These places charge 10,000, 12,000 a month, pay their staff peanuts and fudge their statistics. This is disguesting.
They have less staff on weekends because family members show up more...huh, what am I missing here.
What about the residents who don't have family members to do unpaid labor. The needs of vulnerable people are the same 7 days a week.
Why is this allowed? Nursing homes bankrupt people. The care should be superior not this.
30
The nursing home was certainly a "ghost town" in my father-in-law's locked dementia unit the night he tried to get out of his wheelchair to toilet himself, because the one aide was helping another resident -- and the nursing station was unstaffed, as the facility had *recently stopped staffing the station at night*. That nursing station was directly across from the toilets, and he might have been seen and stopped. Instead, he broke his hip, and as he was 94, wheelchair-bound, and deeply demented (he had lived there for seven years), we opted for hospice rather than inflicting surgery on him. So his last days were a struggle to control his pain and help him accept that he couldn't get out of bed. He was well-loved by staff and they grieved along with us.
17
Nursing homes are but one of many areas of significant labor shortages. The real story is one of demographics - we are getting old and it is about to get a whole lot worse.
Another NYT article shows that the hope that American women will embrace motherhood and replenish our youth is fading quickly. We have the lowest fertility rate ever. Trump, already incoherent on our growing labor shortage has the naive belief that American productivity will blossom by giving corporations, including for-profit nursing homes, free rein by cutting regulations. All it does is allow nursing home operators to understaff without getting their hands slapped. But there is no way that cutting regulations can produce an educated, experienced professional.
At a time when we desperately need more young people, we are shutting our borders and cutting off immigration and denying the most obvious source of fresh young people, DACA educated in America and eager to work in America. We need to make the deep investment to make it worthwhile to grow up in America and we need the immigrants to help us fix our labor shortage.
17
New York Times. Can you please research the food at these facilities? They want sick individuals to get stronger and healthy . What they serve can’t be eaten by a dog. Sometimes a chicken wing and two sides are given. And yes I mean 1 wing. I took pictures of rhis as they served my father because I couldn’t believe this is what they called protein. Please please please look at the food service in this facilities you will be shocked!
20
My mother was in several nursing rehabs in NYC and Brooklyn, and unfortunately, they were all terrible and they were all rated 5 stars. She got progressively weaker, instead of better, got bed sores from sitting in wet diapers all day, and ended up passing away from septic shock. I don't see how one aide can care for 8-12 patients and in some cases more which is the norm in these places. They don't have enough staff so they wheel everyone into a "day room" where everyone sits for hours on end with nothing but a television blaring. Many have dementia. The homes have a heavy lobby in Albany and will resist all efforts to have minimum staffing levels. Until then, our elderly suffer, and the greed of these operators that run these places is never ending.
20
So my question is...what can we do about staffing shortages? Because it is NOT a one facility issue...it does not discriminate with a particular facility or field on nursing. Hospitals, home health agencies and hospice agencies are also afflicted with short staffing. It is also not a one state issue. Healthcare in the United States needs to be revised. Also, short staffing is not new...worse but not new. But again, are we just going to sit and complain about it, shame facilities and the hard working staff...or are we going to try to do something to HELP fix it. There is a saying that if you are not going to contribute a solution then dont complain....thought provoking isn't it?
12
If we don't take the profit out of healthcare America is doomed. Not only do we pay more than every other wealthy nation for medical care, we pay more for inferior, inadequate care that has become so depressingly transactional the 'care' element is in name only. Most of the $$ in our healthcare system goes to profit, not patient care. Nursing homes charge thousands per month. They have more than enough income per patient to provide adequate care by paying competitive wages. Our tax dollars, and insurance premiums/deductobles are being used to provide low budget care at top dollar.
And it's getting worse over time. Those of us who are young and healthy, should think of what nursing home care will look like in 30 or 40 years when our generation is elderly.
29
Crocodile tears. a), we live too long and b) nobody wants to work in these places. We had a woman here in Canada, Gillian Bennett, who wrote a blog www.deadatnoon about the uselessness of living past your best by date. Better to go at the peak, like Anthony Bourdain, than the trough. People who claim these "other cultures" care for the elderly so well are talking about countries with a pile of low-status women with no opportunities in life, who do all the tending. We never did this in the past. It was common to nudge you along with a hit of morphine and Alzheimer's patients ended up in the asylum. Now we see it as a good way to extract all your assets before sending you on your way, dead from neglect. We need to expand medical aid in dying, not making cancer the best way way to go.
20
I agree. My grandmother passed away this week after a third battle with cancer at the age of 76. For the past few months we watched her wither away physically and mentally. In and out of the hospital and daily home health care. She spent her last month with my aunt near Atlanta. And for the last 2 weeks in and out of the hospital and 24hr in house hospice care. And yet we begrudge poor people basic healthcare and subsidies for healthy foods that would greatly reduce the need for such expensive end of life care.
14
Democrats could have solved the problem when they set up Obamacare. Instead they cut over 600 billion dollars in payments for Medicare providers.
9
This is not about money but the type of society we are. For some strange disturbed reason we just have no sensitivity for seniors in the same manner we care so much about the unborn but we cut the snap program for children and loose three thousand children at the border.
We don’t care about seniors period despite our marketing we care.
Another example on why we need single payer health care for all
I don’t want cookies I want medical care and I don’t want to spend my golden years alone in a wheelchair and the only conversation I have is when family members come to visit.
This is a scary greedy country and we can be do much better.
No I don’t like greedy corporAtions we are human beings not dollar signs.
God help us and the midterms are coming.
18
Everyone, please google National Consumer Voice for Long Term Care, and the National Priorities Project. We will never have the money as a nation to support decent nursing home care until we reorder our national priorities along more civilized, humane lines. We spend our national wealth on global militarization. We refuse to tax the excessive (to understate it) personal wealth that the ultra rich amass. Just as the government underwrites the cost of building bridges, roads, military bases, we need to subsidize the costs of high quality long-term care. And not by contracting services out to greed-driven corporations and individuals. Surely America has the ingenuity to figure it out; what we seem to lack is the will and the altruism.
20
I encourage every one the commentators here to join a #metoo elder care twitter campaign . Tell your stories on line.
Do it today!
15
Reading over these comments is enough to break the heart many times over.. There is not one comment about a positive nursing home experience.
Healthcare needs a #metoo movement to broadcast this all over twitter and the internet. We have to have protests and call out the names of for profit companies,their owners, and their executives. We need to publish what their salaries are. The NYT's and WP and others need to do serious high profile investigative reporting on this. If you can do it re #metoo sexual abuse you can do it re this utterly disgraceful and evil tragedy.
Ronan Farrow - where are you on this one?
Only intense nation wide exposure and outcry will put pressure on this entrench system.
13
And of those who are on duty, from my experiences of having both an older sister and a daughter work a the same nursing home over a period from the mid-70s to the present, increasing numbers are drug addicts who are more frequently let go for stealing meds than the public realizes only to move to another facility and begin stealing there too.
This aspirational society of ours where we have been turned into happiness-seeking machines who care only about ourselves has become a nightmare for more and more lonely people at every level. I just read an article last night that said facilities call old people with no relatives to take care of them the "unbefriended". That pretty much sums up America-- unbefriended with an egomaniac in the White House and a class of self-serving, hipster liberals spewing carbon via their hedonistic lifestyles-- 10% of the total CO2 destroying our planet comes from tourism (those wishing to party all over the planet) alone-- while in bed after bed, room after room, facility after facility old folks die slowly in pain and loneliness, given only enough care to keep them alive so that they can remain paying customers as long as possible.
11
Republicans in the Iowa legislature have now cut all nursing home inspections to save money. Who cares about the elderly anymore?
10
Put the republican legislators in nursing homes for a month.
19
We really have to concentrate on the national debate about ethics that guides us as a nation. We need new politicians who can work to protect communities, families and disabled individuals. The shortage of compassion and empathy in this country is staggering. The US economy produces enough money to help the elderly, the sick, and the people whose job is to take care of the elderly and the sick. We need a new public policy that can pull us out of the misery caused by greed, and the blindness to injustice and suffering.
11
As a frequent visitor to a few nursing homes in my city, it is eerie how closely the comments below mirror my experiences. Ruth Anne's observation on the discrepancy of care between rich and poor, however, makes the situation even crueler. In my town, a for-profit chain recently bought a nursing home that primarily serves medicaid and medicare recipients, then rehabbed the first floor so it would be attractive as a rehab facility (where the money is). The long-term residents previously on the first floor were relocated to the second floor, where people live 3 or 4 to a room, many with only a few feet around a bed to call their own. And that is the important and terrible thing: for long-term residents, this is indeed home, where they will live for the rest of their lives, in conditions not much different from prison. And yes, "visitors" to the second floor are few.
Nursing homes are like schools. Children fortunate enough to have parents who advocate for their interests (or have enough money to serve as proxy) go to decent schools. Children whose caregivers can't or don't act as advocates go to the "other" schools. I am always frustrated by the argument that if "families cared enough" to visit their relatives in nursing homes or make sure their kids ate breakfast, it would solve things. Maybe - but beside the point. Vulnerable people without support systems are as deserving of human rights and opportunities as those who are fortunate enough to have family support.
28
My mother, who suffered from a devastating form of Parkinsonian dementia, spent the last 3 years of her life in a nursing home. Dad (who now lives with me) and I looked at the home care options, but my mother -- who'd become completely non ambulatory -- required 24/7 care. My parents' place was too small for live-in help and their supply of money not endless, and I also felt my dad needed some down time for the sake of his own well-being. We found a nonprofit home, nothing fancy in terms of decor, but I have to say it was a pretty decent solution, all things considered. Sure, there were staffing issues at times, Mom had to share a room, the food was lousy, and the ambiance on the "memory care" floor had the requisite element of screamers, strippers, wanderers, and generalized chaos. But I also saw some wonderful things there, like the two old ladies who'd become inseparable and walked the floor holding hands. Or the time an African American family brought in a harpist from their church for a beloved auntie's 95th and the residents became transfixed, like something out of Cocoon. The day my mom was unexpectedly lucid and led her caregivers in a chorus of Take Me Out to the Ballgame. The homemade food people would bring in for my Dad, who visited daily. In return, I knit scarves for the staffers and remembered them with gifts at holiday times. Bottom line: don't judge a nursing home by its lobby and remember they're not all horror shows.
22
As I am heading out to check on my mom who lives in an assisted living dementia unit - yes, it is as absurd as it sounds - I did not read the whole article.Just wanted to emphasize that after deregulation during Reagan years (https://www.nytimes.com/1983/07/05/opinion/nursing-homes.html) hybrid nursing home care popped up - these poorly staffed assisted living facilities. The statutes and regulations are so different for assisted versus true nursing home facilities. What would have been an ambulatory wing of a nursing home 20 years ago, with a professional nurse on the floor giving meds, and a ratio of CNAs of maybe 6 to 1 - is now a unit with 24 people with dementia and all of the medical issues that comes with older adults -no nurse on the floor - 2 CNAs - each with 12 patients ( sorry cannot bring myself to call them residents) and one of these CNAs is giving meds to the whole unit.By law in Maine, you don't even need a nurse in the building 11-7 - only available by phone. And you don't have to have all CNAs, PCAs are all that is required - non medical personal care attendants. I learned all of this as the primary support person for my mother who lives in one of the better units around here. As a former nurse I know exactly how deficient these places are and the ramifications. I do not blame the staff - most of whom are dedicated young women who care for their charges and are paid minimum wage. Sadly, greed is the order of the day when it comes to our most vulnerable.
17
Only if you have a dedicated, informed family member or loved one visiting you every day will you be more tended to by the staff in a more timely manner as well as being tended to by your "visitor/s".
16
Actually when my wife with advanced Parkinson's was in a nursing home for 2 weeks for post hip replacement matters,I took over that staff's job for 8 hours a day and often into the evening.
Putting my wife on the toilet ,cleaning her and feeding her , going after the one RN on the floor (who dished out pills for 21 patients!!) to retrieve her med's .
Yes , truly I had a lot of friends working at her unit!!!
5
When will the Democrats start putting this issue, and others like it, front and center? The Greed Over People GOP sure doesn't recognize THIS "right to life" issue, nor does Trump's base seem to care what will happen to them and their parents in a not-too-distant future.
16
It seems odd that the red dots seem to cluster in some states. Texas, Louisiana and Georgia but not Mississippi, Alabama and Florida. They seem scarce in the west and New England and plain States. One has to suspect state policies must play a role in this unusual distribution.
11
Many thanks to Jordan Rau, Kaiser Health News and the Times for this important story. A few readers have mentioned Medicare's home health care benefit, which may be an alternative to nursing homes for some patients. This Kaiser Health News story describes how federal law requires Medicare to pay indefinitely for home care — with no copayments or deductibles — if a doctor ordered it. But patients may need assistance to overcome the obstacles that may make it difficult to obtain these services. https://khn.org/news/home-care-agencies-often-wrongly-deny-medicare-help...
