We need assisted dying with fewer barriers. There’s no way older people can age with dignity once they lose their independence. Without caring, responsible adult children, we’re looking at abusive environments with fewer rights than we’d have in a prison and about the same quality of food and privacy. Suicide among the elderly should be viewed as a rational response to an impossible situation. Spy pilots were given that’s option as an alternative to POW camps, which apparently resemble nursing homes but with no possibility of release.
10
Suicide done right is more dignified and relieves family of great financial, logistical, and emotional burdens.
9
People who can afford this could likely also afford a private aide. There needs be a measure tied to $$ that indicates conversational interaction (at least to those most applicable) - and monitored surveillance - otherwise there is no change here just a home for a few lucky ones already fortunate probably.
5
Ms. Span - thank you very much for taking the time to reply to so many comments. Sometimes I wonder if the author of an article ever reads the comment section. Thanks for sharing your perspective and information on so many levels. I never knew there were alternatives to "traditional nursing homes". The Green Houses at Green Hill truly does appear to be a "better kind of nursing home" on so many levels. Thanks for sharing this option.
2
If you do not disclose what this costs....the information here is nearly worthless.
When I had to place an elderly relative into Assisted Living a few years ago, I toured nearly every facility in my area (which does not seem to have a Green House). NO facility would give me pricing upfront and honestly, in a simple format I could easily compare (some included personal care, others charged for it and so on).
To get pricing required you come in person, and take a tour. That could take up to 2-3 hours! for each facility! this is very difficult for a family member who works full time to arrange! Nobody would give out prices on the PHONE.
With no upfront pricing, you often have to waste 3 hours touring a place only to find out at the very end, that the cost is laughably unaffordable. And with no clear, open prices...you have no idea if the price is "rack rate" or negotiable or if you are being offered the best deal.
Nursing homes (including Assisted Living) are a HUGE racket today, that make obscene profits off of the frail elderly. Their pricing often bears no relation to the actual quality of care (or food! or amenities!) and is designed to extract every nickel of an elderly person's assets and when that is gone, to rip off Medicaid (i.e., taxpayers) -- it is a horrific national disgrace!
Not giving out factual pricing info is what I call "The Big Lie". A Green House matters little if nobody can afford it!
17
Unfortunately, the vast majority of assisted living communities do not accept Medicaid. The Green House model generally applies to nursing home level care. Nursing homes generally do accept Medicaid but the proportion of residents receiving Medicaid varies. Nursing homes are more closely regulated than assisted living facilities, with federal statue and regulation and state regulatio applying. Assisted living facilities are basically regulated by states and the adequacy of regulation varies widely.
5
The omission of naming Dr. Bill Thomas, the creator of Green Houses, is disappointing. His Eden Alternative project, as well as Green Houses was decades ahead of their time regarding the treatment of elders in America especially. Dr. Thomas has evolved and his Changing Aging moment is likely to appeal to those of us lucky enough to grow old.
11
No one wants to live in or visit a loved one in a nursing home - period. There is no right way to do the wrong thing, Green or not.
As we know, small is better in any human service, but this country is going corporate with health care, not back toward Mom and Pop agencies. Also, following daily routines on a person-centered basis should not be revolutionary regarding time to eat, sleep, watch TV, or have visitors. These are just common good practices, not worthy of an increased cost to either tax payers or persons using the '"services." Check out The Village model (recently on NPR) to support folks living in their homes with supports coming TO them rather than them moving to supports, live a Green nursing home.
9
The village movement is great but it cannot deal with all eventualities requiring nursing home level care. Members of villages pay for home care, medical care, etc. they may have acces to vetted providers but they still PAY. The options available for older adults must be many and varied. Living in the community with home based services may suffice for a time but then more care may be needed or community care may be or become unaffordable as need increases. Close to 50 % of older adults end up in rehab or long term care at some point--not necessarily long term but post-surgery, hip replacement or after long term illness and then may be discharged back home. A smaller percentage are in long term care more permanently. Caring for people with dementia, for example, may become impossible as the disease advances. Aging in place is great but we deceive ourselves that movements, such as villages, are sufficient for all or even most.
7
Medicaid is the payment source for those who require long-term care in a skilled nursing setting and have no financial resources. Of the 1.5 million older adults living in skilled nursing facilities, 75 percent are being funded by Medicaid. Buried in the article is the answer to the question, 'why are there so few Green Houses?" They are eight percent more expensive to operate, and since the average Medicaid rate for skilled nursing care is not (in most states) sufficient to cover operating costs, there is no business case to be made for the Green House model.
8
Green Houses appear to be more costly because they have "shabhaz" caretakers that spend more time with each resident. But I read nothing here about the actual cost in dollars (or what other nursing homes really cost), nor if they take Medicaid (not all nursing homes do! not the fancy ones!). The author's father was here, and the only resident she interviews is ALSO the mother of a NYT reporter. Hmm.
Nursing homes are not only crazy expensive, I am mystified as to WHY they are so costly. The care is often substandard. The ratio of aides to patients is usually abysmal. The food is steam table crap I wouldn't feed a dog.
If you visit a nursing home randomly, you typically find residents in wheelchairs in front of a TV in some common area or lounge -- staring vacantly. Depression and isolation are commonplace. The facilities often lie to family -- who can't or don't visit all that much -- about "activities" like arts & crafts, music, exercise, games -- in reality, 99% of what residents get is a TV that is always on. Aides are either busy with menial tasks OR yakking on their smartphones -- they pay little attention to residents outside of a crisis.
Often the WORST aspect of nursing homes is that residents with even a minimal amount of mental acuity are left utterly bored, depressed and with literally nothing to do but count the hours until merciful death.
Most people would rather DIE than go into a nursing home; what does THAT tell you?
13
In our experience of both a nursing home and in-home care for our parents, in-home care is actually not more expensive and is much more humane. The caveat is that the family must remain involved and take on their share of the caring - in either setting. Otherwise, you simply don't know what sort of treatment your loved one is receiving.
21
Deb: that is simply untrue, unless your definition of "in-home care" means an illegal alien caretaker who is paid $5 under the table in cash.
A licensed, bonded caretaker who is a legal citizen or green card holder costs $19-$24 an hour in most parts of the US. (I live in the Rustbelt Midwest, and I had to pay $21 an hour in 2013-2014 for licensed, bonded aides from an agency.)
If the senior requires "round the clock" care....including someone there during the night, while they sleep....that's 24 hours of care. No one aide can do that, so it requires at least 2 and more likely 3 shifts PER DAY.
At $20 an hour (lowball), that is $480 a day or roughly $3360 per week, $14,400 a month...or $175,000 (!!!) per year.
Even at that price, you will get an unskilled aide with no more than a CNA certificate (if that) -- not a "nurse". Many are bored and do little more than "babysit". Worse case scenario, they are abusive or even steal from the senior -- the temptation for a poor caretaker (who take home only about $9-$11 of that $22 an hour) to steal from a affluent senior is very strong.
And while sure, family SHOULD be deeply involved -- in a perfect world -- what about seniors whose family all live out of town? all work full time? are sick or elderly themselves? or the senior who has NOBODY?
Most people WOULD prefer to stay in their homes, but contrary to what you state here, the cost is vastly higher. An Assisted Living home averages $5000 a month vs. $15,000 for home care!
9
Most elderly people on Medicaid with in home care are not living alone and are not receiving 24 hr care. Able, caring adult children of these folks generally have a significant commitment to care .My mother, at 96, is NO DOUBT saving the state of NY plenty of money by being in at home care. In NYS, Medicaid pays 12.10 cents per hour. We do not need an RN and most elderly do not need RN care on a daily basis.The level of care and basic compassion, humanity afforded to my Mom in these circumstances compares in no way to the nearly egregious lack of care in a Medicaid nursing home. We have been there.
