at these Facilities. My pleads for help, even before my Mom died, were meet with deaf ears. Her Death was basically swept under the Carpet! Twitter:@ronald_terrell
1
Your casual tone about the loss of the right to sue is disturbing. You previous article about what an important gain it was, was excellent.
$98 a day is a lot. Enough to pay wages for professional care. Too much goes to profit.
$98 a day is a lot. Enough to pay wages for professional care. Too much goes to profit.
Seriously, you think $98 is a lot?
2
Right, it is 4 dollars an hour!
Too much does go to profit. Sickening
Too much does go to profit. Sickening
The worst abuse I see is spending money on cosmetics and paying the absolute minimum to the aides who do the hardest and most thankless work. Recently the care center the houses my mother embarked on an ambitious redecoration program but their aides are the poorest paid in town, so they don't stay. They are treated very badly and don't make a living wage, yet when something goes wrong they are the first to be blamed.
I doubt the high-level employees have to struggle with pay cuts. $9 to $11 per hours is *not* a living wage, and these helpers are doing their best in impossible circumstances.
(location of home: Princeton)
I doubt the high-level employees have to struggle with pay cuts. $9 to $11 per hours is *not* a living wage, and these helpers are doing their best in impossible circumstances.
(location of home: Princeton)
12
"cosmetic" was meant to mean appearances and surfaces, not makeup ...
1
I've worked in senior care communities (IL, AL, Memory Care and nursing homes) and can attest that the biggest problem they all face is retaining quality staff. It starts with what the facilities are willing to pay. It is truly a case of getting what you pay for. There is tremendous turnover at many of these place. Take dining service: servers get no tips so why would they stay at a job where their hourly pay is rock bottom with no additional opportunities to make more more. As soon as they can get a job serving in a restaurant, they are gone. Nurses and CNA's same thing. Rock-bottom pay creates continual turnover. Many of the for-profit retirement homes (IL, AL, Memory Support) are now consolidated and owned by huge investment trusts and exist to serve shareholders and investors first. Unless you know from someone's personal experience that a for-profit care facility is top notch, stay away. As to the lawsuit to throw out the arbitration clause challenge, it is a necessary failsafe to keep the joints honest as you can. You get what you pay for...
10
Oh the misery of nursing homes. Number one issue is understaffing, which is pointedly not addressed in new legislation. My Mom was in four different nursing homes after hospitalization,once Medicare's fourteen allowed days were over she was discharged: she was just a money machine. Her last nursing home was HORRIBLE, as in: discovering feces covered washcloths in her laundry bin, overmedication with Depakote (https://www.justice.gov/opa/pr/abbott-labs-pay-15-billion-resolve-crimin..., arriving to find her with two arms in one sleeve, or bedclothes and mattress SOAKED in urine, urinary tract infection and resulting dementia, or her having been "assessed" as able to eat on her own but visiting and finding food everywhere on table, floor, and clothes and no one in the dining room even seeming to notice.
So, after two different six bed board and care environments found through placement agencies (who get a month's kickback from the board and care homes) I at last had a friend recommend a well run caring board and care run by ethical owners. Here she lived out her last year in dignity, with caring personal attention, unfortunately too, too rare.
My advice to the loved ones who are caring for the elderly 1. Keep them out of nursing homes, if at all possible at home. 2. If they have to be placed talk to everyone you know go on personal recommendations from friends and church ONLY do not use a placement service.
So, after two different six bed board and care environments found through placement agencies (who get a month's kickback from the board and care homes) I at last had a friend recommend a well run caring board and care run by ethical owners. Here she lived out her last year in dignity, with caring personal attention, unfortunately too, too rare.
My advice to the loved ones who are caring for the elderly 1. Keep them out of nursing homes, if at all possible at home. 2. If they have to be placed talk to everyone you know go on personal recommendations from friends and church ONLY do not use a placement service.
3
While I agree with you on some of the horrors of nursing homes, we've twice found the assistance of a placement service to be invaluable.
This is a cautionary tale.
Having to place my parents in a nursing home still haunts me. I did it as a last resort because I the only care giver was at my wits end. My father was 94, blind and diabetic. My mother was 89 and suffering from dementia. These were not people looking for a hand out or marginal parents, they worked hard and saved their money, they loved me more than oxygen.
But as I said, I was coming apart, so believing that the people I loved would get the care that I could not give them, to the nursing home they went.
First the home took their money, 9,800 dollars a month each in a pay down. Then it took their dignity, diapers even though they did not need them (the residents usually don't need them, it is easier for the staff, why take them to the bathroom ? ). Lukewarm trays of food, you better focus cause the staff is coming back for that tray soon enough. There is plenty of recreation, if sitting in a chair in the lounge is your idea of activity. My father's spirit was crushed he lasted 8 weeks. My mother's dementia anesthetized her so she adjusted to the neglect, like the time I came on a surprise visit and found her sitting in the lunchroom completed naked. I would complain in the softest of tone, my mother's life was in their hands.
You are there a few hours a day, your relatives are at their mercy. This situation continued until my mother's death.
As I stated in the beginning, this is a cautionary tale, nursing homes are an unholy hell.
Having to place my parents in a nursing home still haunts me. I did it as a last resort because I the only care giver was at my wits end. My father was 94, blind and diabetic. My mother was 89 and suffering from dementia. These were not people looking for a hand out or marginal parents, they worked hard and saved their money, they loved me more than oxygen.
But as I said, I was coming apart, so believing that the people I loved would get the care that I could not give them, to the nursing home they went.
First the home took their money, 9,800 dollars a month each in a pay down. Then it took their dignity, diapers even though they did not need them (the residents usually don't need them, it is easier for the staff, why take them to the bathroom ? ). Lukewarm trays of food, you better focus cause the staff is coming back for that tray soon enough. There is plenty of recreation, if sitting in a chair in the lounge is your idea of activity. My father's spirit was crushed he lasted 8 weeks. My mother's dementia anesthetized her so she adjusted to the neglect, like the time I came on a surprise visit and found her sitting in the lunchroom completed naked. I would complain in the softest of tone, my mother's life was in their hands.