4
Medicare pays for home visits and a CNA to bathe a person, but it will not do this continuously, nor is this more than a total of several hours weekly. NY pays for continuous care for indigent people living at home, though it may not be 24 hours a day. Otherwise, you must pay privately in most states, even if you qualify for an aide, which is never more than part time. Custodial care for every elderly person living at home is impossible-who will pay for it, and how many people are needed for this 1:1 care? Extended families can make it work for one person, with some hired help. Or, you need the money to have a live-in, and some outside supervision to make sure it's working out.
3
I live in Europe and wonder time and time again when my fellow Americans living and working in the U.S. will understand and demand single-payer health care. Fortunately, as regards the case of corrupt “gaming” nursing homes, my father and much older brother were veterans of foreign war who ended their lives in the care of the Veteran Administration (before the Bush administration Iraq folly led to a decline of the administration). When needed, they were given excellent Veteran Home care and then admitted to the Veteran's Hospital. In those years I often traveled to the U.S. And, every time, I was amazed by the quality of care they were given in both institutions. More recently I came away from the treatment given in Italy for a dear old friend with cancer whose death in a public health hospice in June came with no pain and with all the care and dignity we human creatures should be worthy of... no cost, no insurance, no pharmaceutical industry involved. Unfortunately, it seems to me that the Washington administration and those of many “Red” state are devoid of human compassion, having swapped it for bottom line money and power.
14
In the 1990s my maternal aunt and uncle by marriage, moved from North Carolina to a "skilled" nursing facility in Central Texas. At the time, my husband and I lived in Austin. My aunt had mid-stage dementia; my uncle was an eccentric (probably psychotic) benign octogenarian.
Because both still had capacity to sign their names (even though they didn't understand the ramifications of doing so), they were snookered into handing over their financial, medical, and personal matters to a smooth-talking local "country lawyer" who was in cahoots with the owner/manager of the nursing facility. This attorney appointed himself their durable power of attorney for EVERYTHING. It was a nightmare to discover what had happened!
The nursing home manager was a personal friend of the country lawyer. Beware!
There was some solace knowing that because my husband and I showed up for visits on a random schedule, that Aunt Mary Ellen and Uncle George received "adequate" physical care.
7
All staff should be well trained and earn a living wage. CNA's need respect and appreciation for performing an honorable job. Who has not thought about needing someone to care for you when the time comes?
7
How much longer are we going to UNDERINVEST in innovative equipment that leverages whatever functional level a given person may have. Read work of Emily Agree and Vicki Freedman re the role of assistive devices in meeting people's need for assistance with self-care tasks like toileting. Let's free up staff to have more time for those who are frail. Such equipment will also help families who are caring for parents aging with mobility-related disabilities. The innovations are out there. So much money chasing the SAME products in software/applications. Not enough in products that address the physical aspects of lifting and transferring...
5
The investing is going to have to be done by you and me, because government, and no facility or agency providing the services, isn't going to do it.
I tell people now they need to have aminimum of $100,000 -- prefererably $200,000 if in NY area -- in lquid cash to cover the home care, devices, etc. Medicare & other resources won't cover.
4
While I agree with you that there needs to be more investment to help caregivers do there jobs, there needs to be investment in staffing for these types of facilities. As someone who has used that equipment, it still takes time and cannot be rushed in order to prevent injury to both the patient and the caregiver.
A caring person is not easily replaced by a piece of equipment.
4
Please, let us not kid ourselves; Staffing for Hospitals and Care facilities is inadequate, over worked, underpaid, over reported and under trained. Same as it ever was...
Hospitals are notified prior to inspections and still can't meet staffing needs most the time.
IMO, these types of services should be provided by the state with our taxes. For profit corps are just that... for profit. They can't be expected to put care over profit. Yet that is what we are demanding. This cat and mouse game of the state overseeing these corps is a bad joke; Breeds cronyism and graft along with regulatory capture. It needs to end.
13
People need to be prepared to provide it themselves as government funding through agencies like Medicare,Medicaid continues to decline and nobody wants to pay higher taxes, especially for things for old people.
In addition to regular retirement savings, everyone needs an extra $100,000 - $300,000 to cover out of pocket medical,home care, nursing home care.
3
New York City has a huge group of" illegal aliens"
taking care of sick people working for around $12 an hour "off the books".They recieve no SSA benefits nor workman's compensation ,many work for less then $12 an hour if they have free room & board.
It's New York's little dirty secret,especially with brain damaged friends and family members needing relief , my social worker at our hospital even recommended for me to do this scheme.
I refuse management of the illness is enough w/o breaking the law and also risking a lawsuit if
such an illegal employee is injured by your loved one which is not unusual with severe dementia.
I've worked as a nursing assistant in the late 1980's after my three year stint in the Army as a (non combat) medic as well as a master's level social worker earlier in my career. The biggest problem with the nursing home industry is the same as the overall health care industry, and this guy states it pretty clearly: "David Camerota, chief operating officer of Upstate Services Group, the for-profit chain that owns Beechtree, said in a statement that the facility has enough nurses and aides to properly care for its 120 residents. But, he said, like other nursing homes, Beechtree is in “a constant battle” to recruit and retain employees even as it has increased pay to be more competitive." Note the FOR PROFIT aspect. any nursing home that is for profit puts money above care, period. The best nursing homes may not be the fanciest or prettiest, but generally tend to have more staff, better pay and benefits, and prioritize good care over profits. Until we take making money for stockholders out of healthcare, the problems with staffing will not end.
24
Healthcare facilities should never be run at a profit. Neither should prisons. Neither should schools. When it comes to trying to run a facility which services any of these three areas of human society (medicine, corrections, and education) you will be automatically presented with deeply entangling conflicts of interest if you seek to run it as a profit-making enterprise.
As soon as your profit becomes reliant upon helping those whose very helplessness makes money for you, that's when you become incentivized to:
A) increase their helplessness
B) prolong their helplessness
C) lie about their helplessness
That's not good medicine (nor good education, nor good criminal justice). That's heinously predatory, and easily declared as criminal.
What's next? Shall we hand over police and fire to private companies, outsourcing those civic services at a profit? Will we see some kind of Halliburton-esque nationwide staffing agency full of mercenary rent-a-cops? Talk about a dystopian slippery slope! Surely instead of taking an oath to defend and protect the Consitution, these rent-a-cops of tomorrow will be entirely beholden to their corporate overlords.
This bizarre blurring of the lines between Government and Private Business looks almost like Ray Kurweil's prediction of "The Singularity" has already happened. But instead of it manifesting as his prophesied merger of Man and Machine, it's actually unfolding as the unforeseen fusion of Washington and Wall Street.
9
Either you don't think the deep state is incentivized or you are incentivized not to publicly reveal the incentive. I guess the latter.
Many nursing homes crowd residents into small rooms with no chairs or space for family to visit comfortably for any length of time. Only one men’s and one women’s visitors’ restroom in an 8-story building.
Conditions for residents and staff are very bad. Making visits stressful for families helps keep them from staying and witnessing the horror. Our elders and their caregivers deserve better.
12
I've asked my kids to take me to Switzerland rather than put me in one of these facilities. No thanks.
12
In our economic system the function of Nursing Homes is to make a profit, the care and well being of the elderly or sick patients is an after thought.
12
"Gaming the system"? --- let's call it what it really is: defrauding consumers, lying for profit. This is far from the exception in a the US healthcare model, the ACA notwithstanding. It reiterates the obvious: "for-profit healthcare" is an oxymoron.
19
When the GOP hero Reagan began deregulating businesses a recent NYT's report said that is when medical costs got moving upward and upward. There were more people unable to get into nursing homes also. I can't understand why the religious supporters evangelicals ,catholics support a mean uncaring group as the GOP to continue this tragedy making nursing home residents suffer. I am sure they are piling up the sins in God books daily and will have to answer to their sins. They deserve that and when there time to enter nursing home care comes this is what they voted for.
6
So, folks, here's your American Free Market at work.
A profitable industry with relatively nice working conditions, requiring some level of training and certification, and offering obvious opportunities for job security and some modicum of professional prestige, can't even find beginners to take the thousands of jobs they have on offer?
And what does economics tell us will happen?
Well, duh, employers will raise wages, increase benefits, capitulate to demands for better conditions, and see to it that their workers are seen and respected through the larger community.
Somehow, I don't know maybe its the Second Coming, a miracle happened and wages remain low, employees remain abused and disrespected, quality of services continues is plunge toward abysmal, and the owners make more and more profits.
Obviously, because we are all Americans here, we know the fault lies with the workers; greedy dissembling little beings looking for any advantage and probably stealing tongue depressors in their pocketbooks and rationalizing this corporate theft because "little Johnny can't afford art supplies at school".
This, folks, is your America, Trump's America especially, where anybody not already on the top deserves to be on the bottom, and they're lucky to be there.
So, yay!, more taxes for you, poor guys, and none for the really, really rich.
And if you don't like your nursing home, grow up, put on your big-boy pants, and get real job. In France.
10
It's important to publish nursing home owner's names in what is essentially a financial free-for-all at the center of society's inability to care for those in their most vulnerable years. The design of these facilities is overseen by individuals who have no interest in creating living/working facilities that are remotely acceptable for residents or staff. Low pay guarantees poor employee performance and highway-robbery rent means mansions and private jets for high net-worth criminals like Forrest Preston, Philip Esformes and Shlomo Rechnitz. Nursing homes and assisted living facilities occupy rotary dial status in an iPhone world and our collective tolerance of elder abuse lies in direct opposition to our seeming intolerance of untoward behavior that victimizes countless other segments of society. Criminals and profits will poison the elderly until we decide otherwise.
10
Mr. Rechnitz isn't being investigated. Unfair accusation.
But, when corporations buy and run dozens of homes, they don't know the residents. What use to be mom and pop type of facilities are now a part of growing portfolios, where patients are numbers, not names.
The medicare star system is only a primer. Families have to research online, spend time talking to staff, patients, other families who place loved ones in the facility. If you don't like what you hear, see, and smell, don't put your relative in that home.
2
Underpaid, understaffed, overworked is the norm for these workers almost always immigrant types. Interesting to see the profits these homes make. Get rid of immigrants and we would have no workers to care for our elderly. Also, who would watch our children? Clean up hotels? Have the Repubs thought of these problems?
8
I would start with the following: As with the IRS Form 1040, false responses are considered lying under oath, punishable as a felony. At least make them think twice before lying.
7
What does it say about our (white) culture that you would be hard pressed to find a mexican, asian, and black in a nursing home? That they value family and the elderly more?
3
You are incorrect. There are many Asian, Latino and black people in nursing homes and SNF's.
They work there.
2
My husband was in a skilled nursing facility for over three years before his death. His roommate was black, and they got along pretty well. There were many other blacks, as well as Asians (Chinese, Philippine, Korean, Indian) and Hispanics, among both the residents and the staff.
You may live in a (white) culture, but here in parts of California, we already are on the path to multiculturalism.
3
I work in a SNF and there are a lot of residents who are Spanish, Asian, and Black; a lot. In fact, the majority of the residents on my two halls are Asian, the second most are Spanish, the third most are Black, and a few White. Think about that for a moment... The majority are Asian. It even surprised me, considering we stereotypically think Asians always take care of their family members, just as you did. Now, granted, family members visit their loved one nearly every day, more than White families, but Asians are definitely entering the nursing homes more and more.
2
Libertarians demand less regulation, but when they are also the biggest crooks, who will force them to obey the law?
6
Who are we kidding? This lack of adequate staffing has been going on for years everywhere in healthcare.
10
CNAs are the unsung heroes of the health care system. Along with home health aides. A good CNA or HHA is worth her weight in gold (and yeah, the vast majority are women of color).
16
Who do these facilities think their fooling other than the government?
Firstly, no one in their right mind deliberately cuts weekend staffing because 'the families " or other visitors can share the load. Are you kidding me? Almost all the seniors in skilled care are there because their families; if they even have any family close by; can no longer care for their loved ones,making this argument ludicrous, at best.
Secondly; what is the breakdown on staff ratio to actual care standards? One Aide can obviously care for 6/8/10 or more patients who just need a little help dressing,delivering meals and meds ect. short term. But bed bound patients who need help with everything cannot possibly get the level of care necessary from an Aide caring for 6/8/10 or more patients in similar straits.
Lastly, it's disheartening that our own government has know idea about what's going on in our nation's nursing homes while claiming to have great oversight in a ratings system people think they can rely on in making decisions on care for our seniors. Through the power of Medicare & Medicaid, they should demand more accountability & so should we.
We need to end warehousing vulnerable seniors in sub par homes based on how they are paying & treating staff in such places as disposable.
11
The DNA of the United States is for-profit. We are a country founded by wealthy white landowners who saw everything as a profit-making opportunity.
That 1770's ethos continues to this day.
Money = swashbuckling, independent, pull yourself up by your bootstraps.
Government = dependency, laziness, inefficiency.
These views won't change until white voters who are willing to cut the social safety net out from under themselves in order to withhold it from black and brown demand that the government they pay for take care of all citizens.