4
I have found that incontinence of stool can be handle in the shower pretty well. Using disposable washcloths. Just a thought.
2
Sure, assuming you are willing to do this for the senior patient. Incontinence means clothing is soiled -- furniture or a wheelchair -- all must be cleaned & sterilized, plus for many caretakers, this is disgusting & repellant. (It is THE No. 1 reason seniors end up in nursing care!)
It is not as easy as you state to get a frail demented senior INTO a shower -- safely! -- clean their person and their clothing -- a senior can weigh 150-200 lbs and some are uncooperative or even violent. Others are hysterical with shame & embarrassment at soiling themselves.
Even for those with sharp minds, the humiliation of having to wear adult DIAPERS sends them spiraling into bleak depression.
Having to deal with incontinence -- sometimes several times daily -- can send even well-meaning caretakers into anger & depression themselves, which can lead (worst case scenario) to senior abuse.
This is the ugly side of senior care, the stuff nobody wants to discuss -- not the pretty facilities with chandeliers or "shahbaz" caretakers -- not the bingo games and art classes. The reality of being a frail demented senior is often humiliating & ugly & demeaning.
A friend of mine committed herself to caring for a mother in law through 11 YEARS of increasing dementia. The patient was incontinent, but also combative and violent -- required 3 shifts of caretakers -- and liked to take stools out of her diaper 7 fling it at the caretakers. You can't just "clean that up with a disposable washcloth".
17
In central NY there is a fabulous program called PACE (Program of All-Inclusive Care for the Elderly) which respects its clients daily rhythms, includes their input as long as they can communicate it and uses a team approach for all medical, social work and physical therapy oversight. My mother was able to age in place until the very end in her 1 bedroom, 1 bath apartment WITH her beloved kitty. It is needs tested so lower income people are able to access it.
As an only child / responsible relative, PACE allowed me to travel and maintain a healthy family life knowing that my mother was always in good hands.
Was everything perfect 100% of the time? Well, no, but it was light years better than her life and my life would have been had she been in a traditional nursing home or living with me. The program administration was responsive and willing to customize my mother’s care to her changing needs and the staff was amazingly kind. Here’s hoping the model spreads to other areas of the country.
9
That sounds like a promising program, though it would not help the seniors who are seriously suffering dementia and memory loss, and can't be left alone even for brief times.
Thanks for mentioning your mom's pet cat -- pets are often left out of these equations. Many seniors don't just lose their independence and dignity and all of their financial assets about entering nursing care -- they lose the pets that are often their only comfort in life!
The pets themselves typically end up in shelters or destroyed. It is a tragedy for both the senior AND the helpless pet.
This is not unlike the rescue efforts of Hurricane Katrina, undone by the fact that people love their pets and want to protect the, and get comfort from them. Not only are pets ALSO victims of nursing home care....living without a beloved pet sends many seniors into spirals of depression & decline from which they never recover.
6
As a geriatric psychiatrist, I've worked in a lot of nursing homes and was hopeful for the Green House at the John Knox Village continuing care community in Pompano Bch where my father lives, and mother lived. The living quarters are prettier than a traditional home but it all boils down to the people wherever you are and my family and I have been largely disappointed in staff. Although there are a few bright lights (as in most place I have worked), we've had to give obvious feedback, such as down blare pop or gospel music during meals (the older people have a hard enough time hearing and staff isn't their to listen to their music). We also regularly find pills on the floor, unsuccessfully administered, and my formerly meticulous father in the same pair of pants from the day before despite huge stains. We often have to remind people the bathroom needs cleaning and go find toilet paper or clean towels ourselves. If my sisters or I didn't come do something w my father, who has severe dementia, he'd sit in his room all day except for meals. Many of the staff don't seem to well-trained enough to encourage people like him to be a little more active. Supervisory staff and admin appear to listen but nothing much ever changes.
20
Yes, my experience was similar with my family member (not a Green House). Much turnover, suggestions were rarely acted upon, lots of disorganization, medication administration was lax and sometimes inaccurate.
As I am sure you know, it's hard work and the aides don't get paid much. Most people don't want to do that kind of work for the wages. I felt lucky if the staff was friendly and kind, which they mostly were.
7
@MadelineConant: what you said, and the staffers seem to have all taken the same courses in "how to talk soothingly to families and promise swift changes/improvements....while doing precisely nothing".
I've reported awful things -- medications laying on the floor -- broken toilets, barely hanging on the wall that could easily topple over -- BEDBUGS -- residents in soiled clothing for days -- with nothing being done until I literally had to report things to the State Ombudsman.
My elderly aunt with dementia was placed in a suite where next door, the water heater for the building was located and it leaked, soaking her carpets and all of her possessions. I didn't notice it right off until I realized the carpeting "squished". (She was too far gone to notice anything.) When I reported it....they cleaned up, but did not replace the mildewed, smelly carpeting for SIX MONTHS, despite weekly complaints from me.
No, aides are not paid much -- but you know who IS paid a ton? The administrators, managers, head of nursing -- the folks who OWN these homes -- who pay the aides $9-$11 an hour, but who themselves take home six figure incomes. While charging residents an average of $5000 a month for Assisted Living and $10,000 a month for nursing care!
The profits are obscene and nursing home operators routinely bribe officials and politicians to keep this sweet honeypot.
6
As a retired speech pathologist who has worked in nursing homes in metropolitan NY I have always felt that architectural changes could provide a safer, less costly, and more uplifting environment for our aging population and those who work in them. Most residents ultimately suffer falls which lead to complications and death, a solution would be use flooring material similar to that of children's outdoor playgrounds so that falls are cushioned Most older folks have visual perceptual issues that are exacerbated by seemingly endless hallways that are illuminated with glaring overhead fluorescent lighting. Breaking up the distances with small lounges and seating areas and using natural lighting via skylights, wall sconces and lighting strips in the floors would improve visual perception. Hearing problems are common as well, sound dampening materials would attenuate harsh background thus improving understanding. Bed hieghts could be lowered so that folks could have an easier time of getting in and out of them. Dining rooms are glaring, clamorous and not conducive to enjoyment of food why not employ all of the above their design. I believe such changes would reduce the the cognitive demands of negotiating a harsh environment and thus free up mental energy for more enjoyment activities of daily living I have always enjoyed and cherished my work with the older folks but I am embarrassed to say that I could not wait for the smell of fresh air and daylight when my work was done.
17
While she was alive, I visited my elderly aunt with dementia in her Assisted Living home -- not even as bad or restrictive as full nursing home care -- 3 times a week. I was responsible for her, and I felt very guilty for having no choice but to put her into a "home".
And I never left the facility, without feeling both depression -- and a sense of giddy freedom that I could get away! -- as you say, into fresh air and daylight, sunshine and the real world. And I never failed to think this thought, "if it comes to this for me someday, I hope I have the wherewithal to kill myself first."
8
If a nursing home costs maybe $20,000 how much do you think these places cost! If you are wealthy you can have 24-hour inhome care, elegant places that function s but do not look like nursing homes, etc. For the rest of us, it’s the same creepy possibility as always - half a bedroom someplace.
9
Realistic costs for an Assisted Living facility in most parts of the country run from $3500 to $7500 a month.
For dementia care or a full nursing home, it is close to $10,000 to $12,000 a month.
$20,000 a month would be the extreme high end, and the fanciest imaginable personalized care.
A wealthy person can likely have live-in care -- 3 rotating shifts -- a real nurse vs. a nurse's aide. But most people are not rich, and the costs of even Assisted Living -- the lowest, least intrusive level of care -- is bankrupting for 99% of residents. Very few people have the assets to pay $60,000 a year, for years on end -- and what if a COUPLE both need care??? $120,000 a year!!! (there are no discounts for couples).
The average that seniors get from Social Security is $14,500 a year. DO THE MATH.