You are there a few hours a day, your relatives are at their mercy. This situation continued until my mother's death.
As I stated in the beginning, this is a cautionary tale, nursing homes are an unholy hell.
6
If you are interested in trying to help your senior loved one remain safely independent in their own home (at least as long as possible) and are concerned that they are becoming isolated. www.televisit.org has a nice tablet-based solution with daily programming and interaction with a live human being to engage and create a safe on-line community. It's in its early stages and have a beta version for the iPad.
3
It is always easy to point out the problems, but much more challenging to strategically seek solutions to the problems at hand.
As this author suggests at the end of the article contacting a long term care ombudsmen may help inform and promote action.
Consider joining a consumer action group such as The National Consumer Voice for Long-Term Care. http://nursinghomeaction.org/
I wondered why I saw all white faces when I viewed this webpage then remembered that most immigrants accept that they will care for their own elders in their homes.
As this author suggests at the end of the article contacting a long term care ombudsmen may help inform and promote action.
Consider joining a consumer action group such as The National Consumer Voice for Long-Term Care. http://nursinghomeaction.org/
I wondered why I saw all white faces when I viewed this webpage then remembered that most immigrants accept that they will care for their own elders in their homes.
2
All the long term care facility regulations in the world will mean squat - unless you have a state that can and will administer the regulations as they are written and expected to be interpreted. Too often administration is not knowledgeable of healthcare practices and fails to protect staff against the complaints of the health care facilities who want to make money and not provide minimum standards: there is absolutely no reason to accept that the standards of care will vary between government run, rural and urban, for-profit and non-profit homes. Nursing home-facilities ought to have the same standards of care (meal planning, cleanliness, nursing expertise, physician availability, . . . ). It is the responsibility of the states to assure the new standards are met and if administration claims it cannot be done due to the location of the nursing homes - then hire new administration.
I had the misfortune of having to spend three months in a ‘skilled’ nursing facility after an accident left me unable to care for myself at home. I was technically there for physical therapy, but the PT was skimpy and poorly individualized. They provided the absolute minimum required to qualify for payment by Medicare and my Medigap insurance.
Problems included no privacy or quiet spaces, medications late or incorrect, badly prepared food served cold, arbitrary scheduling of bathing and meals, theft, and missing or inappropriate supplies. I could go on, but two years later I still get upset thinking about it. Several of the standards listed would help, but only if they are actually applied and not just given lip service.
All of this was on the ‘skilled’ side where most of us were able to recognize problems and articulate enough to advocate for ourselves. The long-term residents were treated (mistreated) even worse.
Incidentally, many of the CNAs were refugees, willing to take unpleasant and underpaid jobs. Most of them were harder working and more cheerful and helpful than many of the ‘American’ staff members. Several were studying to become nurses. They also had to put up with subtle (and blatant) racism at work and away from work. The majority were Somalis, some of the people that Trump is keeping out.
Problems included no privacy or quiet spaces, medications late or incorrect, badly prepared food served cold, arbitrary scheduling of bathing and meals, theft, and missing or inappropriate supplies. I could go on, but two years later I still get upset thinking about it. Several of the standards listed would help, but only if they are actually applied and not just given lip service.
All of this was on the ‘skilled’ side where most of us were able to recognize problems and articulate enough to advocate for ourselves. The long-term residents were treated (mistreated) even worse.
Incidentally, many of the CNAs were refugees, willing to take unpleasant and underpaid jobs. Most of them were harder working and more cheerful and helpful than many of the ‘American’ staff members. Several were studying to become nurses. They also had to put up with subtle (and blatant) racism at work and away from work. The majority were Somalis, some of the people that Trump is keeping out.
12
Skilled nursing facilities (what I suppose this article means by "nursing homes") are a blight, as are the NY/NJ requirements for assisted living facilities that unnecessarily require patients to move from relatively comfortable and humane settings into institutions where they are shot up with morphine on a regular basis and have no quality of life. When my mother didn't die fast enough at the Joe Rasso Hospice House, the "social worker" there gave me one option: she would find a single female bed and that was that. Because she needed two people to help her out of bed and into a wheelchair, she could not return to assisted living. I opted to look at laws in other states and moved her to Virginia, where a "two person assist" is legal for assisted living facilities. She enjoyed a good quality of life there. If national laws are questionable, state laws--particularly NY, NJ, and FL--are dreadful. They don't protect the patients at all.
3
America's treatment of old people is appalling.
14
One change I would like to see is closed circuit tv to to keep a watchful eye on vulnerable residents who need as much protection as the littlest among our population for which nanny cams have become popular.
Just knowing someone is watching may keep some to behave safer and kinder 24 hours a day.
Just knowing someone is watching may keep some to behave safer and kinder 24 hours a day.
17
Folks pay a premium price for care in nursing homes. They should, by law, get what they pay for. Some did not have a registered nurse in house. They pay under the table for one to have their name put on their books. I have been to several, as a home health care nurse, that should have been closed. No staff, filth, no care. Unfortunately, where would these folks go? A real moral issue.
6
I lived in a SNF for 2 yrs at age 65 and survived! I can say the low-level staff is sympathetic and helpful, but ignorant of the basic needs of a ill person, even when given instructions by a physician as to daily care. The problem is language skills and money management. Staff always has potential for improvement, that's why they hire people who are one or two notches below the level necessary to perform their tasks. Because lower level staff is ignorant, they really on go thru the motions of their job. Laundry is overpacked and comes back smelling of mold. Mattresses are only perfunctorily cleaned between patients. My back was never examined as I was never turned and I got ringworm lying on a rubber mattress. Food is improperly prepared, the kitchen doesn't even know how to make an omelet!! they cut brisket with instead of against the grain. I got superbug infections at the SNF. The doctors are 8 to 5 pm, 2d rate and 3d world trained, just enough skill to complete a death certificate. Paralyzed people got their arms caught in the tilting bed. Mutes are ignored because they can't reach the call button, or just die from lack of proper attention. They don't provide 'talk boards' or books. Its all about the money at the Aetna paid facility I went to. I couldn't discharge myself fast enough. Ended up in the hospital again 3 more times because the SNF MD missed other infections. STAY AWAY FROM THESE PLACES or attend to your family members who enter one.