Godspeed to these CNAs and nursing home residents.
5
Greed over people.
8
I worked as an RN for 30 years at a nonprofit hospital, in a very blue state, with a nurse's union.I was very active in advocating for patients and safe staffing.The last few years, the nurse managers were getting as much as $25,000 bonuses every quarter for coming under budget,i.e. short staffing the units.After years of trying to get our air system fixed,attending many meetings,filing reams of paper work,I finally reported them to OSHA.Asbestos dust,several molds,vents catching on fire,system had not been working for 10 years,was suppose to be cleaned every 6 months,not done.They had to put in a $5 million dollar air system.I had little support from my union,as they thought my complaint may close the unit, and lose jobs.The hospital found out I was the reporter, and bullied and harassed me after the 4 month protection period an OSHA report guarantees,and they tried to fire me.I won that battle,but knew they were relentless,so resigned.I graduated 1st in my nursing class,received many awards in my career,miss my patients.I would rather bag groceries than participate in the fraudulent,greedy complex called Healthcare in our country.Don't get sick.
17
Profit has taken presidence over care.
8
Actually, many of these facilities providing substandard care are "nonprofits." The place I had so many problems with in Manhattan regarding both nursing and administrative issues was a Jewish-affiliated "nonprofit."
4
NFP doesn't always provide better care. Management has a way of rewarding themselves with large salaries and huge bonuses.
However, often the NFP places are better. But, be aware that even the best hospitals cannot provide the type of staffing patients and their families think they deserve. Where I worked in Chicago, 1 CNA for 7-8 patients was the norm. Some days it was fine; other times it was insufficient. If a patient requires a lot of 1:1 care, a private caregiver is the solution. Hospitals seldom pay for that, unless it's a suicidal person or one dangerous to others.
Exactly how profitable are these facilities? Any analysis on that? Looking at nursing home rating.org, I see a lot of these are owned by family groups. One CPA has interests in about a dozen, including one mentioned in the article. Following ownership info, I see owners naned who are wholly owned by private companies.
This would be good to know.
6
But as usual, not a single thing will be done about it. All you will hear are politicians blowing hot air and maybe a little fine here and there. It is the same with every corporation across this country, whether it is polluting the environment, unsafe working conditions, banks that screw everyone over and destroy our economy and then our tax dollars are used to bail them out and provide them bonuses, and tax cuts for company so they can buy back their stock and increase their profits. The nursing homes have been killing people, not caring for them adequately, and neglecting people for decades and nothing has ever been done about it, so don’t expect anything to change.
7
One of my first jobs as a teenager was an aide in a nursing home. I didn't last long in that job, it was very hard work and I was treated poorly by the staff. Now, I've been a nurse in the emergency room and critical care for over 20 years. I've taken care of countless patients that have come to the hospital from care homes due to falls and other preventable injuries or illnesses. Most due to what I believe to be understaffing related issues. The administration in nursing/care homes need to start treating their staff as good if not better than the patients or nothing will ever change. The staff needs to paid a fair wage, they need good staff to patient ratios, a pleasant work environment, administration who listens to their concerns and cares about them as humans not just about making a dollar. Care homes don't need to be for profit facilities or they will never benefit the patient or the staff. It is very sad that some patients don't have family members come to visit them, the same if true in the hospital. However, that doesn't mean that kind compassionate staff can't care for patients. You will have kind, caring and compassionate staff when they feel they are cared for by they people they are employed by. Also, they will stay working their for a long time and enjoy their job. When administration finally realizes this, lots of problems will finally be solved. A fair wage is a sign of showing they care. Working at these facilities is very hard work.
6
One more for win for Capitalism and another reason to require proper staffing, proper training, well paid CNA’s, nurses and doctors. Outside auditors of record keeping. And strict cleanliness adherence.
I have had several relatives in Nursing Homes and have witnessed filthy conditions, severe understaffing and poor quality food served.
And no oversight by State Health Authorities, social services or Medical boards
But you can bet the owners of said facility received their payments
One more reason to change the for profit model
7
Both of my grandparents who entered convalescent care facilities after they became ill, one in the sixties and the other in the seventies, were severely neglected and suffered because of it. This neglect has been the industry standard, it’s how these businesses are designed with the tacit approval of our local governments. People often complain but nobody ever makes any effort to change the practices which produce this outcome. The elderly are considered to have one foot in the grave and their care is not considered to lead to anything but big expense followed by an expensive end.
5
Medicare needs to provide more assistance to families so they can keep Mom or Dad home and care for them. Institutional living is something is Something None of us should have to endore. I Fully Understand not everyone is able to care for a family member at home. It Cost Medicare more if one is in a Nursing institution than at home. More Financial help is needed to cover cost of home care.
7
If Medicare paid for in patient nursing home care for as long as the patient needs it we would almost overnight
have better and more nursing homes.
The medicaid law's are sick by themselves in having say childless couples filing with lawyer's a "Spousal refusal"
of joint savings .stocks and other properties that the well spouse must do to keep those joint properties from the
wolves .
Couples with kids just give them the money and hope and trust that they will use it for mom & dad's needs.
Childless couples hand over 12 or more thousand dollars to a lawyer to do the "spousal refusal" filings against Medicaid and even then medicaid will come after the monies they think you owe them till death do you part.
Ain't it wonderful to be truly sick in our country?
NYC nursing institutional care can cost easily 25 thousand dollars a month ,who has enough savings to last at that rate of spending for 10 years and not be broke and out on the street?
I have known patient's with private nursing home care insurance who all of a sudden must find a new home for loved one's as that nursing home no longer participated in that insurance companies plan.
Have you see the waiting list for "decent" nursing homes?
Let, alone finding one on an emergency basis in NYC when an insurance coverage is dropped by that institution.
2
Adequate healthcare for all of the living. Equal opportunity for all pre-K through post secondary education. Minimum living wage for all of the living. Return to the progressive levels of taxation of post WW II -1960's era. Redefine corporate monopolies and extract and redistribute an adequate percentage of their wealth. Bolster unions and small businesses.
The late life ill care of our elderly is but a symptom of the galloping greed of far too many of our countrymen and politicians, and the 4+ decades of misplaced focus, by religious leaders and politicians, on 12 week zygotes rather than the living. Instead of Marches for Life, how about Marches for the Living?
6
My grandmother was at Beachtree and passed away five days ago due to complications with dementia. While I am still processing her loss and the experiences of other residents as reported in this article, I believe everything reported here reflects what I saw. My Dad and I visited my grandmother on the weekend and it really was a ghost town. We felt we had the run of the place and no nurses came up to us and many actively avoided us. My family gave Nanna round the clock care in her final weeks, but I looked around and couldn’t stop wondering “what about everyone else here?”
11
I'm a male nurse and work in a nursing home for multiple handicapped people. The situation in Germany isn't that much better. It's all about the money, and the health insurance companies call the shots.
9
I now approach my 73rd year and have no family left so am not looking forward to having to go to a nursing home when I become to fragile to.take care of myself. I will consider taking my own life rather than rot away in a nursing home. Our nation and politicians give lip service to their constituents in their old age and only care about them if they are young, vibrant, and paying taxes, or are old with a lot of money. Is Soylent Green right around nthe corner?
11
My daughter worked in assisted living and rehab facilities for years and it was unimaginable how many patients she was expected to care for. Nine patients was workable but by the time she left she was assigned thirteen critically ill patients who had to be fed, bathed and have their diapers changed. It was heartbreaking for her because she cared so deeply for the patients.
Elder care is BIG business. Like all BIG business today it's about profit - not caring for anyone or anything else. Most of the caregivers are Socially Conscious, loving individuals who are in the business because they want to help people.
Most simply want to live well - not rob elders and their families blind.
Perhaps it's time for these employees and Socially Conscious billionaires to start co-operative elder care facilities where they share responsibility, decision making and profit - with the patient first in mind.
12
As an RN case manager, I meet with patients and their families in planning how to emerge from poorly planned aging in place. Many have not even considered how they will care for themselves or a loved one after a fall, stroke, quickly developing dementia.
Consider the multiple root causes of why we need nursing homes at all.
1. A an aging population living longer with chronic heart disease, lung disease, dementia, kidney disease and physical decline.
2. Dispersed families without caring connections.
3. Poorly funded long-term healthcare access for home support by both government agencies and private insurance.
4. A healthcare model based on illness and injury rather than prevention and support.
5. Extreme lifelong poverty in many populations.
This article on "short staffing" only introduces the tip of the iceberg in a global problem of poor planning for aging in place.
Nursing homes are not staffed by nurses. They are staffed by minimally trained caregivers supervised by an LPN, and overseen by an RN.
Consider a cost analysis of insurance paid home care and support vs. the $9000/month that many must find a way to pay.
It is us babyboomers who have the money and influence. Where will you age in place?
15
Thank you for this article. I would like to see more of these issues reported on and brought to the front page. A common man's problem. As many others have said, this simply reports what many of us already have witnessed. It is exhausting being on the family counsels, fighting for a loved one and not making any progress. We all age and many will find ourselves in these places. Let's fix them.
8
I worked as a traveling physical therapist at a SNF in Billings Montana last summer. During my contract the facility was sold from a community based health care system to a national corporation that manages many nursing homes in the west. When the transition occurred staffing was cut in half. Money became the central focus. The billing practices in rehab were unethical. I reported all this to CMS and have heard nothing back. Im glad a light is being shined on this issue. We must improve this deplorable situation.
14
My wife is a nurse who worked at numerous nursing homes in lower New York State and she has always complained about having way too many patients to care for because there is never enough staff. Not only does Medicare not require a certain patient to nurse ratio but the authorities announce inspections ahead of time so that nursing homes make sure they have plenty of staff on the day of a health dept or Medicare inspection. They also make sure that everything looks good when families of prospective patients come to see the facilities. Then when the inspectors or families are gone, it’s back to bare bones staffing and sometimes 40-60 patients per nurse. It’s beyond a joke and it isn’t funny. It got so bad that she quit and has been out of nursing for years now. Of course the problem is that these are not non-profit facilities and like many businesses their biggest expense is payroll. So, the smaller the payroll the bigger the profit. It’s that simple and no one is watching these criminal nursing home owners.
16
It's time to re-evaluate how much Medicare/Medicaid reimburses nursing homes for their service.
7
While we're at it, let's examine the levels of executive salary, perks, and profit thrown off by these woeful excuses for care facilities to the benefit of their corporate masters and investors.
21
Not to put too fine a point on it, our government prefers to cut taxes for corporations and millionaires rather than to fund all levels of health care. Medicare doesn't cover long-term care and Medicaid is underfunded... as a political strategy.
When the country places a higher priority on lower taxes for rich people than on health care, what do we expect?
This is why people don't vote. Nobody is advocating for us, the people.
15
Not to put too finer a point on it, Republicans prefer to, and consistently do, throw money at the rich and the corporate, at our sub-par, internationally mocked military, than to do the things that would make us a truly formidable country: feed, clothe, house, educate our people; provide the means for healthy and satisfying lives regardless of the vicissitudes of corporate malfeasance or international economics; welcome in the world (no, sorry, not "open borders" you Right wing FOX victims, more like "open minds"); and realize that in our perverse version of "free" markets, there will be plenty of times when there are not enough jobs to keep everyone busy, and there will be plenty of jobs that make people too poor to survive, and that this is the result of corporate strategizing or greed, and has nothing at all to do with the ambition, will to work, intelligence, or value of the people cast aside.
Not too fine a point, one hopes.
Republicans.
4
Republican "De-regulation" at it's finest. They have ZERO interest in funding the kind of intrusive inspection regime that would be required to remedy these problems. Meanwhile, their donor class rolls up the smaller operators, piles up fortunes, and campaign contributions from the industry roll in (for Republican candidates).
I personally experienced many of these problems in Texas (Dallas) in 2016 when my Mother entered her terminal decline; Members of the family had to disrupt their lives and be present continuously, (Ten weeks for me over a six month period) or it would have been far harder on her. And she had excellent secondary insurance that paid for the in home health aid visits.
But solutions are impossible as long as Republicans control the legislatures.
17
Thank you for this investigation. This article is exposing what most people involved with long term care have known for decades. Many of these facilities are Warehouses for the elderly and disabled who have no other options. I have former students who have just graduated from RN programs who find jobs in long term care or rehab facilities where they report that they are the only RN in the facility. Others report staffing ratios in evenings a 1 nurse to 35 residents. They worry about working conditions that endanger their newly earned nursing licenses. I would appear that Medicare's lack of thorough investigation is simply a matter of not wanting to know how bad it really is.
16
We entrust our love ones to staff that is not paid a living wage. They are not paid enough then add the hours they work. We need to pay these workers more so they can live in a home/apartment, afford transportation, put food on the table, pay utilities and send their children to higher education. This can not be accomplished at minimum wage for the work they do.
13
Has anyone asked do they all belong in nursing homes?