That's why so many end up destitute and in a Medicaid facility. BTW: most of those fancy "chandelier buildings" will NOT take Medicaid, which is much lower than the published rates. If you use up your money, they boot you out. I've seen this many times! and the Medicaid facilities are typically third rate -- understaffed -- not very clean -- awful food -- and Medicaid WILL ONLY PAY for a double (shared) room, with no private bath.
God willing, before that happens to most people, they are so far gone with advanced dementia that they do not know their surroundings or miss their own possessions, pets, family or anything else. I pray that is true.
2
Sure do love the photo of Green Houses which accompanies this article - it has such a positive curb appeal. Nicely done Mr. Anselm.
4
Good luck getting this with our de facto criminal health care system where profits are put ahead of people.
12
Just like our regular medical system...Assisted Living and nursing home care is FOR PROFIT.
As such, it is insanely profitable as they are charging more than the cost of a weekly luxury Caribbean cruise -- but giving patients substandard, miserable care even in the "nice chandelier buildings". They underpay workers and yet are almost always badly short-staffed.
Greedy nursing home operators squeeze every dime out of their vulnerable customers -- like medicine or hospitals, what a glorious business model! your "customers" are all suffering, miserable and forced into buying your product with few alternatives and NO ability to shop around on price! You can pretty much charge anything you want, and so they do.
There is no way to "nationalize this" or have a non-profit system, the ways things are currently set up. Like health care, the model is FOR PROFIT and it is run by the most greedy, corrupt folks you might imagine in your worst nightmares.
3
You can have for profit, price regulated by the gov't Concerned Citizen. Many countries have it. We have a version of it for medicare.
3
I recently discovered something about nursing homes. An immediate member of my family fractured her hip and went to a local nursing home for rehab for about six weeks. It was a very difficult experience for both of us.
The main reason was that many of the nurses aids were untrained among other things. I had to stay there every night to see that she was put to bed properly.
Upon doing a lot of research, I discovered that a great number of nursing homes throughout the country, including major ones here in the New York area, have been bought up by private interests looking for income. The result is substandard care of nursing home occupants. This has been written up in several major newspapers. We have money from public sources (Medicare and Medicaid) flowing into private pockets.
Anyone can obtain the same information found by myself. Just look at reviews and search using any one of the major computer search programs.
Are you listening New York Times. You can verify my statements for yourselves.
24
To my horror, in looking up Green House Homes in New York City the sole pending affiliation found is with a nursing facility on the upper west side of Manhattan whose fourth floor nursing care performed below any standard of care. My husband endured a difficult month in healing post hip fracture due to neglect and lack of medical care. Add the fact that the facility booked himinto room undergoing renovation to put in sprinklers, not having had the sprinklers previously.
Rehab was not done unless pursued by caregivers. Daily.
Having no doctor available for patients on a floor, ignoring bells and calls for help, including patients trying desperately to leave beds who could not walk without help, the list goes on. Walking the floor, telling nursing staff and desperately calling “higher ups,” did no good..
This heartless environment will pull down any positive reputation Green House Homes enjoys.
11
Whatever home your loved one is in, it is imperative that someone visit regularly. Hard pressed staff will serve the ones who have a monitor first. Sometimes they make decisions based on standard operating procedures, without taking the patient into account. They aren't mean-spirited, they are just human. They appreciates having relationships instead of patients, and being the monitor of one of the patients provides this. You can tell the nurses what sort of person the patient was, explain certain behaviors, tell them about favorite foods, laugh with them about the patient's quirks. It makes their job easier, and it is essential for proper care of the patient.
17
Organize a gaggle of do-gooders to go do-good.
5
Definitely it helps if family is directly involved and visits regularly. However, even that is not a guarantee -- I was able to visit my elderly relative 3 times weekly, and to drop in for occasional meals with her (so I could monitor the food, which was troubling in how bad it was, and how little residents eat of it).
However, all this did was ANTAGONIZE upper management, who were sick to death of my complaints and demands. I don't think they mistreated my relative as retaliation but they DID start to avoid me, and simply would tell me "oh yes, we'll fix that immediately" while ignoring the problem and likely laughing at me behind my back.
Please remember that many seniors do not have family in the area -- or family that can visit multiple times a week -- some seniors have NO family, or the only relative is a spouse who is equally old & infirm.
I agree, the aides themselves are overworked -- horribly underpaid -- disrespected -- must do a disgusting awful job -- few of us could do any better, no matter how good our intentions.
It is not the AIDES making MILLIONS off of desperate families -- nor extracting people's entire wealth at the end of life for their own profits.
This is a really, really evil industry -- everything that is bad in our medical system, only on steroids.
5
So people without competent, available children should be offered cyanide tablets to be taken as desired, without need for approval by psychiatrists.
Incontinence is the line that drives people send to eventually send their family to nursing homes. But wiping your dad's bum really is not that different from wiping a baby. I'm just glad my dad isn't a big guy; another reason to keep the weight off as it burdens caregivers.
10
Justine: if you can change and clean and diaper your dad with a cheery attitude -- more power to you.
Most people cannot do that, and even if they WOULD do it -- often the senior does NOT want their own children to have to change their diapers or clean their butt. It is degrading and demeaning to both parties.
And the difference from a BABY is that the baby weighs 8-20 lbs but the senior can weigh 150-200 lbs -- and that is not "overweight" -- that is a normal weight senior.
Even a frail skinny senior is going to weigh 100 lbs or more. NOBODY can easily lift a person of that weight, or manage them with soiled diapers, soiled clothing, etc. and get them cleaned up, showered, sanitize clothing & wheelchairs and all while maintaining that person's dignity.
To reduce this horrific problem to a matter of "just keep the weight off" is trivializing probably the biggest, worse issue in senior & dementia management.
2
Calm down. Lots of people are and have been successfully caring for their elders for all of humankind. It is not such a great, big deal.Yes, it is inconvenient and messy at least part of the time. Stop with the negativity.
2
My grandmother grew up in the 1920s and was a livewire her into her 90s, wearing mini skirts and high heels and playing jazz piano.
After major surgery, she ended up in an expensive independent living facility, where she was unhappy. She felt that the activities offered, including being handed one sparkler on the 4th of July, were demeaning. “Why would anyone who’s lived a long and full life find a sparkler exciting?”
I worked during grad school as an assistant nurse at a similar place. The largest problem there by far was loneliness and lack of stimulation. I’m glad that independent facilities are trying to up their game. It’s about time.
14
If Green House is remotely like this article, then it is better than the average home -- but also considerably more expensive (and all nursing facilities are priced as if they were luxury resorts!).
What I have seen with my own eyes is so bad -- so depressing and horrifying -- that frankly, most people would rather die than live out their final years in such a place.
To say "loneliness and isolation" is the overstatement of all time.
What a shame your lovely and remarkable grandmother had to end her days in such a place!
My own grandma died at 71; I have grieved her terribly these past 42 years -- but I assure you, if I thought that having her live to her 90s, but be demented and have to live out her time in a dreary, controlling, expensive nursing home facility....frankly, she is better off in Heaven and I'd say the same for myself. Nursing homes actually manage to be worse (and scarier!) than death itself.
4
Paula, I am always pleased to see another of your columns and very much miss the old 'Booming' and 'New Old Age' sections of the NYT's. I think it was a mistake for them to drop it.
I am very much surprised to hear how expensive both bad and good nursing home care costs in the US.
I worked as the accountant in a 55 bed facility in Canada for 20 years. I think the actual cost per resident day at the non-profit I worked for (that did not have a mortgage) would now be not more than $230/day. It had many of the features you note for the Green House model (private rooms, residents wake and eat when they want, consistent assignment), had care aide and nursing support for 3 hours per resident day, those staff did not prepare meals or do laundry. All the staff were unionized, and a care aide makes about $22/hour, a nurse can make up to $45/hour (with differentials for shift work). There was a recreation department, in house physiotherapy, and part time chaplain. Food was home prepared, not bought from a catering company.