17
F
And guess what else that stands for.
And guess what else that stands for.
3
Since these went into effect so late in the Obama administration, one wonders if industry lobbyists will work to have them overridden by the new Congress.
4
Very few Americans have a plan for their long term healthcare needs as they age. While some of us may be living longer, we are more complexly ill with cardiovascular diseases and dementia.
Warehousing of humans at the end of the road has been accepted by Americans as a means to the end for decades, but we are not at all prepared for the silver tsunami about to affect our healthcare system.
It is easy to criticize "nursing homes" until you have provided care for many people incontinent of both urine and stool who require constant supervision to remain safe and clean.
If more of us planned for the realities of aging both financially and in our home environments, there would be less dependence on long term care institutions (aka nursing homes....were very little real nursing occurs) and we could remain in our homes where our personal choices and preferences are maintained.
Allowing any visitor any time in a long term care institution requires that these visitors are also monitored. Consider that not everyone that ends up in "nursing home" is the sweet frail elderly. Many are at the end of the road from a lifetime of drug and alcohol abuse.
As much as we want to sugar coat the idea of nursing "homes" as lovely, warm, cozy inviting places to celebrate the end of a life well lived....they simply are not and will never be home.
There is no more money to pay for the thousands of people who need long term care at the state, and certainly not at the federal level.
Warehousing of humans at the end of the road has been accepted by Americans as a means to the end for decades, but we are not at all prepared for the silver tsunami about to affect our healthcare system.
It is easy to criticize "nursing homes" until you have provided care for many people incontinent of both urine and stool who require constant supervision to remain safe and clean.
If more of us planned for the realities of aging both financially and in our home environments, there would be less dependence on long term care institutions (aka nursing homes....were very little real nursing occurs) and we could remain in our homes where our personal choices and preferences are maintained.
Allowing any visitor any time in a long term care institution requires that these visitors are also monitored. Consider that not everyone that ends up in "nursing home" is the sweet frail elderly. Many are at the end of the road from a lifetime of drug and alcohol abuse.
As much as we want to sugar coat the idea of nursing "homes" as lovely, warm, cozy inviting places to celebrate the end of a life well lived....they simply are not and will never be home.
There is no more money to pay for the thousands of people who need long term care at the state, and certainly not at the federal level.
10
Many Americans cannot afford a decent retirement outside of a nursing home, let alone in a well run long term care facility.
10
I agree that more people should plan for the financial realities of aging. However few middle class people can afford long term care insurance, even if they qualify, and even fewer can amass a fund large enough to put a dent in the costs.
1
Assigning a letter grade reduces the analysis to a meaningless data point. Within a single facility, one patient may have excellent care and one may have dismal care. Determinants include the systemic functions of the facility, but also the individual dispositions of a particular resident, the particular staff assigned to that resident, and the attending physician. Also the resources and medication therapy may be influenced by the insurance carrier for that individual resident. The relationship of the family members and the staff can highly influence the care received, ranging from mutual respect to constant conflict.
Finally, much of the regulatory framework is not necessarily helpful, and often regulators value paper compliance above actual care delivered, and their intervention may actually divert good caregivers from delivery of care to completion of forms.
Ultimately, the complexity of care given to the frail resident matches the complexity of varied styles of living. Trying to force the entire care structure into the medical care system, increases cost, increases liability concerns, decreases individual choices, and ultimately separates the resident from their natural social contacts. The formality of this high tech care is often used as a salve for the guilty consciences of the family.
Finally, much of the regulatory framework is not necessarily helpful, and often regulators value paper compliance above actual care delivered, and their intervention may actually divert good caregivers from delivery of care to completion of forms.
Ultimately, the complexity of care given to the frail resident matches the complexity of varied styles of living. Trying to force the entire care structure into the medical care system, increases cost, increases liability concerns, decreases individual choices, and ultimately separates the resident from their natural social contacts. The formality of this high tech care is often used as a salve for the guilty consciences of the family.
1
you make a lot of good observations; it is a very complex and difficult problem; we know whats bad, we know how difficult it is to provide appropriate care under the best of circustances; how do we move towards something better?
For what it is worth: I work in two nursing homes in rural upstate New York as a Hospice volunteer and I am overwhelmed how good they are - perfect, no; very good, YES! It can be done. How do we get more to do it right?
For what it is worth: I work in two nursing homes in rural upstate New York as a Hospice volunteer and I am overwhelmed how good they are - perfect, no; very good, YES! It can be done. How do we get more to do it right?
4
Why is this article illustrated with a cartoonish depiction of an elderly lady, tiny useless hands, helpless-looking, feet unable to touch the floor, looking upward for salvation? Be careful: the ways in which you caricature the elderly have an effect on society and institutions, and give signals. This cartoon seems to sanction the dismissal of older human beings.
28
A few comments.
I recall the nursing homes that my grandparents were in, in the 1960s. Filthy and smelled of urine. Staff couldn't be bothered.
My mother-in-law was a patient recently in Amsterdam House /Amsterdam Nursing Home in Manhattan. A world of difference. The facility was clean, the staff sincerely dedicated to the patients. Our family physician said that it's the place to go if you have to be in a nursing home, but you'd rather not be there, which I thought was an apt description.
Of course, it also helped that my wife visited her mother every day. In fact, a prime rule of health care is that you always want a "police officer" at the best facility, be it a neighborhood hospital or an exalted place like New York Presbyterian Hospital (where my mother-in-law didn't get her glaucoma medication for days).