Has anyone asked if hospitals which perform complex surgery requiring longer stay or care should have facilities at least for 30 days or is it more important to free space for higher revenue
Has anybody asked if people with short windows to die should not have a hospice wing at least for a month.
There are famous people who ate right exercised whose life were impaired by Parkindons by cancer
by Alzeihmers early on. What makes anyone believe such may not happen and they are immortal
1
I went through the chart, and found it misleading or just bizarre. Two different places, one average, one above, yet the numbers were only off by one . The numbers for the worst days, Average 10/26 and the Above Average was 9/26. Same for the best days. As a retired fighter /EMT, I can say that on many calls at night or weekends, we had to hunt down the responsible person in charge. Also, some of the worst places are not even on the map! We had many a comment that if we got sick, take us to the woods and not put us in XYZ place. sad what we do to our families. But if you do not have the money, guess where your family winds up. Best get a Long Term Care insurance policy.
8
Long term health insurance often ceases at age 85 and is by itself as with Medicaid useless if the facility who benefits from insurance payments is inadequate .
I noticed in a" very fine"facility down South with very few
poor patients that altzheimer patients were tied up 24/7 in bed, other patients were often getting threats of punishment for aggressive behaviors from staff even though that aggressiveness was part & parcel a part of the disease .
6
This article states what we who work (or otherwise involved) in this industry have long known. What this article and perhaps the CMS study, neglects is to address is the root cause of staffing shortages.
SNFs receive the majority of their funding from CMS- at rates so pathetically low that running a facility fully staffed with well paid, educated, well treated staff, is practically impossible. CMS must shoulder some of the blame for poorly staffed nursing homes because of their poor rates of reimbursement. Our elders deserve better, from the nursing home industry, and from our government.
13
The color coded map is very interesting as it appears that the below average - red dot - homes are often clustered together. An analysis of why this is would be very useful - is it due to local customs, degree of state or local government oversight/regulation or state Medicaid funding as Medicaid is often the funding source for many residents.
Also an explanation of how the descriptive ratings - "much above average" etc were calibrated would be helpful as a quick random examination of the data for specific homes makes it appear that some homes have a better descriptive rating than others which may to have a better numerical score.
3
When my father was temporarily in a nursing home I was quite shocked to see that the people who did all of the critical, daily care were part-timers who also worked 1 or even 2 other part time jobs to make ends meet. They were paid minimum wage so their main focus was on showing up and putting in their hours and rushing off to the next job.
These people had no loyalty or emotional connection to the nursing home or to the patients. I realized that if I needed someone to pay more attention to my father, I needed to give them cash out of my pocket. And that’s what I did. Imagine if you had a family member in a hospital and you had to bribe the nurses to do their jobs because they are underpaid and under-appreciated.
Each time that I spoke to someone in the nursing home’s main office I was repeatedly asked to sign my father’s home over to them. Money was always their main focus and I suspect that it may be the same at other such nursing homes.
I have become cynical: People don’t enter the nirsing home business because they care about the elderly. They see it as a potential cash cow, draining the pensions and assets of those who are at the end of their lives.
21
With roughly 70% of nursing homes being run by for profit corporations, this article missed the boat on addressing the causes of the nursing and care worker short staffing. When adequate staffing cuts into company profits, someone has to suffer and obviously it's not the shareholders.
19
It's been 30 years since I worked in a SNF. It was my first job as a 20yr old new LPN. I tried switching shifts from afternoons to midnights, then I reduced my hours from 40 to 32 a week. I finally left nursing altogether after two and half years because dreading going to work every day was no way to live life. The comments posted here reflect what I experienced and prove to me NOTHING has changed or improved.
19
I assure you that it is much much worse today, as 30 years ago it was a lot of non-profits and religious-run institutions and today it is mostly FOR profit.
1
Years ago A nursing home surveyor noted that even in the worst nursing homes, if family members visit often and at varying hours their loved ones get better care, as they are the first ones washed and dressed in the morning because the nursing home does not know when the visitors are coming. It would also help I suppose if nursing homeowners did a better jobHiring enough staff and most importantly training those that are willing, and getting rid of those that are not very helpful.
4
This terrifies me. I could be one of those neglected patients. I’m in my 50s and healthy, but 20-30 years from now? Who knows?
I have no kids. My siblings are much older than me (70s) and live far away. They’ll be gone by then. I am active and have lots of acquaintances, but no real close friends. Heck, since my husband died a few years back, I haven’t even figured out who to pick for a power of attorney. Honestly, I don’t think there’s really anyone who would visit me, especially not often enough to keep an eye on my care.
I have a great life now, but I guess I’ll just hope I go quickly when the time comes.
16
I work as a RN Case Manager. please research Long Term Care (LTC) insurance policies that cover at home attendant care/caregivers and assisted living care. I find the patients that have this are usually in a much better position as they get older.
3
I am in a similar situation, AG. I am 63 and my husband is 80. Three years ago, we brought my 92-year-old father in to live with us, so he is one of the lucky ones. But I have no kids and my husband's kids were grown when we married. So I can't help wondering what will happen to me when I am old and frail. I have some very nice friends and a few close relatives, but no one I would feel comfortable calling on at that kind of level. If I were younger, I would start up a business of professional elder advocates -- I think there's a huge need. Hopefully someone else will have done so by the time I get there! And hopefully I'll still have my marbles so I can find them! The other alternative is for people like you and me to band together and form some sort of mutual support system. A lot of people are in the same boat.
3
I do have LTC coverage, and I'm financially stable. But yes, that's something everyone should look into - good suggestion.
It is very important for people in nursing homes (and hospitals) to have an advocate. First, they need some one to help them understand what care they should be receiving and second, they need some one to make sure they are receiving that care consistently in an appropriate manner. That advocate needs to be there frequently, not just an hour or two on Sunday afternoon.
14
My first job in high school at age 16 was working as a nurse's aide in a "skilled" nursing facility (there was no certification for aides then; you learned on the job). For 30+ non-ambulatory patients, 1.5 aides for the 3-11 shift were assigned as well as one LPN to pass meds and, I guess, supervise. Although I was going to school, I was often pressed to work until 11:00 p.m. because the full-time gal I worked with had already done a double shift. It was grueling. And because we were spread so thin, we had to rush frail, elderly, often confused people to eat, toilet, and get in bed. We weren't at all mean to anyone, it was THE SYSTEM that put profit over compassion that was mean. After one year, I vowed never to work in health care again. And I'd rather die on the street than go to a nursing home to end my days.
20
I agree with you wholeheartedly; I'd rather die, frankly and I would hate most of all the loss of personal autonomy and dignity.
The problem is....it is very rarely a CHOICE. Most people end up in AL or nursing homes after a medical catastrophe -- a bad fall, a bad infection, heart attack, a stroke, a broken hip.
At that point, you undergo a long hospitalization and rehab. By the time you have exhausted your Medicare -- it only covers about 3 months of rehab -- if you cannot go back home and manage on your own -- you WILL be transferred to some kind of AL or nursing home REGARDLESS OF YOUR WISHES. If you have no family to do this, a social worker from the state or county will sign you over.
You will be so weak and helpless, you won't be able to argue to prevent this or make any other choices. Your home, your possessions will all be liquidated making any possible move back to your home impossible. And that will be that.
2
Are better pay and benefits for the nurses and staff the solution we are looking for? Yes, and the follow -up question is how do we provide them? To whom with the ability to help do we appeal? Nursing home problems have been in the news for decades and we have all seen them so where do we turn and how do we assure people who will soon be is these homes that their future will be covered?
5
So many here have written: nursing homes (and include personal care homes under that umbrella) are no place to put a frail elderly loved one. But often it gets to the point that families can't keep them at home because it does 'take a village' to care for someone with dementia and other physical frailties. What to do? If you must moved your loved one to a long-term care home, be there for them as an advocate. You no longer need to have the 24/7 responsibilities of caregiving, so it should be a no-brainer that you can visit often, pay attention, and report on what your loved one needs. And report it again. And again. And to your state health department if necessary. Work with the home administrators and let them know that you will work with them to get them what then need so they can care for residents properly. And this always comes down to more staff. And properly monitored staff. We all need to lobby for this.
9
I have worked as a nurse in assisted living/memory care; I also have elderly parents who are residents of assisted living/memory care, and my mom has done subacute rehab in nursing homes. This article is absolutely right - staffing is horrible. The bottom line, I believe, is the severely low wage that the direct care staff are paid. Specifically, the nurses aides are paid an hourly rate that is so low, it is below what is now mandated minimum wage. It is incredibly hard work, physically and psychologically; plus when they are expected to pick up extra shifts and duties due to incessant shortages, it is quite simple to see how patient care and quality lags. The administrators and those who direct them are absolutely “complicit” in causing and perpetuating the problems which result in poor care, as they decline higher rates of pay for direct care staff.
16
My mother is in rehab nursing care in another state. I think most of the staff is kind, but there are gaps in care, especially on weekends, when there are fewer staff and no activities, and when family can not oversee easily. My mother is in another state, so I can only visit infrequently, and she has declined rapidly. I wish that patients on Medicaid could be moved to another state, and the whole complex process of on getting on Medicaid didn't require an elder care lawyer. Once one is on Medicaid after spending down all assets, transferring to another state, requires going through the process again in a new state with certain new requirements, plus the challenge of moving someone in ill health, and the fear, under Trump, that Medicaid itself will be cut. The costs of nursing care range between $9000. and $16,000. a month with no real difference in care despite price. A lot of this money must be going to administration or profit for ?, because it's not going to direct care, rehabilitative care, activities, mental health therapy, daily physical activity, education, trips/enrichment outside of the institution (even a wheel around outside), or healthy food. We need universal health care, and better options and standards for elder care. Instead of profit, perhaps the rubric for excellence should be closer to standards for public schools, and self and family reporting should be part of the report card for nursing homes. What do residents say, when they can report?
20
Truly , the double whammy of severe illness are the insane eldercare laws our country and of Medicaid.
The process of applying even with an eldecare attorney is truly in itself a punishment ,with uncertain outcomes and fear that even minimum benefits will cease if one is lucky enough to establish a Medicaid trust for the loved one.
One nursing assistant for eighteen residents is neglect, plain and simple. For-profit organizations want to make money. By keeping staffing to the barest of bones they can maximize profits. I bet they are not short staffed in their accounting/collections departments. A shame.
21
I am sorry to say as an elderly husband caregiver at home by myself 24/7 for my wife who has suffered Parkinson's disease for 18 years ,my only thought as she can do little for herself is that she die before me as I don't want her with dementia in any nursing home on our city ,I have heard to many horror stories
from other caregivers in my PD support group about the lack of care.
In one instance ,one member called his wife up crying that he had not been changed after a bowel movement for 7 hours .
The wife called the administrator's office to complain and her
husband was eventually cleaned .
I can state many worse scenario's when my wife was in rehab in one of New York City's best nursing homes ,how I found they had omitted part B of a part an A & B Rx combo for her movement disorder.
Yes ,dear creator(s) to give me peace of mind in my last years let her die first rather then imprison her scared and lonely to such care.
Human nursing warehouses are not cool to talk about,all suffer from inadequate pay and benefits for staff and the fact that almost any issue facing people with severe illness that are dependent on others is still too quiet ,till one finds them in such a place . I can't think of patients that do not have friends and family watching out for them and helping the over worked staff
in assisted care and nursing facilities, better care is given in
a jail.
theirselves
23
Your sad experience is very similar to my own when my mother was in one of Manhattan's "best" facilities for rehab. I am looking to get out of NYC as I have decided there is no place here for a middle class old person.
1
This article confirms what many people have always suspected: nursing homes are no place for loved ones. Still, what do you do when you can’t care for a loved one at home?? It’s a lose-lose situation for the patients, their families, and the nursing staff.
Why can’t we do better by our elderly and infirmed? Must EVERYTHING come down to profits? Sickening. I believe a society should be judged on how it treats its least able citizens. We are failing badly.
22
As long as we have attitudes about age "Oh my G-D I have wrinkles" "She/he is trying to look younger" among
other age shaming attitudes ,we will never have decent eldercare management nor respect for the ageing process.
I remember my wife's neurologist stating to a front desk employees at one of our major hospital's who was short of temper with patients "Mr____ please remember that no one wishes to be here"!
1
Transparent in metrics are important and data that cannot be manipulate is good. At the same time, we have an obligation to use information effectively. Rather than abusing nursing homes and staff on measures that reveal opportunities, we need an environment where data is studied and embraced as a guide to improving care. Those facilities with effective solutions to the lack of available staff to employ and ways to provide a more nurturing life for our vulnerable loved ones need to be identified and their practices shared and implemented elsewhere. Who would want to work in an industry that is routinely demeaned. While no one wishes to be in a nursing home, most of us or our family will need one. Should we be surprised that few are drawn to this career where rewards and recognition are personal, but you should not expect encouragement or congratulations from the public. Would you encourage your children or grandchildren to work in a nursing home? Anyone who has been a caregiver, knows how hard but important this work is. The number of frail and elderly continues to grow and the pool of caregivers declines. As someone who is getting older, has provided skilled care and has had parents in nursing homes I am concerned that we need solutions, not whining or abuse.