Not having a mortgage was a big cost saver course. But I am staggered at the costs mentioned here.
21
I neglected to mention that our tax supported health authority paid about 75% of that cost, and the residents paid the rest on a sliding scale based on income.
15
Thank you, Ms. Span, for responding to comments! That's extremely rare and extremely welcome.
4
Having seen a 'small' Nursing Home in Ann Arbor some years ago, and their 'owners' seemingly content with their luck, one cannot help but think it may be a suitable alternative to living at home...when one is unable to cope safely by oneself. It certainly beats loneliness, with it's attendant acceleration of accidents (falls, fires, bathroom mishaps, forgetting to eat and/or taking medication), if reliable loving company is what makes the difference. Still, there remains a healthy skepticism, requiring regulation and supervision to minimize abuse or neglect. Obviously, to find a select Nursing Home, the pesky issue of it's cost lurks ahead (I doubt there are many out there who bought long-term insurance for their 'golden years', lonely as they may be). Social animals as we are, this individualistic society of ours may be an impediment to end our days feasting in each other's company, to kiss good bye the pleasures once enjoyed, while the always evanescent time was not the main consideration.
4
Even if you bought long term nursing home insurance....it rarely covers more than 30% of costs and it runs out in THREE YEARS, long before most people pass away.
It is mostly a rip-off product, and the insurance companies try to come up with any possible reason not to pay out on these policies. They were underpriced from the get go -- no insurance can pay for something as absurdly expensive as a nursing home! -- and by the time most baby boomers hit nursing home age, you will see that A. insurers routinely cancel such policies or B. refuse to pay out on them.
Nursing home insurance is NOT a solution to this!
1
I spent two months this year in “skilled nursing” places in the Bay Area. I was almost crazy when I finally left. A subarachnoid hemorrhage can be fatal but I’ve survived thanks to excellent brain surgery. I was delirious for weeks. And recovery will not be simple. The food? Powdered eggs and prison style. Nutrition was terrible.The nurses aides were
Underpaid and undertrained,ignoring my need for
blankets and water. My single room ( 50$ surcharge)was dingy, cold, and way too far from the outside enclosed patio. I barely slept on the hard cot with a plastic cover. Bathroom visits were difficult as I required a walker and assistant. Overhead fluorescents, industrial carpets and rolling things full of meds and tubes and monitors- all added to a sterile hospital scene. Elder Care is a national disgrace.
50
You get what you pay for
1
Kate May: i am grateful you recovered DESPITE the horrors of nursing home care! I've heard as bad or worse many times -- you do not have to be a senior to suffer terribly in such places.
Bad nutrition was actually my No. 1 complaint with my senior relative. Like most seniors, she ate poorly -- had no appetite -- refused to drink water & liquids despite being dehydrated most of the time. But to get her to eat required that she be given tasty, attractive food and pleasant, socialized eating experience -- all of which were totally lacking in a nursing facility.
To save money, they serve seniors the worst imaginable food -- steam table crap -- probably prisoners in jails get better food. The staff and kitchen know that most residents have dementia or no appetite, are polite and won't speak up about bad meals! they have a captive audience -- nobody will escape to McD or order a pizza!
Aides run the gamut from kind to "Nurse Ratchet" but the truth is, they are wretchedly underpaid and understaffed, plus must do the most demeaning and disgusting jobs -- diapering, cleaning incontinence, showering difficult elderly people -- and it is easy to get impatient with slow seniors or needy patients.
Our elder care is awful, but in truth, I do not know where it is done well -- because it is a FOR PROFIT industry making money off of desperate seniors and sick people.
2
Hello- great article but still confusing on many levels. I'm in CA, where a nursing home is used for two purposes 1) for short term rehab, due to stroke, broken hip, etc, paid for by your medicare days, up to 100 days. 2) Long term care (meaning for the rest of your life) ususally paid for my medical/medicaid.
This Article seems to skirt over these two situations. My questions would be: who is paying for these wonderful homes? Are these short term or long term?
It all looks wonderful- but I am confused.
9
I just put my 80 year old dad in a newly-opened Green House nursing home. I call it the "ski lodge" because of the layout with it's central living room and kitchen. My dad has dementia and is wheelchair bound. He had to prove that he could afford the $415 daily cost for 2.5 years in order to be accepted. It's my understanding if he were to run out of money after 2.5 years, medicare would cover him. I expect he will spend the rest of his life there, and he'll go through his savings. The cost is about 2K more than the assisted living he was in before, but the layout, the philosophy, and his room are exponentially nicer. The "shabaz's" prepare the meals, clean and change him and seem to run the whole house. They also make more than the aides at the assisted living were making, (I asked), and are young, friendly and well-educated. There is one nurse for 2 houses, so she cares for 20 elders.
I toured a nursing home before I heard about the Green House. I saw a lot of frail elderly people in hospital gowns, in their beds, in their shared rooms, with the doors open in the middle of the afternoon. I left appalled and horrified that this was the only option available. Finding the Green House nursing home removed some of the guilt and sadness I had about his needing a nursing home. I am thankful he could afford it, and I hope this model replaces the depressing hallway style nursing homes.
11
In general, I am pretty sure it is Medicaid, not Medicare that covers care when patients money runs out.
10
Yes, Justine, my mistake. When he depletes his funds, Medicare will kick in, (assuming the #%!@'s in office right now don't destroy that too). Ultimately, my point is that the Green House is more expensive but the difference is worth the higher price if one can afford it. My parents were teachers and we lived modestly--I will most likely inherit nothing, but my dad's needs are so complicated there was no other solution.
4
I wonder if a viable next step would be to give people a home for life, from cradle to grave -- a place to return to when they need or want it. Maybe inexpensive, barracks-style minimal housing for the healthy but dispossessed could subsidize nursing-home care and provide continuity of life for those who otherwise will never have it.
1
That's a vision of the welfare state that even the hardest left liberals in Scandinavian socialist nations have not yet conceived of!
Cradle to grave "barracks"! Oh boy! that sounds great....NOT!!!!
Yes, I have seen beautiful nursing homes in Mississippi and Texas. However, when the senior is up in his/her 90s and spent up funds for healthcare requiring Medicaid, life becomes a different story. I have no complaints. Yes, having durable power of attorney is a lot of work and very time demanding. Being a guardian is a real job. The younger generations need to understand that there is no way around it. If you visit & watch your elderly family member or client for a hour or two everyday at different times, you will see what happens and why it happens.
14
What about single people?
something else to consider as the eldercare crisis deepens in the coming decades: https://www.seattletimes.com/nation-world/outsourcing-the-elderly-low-co...
4
I recall when my parents had "adopted" an elderly woman in one of the nursing homes in their town. I used to accompany my folks when they visited Agnes because I was curious why they would extend themselves like that (since they both had health issues of their own). The place was clean and nice enough although they all seemed to have that same smell. The folks that worked there were competent, caring and attentive. But it's what Agnes told me that struck a nerve - she didn't care how nice the place or employees were, she felt abandoned and lost because none of her family every came to visit. Without that personal and direct link to her loved ones on any kind of basis or frequency, she said she could care less about bingo, charades, Lawrence Welk or anything else the nursing home assumed she would want or need.
While I think "Green Houses at Green Hill" is beautiful with an intimate and caring staff, all of the pleasantries and niceties of an assisted living residence is secondary if the resident's family members stop coming by or simply forgets about them.
After spending time Agnes I got it. I made a promise to my folks that I would never abandon them. I figure they spent 18 years caring for me in the beginning, and I should care for them first hand during their remaining years. My husband felt the exact same way about his mother too.
Abandoning one's parents is like dumping a cat or dog alongside of the road - it's cruel, mean, and heartless behavior.