In short, there is no substitute for knowledgeable family members overseeing care.
I recall the nursing homes that my grandparents were in, in the 1960s. Filthy and smelled of urine. Staff couldn't be bothered.
My mother-in-law was a patient recently in Amsterdam House /Amsterdam Nursing Home in Manhattan. A world of difference. The facility was clean, the staff sincerely dedicated to the patients. Our family physician said that it's the place to go if you have to be in a nursing home, but you'd rather not be there, which I thought was an apt description.
Of course, it also helped that my wife visited her mother every day. In fact, a prime rule of health care is that you always want a "police officer" at the best facility, be it a neighborhood hospital or an exalted place like New York Presbyterian Hospital (where my mother-in-law didn't get her glaucoma medication for days).
In short, there is no substitute for knowledgeable family members overseeing care.
35
My husband noticed the same difference (in the pervasive stench of urine) between his mother's 1990s nursing home and his dad's 2000s nursing home. Nursing aides confided what has made most of the difference: adult diapers. This has certainly reduced the odor problem and the tedious work of changing wet/soiled bedding, but if diapers go unchanged, it's still a health problem for the resident.
6
This problem is only going to get worse. There needs to be a balance between policing these nursing homes and merely driving up costs for little or no actual benefit.
3
Imposing an ought imperative of what "needs" to be done doesn't really help.
Medicare does not pay for long term care only short term "rehabilitation" in a nursing home setting (about 3 weeks).
What is your suggestion for affordable change?
Medicare does not pay for long term care only short term "rehabilitation" in a nursing home setting (about 3 weeks).
What is your suggestion for affordable change?
2
I am glad to see these changes in SNFs. my grandpa is in one and always complains about his watches and razors going missing. I am sad to hear about not incorporating staffing minimums with a waiver for those who are rural. I also think a minimum amount of money should be paid to CNAs because they are doing the bulk of the work and get paid under a living wage. I worked as a CNA for 4 years, and working in a nursing home was the hardest type of work and it seemed to be the lowest paid.
15
Thank you Courtney for your care. Skilled nursing facility (SNF) refers to only temporary care of a person in a nursing home setting. This is paid by Medicare (or the many private Medicare plans if authorized) for about 3 weeks without a co-pay.
Permanent long term care is NOT paid for by Medicare. Which means individuals must come up with an average of $4500/month, or rely on state funding (Medicaid) but only if they qualify with very low income demonstrated.
Permanent long term care is NOT paid for by Medicare. Which means individuals must come up with an average of $4500/month, or rely on state funding (Medicaid) but only if they qualify with very low income demonstrated.
4
As a constant visitor to see my mother a small skilled nursing home[SNF] over the last 8 years, I'd say regulations do make these residences more careful - eg, any fall or bump or bruise is recorded and i'm notified. I also believe that most of their employees want people to be content and safe. But the conditions under which staff work - especially lpns -and aides -are demanding -- and there are never enough aides to provide a comfortable level of assistance to those who most need it.
Plus, there is high turnover of the aides (this home uses another strategy to increase the supply of aides - probably also limiting costs - by training students from a local community college.] There are some who have been around and know residents -- but too many strangers who come and go, who are short on skills they should have to understand and communicate with people who can't see or hear well, have problems moving, and who may have some or considerable dementia.
The regs give auditors and inspectors some more easily measurable indicators of care. But if they were to spend a day just observing, it would become clear that staffing levels, and pay and benefit levels for those who literally shoulder the basic care of residents, are the keys to quality of care.
Plus, there is high turnover of the aides (this home uses another strategy to increase the supply of aides - probably also limiting costs - by training students from a local community college.] There are some who have been around and know residents -- but too many strangers who come and go, who are short on skills they should have to understand and communicate with people who can't see or hear well, have problems moving, and who may have some or considerable dementia.
The regs give auditors and inspectors some more easily measurable indicators of care. But if they were to spend a day just observing, it would become clear that staffing levels, and pay and benefit levels for those who literally shoulder the basic care of residents, are the keys to quality of care.
19
I currently know one person who resides in a nursing home, and they are miserable (and they are a relatively young person, not terminal, not living with dementia, etc. but who happen to have an incurable illness).
Nursing homes, in general, are not pleasant. You lose your privacy, your dignity, your sense of self. Personal possessions get lost, stolen, damaged, etc. You cannot go anywhere without staff watching your every move -- and most of the time, you cannot go anywhere without another person accompanying you.
You have no independence. This is not normal living.
Often, relatives will place a person in a nursing home because they either do not have the financial means, time (they have busy careers),live in other states, or interest in keeping the person at home. In other words, they think that this is the best solution, whether or not that is in fact the truth.
Nursing homes, in general, are not pleasant. You lose your privacy, your dignity, your sense of self. Personal possessions get lost, stolen, damaged, etc. You cannot go anywhere without staff watching your every move -- and most of the time, you cannot go anywhere without another person accompanying you.
You have no independence. This is not normal living.
Often, relatives will place a person in a nursing home because they either do not have the financial means, time (they have busy careers),live in other states, or interest in keeping the person at home. In other words, they think that this is the best solution, whether or not that is in fact the truth.
9
I can't imagine there is any way a nursing home is cheaper than moving the relative into your house and hiring daytime care for them if you work, but I am open to enlightenment.
Easier? Definitely. Cheaper? How?
Easier? Definitely. Cheaper? How?
3
My sister once looked into taking our father in (for hospice care) and hiring home health aides. She made some inquiries -- in the major metropolitan area of Seattle -- and was essentially told "Good luck finding anyone." And at the going rate (which they earn!), anyone you'd find would be prohibitively expensive for 24-hour care, meaning family members would provide unpaid care for much of the 24 hours.