3
It's fine to say "Don't whine about conditions," John, but when you politely request, over and over, that some need be attended to and nothing changes from day to day and week to week, it's hard not to become angry at those in charge. Not the aides, but the administrators who go along with the owners because they won't rock the boat to demand better staffing or better wages for aides--or better discipline up to termination for those slacking off too often during a shift.
12
john
You're a corporate trainer, right? Or a motivational speaker?
Because rah-rah, challenges.
We have a situation here in which cynical owners intentionally mistreat clients to maximize profits.
Nobody gets into this business because they had no clue personal care would be so difficult, so hard to squeeze profits out of.
They get into it because they know how to sidestep regulations, how to demean and disregard the concerns of patients and their families, and how to effectively lobby for relief when all else fails.
That is, they know what they're doing, they freely choose to do it, and they're making plenty of cash in the process.
No one with any experience at all of one of these "homes" disrespects or demeans the staff providing the services.
It takes ten concentrated minutes of observation to see exactly what's happening. Ownership, for all the keening and sorrow you read here, cares not one bit about staff or about turnover or its impact on patients.
They care about looking like they meet mandated standards while grabbing maximum bucks.
Think about it: you can dig up a CNA or registered nurse anywhere, or rent one from a service. All that matters is to keep the money flowing. Literally, all that matters.
But for the extraordinary skill and the stress of those providing daily care, this is not rocket science. Its like caring for a building full of puppies.
All you really have to do is care about them, and wish them well.
Not happening here.
7
Actually, I am a retired geriatrician. I have spent 35 years in practice, including long term care and have 3 parents who have lived and died in nursing homes over a period of 10 years. I have been there.
I guess if you work in a place that is unable or unwilling to change, that is sad.
My point is that there are places that are making a difference. I have worked in them. Embracing data and working with patients and families to improve delivery of care can make it better.
At the same time, we need to attract more dedicated nurses, CNAs, therapist, social workers, activity directors and other staff into the homes. Wages are the major determinant, but we all can encourage those drawn to this calling. If there are no people to help, how can we solve the issue you raise.
Good luck and I hope you feel better.
1
This is not a new problem. I know a nurse who graduated from nursing school in 1975. A few days later she started her first nursing job on the night shift in a Manhattan nursing home and discovered she was the only nurse on duty. She quit the next day believing her lack of experience made her unqualified for such responsibility.
13
During the summer of 1970, I was a nurse’s assistant in a nursing home. Often, I was responsible for the basic care of 50 elderly patients and there was one registered nurse on duty. On a good day, I bathed & dressed my neediest patients and changed the sheets for all of my patients. If there was time, I visited my patients who rarely had visitors. It was a physically and mentally taxing job with low wages. My experience taught me about the low value for the elderly, the sick, and health care workers. It appears little has changed in 48 years.
16
As someone who has clocked more hours than I care to think about -- in nursing homes, Assisted Living homes, dementia units, 55+ senior housing -- due to having several elderly relatives -- I can absolutely attest to this article and in fact, if anything, it underplays how bad the problems are.
When I complained about treatment of my elderly relative in Assisted Living....and why the food was so poor quality....compared to her several stays in Nursing Rehab after surgery .... I was told by Assisted Living managers that "well, Rehab is insurance-paid and we can bill them $440 a day and up (this was in 2014) but the AL residents are all private pay, and around $150 a day....so we cannot give the same care for 1/3rd the money".
At least they were honest. I appreciate honesty, even in terrible people.
15
"With nurse assistants earning an average of just $13.23 an hour in 2017, nursing homes compete for workers not just with better paying employers like hospitals, but also with retailers. Understaffing leads predictably to higher turnover."
American medicine (which is what this is after all) for-profit and fighting for "caring staff" against McDonald's.
Pulling statistical hoo-ha to appear to be doing a competent job for their clientele while doing less than less than the minimum whenever they can.
What kind of measure is staff-in-the-building, for example?
What I want to know is staff-who-know-my-mom-well-enough-to-see-something-is-wrong-and-interested-enough-to-do-something-about-it-preferably-the-right-thing.
I don't care about burn-out of the "nurses" or the ravages of doctoring chronically ill people often on their final approach. I care about the people providing those services, and I feel deeply for the challenges they face daily, the killingly few glorious moments they are granted.
None of that excuses the corporations and "foundations" that penny-pinch their way through every day. Who guarantee their staff will be burned out and angry. Who assure patients receive grudging, sub-standard care.
What I care about is that my mom be respected for the unique person she was and treated like the desperately needy person she is, compassionately and professionally. To the end.
I don't care about your bottom line; in a civilized country, you wouldn't have to either.
20
Wow. I feel like I know you because I agree with everything you wrote. My mom, who has Alzheimers and is in an skilled care facility, was diagnosed with a blood clot in her leg on a Sat. morning. We couldn't get a nurse practitioner to see her until Monday afternoon, because they don't work on weekends (and she is in a large, allegedly well staffed, highly rated facility). We were left with a difficult choice b/w having her taken to the emergency room in an ambulance and holding our breath and waiting until Monday afternoon. We chose the latter and, thankfully, she is doing fine.
10
So long as we taxpayers and voting citizens continue to keep in office people who continue to vote for obscene military budgets and who refuse to tax the outsized wealth that the wealthiest financiers and celebrities amass, we are ensuring that our government has little or no money to subsidize good healthcare for every single person in the US. Check out the work of the National Priorities Project because we need a rethinking and a restructuring of our national priorities. We have prioritized global militarization instead of health, education, and domestic security. If anything in nursing homes is to change, much more must change about how we use our national wealth.
11
A blood clot is high risk! While employed and deployed to NY my husband visited and developed an acute
pain in leg. I called my NY doctor across from Lenox Hospital my husband was admitted immediately and hospitalized for 8 days.
in Miami my husband hospitalized nurses reached the backup of a primary to inform he had a blood clot on other leg the idiot back up doctor
did not do anything or give orders, later nephrologist reached by the nurses rushed test medications and measure
I am glad your mother was well On the other hand
maybe the first diagnosis was incorrect
I have spent since 2001 weeks at different times in hospital and even doctors confirm there is high risk. The response to a condition of an elderly or compromised health is prejudiced if perhaps subconscious.
In the "How Staffing Fluctuates at Nursing Homes Around the United States" graphic I searched on Tacoma, WA. It showed Park Rose Care Center with a "Much below" red dot, and University Place Rehabilitation Center with a blue dot between "Much above" and "Average." But if you look at the staffing ratios Park Rose Care Center looks the same or better with residents per aid/nurse at 7/13 on the best days, and 9/18 on the worst days. This compares with the University Place Rehabilitation Center with residents per aid/nurse at 9/13 on best days and 19/24 on the worse days. So it seems like they should be ranked the opposite of how they were.
5
As a teen, I took a job in an assisted living facility as an aide. After being chastised & being told it's quantity over quality, I left, feeling sadly defeated by "the system." That was the early 70's. Sadly it's worse since then.
In 2015, a dear friend was hit by a car & sent to a "rehab facility" following his hospital stay. On admission, I was there & reviewed all his meds with the nurse. All his pain meds were inexplicably stopped, throwing him into withdrawal, leaving him violently ill. This was their excuse to avoid real physical therapy which he had 4 times total, in 3 weeks. The staff didn't care. Rather than being instructed in transferring to the toilet, they put him in diapers for staffing convenience. His inhalers were never given to him. After asking repeatedly why he wasn't getting any necessary medication they claimed they never had an order for them. Lies,and excuses were prevalent. Seems his own
inhalers were given to another patient. His dentures went missing. I got a call from him crying, saying the aide yanked his arm pulling him out of bed in a rush and he heard pop, pop, pop. The facility claimed xrays were normal. I took him to his orthopedic surgeon - his arm was fractured in 3 places. We decided to bring him home and care for him ourselves.
As a society, we no longer respect the elderly. Family is fractured and caring for relatives isn't the priority it once was. We must respect our elderly, place value on their lives and expect better care.
12
Face it: a country must look itself in the mirror.
We don't care about the elderly, the young, or anyone else that requires attention.
If we did. we would elect leaders who do care.
15
Excellent. Exactly right. What is the problem? As GK Chesterton wrote, "I am." Because I -- we-- allow our government to set priorities that don't leave money to fund decent healthcare, among other things we need.
5
After seeing my mother's care during two "rehab" stints in SNF and a final short NH stay, I will spend the last dime of my inheritance to avoid ever spending even a night in a NH.
Yes, paying staff more could help. Hiring staff above an LPN level for seriously ill complex cases (hint: they are ALL complex after 80) would help. Training direct care staff better would help.
If you or your loved one has ANY ability to receive homecare therapies and nursing, do so. Your hospital may not bring it up, so you should. Spend the money for private homecare if you have it, because bad care could end their life or permanently disable them to the point at which they will be forced into a facility.
A good example would be not identifying a urinary tract infection, which becomes sepsis and so seriously weakens an older person to the point at which they are no longer able to walk. Simple mistake, caught more easily if you have skilled care and people who know that grandma is behaving strangely, not just demented.
It isn't the individual caregivers that are so dangerous, it is the system. Stay out of the system if you can. Do not trust that ratings or a fancy lobby mean much of anything regarding the quality of care. Hire a private aide if you feel you have no choice but to use a NH, and show up unannounced to see if your aide is sleeping while your family member needs care.
14
Before moving my mom, who has Alzheimer's, into a facility (and, now, a second one due to problems with the first), we used home health are aides. Unfortunately, we were not impressed with the caliber of individuals assigned to her across the board. With some exceptions, there was little continuity and very little skill involved. Choosing to move her into a facility was the lesser of two evils.
In either case, the pay for the positions is so low that turnover is a constant and the positions don't attract competent individuals.
10
Phil is correct. Unless you're around to monitor the home aides, there's no guarantee that they're providing the care needed when you're not present. Once a frail elderly person can no longer express their needs and communicate reliably to family members the quality of the aide's responsiveness, then, I believe, it's time for long-term care--that horror of horrors. So, we MUST advocated strenuously for quality care.
1
I was lucky to be able to care for both of my very frail parents for five years, 24/7, in my home until their deaths. Their "care staff" to patient ratio was greater than 1, because I occasionally had others in to help.
Each had some a three to six week stay in a care facility, because our health care system almost mandates that the maximum medicare coverage be utilized if they go to a hospital for almost any reason (just try to get them discharged back to home!)
My observation of these care facilities was that they drugged patients, refused to allow them out of any wheelchair (even if they were somewhat mobile), and grouped them in clusters in hallways or big rooms so one, probably under trained, person could "watch" almost 20 patients at a time. The staff were sincere, good people. But I cannot say the same for the bosses who were making huge profits with the money that they were draining from America's families. They should be in jail.
I remember so well the woman who wailed in her wheelchair over and over again, "Please, don't throw me away! Please don't throw me away!" Endlessly.
I understand that many families cannot do what I did and wish they could, but I also know that there are many families who do not care. Let me tell you, the owners and profiteers do not care (even if the aides and nurses do care).
14
You are a good son and took a hands on position in caring for your mom & dad.
One of my observations in a nursing home that recently cared for my wife after a hip replacement was that older
residents many with great careers and education were treated like children , I would engage many "inmates"
in conversation (as I am their age, but well) about the old days i.e. , the arts ,music and politics of the past we all shared
As the saying goes "old people talking together are not so old".
1
Get profit out of long term services and supports. It's widget care by design delivered by extremely stressed worker while owners live the high life. This is not a mystery.
12
My mother was killed by a skilled nursing center. She suffered from heart failure and was well cared for by her own family until a fall put her there.
With heart failure there is a simple, well known rule: two pounds of weight gain in a twenty-four hour period means fluid is being retained and will lead to a heart failure episode if not dealt with immediately. Anyone with any medical experience should know this.
My mother was released after two weeks and at the discharge meeting the staff proudly announced that “she’s gained six pounds and we think that’s a good thing!” She died 2 days after discharge from heart failure due to fluid build up.
There was no skill involved. They killed her.
22
The information in these payroll records should be made available to those searching for nursing homes for their loved ones.
4
There needs to be a national soul searching about why traditionally female professions (like teaching and nursing) remain low-status, low-paid occupations. I'm not impressed by the current women's movement (ie #metoo) if it only focuses on the travails of women who are seeking high-status employment. The sad fact is that our society continues to glorify people who manage to escape doing all the dirty work (ie., white males). It seems that every time white males get interested in taking up an occupation, pay and conditions magically improve. Honestly we need less college education for our young people and more mandatory assignments in taking care of the elderly before they can aspire to their adult careers? Young people are allowed to run around uselessly like little princes and princesses, glorified at every turn because of their "potential," and they never learn the compassion and practical skills involved in caring for the elderly and disabled in our society.