38
What if you have been a focus of their abuse for those 18 years?
9
"After spending time Agnes I got it. I made a promise to my folks that I would never abandon them. I figure they spent 18 years caring for me in the beginning, and I should care for them first hand during their remaining years. My husband felt the exact same way about his mother too."
This says it all!
2
You obviously have a healthy relationship with your parents, but please understand that some parents are toxic and their sons and daughters can only manage to get through life by disconnecting from them.
10
How about some articles about how other countries deal with the elderly? We know that in basic health care insurance, America is about the worst in the industrialized world. I'm guessing our treatment of seniors is about the same. We have a LOT to learn.
30
Same rotten conditions here in Australia, too.
Although 'deal with the elderly' says something about the attitude brought to this issue.
The simple fact is, there's a point beyond which staying alive isn't worth it. "Having a pulse "and "having a life" are not synonyms.
How many of these people would die if the meds ceased? Dementia patients are kept alive only by medication, and they're not the only ones.
15
I have an elderly aunt in a traditional nursing home. Sadly she's a Medicaid patient and our family lacks the means to get her into anything better. I love the idea of a elder care environment where it feels more like a home and patients have greater autonomy but I suspect that they will be limited to those who have the means to pay for them.
I can say that a private room and consistency in caregivers make all the difference. My aunt has dementia but she's had the same caregiver since the beginning. She adores him and he's able to be there for her which gives us peace of mind. Before they moved her to a private room he was able to calm her when she got agitated with her roommate.
We're about to have a crisis on our hands because of our aging population. Perhaps the silver lining will be that we'll put greater thought into what we want aging to look like.
24
Ami, it is already a crisis. If you don't know this, it is because you don't have a senior in a nursing home!
I am sorry about your aunt, but her case is pretty typical. She is lucky to have even one aide who cares for her.
It would do this article and the posts well to consider the TRUE COSTS HERE. Yes, Green Houses look very nice -- but the one poster who had a father at a Green Home ADMITS it costs $415 PER DAY -- or $3000 a week -- or $12,000 a month -- or $150,000 a year!!!
Is that affordable? Can the US pay for $150,000 a year for every senior like your aunt? HOW? how would we pay for this?
Medicaid does pay for 75% seniors in nursing homes -- but they reimburse at $1700 PER MONTH. Green House is $12,000 per month. Who is going to take that $10,300 per month LOSS on each patient -- every single month?
How can a nursing home -- even with well intentioned staff -- provide $12,000 worth of care for $1700 a month????
Until we can talk honestly about this -- about the true costs -- about host 99% of us cannot afford Green House, no matter what -- about how even $1700 a month is bankrupting Medicaid -- we are headed towards a demographic disaster as baby boomers hit this age group.
1
Is the Times unaware of board and care in California? Some of which are exceptional.
5
After my dad took to wandering at night, eventually falling and breaking a hip, I had to find a place where he could get more care than I could provide. I chose a wonderful board-and-care home, which looked just like a nice suburban ranch home. He gained needed weight - he liked their cooking much better than mine! He lived there very comfortably for three years. I highly recommend (good) board and care homes.
11
While a more personalized environment would always be better than the institutionalized one, there is an underlying problem here. First, the cost of such care is not mentioned in the article, except an oblique reference of charging more than the traditional model, which runs somewhere around 5oo dollars per day. Either way, the cost is extremely high for most people. One year costs about the same as the cost of four years at a private college. Imagine how this might affect a family if the elderly person lives for years in such a facility.
I think it's cruel not to expand assisted suicide for the elderly who don't wish to linger. Right now, maybe eight states allow assisted suicide for those who are terminally ill. Somehow this doesn't include aging, which certainly is terminal. At the bottom of it all, I suspect, is the decades-long lobbying effort by the nursing home industry on our Washington elites. As we all know, pretty much all of them can be bought off. No doubt some religious concerns and abuse concerns would have to be addressed, but as it stands now -- it's the government that is abusing the right of each and every person to determine how he or she wishes to live or not.
36
The conversation about assisted suicide can be had, however, should not be had because of the awful services nursing homes offer. with no other alternatives. Ethically, it is untenable to hold this debate because the wealthiest country in the world cannot bring itself to stop making profit off of nursings homes. The care should be high quality for all, regardless of income, and not a cause for any of us to want to kill ourselves because the environments are so bleak. Take me to Sweden for this part of my life please and the assisted suicide questions will be based on other criteria than quality of care.
2
I don't see anything unethical about bringing it up in conjunction with nursing home care. And by the way, there usually is no bridge over the river "should be."
2
This is all aspirational if the individual caregivers (shahbaz's) are not trained and dedicated. We had a loved one at a Greenhouse because her friends were there but removed her because there was a revolving door of shahbaz's. To them it was just a job and unless one is attuned to the responsibilities and accept them, then the system as designed does not work. We found there was no required training and there was a disconnect with the institution, thus no control. We were better off with 24 hour home care.
22
My 88 year old Mom died in April 2016 at an Assisted living facility in Oyster Bay, Long Island. She spent her last 4 years living there after suffering a stroke in Feb 2012. She had been a widow for 24 years but was super engaged in life; golfed,played bridge, volunteered for Save the Children and Meals on Wheels and traveled all over the world with my husband and me.
So,this change was a tough adjustment for all involved. The cost was not insignificant but we were fortunate to be able to manage. My job had ended 6 months into her new life so I was able to dedicate a lot of my time to her adjustment. I had many days when a visit was depressing but at the same time it was clear that the majority of caregivers were trying really hard while getting paid SO little.
Green House sounds like they have the right ingredients (like letting someone sleep in) to make this final chapter a more pleasant one. I salute their dedication and efforts.
We can only hope that by the time we get to this stage of life there are fewer nursing homes and more Green Houses.
32
Something of this sort would be the ONLY living option for me; otherwise, I too would just stash enough pills to send me off. As to the comments that indicate fears of not fitting in because of religion: I would very much enjoy learning about religious traditions other than Christian. I'm curious about almost everything, and if my mind holds out, I am sure I would love to celebrate the traditions of other religions and learn their customs. For those of us who do not live in a culturally diverse environment, that would be something to look forward to.
19
Hopefully, the future of health care, and the technology that goes with it, will be concentrated on creating better ways to age in the home.
https://www.youtube.com/watch?v=k0KIqRAoGBk&t=73s
9
Thirty percent more.......................Wow!! Most people can't afford nursing home care now.
22
the 30% savings to Medicare/Medicaid, which in my state end up paying for most long-term SNF residents, would seem to balance the higher cost. Fewer hospitalizations, fewer bed-bound seniors, more consistent and familiar staff.
No Alzheimers wing where a slightly demented/senile new arrival is placed across the hall from a long term resident who screaming constantly from her bed, while a country rock station blares in her room (surely not a choice she'd ever have made while able). Green House plan has been around for years, but elder care is not a priority in the US. Estate planning to insure that family get to sell the house and keep the estate is a refrain we hear too often.
10
I infer from the very vague discussion of cost of that Medicare savings do not reduce costs to patients or their insurers. Many if not most people in nursing homes rely on Medicaid to cover the cost. I can't imagine these facilities accept Medicaid. So this is great for wealthy New York Times readers.
7
They DO accept Medicaid, at least from residents who run out of their savings while they are there. To enter as a private pay patient, my relative needed to have assets for at least 6 months of care. When her savings eventually ran out, she switched to the standard Medicaid reimbursement, which her Green House model nursing home accepts. So the private pay patients help subsidize the Medicaid patients, and everyone benefits from a wonderful nursing home (except for any adult children who were hoping to inherit more money.)
1
Read Being Mortal by Atul Gawande. He can tell you what nursing homes SHOULD be like.
16
"Compared to conventional nursing homes, Green Houses also are far less likely to offer formal activities."