1
One challenge with providing in-home care is having an elder-appropriate home. Fall prevention is critical. Even a ranch home may have a step up or down to navigate around an entry, and many bathrooms have been long designed to minimize space, rather than the room needed to provide assistance or structural supports such as grab bars. More effort is needed to make universal design features such as larger doorways, easy to grab knobs standard features.
2
I try to do my best for a healthy life as long as possible. In this sense, I try to eat and supplement necessary nutrient as much as I can. I occasionally watch or hear about foods at nursing homes that are mostly behind the curve, centering carbs instead of fats due to erroneous diet recommendations by the government or any authoritative medical organizations that accelerate poor health condition of the elders. By feeding carbs-centered diet, they are actually accelerating the speed of dementia/Alzheimer's, CVD/stroke or type-2 diabetes, which require lifestyle change instead of medicines. It is sad, but this is the way Americans will die because it takes a lot of time to change dietary knowledge of the general public even though scientists reach break-through findings one after another. A largest victims are a large number of health-conscious women that have become fat and animal protein phobic due to the notorious dietary guidelines of the last century that still influence dietary guidelines of this century. We are the products of the time.
4
The majority of facility patients are not expected to have a long life expectancy, and dietary interventions to extend survival or make a difference in future function may have little impact during a short time.
Conversely, lack of appetite and poor intake is frequently a problem for debilitated patients.
Dietary intervention is monitored by professionals in the facilities, but modifications to provide personal satisfaction and appetites may need to compromise the ideal long term benefits that a healthier individual is looking to achieve.
Conversely, lack of appetite and poor intake is frequently a problem for debilitated patients.
Dietary intervention is monitored by professionals in the facilities, but modifications to provide personal satisfaction and appetites may need to compromise the ideal long term benefits that a healthier individual is looking to achieve.
3
Reading this article in good health at the age of 71, I rejoice that I keep a sturdy handgun among my possessions. I don't need it yet, but I can assure you that I'm not going to go to any of the nursing homes described in this article and its comments.
16
This is only a start. America does a terrible job of ensuring the elderly are cared for with dignity. Nursing homes need inspections...and at least one nurse on staff 24 hours a day otherwise you are not a nursing home but a elder sitter. America needs to see this problem that all of us one day will experience.
10
Nursing homes are inspected and licensed by states and states also have nursing home regulations. Such inspections are used for federal certification to receive Medicare and Medicaid reimbursement.Federal regulations are de minimus; state regulations may need to be brought in line with the new federal regs. But there is nothing to stop states from promulgating stricter standards than the Feds, e.g. Requiring that at least one RN 24 hours a day.
But states are also subject to budgetary pressures, including pressure to keep Medicaid reimbursement at a sustainable level. (Medicaid is a state/federal program). Industry, resident and other advocates all influence and can comment on state regulatory changes. We are not talking red states vs. blue. Some blue states have deficient regulations and inspection. My suspicion is no state has enough inspectors. As stated in the article, there are also long term care ombudsmen in each state. State agencies and long- term care ombudsmen receive complaints and must follow up. It is often at the state level that we can be most influential in seeking quality care. State inspectors and local ombudsmen are the proverbial "boots on the ground." Federal inspectors can be called in and do make inspections but the vast majority of enforcement is at the state level. Contact your STATE legislators and departments of aging. Keep your eyes on the Feds with Trump but demand your state agencies be adequately funded and staffed to do their jobs.
But states are also subject to budgetary pressures, including pressure to keep Medicaid reimbursement at a sustainable level. (Medicaid is a state/federal program). Industry, resident and other advocates all influence and can comment on state regulatory changes. We are not talking red states vs. blue. Some blue states have deficient regulations and inspection. My suspicion is no state has enough inspectors. As stated in the article, there are also long term care ombudsmen in each state. State agencies and long- term care ombudsmen receive complaints and must follow up. It is often at the state level that we can be most influential in seeking quality care. State inspectors and local ombudsmen are the proverbial "boots on the ground." Federal inspectors can be called in and do make inspections but the vast majority of enforcement is at the state level. Contact your STATE legislators and departments of aging. Keep your eyes on the Feds with Trump but demand your state agencies be adequately funded and staffed to do their jobs.
5
The measure of a civilized community is how it treats its most vulnerable. When the treatment of the most vulnerable is constrained to money the community is worse than 'barbarian'.
When those making money wish to control the dispute process behind closed doors, the community has to know that they wish to/are acting unconscionably. The worst feature of this mindset is that it spreads like a "moral" virus, infecting every such facility.
When those making money wish to control the dispute process behind closed doors, the community has to know that they wish to/are acting unconscionably. The worst feature of this mindset is that it spreads like a "moral" virus, infecting every such facility.
10
The disease is the for-profit motive in health care. Once you accept that premise your immunity against the virus is non-existent.
6
Former nursing home staff here: this is ridiculous! Until staffing ratios are improved everything else is window dressing. A better trained staff with living wages is what will improve nursing homes and address the shortage/turnover of staff.
71
I agree with Gerry.My wife is an LPN in a SNF and she says that is the bggest issue. There is never enough staff,and what few staff there are on the floors can't be in two places at one time so as a result there are increased falls,weight loss from residents not being assisted with their meal trays and increased bed sores or other skin issues from not turning residents and not changing incontinence briefs. Once this is resolved and CNAS are paid a decent wage, quality of care will improve dramatically.
6
It would help if staff got better paid to reduce turnover. My daughter is a cna and recently sent me a picture she took at a McDonald's drive through, saying hiring at 13$ an hour. That's more than she makes. CNA work is hard especially in dementia wards, she gets physically and verbally abused during every shift.
29
As a nursing home director in a small town I could make many comments on the issues in the article, but let me make one. Most often, the care that our residents receive in the nursing home is far better than the care that they were receiving at home.
Many of our residents were cared for by me as their primary care physician in the community and I had occasions when I would visit them in their homes. I have a pretty good picture of the before and after. However well-intentioned the family is, however much energy and resource they can pour into the care of their loved one, the nursing home tends to do better.