10
Beautifully stated! My father's nightmarish 3 years in AL ended up with him dying from the truly horrendous bed sores they never told me about (until he landed in the hospital where the nurses pointed them out). You are so right about privileged white males never having to do the "dirtiest and hardest work" and yet they are held up and glorified. I think I will once again visit the National Priorities Project that another commenter mentioned. Meanwhile, thank you for your astute and correct observations.
3
70 years ago as presently with my wife's Dx I had an aunt with Parkinsons ,my dad and the entire family came to her aid taking care of her.
Today sadly we usually don't have that wonderful close family caring "as of one of our own",dynamic .
Families have become uniquely self absorbed today in a way unheard of in the past ,members requiring help are often unable to ask as they wish not to be an imagined burden.
In my PD caregiver's group a wife of a PD patiert herself came down with a recent Dx of MS.
Not only did she not tell her husband "why worry him more", she did not tell her son a busy attorney (who does little to help his dad) for fear by telling her son & daughter in law she has MS she would not be allowed to babysit her grand kids ,overnight .
Some close family!!
Teaching and nursing pay very well -- about $70K to start in big cities -- and can go up to $100K or more over time or with a specialization.
These are NOT NURSES we are talking about but "health aides" -- certified nurse assistants -- sometimes not even that, just ordinary people willing to do grunt work like bathing, feeding, toileting frail seniors.
It is a huge mistake to think most of the care is done by licensed nurses (RNs) vs. aides.
1
Maybe Elon Musk (since he’s known for thinking outside the box) can come up with some ideas/solutions to alleviate these unending and maddening nursing home woes.
4
It doesn't even take Elon Musks's technical creativity--though it will take his money. Hire a sufficient number of aides for each shift. Pay them a living wage so they don't have to work two jobs or double shifts. Train them properly in what person-centered care means. Hire someone whose primary obligation is not paperwork or marketing but monitoring performance of aides. These solutions aren't rocket science. Yes, there are other things we can look at, such as the physical condition of the home. But the quality of the care provided by the staff is central to the well-being of your loved one. And until we have a sufficient number of properly trained, adequately paid, humanely supervised aides, nothing else matters. Advocate for these things with your state and federal legislators!
9
Maybe a chain of small group home units would be better for all? Caring for 6 patients in a homestyle environment might result in better care and be more cost effective than a 3-story fancy building with understaffed, underpaid caregivers. Just a thought.
4
One thing not discussed in this article is the tendency of some rehab facilities to require families to make up for their deliberate understaffing by hiring additional aides not covered by medicare - a severe unexpected and not always doable expense. This is particularly true for patients with cognitive issues. Homes that are ill equipped to handle such patients nevertheless accept them, and the medicare fees they bring. Then once they have control of your loved one they leave you no alternative but to pay for 24 hour aides, because your loved one is a "problem". The cruelty is excruciating.
15
Thanks. It's an industry designed to meet minimum state regulations with little oversight and weak to non-existent penalties for violations. Usually violations result in a slap on the wrist or requirement for more training. Oversight is mostly on input compliance with little to no focus on measurable indicators for outcomes, purpose and goals, and no data or analytics on lessons learned linked to management changes. At least that is my impression. Pretty much the same story in memory care and assisted living facilities.
I suppose in some ways this may be driven by the Long Term Care Insurance fee structures as well as State regulations. LTC generally sets allowable claims as a daily rate and the industry designs to that level. Also State regs are focused on requirements to license for operation. Contrast that with what happens in the case of cancer or cardiac care where the doctor and the disease set the treatment, therapy and after care requirements and good health insurance companies and Medicare to a large extent foot the bill while trying to contain costs. In LTC the insurers cap costs and the industry constricts care and designs care to maximize profits rather than design and deliver care needed and bill for it. The LTC coverage model is more like a per diem cost reimbursement scheme for room and board rather than a flexible coverage model to cover care needs. In a nutshell coverage is denominated in days, not care needs.
7
True, true, true.
The Affordable Care Act, big government, did not I price the quality of elder care? How shocking. This will be yet another challenge for POTUS to conquer.
3
For profit nursing homes are the biggest frauds in the business. Extra staff is brought in for inspection periods, etc. I worked in a 638 bed facility and we always had RN's on duty 24/7. We maintained a minimum level at all times, but the night shift naturally was lesser in numbers of CNAs. One of the reasons we held people over for a second shift was because the next shift called in excessively. Lack of disciplinary action by supervision only contributed to those calling in. We were a NOT FOR PROFIT nursing facility.
4
“While staffing is important, what really matters is what the overall outcomes are,”
Yep...profit for the company and neglect for the residents.
7
"David Gifford, a senior vice president at the American Health Care Association, a nursing home trade group, disagreed, saying there are legitimate reasons staffing varies. On weekends, for instance, there are fewer activities for residents and more family members around, he said."
I'm baffled by this statement. While there may be fewer social activities, these fall under the responsibility of activities personnel, not nursing and health care. Residents don't receive fewer meals, don't require using the bathroom less frequently, and still have the same medication requirements during the weekend. Families visit more frequently? My guess is that Mr. Gifford has never stepped foot in any of the facilities that he represents. Ignorant and abhorrent mindset.
15
Just wait. The GOP will continue to ram things through to cut medical costs so they can give more tax cuts to zillionaires!
4
The photograph accompanying this story is frightening. The comments about everything from patients left to lie in their waste to being denied medication or even food are even more horrifying.
Worse, is the knowledge that there will be no intelligent conversation. Or literature. Or music, art, fine food and wine. Nothing but moaning and screaming and bad odors. And television or radio -- which I don't possess and abhor.
That's why I have made my plans to die before I suffer any of this.
9
I think assisted living has the same problem. I hope you will do a story on it.
6
NO, it's not a "nursing home" and it's not a "skilled nursing facility." Please call it what it is: a WAREHOUSE in which we keep people who need care.
The inmates may or may not get that care.
The level of care will almost invariably be lower than what they need, the staffing is usually an out-and-out fiction, and the bottom line is that the OWNERS of the for-profit WAREHOUSES are very rich b/c they collect a ton of money from people and from Medicaid, and spend as little of it as possible on caring for the unfortunate inmates.
I've seen it up close more times than I'd wish on anyone, and it's always awful.
And if you don't visit your "loved one" pretty much every day, the "care" they receive will be even less.
This country hates people who are old, sick and/or disabled, and we refuse to provide the quality care & dignity they deserve. Why? Because GREED wins over decency & compassion every time. EVERY TIME.
Find me an impoverished owner of a "skilled nursing facility." You can't!
14
I don't think this country hates old or ill people it is that we encourage in our too important pop culture that with our increasingly longer life expectancy or "getting on in years" is a sort of illness by itself ,it is not.
I have to say people seeing me wheel my wife around in Manhattan come to my aide immediately if it seems that I am in trouble ,say pushing her up over a curb ,while I love and respect this attention when I reply "Thanks but though elderly ,I am still strong" I get quite often a smile back to me and and a thumbs up!
Odd is it not? that pedestrians on our streets are so much more helpful,then many institutional caregiving services.
Every single weekend the hospitals I have worked in get the nursing home dumps. It’s a never ending revolving door of neglect and despair. To those of you who don’t think this impacts your life, think again. We all pay for this , and there isn’t enough money in the us treasury to fix this. My plan, an overdose, then blissful sleep. End of life care, indeed.
13
Why should this surprise anyone? When Katrina hit Lousiana, some elderly were left to drown by the nursing staff at a retirement home. Unless you have the financial means, the place you'll wind up in, in your old age, will be worse than a holding cell. It's all about the money. If you've purchased a long term care policy, good luck trying to collect on it as many are worthless. Again, it's all about the money.
There is no politics involved only greed!
10
George, what did you say ?....... Makes me shudder Not political ? and you are emphatic with your statement.
This article describes what will become a widespread crisis in the decades ahead. The final years for millions of elderly people will most likely be spent in crowded isolation with little stimulation and only sporadic, indifferent care. In fact, that's what care for the elderly already is, unless, of course, the person has incredible wealth and/or life savings to fall back on.
Deepening this crisis is a factor very few want to even acknowledge, must less admit: Americans increasingly don't want to have to deal with their elderly parents or grandparents. They are costly nuisances in many households, regretted and even ostracized for remaining alive when it would just be better if they passed away quickly and quietly. This corrosive attitude manifests itself in nursing facilities that are already short-handed; few well-meaning people want to volunteer to help the aged especially those who are bedridden and need feeding, cleaning and changing.
The future for entire generations of citizens in this nation, where health care is privatized and monetized, isn't going to be pretty. There is not adequate ROI for an 85-year-old with Alzheimer's, after all.
10
A good follow-up article would be to look at variations in reimbursement rates.
My mother was in a facility rated two stars out of five, but it was 6 blocks from my Dad's house and he was there constantly. It was termed a nursing home but warehouse would be a more apt term. The stated rate per month (I do know the Medicaid reimbursement rate) was ~ $3,500/month. My father is now in a dementia level assisted living facility with a stated rate of $5,700/month and the care is favor better than my mother experienced. A co-worker's father is in a facility paid by Medicaid with a stated rate of $9,000/month. Again, I do not know what Medicaid pays.
Why the drastic variation in rates and how significant are the consequences of this difference?
9
I am a RN and have worked as a case manager. If a person has Medicaid that means they either have a qualifying disability or have met a certain (low) income level and don't have any financial assets. Medicaid will pay for long term care in a custodial facility, what is commonly known as a nursing home for as long as the person continues to meet the minimum requirements for Medicaid. Medicare, on the other hand, which everyone gets at 65 years of age, only covers acute stays at hospitals, or up to 100 days per year of rehabilitation in a skilled nursing facility. However, most stays at a rehab facility rarely go beyond a week. The facilities you refer to are likely assisted living or custodial care facilities. Rates vary greatly depending on what is being provided. Custodial care is what one usually thinks of when a nursing home comes to mind--spartan staffing levels, basic needs are met such as feeding, bathing, dressing, but not much is done otherwise. Memory care is usually a secure facility for someone with cognitive issues such as advanced Alzheimer's disease, traumatic brain injuries, or advanced dementia--this may be covered by Medicaid but is usually private pay. This is usually expensive care. On high end, that may be an assisted living facility or independent living facility and I doubt Medicaid pays for it. Usually this is private pay as well. These facilities charge for services from a "menu" of options, and for each additional service, the cost goes up.
4
.... and instead of doing their jobs and routing out this fraud, the investigators are wasting their time checking to make sure that I ask every patient whether they have "hot or cold intolerance" or whether I checked their ear drums for redness , in order to get paid for saving their lives with emergency dialysis in the middle of the night.
2
Just when we thought it couldn't get any worse, we discover geriatric Willowbrook.
3
Stories like this are, in part at least, why I believe assisted suicide should be legal. A 60 year old friend who has rapidly progressing FTDementia tried to kill herself three times. She has few resources and will be placed in a facility like the ones described here. I can only imagine that she knew she was failing and tried to end it all. What sane person would want to live as these people are forced to live? Incarcerated is the right word. Shameful is also an adequate description. Sad is probably good too. And how about those who work there doing yeoman's work at low pay with little psychic reward day after day?
12
I agree with you 100%.
In Florida or South Florida this is big business as homes are converted for this purpose also. The condition in nursing homes and some hospices are appalling. No one cares no one suffers consequences. it seems many are over medicated with tranquilizers.
8
And this right here is why I plan to commit suicide before I'm unable to, if I live so long that my ability to care for myself with minimal help, such as a visiting aide, becomes impossible. Why should I waste my money on substandard care when I could leave it to my children and favorite charities, who will make better use of it than a nursing home ignoring my basic needs?
13
I've been a CNA for 7 years. I'll address 2 quotes above:
1st QUOTE: "There is no consensus on optimal staffing levels. Medicare has rebuffed requests to set specific minimums, declaring in 2016 that it preferred that facilities 'make thoughtful, informed staffing plans' based on the needs of residents."
MY TAKE: The words "thoughtful" and "informed" are legal fluff words. These nothing-burger guidelines in Medicare's current position allow facilities to staff stingy. Without outside agencies (such as mandated staffing ratios) holding management to task, daily staffing decisions keep getting made by the people who wear suits, not the ones who wear scrubs.
2nd QUOTE: "Understaffing leads predictably to higher turnover. 'They get burned out and they quit,' said Adam Chandler, whose mother lived at Beachtree until her death earlier this year. 'It’s been constant turmoil, and it never ends.' "
MY TAKE: And THAT is your answer! Burnout and turnover are what's killing nursing. Some nurses literally cry on their way out to door every day to the parking lot. Nurses and aides routinely hold their bladders for well over 4 hours, skip lunch and just wolf down a pack of peanut butter crackers in the linen closet in a fast 3 minutes, yet still get docked a half hour in their paycheck. If we heard about such practices in a Third World factory, we'd be crying "Inhumane labor practices!" But what I just described is not only normal, it's de rigueur in every facility I've ever worked.