Anyone who's ever set foot in a nursing home knows how depressing these "formal activities" can be. I don't care when I eat or shower, but don't drag me into a circle of semi-conscious codgers to sing along to "If you're happy and you know it clap your hands."
103
You've hit it squarely on the head. I have no desire to be turned into a trick-trained dog for the amusement of young staff. Cuteness at the expense of dignity is always repellent.
31
As an activity aid in a nursing home the activities were strictly for show where the pliable and wheelchair-bound were forced to participate in joyless activities while those more alert were totally ignored. At that time there was a group of high-functioning intellectually disabled young adults for whom homes could not be found anywhere else, plus of course those with diseases such as ALS and MS that rot the bodies in fully alert brains. It was horrible and heartless...
24
Although not a nursing home situation, I took my mother, who had dementia, to an adult day care program for a test run -- we spent an afternoon there getting to know the staff and observing the activities. After watching a session where the leader held up flash cards of zoo animals and called on participants to identify them, my mother -- who was closer to the severe end of moderate dementia -- turned to me, rolled her eyes, and said, "Oh, for God's sake! Wait til I'm much worse. Let's get out of here."
28
I helped my parents find a retirement community. It was an ordeal. The big thing I wanted was a CCRC, where they were assured, in a single contract, the care they needed, from ind living to assisted living to skilled nursing (i.e., nursing home). There are relatively few CCRCs, at least in Fla, and they tend to cost significantly more than other options.
In a few yrs, I'll be looking at this again, for me. I suspect the comments that say the author will take care of himself, forever, and, failing that, will kill himself are from persons most likely to end up in unsatisfactory living situations due to a lack of planning and preparation. For the rest of us, I'd appreciate regular stories on programs like Green House that offer a new way of approaching retirement living. This was a good article, but for one thing: a failure to specify costs. It doesn't help to read that Green House charges "somewhat more" than regular nursing homes when I don't have figures for either, and fear of cost is one of the biggest reasons that people avoid planning and preparing for retirement living.
25
The costs vary, but in my family's experience of looking for care for a relative, it was just a little more than the standard nursing homes in the area. And since they accept Medicaid from their residents who have run out of savings, there isn't a worry about what would happen if they do run out. When my relative had to go on Medicaid, there was a seamless transition. She kept the same room, the same aide, and everything else. Only the source and amount of the payment changed (since they accept the standard Medicaid payment but charge more for private pay patients.)
I think that's confusing for a lot of people. I am speaking of nursing homes where they have a higher price for the elderly who have the assets to pay the higher price. Then, when the money runs out, the nursing home will accept the lower rate Medicaid (NOT Medicare) pays. Sometimes they say you have to pay the higher rate for a specified period of time (say, two years) before they will accept you in the beginning, knowing you will be dropping off to the Medicaid rate later. Private pay families are often shocked when they realize others are paying less for the same service.
1
I have worked as a carer in a few nursing homes of different styles, and the conclusion was that I have built a stash of exit pills. My only worry is their expiration date.
75
I'm reluctantly laughing, having just experienced a rehab center for my dad's recovery. They almost did the "exit" for him, but he got to the ER in time- septic and in coma. This was a highly rated facility in affluent area, if that matters.
10
See "Final Exit" by Derek Humphrey
4
Don’t worry about Rx expiration dates. I’ve read that Rx remain viable, effective, for way more years than the bottle date indicates. If I could only recall the specific article, I’d post it here. Possibly from the NYTimes, 2016 or 17.
1
Lily comments that, as a Jew, she would feel out of place in a nursing home with Christmas decorations and lots of Christmas caroling. Elderly gay people generally have an even more difficult time, including in senior residences and various types of care facilities. It's hard enough to deal with bigotry when you're in good health, much harder when you're fragile and at the mercy of staff members who despise you.
51
Let us hope that in this country, care for elderly folks is moving toward the same welcoming and inclusive policies that we see in many enlightened segments of our society, including Portland Oregon. There are many fine CCRCs in Portland that embrace all seniors.
12
I don't see any mention of that in the article? Is there something I'm missing, like a video?
Do you have an examples of this?
I've never seen any such bigotry in any nursing facility. Nobody asks nor cares about your sexuality. Most residents in an AL or nursing home are over 80, and not likely to be doing much in the romance department anyways, though your mileage may differ.
Many commenters seem to think that they can avoid needing help if they live long. I think all these articles on 95 yr. olds playing tennis , has mislead this generation into thinking exercise and friends can keep you from getting sick. If only that were true!
People need to really think and plan how they want to live when they can no longer take care of themselves.
People please realize that 90% of us that live to be very old will not be able to care for ourselves till the end.
I certainly understand those who say they'd rather check out early but remember don't dump these burdens on your love ones!
A good CCRC is a great alternative to a nursing home and so much cheaper than these Green Homes.
46
There are so many millions of Americans who can never hope to afford a "good CCRC", especially if they enter in their 70s and live to their 90s. And for those who think they can exploit Medicaid's CCRC benefits by shielding most of their worth will likely not end up in the kind of quality CCRC environment Susan refers to because they don't accept Medicaid.
20
What is a CCRC?
5
Ms. Span, please write about CCRC's. I'm close to 80, applied to two in the NY metropolitan area, and was recently offered a desirable apartment by one. Yes, they are very expensive (entrance fees depend on size of apartment), with high monthly maintenance, but they offer a wide range of amenities. Care is provided to the end of life, and no resident is evicted, if s/he runs out of funds. The risk of "paying in advance" is that one doesn't know whether dementia care and/or skilled nursing are ever needed or for how long. As you mentioned, CCRC's offer various financing plans including "fee for service."
3
This will be in vain for most elderly if the GOP ratchetts back in Medicare coverage of long term care patients. I the past they they had to exhaust their worldly assets the government stepped in. Under Trump and the GOP even that is being challenged.
26
Guanna: Medicare does NOT (and has not covered) cover long term care unless it is following surgery and then it is limited to a month or two.
So please start thinking about your nursing home care NOW.
Buy long term health care insurance..........................although it will not cover the expenses of these Green Houses..............especially in places where the cost of living is a lot higher than the places in the south that you mentioned.
11
esp: you'd better read that long term care insurance contract fine print!
For most folks, it barely pays 30% of nursing home costs and most policies are capped at 3 years -- so you better die fast.
The cost of nursing homes is climbing drastically each year, and nursing home policies were/are underpriced, and can NEVER keep up. Insurance companies are dropping these like hot potatoes, and I expect in the future -- with boomer retirees -- they will refuse to pay or reneg on contracts.
Thank you, Paula Span, for this great article. It’s too late for me (my mother was at Green Hill before these houses existed) but the great portrait you paint of this improvement in the care of our loved ones is important!
7
My goal as a physician, is to keep as many people out of nursing homes as possible and in their own homes. While for some, those with dementia or no viable home situation, the prospects are dire. Show me how I society treats the very youngest and the oldest citizens and I will tell you if that is a great society. We are not doing a good job with either end of the age spectrum; no great improvements in sight. We have to look at these issues in our communities.
123
We just went another trillion dollars into debt to give corporations and millionaires more tax cuts, and yet, we don't cover skilled nursing care for seniors. It's inhumane. How can we be so stupid?
How many families actually budget for their parents' nursing home care? Most people in this rich country end up in the Medicaid Wing, with few amenities and fewer staff. Out of sight, out of mind.
Next time we borrow from China, let's do it to promote the general welfare.
126
Guns for the military and butter for the billionaires. Welcome to GOP America.
88
You cannot budget for this, because the cost of nursing care can easily exceed a person's entire net worth.
The "Green House" is $12,000 to $15,000 a month, or $160,000+ a year -- most Americans earn about $50K a year per family -- seniors on SS get an average of $14,500 a year.