Staff are trained and motivated and reasonably well rested when they start their shifts. The physical plant is far safer than most private homes. Medications are given more reliably and monitored more closely. Nurses assess patients daily and communicate with doctors as frequently as hourly. Experts in physical therapy, speech therapy and occupational therapy can be consulted regularly. Special equipment is available to move patients and protect them. And families are welcomed and encouraged to be there as much as they can to further enhance the care.
It is true that there is no place like home. But if we can all accept that now our loved ones are in a new home, we can work together, nursing homes and families, to make it much better and safer than their old one. Good will and consistent effort on the part of all will trump regulations and ratings every time.
Many of our residents were cared for by me as their primary care physician in the community and I had occasions when I would visit them in their homes. I have a pretty good picture of the before and after. However well-intentioned the family is, however much energy and resource they can pour into the care of their loved one, the nursing home tends to do better.
Staff are trained and motivated and reasonably well rested when they start their shifts. The physical plant is far safer than most private homes. Medications are given more reliably and monitored more closely. Nurses assess patients daily and communicate with doctors as frequently as hourly. Experts in physical therapy, speech therapy and occupational therapy can be consulted regularly. Special equipment is available to move patients and protect them. And families are welcomed and encouraged to be there as much as they can to further enhance the care.
It is true that there is no place like home. But if we can all accept that now our loved ones are in a new home, we can work together, nursing homes and families, to make it much better and safer than their old one. Good will and consistent effort on the part of all will trump regulations and ratings every time.
38
Do you know of any studies that substantiate your opinion?
2
gh, As someone who worked in nursing homes in Canada for 25 years in an administration capacity, I agree with you. My perspective comes from contact with the families who described an overwhelming burden of care, which only got worse as their family member deteriorated. Unless the family is very large and well-intentioned, it is almost impossible for a person with mobility/ incontinence/dementia issues to do well at home. One person, often an elderly spouse, usually ends up doing most of the work.
Residents would be admitted with skin breakdown, malnutrition, emotional withdrawal and depression. Those admitted from hospital after having been at home were recovering from fractures, infections and the results of not having medication administered properly.
I have comforted many more than one family member who broke down in tears in my office. They struggled with grief and guilt, they were exhausted and emotionally burnt out. After they saw that their loved one was adequately cared for, had a more stimulating environment, was fed food with a texture they could tolerate, they were relieved.
The US and my country can afford good care for the elderly and disabled. It is all a matter of priorities.
Residents would be admitted with skin breakdown, malnutrition, emotional withdrawal and depression. Those admitted from hospital after having been at home were recovering from fractures, infections and the results of not having medication administered properly.
I have comforted many more than one family member who broke down in tears in my office. They struggled with grief and guilt, they were exhausted and emotionally burnt out. After they saw that their loved one was adequately cared for, had a more stimulating environment, was fed food with a texture they could tolerate, they were relieved.
The US and my country can afford good care for the elderly and disabled. It is all a matter of priorities.
15
Why would someone move out of a home where they were being well cared for into a nursing home?
1
We actually need more of a warehousing set-up for people who cannot bathe themselves or walk to/from a bathroom/cafeteria (the permanently bedridden/wheelchair bound).
Instead of private rooms, there should be open rooms with beds lining the walls, tile floors, and personal tv's with headphones for each person. Eye masks could help people who want to nap during the day.
No abuse would go unseen and the financial savings could be channeled to hiring dozens more staff--and paying them well.
Residents/families seem unable to realize that a private room/bathroom with loving caretakers, excellent food, and immediate medical care is luxuriously expensive. If I'm degenerated enough to need round-the-clock feeding/bathing/toileting, I want great staff way more than a private room and an unused "library" that sits empty all day.
Instead of private rooms, there should be open rooms with beds lining the walls, tile floors, and personal tv's with headphones for each person. Eye masks could help people who want to nap during the day.
No abuse would go unseen and the financial savings could be channeled to hiring dozens more staff--and paying them well.
Residents/families seem unable to realize that a private room/bathroom with loving caretakers, excellent food, and immediate medical care is luxuriously expensive. If I'm degenerated enough to need round-the-clock feeding/bathing/toileting, I want great staff way more than a private room and an unused "library" that sits empty all day.
15
Honeybee, just because someone has mobility/continence issues does not mean they have should have no dignity or privacy. I don't know how many people you are suggesting should be in those 'warehouse' rooms, 2, 4, 15, 30?
The current thinking where I live is that all residents should have a private room and bathroom with a toilet and sink.
Poor care/abuse can be eliminated by adequate staffing and superior training, and can I say 'vetting'?
I would not want to live in a slot in one of your warehouse rooms plugged into a TV, listening to the rest of my roomies all night and most of the day. I bet you wouldn't like it either.
Good care is affordable, take some of the money from the military (a very small fraction of the $598.5 billion spent in 2015 (54% of your budget) would do nicely),
The current thinking where I live is that all residents should have a private room and bathroom with a toilet and sink.
Poor care/abuse can be eliminated by adequate staffing and superior training, and can I say 'vetting'?
I would not want to live in a slot in one of your warehouse rooms plugged into a TV, listening to the rest of my roomies all night and most of the day. I bet you wouldn't like it either.
Good care is affordable, take some of the money from the military (a very small fraction of the $598.5 billion spent in 2015 (54% of your budget) would do nicely),
14
I would personally prefer death to being assigned to one of your nightmarish patient warehouses, wired up to a TV (you know, many people prefer to read or just sit in quiet places), with my only refuge being an eye mask.
Many or most of the people in your warehouse would probably snore, making sleep impossible at any time, day or night.
Your real attitude is revealed in the word "degenerated." People who are "degenerated" enough to need help with eating or feeding don't need dignity or privacy any more, right?