20
Looking at the map associated with this article, there seems to be a lot of red dots (poor patient to nurse ratios) in the so-called red states...especially Texas. So if you're going to vote republican, you better be sure you have the vast sums of money needed for quality long term health care when you reach that stage of your life
10
The article is absolutely on target. I’ve experienced staffing shortages in nursing homes for my mother and mother-in-law. In most cases, if there was a snafu of some kind, it was on a weekend. The staffers usually try their best, but they are simply overwhelmed. The most frustrating issue is when patients push the call button and get no response or a very slow response. Medicare is trying to downplay the problem, but if you ask patients and their families you will find it is real.
10
This is old news. Gross Understaffing of nursing homes has been documented since the 80s. Studies also have documented higher psychotropic drug and sedative drug use in homes with suboptimal nurse staffing. Keep electing GOP so this situation becomes even more deplorable. It’s immoral. Tax cuts for the rich; rotten nursing home care and paupers wage for their caregivers.
7
the beechtree sign for help wanted is requesting an LPN.anLPN id not an RN, another way to cut corners.
5
My sister is a nurse and has worked in nursing homes for over 15 years, all her phone calls to me were spent complaining about the lack of help in her jobs, she dispenses meds and often times was swamped with 50 or 60 patients per day to get around to, very often having to go find someone to do their job so as she could do hers... the bottom line is the administration for sure will lie about everything, and family members do sue when they find out their mom or dad is sitting in a soiled diaper all day, she finally quit this year altogether, disgraceful!!
5
Reality check how many nursing homes use sedation as way taking care of old folks during evening hours so they sleep thru nite? Children of parents who placed in these nursing homes should be concern their parents being drugged to keep them in there rooms at nite.
5
Since staffing levels are lower on weekends because “families are around,” I suppose the weekend rate charges are lower, too.
6
To the writers: please be consistent in reporting numbers.
"Of the more than 14,000 nursing homes submitting payroll records, seven in 10 had lower staffing using the new method, with a 12 percent average decrease, the data show."
"seven in 10" versus "12 percent" and no absolute numbers to put this in context. A 12% decrease (1 in 10?) from what? A staff of 10, 50, 100?
3
Unless patients or residents have a personal butler, aide, and 24/7 nurse, and gilded fixtures in bathrooms along with top of the line furnishings and cuisine, there is no way these facilities should cost what we are charged per month. Even the “better facilities” are grossly understaffed. My late mother-in-law was supposedly being watched 24 hours a day but still managed to fall out of her bed and fracture her elbow. My late mother fell and had a fractured hip one time, a banged up face 2 other times, and a bruised rear another time, all from falls. There was NEVER enough help at the nursing home. The quality of the aides in most cases leaves a lot to be desired. Turnover is constant. Fired aides from one place are hired at other facilities because bodies are needed. Who wants this job? No one I know. What a horrible state of affairs for our elderly, and soon enough, for me and my contemporaries. New assisted living properties and nursing homes are popping up everywhere. Who is going to care for the seniors? From what I’ve witnessed, these places scrape the bottom of the barrel of the employee pool. This is the reality, harsh as it is. I’ll take a cyanide pill over a stay in the warehouse of death any day.
7
I can definitely attest to the poor Staffing ratio on the weekends for one of the facilities in my area. Like the gentleman in the article my mother suffered a stroke earlier this year and spent a precarious month in a facility whose long-term care residents were sad and neglected, misdiagnosed her as diabetic because her blood sugar was high from the liquid diet in the hospital, caused her to get a urinary tract infection because she had begun holding her Pee until she thought someone be free to immediately see to her need, and weren't consistent with her medications. They were tired of seeing/hearing us everyday. I will say the daytime therapy staff did challenge and aggressively work her. The last straw was my cousins visiting one Sunday and on their way out of the facility hearing the ringing of a heart monitor which was vaguely familiar to them because they're both doctors. They immediately went to give Aid and found themselves performing CPR on a blue faced resident. Aids ran around frantic until the RN on duty showed up and joined my relatives. None of the staff retrieved an AED which my sister had noted only one in all our visits located closer to the administrative offices. My cousins managed to revive the patient by the time EMS arrived, who apparently had choked on her food from lack of attention. My mother was out of there a week later.
6
There has been a recent scandal in private care homes in Ontario. An RN became a serial killer over many years plus she had some near misses. She was reported repeatedly but it was fluffed over by the authorities. She worked for 2 care homes and then in home care. She actually turned herself in to a psychiatrist. Canada got rid of the death penalty many years ago. Clearly she had some major psychiatric issues. BUT ONE OF THE MAJOR ISSUES WAS SEVERE UNDERSTAFFING ESPECIALLY AT NIGHT. Some of the people she killed were not demented.
6
Working in a nursing home is one of the hardest caretaking jobs you will ever have. Administration consistently understaffs EVERYWHERE - I don't care how much you pay - and nurses aides couldn't care less about the patients as people. Add to that the horrible work ethic that has settled in on this country, where so many people come down with the "Friday flu", and you end up with cattle pens with no love lost. Houses of horror, most of them.
3
These places represent America: 1. Old people don't matter. 2. Charge an obscene amount of money for horrible care when people have no options and no national system to take care of the old.
Many so-called poor countries put us to shame in the way they treat the old. Africans honor age. Americans worship youth and the buck.
America is not great. It is pathetic and cruel in the way it treats the helpless. it will only be "Great Again" if we can get someone like Bernie Sanders elected and get rid of the medieval Republicans in DC.
6
One third of the money spent on healhcare in the US is wasted. http://blr.healthleadersmedia.com/content/241965.pdf
As much as ten percent is actually a fraud.
Our elected officials do not represent the American People on this and many other issues. They represent the lobbiests who pay them.
Support and vote for your indepenat candidated both the Deomocratic and Republican parties are severally corrupt.
1
I worked in a nursing home for a short time and the staffing was terrible! There would be 1 nurse and 3 aides to take care of 40 people. I agree that inspections should be unannounced. It is sad to see people neglected, especially when they are paying for their care.
8
Where are all the "Christian pro-lifers" on this issue? Spending their time trying to save a clump of cells.
19
You buried the lead way down in the 12th paragraph: "The for-profit chain that owns Beechtree." Why should anyone PROFIT off of taking care of elderly and vulnerable people?!
12
In BC years ago some...not all long term care were part of the public hospital system. Then most were privatized by the right wing provincial govt. Next step saw most of them sold to the Anbang Insurance Co. (They almost financed Jarred Kushners New York money pit but it fell through.) Next step..I.am not entirely clear how or why...but they were taken over by the Chinese Government. To their credit the govt. then the BC Provincial Liberals...not liberals but actually a conservative party, tried to object but the Federal Liberals okayed the takeover!!!!! My big advice people is do not get old. There is some medical aid in dying here but not for senility or dementia. Death has to be predictable within 6 months and the person has to be of sound mind. Can you imagine living in nursing homes run by the Chinese Government.
5
So now we have a geriatric Willowbrook?
2
A few years ago I had a hip replacement and spent 20 days in a nursing home/rehab center. I only got to take a shower once during my stay and I had a constant earache from the air conditioning (which was extremely cold) blowing into my right ear when I was in bed. The nurse practitioner, who I told about it, didn't know what to do about the earache. I had my brother bring sweet oil from home which took care of it. The food was quite unhealthy and poorly cooked. I was awakened at 4:00 a.m. every day and asked if I had had a bowel movement. I had nightmares about the place after I left, and I would rather die than be put in one of those places when I'm old.
10
This is what you get when you let corporations, with very little accountability run the country. The battle isn't Republicans versus Democrats, it's nothing-but-profit seeking corporations running most aspects of our lives. They will suck every dollar out of us and pay their executives hundreds of multiples over what they pay their average worker. Taxes are the price we pay for a civilized society. One can argue about the reasonableness of a given tax system, but they are necessary to provide the structure to ensure the safety of society at large. When will we wise up to this?
6
I work as a caregiver and this is absolutely true. There are nights we have 20_22 patients each. 4_6 patients to give showers and then dress and transfer from bed to wheelchairs 4_6 patients before 7am.and we work 3cnas-5cnas if we are lucky we work 7 cnas. And no raise in income. I have been working here for almost 4yrs and I still earn $9.50\hr. Sometimes it almost as if you will get blisters from too much going on. The worst is we get only 5paids days off a year. I have 144hrs and I can't ask for days off because I won't be paid for. We don't have forest deposit we have to drive and come to work to get ur check yourself. Sometimes residents reuse their foam cups for 4 days before we get new ones. Some days we use bedsheets to clean poop because we don't have sufficient materials to work with. Beds are bad the won't even raise so we have to bend really low to change residents the worst is the 500lbs patients. My lower back hurts but I have no choice I need the job.
13
Like everything in the U.S., unless you're a millionaire and can afford something better, most nursing homes are a nightmarish hell on earth for the "residents," the main goal of which is to make obscene profits for the owners.
11
This staffing problem could be greatly helped if America established 2 years required National Service for all able-bodied citizens between ages 18 and 24, choice of Environmental Service, Social Service, or Military Service. Our infrastructure (roads, bridges, parks, etc), elder care and child care, and military needs could be met.
12
Reality check look at this picture open mind do you really think this women is sleeping in the wheel chair or is she being sedated so nursing home doesnt need any one to watch over her?
4
Have you ever been caretaker for an elderly person? If not, you could not possibly understand the dynamic.
So, how do the nursing home state surveyors pass these places? We need many more unannounced surveys.
Also, the Directors of Nurses in these places need to get out of their offices and actually help their nurses and CNA’s. They need to assess residents in their rooms frequently.
These things should be givens, not exceptions.
9
Not long ago we saw how a nurse was arrested in the death of former national security adviser H.R. McMaster's father. Apparently she did not do the required neurological checks every 30 minutes after he fell and hit his dead. A video monitor showed she never did it but she wrote that she did. This is what can happen due to shortage of staffing. I have done per diem work at nursing homes over the years but now I'm at the point where if an agency calls me to work at one I turn them down. It's really not worth it. You can easily lose your license or end up charged criminally like that nurse. And weekend staffing is the worst as the article mentions. There is a lot of paperwork. And a lot of medication almost as if the pharmaceuticals run the nursing homes. The medication administration takes up much of the time. And there are all sorts of paperwork. There was one incident where I worked where one resident actually walked out of the nursing home only to knock on someone's door. The police brought her back to the nursing home. Needless to say the security guards at the desk were fired. The incident brought on lots of retraining for the staff along with lots of paperwork and monitoring of residents who are called "wanderers" who tend to walk around on their own. The nurse has to check every 30 minutes to document the resident was observed in the room or on the unit. That takes a lot of time away from doing other work that must be done.
11
Don't worry, regulations that tied the hands of the nursing home owners will be loosened before the year 2020. This will help maximize profits with fewer employees. Also, it might help lower medicare costs if the sick people receive inadequate care and just die quicker as the GOP want to happen.
10
My whole family is from Cayuga, just up the lake from Ithaca. It’s not just the nursing homes that are short-staffed. The area is full of young people waiting to get out and old people staying there because that’s where they’ve been. Constant drain off of people from the region since the 70’s.
4
I found this article to be interesting and informative. However, it only scratches the surface of the problems of nursing home care and their business model. I have seen the operations of these facilities from two perspectives. My mother was a patient and I was a medical discharge planner at a 400 bed hospital.
In my experience, the issue is less about availability of staff and more about profit. These facilities often run at minimum staff levels to increase profitability and instead of directing resources to hiring staff, they spend thousands of dollars every month employing "Medical Directors". These medical directors are physicians whose sole purpose is to influence families and recruit Medicare patients to benefit the facility's bottom line!
In addition, patients are often "seen" by their physician with little more than "How ya' doin' today?" and a bill to Medicare for $200-$300! The lack of oversight and the for-profit motivation for nursing home owners leads to abuse of the system.
22
Lowering the rating if a home doesn’t report having a nurse in sight for 7 days? How about shuttering the location and jailing the executive staff, plus refunds to the patients and their families?
23
I needed long term care after an illness and spent one year at a nursing/rehab facility. Mind you that Medicare only pays for 90 days of such no matter the illness. After that 90 days i had to pay $300 per day. So buy long term care insurance if you can. What I saw there in one year was mortifying. Short underpaid staff was common. Some outright mean. And I was in a high rated facility! I survived and left. Many are life time residents who cannot cope for themselves on the outside. When you hear the commercials for a "place for mom" it all depends on money. You can leave this life on a magic carpet if you have the money. If not, it's pretty grim. My family became my watchdog to see that I was cared for. Others need to rely on advocates who are also scarce. I pray I die in my sleep or suddenly, because the alternative is awful. Only when you are in this reality can you understand assisted suicide. I hope this article provokes some sorely needed changes.
32
Thank you for your enlightening addition to this NYT article, especially your suggestion about long term care insurance. I wish you all the best in your recovery!
7
Thank you .... it's all so true! Joan Lunden should be ashamed for promoting "a place for mom" until she has read and understood all that is being said here. They mislead people into thinking there are lots of great places to choose from. There aren't!!!!!