To afford this even for a couple of years burns through a person's total financial assets -- in effect, transferring billions per year in personal wealth from individuals to NURSING HOMES.
That is a pretty sweet business model, no? and because by this point, you are sick, frail, desperate and demented -- you have no choice whatsoever.
Whether you are rich or poor, the end of life should be as comfortable as possible. Respect for each individual, privacy as wanted, and opportunities to explore and reminisce are important. For some it might mean a quiet place to draw, for others a piano to play. More opportunities must be provided to meet the coming needs of the boomer generation.
19
Apart from post-hospital stays, Medicare does not pay for nursing home care.
So how exactly does the model save Medicare 30 percent a year? 30 percent of what?
19
I suspect it is the cost of medical treatment that is avoided by keeping individuals healthy through lifestyle. Fewer catheters and treatment for bed ulcers.
17
Medicare only pays for up to 100 days after a person is discharged from a hospital as J OKelly said so your statement would be moot unless the resident had more than one hospital stay.
People in nursing homes generally self pay until they run out of money and Medicaid kicks in. Medicaid is the primary insurer and payer for nursing homes throughout the country.
This article would have been great had it gone into payment rather than “costs slightly less” etc.
47
People in nursing homes who develop conditions sich as bedsores and catheter-related infections require medical care for those conditions, which is covered by Medicare.
The luckier ones may only require outpatient care, but many will need to be hospitalized for them. Either way there are associated costs which are avoidable.
One of the things I value most about my home is my privacy. And my right to decorate as I see fit. You will never convince me that a house with ten people in it is better than mine. And if it comes to it, I'd rather move to a hotel, where I can at least be relatively anonymous.
12
As you advance in age, you often need help with IADLs first - shopping, cleaning, managing to take the right pills at the right time - and then ADLs - bathing, grooming, toileting, getting from bed to chair to toilet without falling. While you can hire folks to help with any of these tasks, it's pretty hard to stay clean and safe without letting someone very close to your personal space. A hotel won't provide any help with these tasks-unless you also hire a geriatric care manager to arrange people to come in and out to you. If you have very deep pockets, your plan might work.
29
You are not realistic here.
When you get old & frail, you will lose your privacy -- as mary describes below -- the more care you need, the less privacy. Nobody (for example) wants to lose the ability to toilet themselves, but it happens to many seniors. No hotel worker will diaper you, clean you up after accidents, etc.
If you are forced into nursing care -- nobody goes because it is swell or fun! -- you will not merely lose privacy. You will never be able to decorate any space, as it is not your own property. You will not have much choice of what food to eat, but have to eat bad institutional food the rest of your life.
You will not get to take most of your possessions like furniture or knick knacks, so forget that. Your books, your collectables -- all gone. Forget gardening or any hobbies. There is no room at the nursing home for these, even if you could manage it.
The worst -- you will lose all of your pets. Nursing homes cannot accommodate animals, so if you get ill and have pets -- they will be given away or destroyed, causing you and them terrible suffering and loss.
You will spend your final years in a soiled diaper, tied to a wheelchair, in a lounge or lobby watching TV all day. Yes, even in a "Green House" at $12,000 a month!
Everything you have ever saved or worked for will go for this purpose and be lost to your family, friends or causes.
I am very sorry about this. I am most sorry for myself! But I have peered into the abyss, and I have seen the truth.
4
You sound like alot of fun :(
1
My mother was in the dementia units of two continuing care facilities for 7 years. The only thing that matters is caring, well-trained aides, and they're hard to find.
54
And I would add, the staff/patient ratio must be high enough that the caring, well-trained aides can get to know their patients and spend enough time with them to take care of their emotional as well as physical needs. My aunt was in an assisted living facility specializing in dementia care for the last four years of her life. During her last year, we spent down her remaining assets hiring additional 24/7 aides to give her one-on-one care because, left on her own, she became very frightened and upset. Fortunately, she had enough assets to keep her not only physically but psychologically comfortable until she died from a stroke. Most people don’t.
8
Diane, you have hit the nail on the head. I don't know how much care aides get paid in good facilities in the US, but guess that it is not much. Nobody aspires to do the work of a care aide, it is a hard job, but some of the ones I have known over the years have a true vocation.
They do so much appreciate words of thanks.
4
It's quite lovely. But!! Let's keep it simple. Aside from the atmosphere, amenities, services ( add whatever else you may chose ) $450 per day is 13,500 per month.That amounts to over $160,000 per year. What percentage of seniors ( or families ) can afford these costs?
140
I was going to inquire how much ? Few siblings I doubt, would shell out that much.
10
The answer: ALMOST NOBODY!
Almost nobody has this kind of money -- about $450,000 for 2.5 years -- and that is assuming you will die by then or that Medicaid will pick up the $12,000 a month cost!
Only very, very rich people have this sort of wealth.
Remember that a senior needing this care may not be a widow or widower -- they may have a SPOUSE who also has NEEDS and cannot be bankrupted!
1
Having recently turned 81, I have been been thinking about what I should do with myself as more time passes. First, I have no interest in a nursing home. Second, our culture needs to expand its acceptance of assisted suicide so that we don't have to spend our last days waiting for the bed pan in a nursing home, but can sign off whenever it pleases us, as Socrates did. So when we talk about ending it all or becoming fixed in a nursing home, let's get away from the concept that suicide is a crime, or, God forbid, a sin. Adult humans should be allowed to decide for themselves when it is time to go. Happy Holidays!
202
With the caveat that Socrates was executed, not my idea of a great way to go, I agree and also think this is an area where we need to have serious public debate. All of us who are aging fear having to make the choice to kill ourselves before we are ready to go or miss the last ferry boat down the Styx and be condemned to helpless boredom and discomfort in an institution. We need to find some kind of time-release suicide law.
27
Unfortunately for this idea -- which the NYT loves so much -- you cannot have physician assisted suicide if you have dementia.
You can ONLY have physician-assisted suicide if you are 100% in your right mind and can GIVE CONSENT.
Dementia patients cannot give consent, and there is a serious problem in that spouses or family members -- wishing to save the huge, ruinous costs of a Green House or other nursing home -- would kill off the senior patient rather than have them exhaust their assets.
The abuse potential here is off the charts.
If you want to kill yourself -- and are in your right mind -- and can manage the pills or shotgun -- nobody on earth can stop you.
But what if you get dementia and do not even remember where the pills or gun are located?
What if you have a stroke, and are completely incapacitated in a nursing home -- far from the pills or gun you have stored for this purpose?
WHAT THEN?
1
Sorry, Jim, but Socrates' suicide was not voluntary.
Between the article and some of the comments, people might get the impression that Medicare will pay for long-term nursing home care, which it will not.
110
The Medicare savings the article mentions come from fewer trips to the hospital, which Medicare covers, and not from anything the homes bill to Medicare.
31
Yes, and it would be good for Paula to edit the article to reflect this.
4
This sounds great but getting and keeping the team that makes it happen is sometimes difficult and always somewhat costly. You generally get what you pay for, unfortunately for those of less means.
13
These Green Houses have been in the news in "aging" circles- the progress seems slow, because of the cost of investment. The "definition" gets a little hazy - as to how much assistance can be provided, and at what point a person would be found t need too much care or nursing help. It is one of those desirable developments we boomer should probably be working for before we need them.
13
Ms. Span might want to visit a real nursing home dealing with, y'know, real patients for her next column.
Idealism and hope for the best are the reason so many people wind up in snake pits.
33
Ms Span maybe should admit the true cost of such luxury nursing homes.
Ms.Span might want to check out what the average income and assets of the average senior are -- not $150,000 a YEAR as it is at Green House!
Ms. Span might wish to check out how many "fancy" nursing homes boot out patients who exhaust their assets -- and Medicaid ONLY pays for semi-private rooms at a max of $1700 a month. Do Green Houses take a $10,300 LOSS per month on most of their patients? How on EARTH do they stay in business then?