Many or most of the people in your warehouse would probably snore, making sleep impossible at any time, day or night.
Your real attitude is revealed in the word "degenerated." People who are "degenerated" enough to need help with eating or feeding don't need dignity or privacy any more, right?
10
Nancy, if I were bedridden, mildly demented, and unable to move myself, I cannot imagine anything worse than sitting in a room all day by myself with sub-par "caregivers" doing God knows what to me with no one to see it happening.
The reality is that our society can either afford private rooms OR highly paid/trained/vetted/monitored staff, not both.
The reality is that our society can either afford private rooms OR highly paid/trained/vetted/monitored staff, not both.
2
I guess with tump ruining everything its time to get carry permits so when they come to take you to the nursing home against your will you can fight back,.
Its wild west time folks be prepared!
Its wild west time folks be prepared!
13
My youngest sister kept very close tabs on both my mother and dad when they wound up going to two different assisted living/nursing homes in Charlotte. That frequent contact made a huge positive difference in their quality of life during the two or three years they were there but was hard on my sister.
24
My family has had some experience with a long term facility that deals with elders. When my aunt would complain about substandard service, we wanted to go to the administrators.
However she would dissuade us by saying that she didn't want to be evicted like another resident whose family had complained about the quality of service.
You would think that $5,000 per month would guarantee a safe, clean and respectful environment but you would be wrong! I hope these new rules will be implemented but in the era of trump, it's going to be all about the bottom line!
However she would dissuade us by saying that she didn't want to be evicted like another resident whose family had complained about the quality of service.
You would think that $5,000 per month would guarantee a safe, clean and respectful environment but you would be wrong! I hope these new rules will be implemented but in the era of trump, it's going to be all about the bottom line!
24
I like the idea of an infection control specialist and someone to keep track of antibiotic use. My mother had three UTI's in one year, and was prescribed the same medication. The last time, it didn't work quickly enough, and after two days, the nursing home transferred her to a hospital, where she died of sepsis. I also believe nursing homes should bathe residents at least weekly. My mother was a very modest person, and she insisted on keeping herself clean. She didn't do a very good job, which led to the UTI's. I begged them to bathe her anyway, but I was told that the Dr. who oversaw the nursing home felt she was capable of making her own decisions. No one would listen to me, even though I was her health care surrogate and had a Power of Attorney. This was Solaris Helathcare in Merritt Island, Florida, and the Dr.'s name is Dr. Wall.
23
Here is a list of things my father had taken from him during his stay at a VA nursing home in NY: his ability to walk (too risky for the nursing home), his feeling of safety(repeatedly scolded for trying to do things for himself), his continence (more convenient to use diapers than take continent patients to the bathroom), his quality of life (home ignored rules that patients with dementia can receive PT to maintain strength and balance et al, the only time pts went outside was when a visitor could take them), and oh, yes, his dignity.
66
I'm sorry Anna. How painful for your Dad and your family.
My Dad, in the beginning, tried very hard to make it to the bathroom. He needed help. His bell would go unanswered as the entire staff sat drinking coffee at the nurses station.
Hugs
My Dad, in the beginning, tried very hard to make it to the bathroom. He needed help. His bell would go unanswered as the entire staff sat drinking coffee at the nurses station.
Hugs
12
My father was murdered by the VA. An electrophysiologist implanted the wrong pacemaker and they did everything possible to prevent us from getting the matter corrected until it was too late.
And when they sent him home to die, we learned that every other electrophysiologist in south Florida knew about this practitioner. But too many of the VA physicians, at least in Florida, are there for retirement and picking up a few extra dollars when they couldn't get a job in NYC. But then again, the best medical care in Florida is a ticket to NYC.
And when they sent him home to die, we learned that every other electrophysiologist in south Florida knew about this practitioner. But too many of the VA physicians, at least in Florida, are there for retirement and picking up a few extra dollars when they couldn't get a job in NYC. But then again, the best medical care in Florida is a ticket to NYC.
6
Well you are talking about a VA home. And that is a double dose of hell.
Here is a lit of "things" my father had taken from him during his 18 month stay at a Veteran' Nursing home in NJ:
2 hats I bought for, what turned out to be his last birthday. One was returned after I raised a fuss.
Shaving apparatus
4 gold crowns...I'm talking teeth, all mysteriously gone one night. The home had a staff dentist and we had our suspicions...Mom wouldn't allow me to make a "fuss" because she feared my father would suffer retaliation.
My Dad was demented, almost non-verbal and couldn't tell us what happened.
This was 5 years ago.
2 hats I bought for, what turned out to be his last birthday. One was returned after I raised a fuss.
Shaving apparatus
4 gold crowns...I'm talking teeth, all mysteriously gone one night. The home had a staff dentist and we had our suspicions...Mom wouldn't allow me to make a "fuss" because she feared my father would suffer retaliation.
My Dad was demented, almost non-verbal and couldn't tell us what happened.
This was 5 years ago.
36
I fear that during the Trump presidency, improvement in most every level of healthcare, from gestation-care to eldercare will be measured more by mortality rates and not in terms of pain, suffering, quality of life and human dignity. Improvements in nursing home care, assisted living and SNFs require more research and evidence-based practices which will most likely not be recognized or funded by a Republican-controlled Congress.
We are still trying to figure out how best to minimize the tendency to warehouse elderly people.
We are still trying to figure out how best to minimize the tendency to warehouse elderly people.
31
It is a knotty problem. Most patients & families do not have many resources to pay for around the clock nursing home care. So, prices have to be low enough to attract patients. Medicaid likely pays poorly, and many who don't have much money don't qualify. If there is a living spouse, they have to either spend down their savings or divorce their beloved so that the patient can get Medicaid to pay.
Then there is the question of staff. I worked as an RN in a retirement community a number of years ago (we worked mainly in the 'health center,' which was nursing care, but there was an independent living area). The pay and working conditions were very, very poor relative to what nurses got in hospitals & clinics. I was the only evening RN. If the night nurse called off, I had to stay until morning (with no sleep and no food). Many of our RNs were immigrants who worked 2 jobs, which meant that they were not interested in working too hard. AND this was a fairly upscale place as such places go... We, as a nation, have to do better.
Then there is the question of staff. I worked as an RN in a retirement community a number of years ago (we worked mainly in the 'health center,' which was nursing care, but there was an independent living area). The pay and working conditions were very, very poor relative to what nurses got in hospitals & clinics. I was the only evening RN. If the night nurse called off, I had to stay until morning (with no sleep and no food). Many of our RNs were immigrants who worked 2 jobs, which meant that they were not interested in working too hard. AND this was a fairly upscale place as such places go... We, as a nation, have to do better.
66
Medicaid paid 15k+ a month--not too shabby--and the home also got patient's ss and pension on top of that.
3
Interesting that you are so unfamiliar with Medicaid spend down rules since you worked in a nursing home. In NY, Medicaid pays $80,000, and the community spouse is not impoverished. Try to keep current.
2
I believe every state has different rules, so it is unfair of you to chastise the commenter for not keeping current.
9
I have the photos of my 86 year old Mother's abused arms and hands. In my mothers own words: " The aide yanked, pinched, and slapped me." I hid in my mother's room until the "aide" appeared to undress my mother for bed. Upon sight of the "aide" my tiny mother who was frozen with parkinson's disease, yelled out "please do not hurt me, please!" That particular aide laughed at my mother, until she spotted me. She stopped laughing, and ran out of the room. The nursing home covered it up, but I notified the local police and prosecutors Office. The local police refused to come to the Nursingg Home because "we get calls all the time from that place! We do not go anymore because the staff tells us the residents make this stuff up!" I called the State and the surprise inspection resulted in 26 violations in a single afternoon. Neglect, injuries, lost files, cafeteria violations, spoiled food, faking physical therapy sessions, and filth galore. My siblings had signed my mother into this dump, and she despised the place. Ultimately, the staff lied, covered up the injuries by stating my mother had "thin skin." My photos, when magnified, showed finger prints that indicated my mother had been pinched up and down both of her arms. certainly the palm print on her back was an easy diagnosis. In addition, the backs of her hands were BLACK. This privately owned nursing home, Cornell Hall in Union NJ, which collected $$$$ from Medicare & Medicaid enjoyed FIVE STAR ratings from CMS.
81
So many abusive, understaffed over-doping places get 5 star ratings from CMS.
13
Unbelievable but true. I am 70 and I don't have a lot of money to pay a high quality facility should I need one. I hope I die before I have to go through the Auschwitz of senior care in this country. Why it is not considered a part of a right to healthcare for all, I'll never know. I hope I will have the resources and brain to get myself to a Dr. assisted suicide state. That would be a good thing to spend my last dollars on.
1
They need a standard and careful supervision with teeth, for conversation/social interaction especially for people who are mentally capable yet physically have functionally "no voice" because of poor mobility, hearing, vision and speaking up skills. Many 'mentally present' people are basically experience solitary confinement.
24
Bravo! So long overdue!!
10
If these regulations smell like they will cost the 1 percent owner-operators any $, the Trump administration will certainly repeal them.
53
Great news- let's see how long it lasts, it might interfere with profit,don't ya know.
27
More Rube Goldberg-type attempts to fix what has been broken for a very long time: institutionalization, warehousing, underfunding, abandonment. It results in abuse. Elder abuse in nursing homes, predominately neglect, is a festering sore in our society.
We need a new paradigm. It's been many decades of struggle and the best we can do is C minus? Folks, if you don't want to end up in one, start planning now. Write detailed advance directives and make sure your decision maker(s) know exactly what you want. Make sure your healthcare providers know, too, and make sure your decision maker enforces compliance.
Think about it: if you end up with dementia and your quality of life is slowly draining away, do you want to be kept alive? Receive any form of life-prolonging treatment? I'm talking the gamut - hospitalizations, surgeries, invasive testing, even and maybe especially antibiotics. Most older persons with advanced dementia die of infection. Why prolong the agony?
We, the people, are in charge. Demand better. Demand what YOU want, while you're still able to say it.
We need a new paradigm. It's been many decades of struggle and the best we can do is C minus? Folks, if you don't want to end up in one, start planning now. Write detailed advance directives and make sure your decision maker(s) know exactly what you want. Make sure your healthcare providers know, too, and make sure your decision maker enforces compliance.
Think about it: if you end up with dementia and your quality of life is slowly draining away, do you want to be kept alive? Receive any form of life-prolonging treatment? I'm talking the gamut - hospitalizations, surgeries, invasive testing, even and maybe especially antibiotics. Most older persons with advanced dementia die of infection. Why prolong the agony?
We, the people, are in charge. Demand better. Demand what YOU want, while you're still able to say it.
34
Demanding what you want in advance is of no use when there is no facility that will provide it. I had my father in two of the most expensive dementia care facilities in San Francisco. He was neglected and abused in both, drugged without permission. These places are all understaffed, and do not fulfill the terms of their contracts. It is very difficult to enforce your rights because it's impossible to document all the offenses and you don't really own your medical records. It is heartbreaking.
The best investment you can make is to fund advocacy organizations like the excellent California Advocates for Nursing Home Reform. I pay for long term care insurance for myself, but ponder suicide before I'd go into one of these places.
The best investment you can make is to fund advocacy organizations like the excellent California Advocates for Nursing Home Reform. I pay for long term care insurance for myself, but ponder suicide before I'd go into one of these places.
21
Perhaps if wealthy people did not "Medicaid plan" their estates so that the taxpayer would cover their nursing home bills, there would be more money available to those in need.
4
My mother said that my grandmother said that she didn't want to live in a nursing home until she got there. Then my grandmother said that she wanted to live. She said that she would rather live in the nursing home than die.
4