Talking about something desirable -- fancy nursing homes, luxury urban condos in hipster neighborhoods -- without giving the true cost -- is what I call "The Big Lie".
99% of us can never dream of ending up in a "Green House" nursing home.
My daughter's father was diagnosed with Alzheimer's in his 70s, and spent the last year of so of his life (he died at age 82) in an assisted care unit that looked like a house, had room for 4 residents, and was run by a married couple. He and his wife picked it out, and my daughter who visited him said he seemed very happy there. From her description, I'd like to know more about these kinds of options -- because they sound like something I'd be interested in. I'm not so much interested in life at all cost -- I've learned that it's possible to outlive your life -- but rather in quality of the life I live.
71
Contact the Long Term Care Ombudsman Program in your state. While the role of their staff and volunteers is to advocate for individuals who already are residents of these various types of facilities, they will know what the resources are in your state for people considering long term care options. Social workers in hospitals and in long term care facilities also know who the contacts are for your state.
6
In my experience with my mother and father, part of the issue is that Long Term Care may cover a "Skilled Nursing Facility (SNF)" (what we typically think of as the big, institutional facility) but not cover "Custodial Care" (for example, small home-based board-and-care). Medicare will cover a SNF for her Parkinson's, but only if she was going to improve/get physical therapy. However, keeping her clean, getting mental stimulation and regular meals is not covered by Medicare. We ended up using all her savings and retirement income--then adding another $1.5k out of my pocket--into a dementia-care facility.
12
Medicare coverage of care in a skilled nursing facility is NOT limited to people who are expected to improve. The Jimmo lawsuit made clear that coverage is available when a person needs professional nursing or professional therapy to maintain function or to prevent or slow decline or deterioration. See https://www.cms.gov/Center/Special-Topic/Jimmo-Center.html.
Toby Edelman
Center for Medicare Advocacy
www.medicareadvocacy.org
25
I'd like to know, at least on a comparitive basis, what this "model" nursing-care home costs relative to standard care (what I'd call warehousing). This has to be an expensive way to live out one's last years.
16
In Queens (NYC) its $450/day to be in one of the more dismal nursing homes we have - patients get about 1 to 1 1/2 hours of "care" a day. Mostly they're wheeled somewhere and left for hours at a time.
18
Paula Span: it says a LOT that you think that is "affordable" -- $415 a day! (Is $407 a a big savings over that?)
That is $12,000 a month or $150,000 a year!!!!
Who the heck do you think has that kind of money? and for 2-3 years, before they "let you go on Medicaid", which I frankly do not believe because Medicaid reimburses about $1700 a MONTH -- 1/10th the true cost -- if so, Green Houses must be going bankrupt like crazy!
In my previous remark I omitted a critical word. Green House nursing homes, because of their staffing models, are appropriate when on a campus that includes a traditional nursing home that is certified by Medicare and Medicaid. RN's and LPN's are then available to provide staffing coverage in the Green House nursing home as they rotate among facilities on the campus. The Green House model is also appropriate for more lightly regulated facilities such as assisted living.
10
Regulators are right to be wary of this model, which has been vigorously promoted by lobbying groups. It has superficial appeal but the deeper questions are not being asked. First, the Green House model is not appropriate as a free standing nursing home. It has to be on a campus with a traditional nursing and back-up from RN staff. Second, the staffing model associated with the Green House features nursing assistants whose personal care duties are diluted with tasks such as housekeeping and laundry. Often a waiver from state rules governing nursing assistant functioning has to be requested. Third, operational funds may be saved by reducing RN staff coverage. On campuses nurses will rotate among facilities, and they are nearby if clinical issues develop among the nursing home residents. I would ask researchers and journalists to look deeper. Don't be seduced by all the pretty scenery.
22
I'm the Director of Nursing at a stand-alone Green House nursing facility in Sheridan, WY. I have to disagree with just about everything you said. We are not associated with a "traditional" nursing home - we are run by a non-profit Board of Directors. We have a total of 48 beds in four cottages and we staff 24-hours a day with two RNs on campus at all times and 2-3 consistent Shahbazim per cottage, depending on time of day. That is much better staffing than any traditional nursing home I know of. To learn more go to www.sheridangreenhouse.org and take a virtual tour. There is meaningful life going on in our homes and our mix of roughly 50/50 private pay to medicaid means that it's not just for "rich people."
61
Normally, I would not get into a debate, but I do owe Ms. Newman an apology because I was too emphatic in my remarks, and I applaud the ability in Wyoming to create Green House nursing homes with excellent RN staffing. The variables here are the state regulatory structure, labor costs in the area, and whether the staff is unionized. The cost center for nursing homes is staffing. At the same time, adequate staffing is essential for quality of care, and no home-like setting can compensate for inadequate nursing staff.
13
Just check out some lovely community based assisted living/nursing homes in the Great Plains...My mother is in the Centerville Care and Rehab in Centerville, SD and she has access to activities all day, every day, and the staff is exceptional. Check out TWO rehab and nursing homes in David City, NE...there are many more, and lets hope that the corporations don’t buy them...
1
I wish I'd sent my mother to Green Hill in West Orange. She lived almost 6 years in an assisted living facility, then moved to a nursing home for the last 10 months of her life. Although there were some good points about each, she didn't get the kind of attention she needed. The whole experience has me wondering if I could have done better in the decisions I made for her (she had a very limited income and had made no prior arrangements), and wondering what will happen to me when I need more help; since I have no family I'd better starting looking into it because there is no one social service agency which will assist.
43
I was responsible for a disabled sibling for 40 years. I did my best to find him the best housing, day programs, medical care etc. He died a few years ago and sometimes I still wonder if I should have done X instead of Y at certain times.
Please don't worry yourself with regrets, you did the best you could. It would be a good idea for you to start looking at what is available in your community. Information is fragmented, but their are seniors groups almost everywhere, you might contact them as a starting point.
2
I feel like we Jewish clients have had to be party poopers for 1000 years. How do you think we feel? I recently joined aauw and had to sit through a session of Christmas carols. The message is clear; you don't belong here.
30
Or perhaps the lesson is that Christmas carols can and should be enjoyed by everyone. You don't have to agree with a religion to enjoy singing.
11
Lily: Along those same lines, I am deathly afraid of dogs; big dogs, little dogs and all dogs. I have been bitten by them 3 times and most recently I was knocked down by one and it clawed me causing deep scratches on my arms.
(And by the way 4.5 million people are bitten by "friendly dogs who never bite" every year. Of those 350,000 require emergency room treatment and a total 850,000 need some kind of medical attention.
And yet I am subject to therapy dogs in nursing homes, service dogs on airplanes, just plain dogs in pet stores. I usually try to leave a big area between me and dogs.
And I hope if I ever have to go to a nursing home, someone will tell them, NO THERAPY DOGS for me as they are NOT therapy for me.
6
Hey, what about being agnostic in the US and having to sit through prayers and "god bless Americas" every where you turn! I don't feel like I belong either. I never realized until this past year how Christianized -- and intolerant -- this country has become.
19
Judging from these photos, would a Jewish client fit in?
11
And it is a place to live, not a religious experience. And yes I am Jewish and live in a place where churches are everywhere.
13
Lily: in my area, with a large Jewish population, there are a couple of very excellent Jewish-run nursing homes (which are non-denominational in the sense that anyone can go there, but they are kosher and don't put up Xmas decorations).
However, to get that -- a kosher, Jewish nursing home or AL home -- costs about 25% more than a regular or Christian home. I have found that church-run nursing facilities are ALWAYS among the lower cost places.
Worse than that, the Jewish places have long, long waiting lists. My Jewish aunt could not find a place at one, no matter the cost, because they had a 6 month long waiting list and her health deteriorated so that her need was very critical and fast.