3
Hedley: most insurers are leaving the "long term care" business in droves because when customers inevitably use the insurance…the cost is astronomical.
They have priced long term care beyond the reach of all but the most wealthy Americans.
Most people cannot even dream of buying this while they are young enough to qualify for (somewhat) reasonable rates.
Insurers will not sell this to you once you are ALREADY old and sickly!
We are talking about thousands of dollars a year -- tens of thousands in some cases.
Furthermore: many insurers "reneg" when faced with huge claims. A skilled nursing home charges an average of $12,000 to $15,000 a month and sometimes more in big cities. Do the math on that.
NO INSURANCE could ever protect against this, because it is not a rare occurrence, like a house burning down. IT IS THE NORM. Most people require some nursing care at the end of life.
1
I have been a State Tested Nurse Aide for 27+ years. Having worked in long term care for the majority. The aide to patient ratio in most of these facilities are ridiculous! Let's break the time down. Let's look at 1st shift, this shift entails breakfast, morning care, showers, lunch, plus what other needs arise during the 8 hour shift. The aide has 20 patients, 3 of which will need showered. Showers can range from 20 minutes to an hour, let's meet half way and say each shower lasts 30minutes. There is one and a half hours of the 8 hour shift, the aide still has 17 more patients that will need toileted, a bed bath, dressed and given meals. This does not include the aide taking a break themselves. I digress, the aide now has 6.5hours to complete 17 patients, answer call lights in between care, and meals. Which translates to approximately 22 and a half minutes per patient not including meal times which lasts at least 45 minutes or longer per meal (depending upon the kitchen staff). So the aide loses another 90 minutes of the 6.5 hours left for the 17 patients that dis not get showered, which leaves 17.6 minutes of care that is / can only be provided to the remaining patients. These elderly people have worked his/her entire life to only be provided 17.6 minutes of care per shift? It is very frustrating for an aide to work in those conditions on a daily basis. You get burnt out, care is less than adequate, careless, preventable accidents happen.
24
You deserve a medal and far more for what you and your peers have endured for so long. I never blamed the aides where my parent was in an AL. They were doing their best under truly terrible circumstances. I was there for several hours nearly every day for 2 full years of my parent's decline. As I said, I never blamed the aides. It was the FOR PROFIT mismanagement of the place that was to blame. Shareholders should not be part of elder care, health care, child care, etc. What a horrible society we have created with our worship of money (mammon) over everything else!
2
I can make it simple: no aide can properly care for more than 10 patients a day and even that is likely too many.
1
I am a nurse. I believe that we have a crisis in assisted living and nursing home care. It is serious and devastating. It is demeaning to the elderly. The article clearly describes the problems, and the comments offer anecdotal confirmatory evidence.
And there are many comments from families, nurses and CNAs. Some, but not all note that the staff tries to do their best with very limited resources. Nurses and CNAs expressed their dismay of care, understaffing and worry of losing their license. Many others clearly recommend that family be involved daily—coming at unexpected times to be with their elderly and make sure the staff atttend their loved ones. And the monthly cost of care is high—perhaps $10 K per month. So families might “save some” by visiting and perhaps getting better care for their loved ones—but those family that live at a distance—ah well.
But what I didn’t read were any comments from Nursing home administrators or corporate owners of for profit facilities. Not a word.
And while I know that politicians rarely if ever respond to NYTs articles, I think they should to this one. But not a peep.
Washington—we have a problem.
Who will step up?
And to all readers, we all grow old if we are lucky. Is this the future you desire? If not what should we do?
47
My mother was a resident of a nursing home for 10 years in Rochester, NY. until her death in February. She was extremely disabled as a result of a stroke and dementia. Because of her degree of incapacity I spent 5-6 days a week there. The nursing home was rated highly by the NYS state examiners but I echo was others have said. The aides she did have were kind and caring. But almost every weekend (and more so on holiday weekends) there were several unfilled shifts needing aides. I was told this was because the facility did not want to hire per diem staff. So The HR department posted lists of the unfilled shifts in the resident's dining hall in case aides would want to take on extra shifts. This is hard work and for an aide to work 16 hours in one day (two eight hour shifts ) is a disservice to both the residents and the aides.
20
As a physician whose wife has spent time in a nursing home, I would say that the money paid to nursing homes is not enough to reach the level of care that everyone wants. Where will the money come from? Of course, it would be helpful to stay out of unnecessary foreign wars, such as the invasion of Iraq. The trillions of dollars saved might have largely covered the costs.
27
People need to provide it themselves -- in addition to regular retirement savings, an extra $100,000 - $300,000 to cover home care, private aides when in a hospital or facility, etc. This needs to start being communnicated to people, as they aren't going to be getting help from the government. This or move to another country with better care, like France, where this type of supplemental care costs less out of pocket.
I've worked in long term are almost 12 years.
You think this is scary? Assisted livings are now caring for residents with the same level of medical needs as nursing home residents, but there is even less staff and government oversight.
23
THANK YOU for pointing this out! ALs are terrible places for "memory care/dementia care." I spent a good part of two years being with my parent almost daily in there because neither he nor the other "residents" were adequately cared for because of PROFIT MOTIVE. Don't let Joan Lunden (A PLace for Mom) fool you into thinking there are any good places for your loved ones. There really are NOT.
1
Elderly care is probably the clearest example of how and why we need to reset our incentives so that humanity is valued. Radically increasing wages and benefits (which will increase social status) of these essential caregivers would truly improve local economies and communities. We value (pay) financial technocrats who contribute very little to communities far far too much while we compensate those who dedicate themselves to humanity far far too little.
27
Absolutely correct. Experienced this for my parents in various facilities. If possible, don't transfer or enter on a Friday night or weekend. And don't fall on a weekend.
14
And really, really don't fall on a holiday weekend.
If you calculate the monthly cost, per-resident, of 24/7 care at the 1:8 staffing level cited in the article as desirable, a CNA who makes $15/hr (add $5/hr for fringes, making true cost $20/hr) will cost $1825 per month per resident.
Now add in the costs of everything else, from building mortgage and maintenance, to meals (and the staff who prepare them) and you can see the typical monthly NH cost emerge: a totally unaffordable $4000-8000/month.
There is no way to square this circle: no way to both pay workers a fair living wage and be able to provide quality care at an affordable price for all, when the work is as inherently one-to-one as this. As a society, we will continue to suffer until we acknowledge that caring for our children and our elderly is a goal more important than maximizing individual -and corporate- profits, and start taxing higher incomes at the rate required to support societal goals like education, health care and child/elderly care.
32
Several thoughts:
1. For those who say this will never happen to them or they’ll choose suicide (assisted or otherwise), it’s entirely likely you won’t have a choice - physically or mentally. No one chooses substandard care but nursing home are full to overflowing for many reasons. A dementia patient can no longer choose; the “geriatric orphan” (as one commenter aptly noted) has few options if immobile with no financial resources.
2. One commenter eschewed Hospice care because of how much they bill Medicare. It’s a lot, to be sure. But those Hospice visits provide an independent check on nursing home care. For instance, Hospice will cover an air mattress that nursing homes charge up to $500/mo for. If the person is private pay, it’s worth it even with what our lawmakers have agreed to reimburse. Hospice staff will attend mandated quarterly care meetings and advocate with family to be more effective partners in care. Hospice does quarterly assessments to justify the need for continued hospice care - many folks improve and no longer need it - but will return if the need arises. The Hospice aides, social workers, chaplains, and volunteers are worth every penny. They are extra eyes and ears.
3. Insurance matters. A Medicare Advantage Plan has to provide their own Hospice care - and in nursing homes, they don’t always do this as well as others.
4. Preplan as much as possible. Talk to elderly loved ones now. Their wishes matter.
17
Nursing Home lobby? Medicare pays for nursing homes, Medicare does not help when you pay for aides in your home. Be good if there was some tax break when you pay your own expenses. Full time aides in NYC cost $75K a year to stay in your own home.
16
Medicare only pays for a couple of months. Medicaid pays for long term nursing care, but only if you have no assets. Long term care insurance is available but very expensive.
The states write the laws for staffing and the physical space. Here the state pays for some home health care, but not 24/7.
Not surprised. Giving staff the day off on weekends reduces overtime costs when family members can work for free (this is a business).
I've seen first hand the inadequate level of nursing home staffing. Most staff are dedicated caring people, but they are given too many seniors to care for.
16
I had to have my father in law in a dementia facility and all of them were sub par. Later I had a friend who worked as a CNA in a nursing home tell me of staff neglect because they were always understaffed. She often worked two shifts back to back because they were desperate and would pay her bonuses for doing this. She eventually was severely injured moving a patient by herself. The facility did not care that they had poor management nor proper staffing even though they were held accountable at my friends workers compensation hearing.
14
The increased injury from falls, bedsores adds to medicare costs wehn the people are hospitalized
5
Residents pay $7000-13,000 per month out of pocket to be in a nursing home if they have not yet bankrupted themselves enough to qualify for Medicaid. The staff are overworked and underpaid for an extremely difficult job while the owners scoop up the profits on the backs of helpless elders. There is no excuse except greed. The nurses that cared for my mother were very kind to her and provided good care but were often short staffed. The price of her care was $11,000 per month and yet,for example, the quality of the food served there was horrible and often inedible. Home care assistance is totally inadequate for people with every health problems and/or dementia. As bad as nursing homes are, though, assisted living is worse because they have little to no regulations/ inspections.
27
You are 100% right! When I selected a “Premier” ALZ Assisted Living facility in Knoxville, they had an RN... one of my main selection criteria. They went through 3 RN’s in less than 2 years . Two of these RN’s resigned because patient decisions were being made by administration and not on a clinical basis. I applaud them and agree with them. Now we have a very nice LPN, but lacks knowledge and stamina to go head to head with administration! Most staff are caring.. but, over worked. Some of the care givers constantly work double shifts which leads to burn out.
3
The transition from free market assisted living to a California Veterans Home (state, not federal) was eye opening. For starters, you bring no medications and the first days are spent with intensive health assessments to determine what the patient needs for a good life (not what commercial medicine needs for its own good life). And then you notice that it is always staffed, that people answer telephones day or night.
I believe it added 2 good quality years to my father's very very long life.
26
You lucked out. Usually not very nice places.
In reading this, I feel like I'm watching an apocalyptic preview of my husband's and my future.
We are blessed with friends but have neither children nor extended family. For two-plus decades, we have compromised our standard of living in the present in the hope that our retirement savings will see us through to a safe and comfortable end. Yet in reading this essay, I get a tight chest in thinking that our savings-first practice is foolish.
As many of the readers who have commented have noted, the miserable pay, benefits, and working conditions of LTC jobs is a significant actor in staffing deficits. Yet when maximizing shareholder profits is the prime directive, it is the elderly and vulnerable who suffer most. In an era where the chief qualification for a position heading a regulatory agency is publicly professed disdain for said agency's mission, I doubt that increased government oversight will do anything to staunch the trend of elder abuse. The vignette about a facility being hastily cleaned before a photo shoot says it all.
38
Reality check i was treated for sever head concussionin the doctor told me an wife i should be placed in nursing home . Wife an i decided she could handle the job an brought me home. After 6 months an numerous doctors it was discovered by chance having a phisical to drive car i had sever hipertenssion causing my vertitgo so cont drive . I was put on medication for 6 more months an was able to drive a car agun. Nerolgist who over saw me in hospital said it well being aware of ones own symptoms is 99 percent an in end exactly what saved me from being put away in nursing home to sleep like picture here.
1
If you and or your husband end up in a nursing home @$7000 /month, it won't be long before your savings are depleted. Take that nice vacation you've been dreaming about while you still have the funds to do it.
1
This problem will grow as Americans age and as immigration drops, cutting off our supply of foreign-trained nurses and aides. In Hawaii, where I worked as a doctor, some of the most tender loving care my patients received was from Filipina nurses and aides, who were recruited from their home country. It's my observation that some of the kindest caregivers come from countries where elders are valued produce some of the kindest caregivers.
I've often thought it made sense to build a whole industry assisted-living facilities on the Mexican side of the border. Staffed with American doctors and Mexican nurses/caregivers, senior citizens could have the best of both worlds.
32
Agreed. The CNA's from the Jamaica were the best caregivers I could have hoped for. Their attitude and casual manners along with genuine empathy and respect were the bright spots during a monthlong stay in a nursing home. Judging from my observations, and my being the healthiest person at 56 in the ward, a nursing home is not the you want to be. Just leave the 'black pill' on the nightstand with hope for not only the strength to take it but also the memory to remember what its for.
5
I spent 3 months in a nursing home for rehab as well. Where I live the best caregivers were Somali and Haitian refugees. But now the Haitians have to go home and we aren't accepting more refugees.
The nursing homes are all advertising free training for certification, with a stipend as well, with a short work requirement. They're mailing former community residents and offering to help them move if they want to come back.They still can't find enough CNAs (certified nursing assistants) to do the work.
Staffing often includes non-payroll staff supplied by agencies. This is especially true during periods of low unemployment because the agencies usually pay more per hour than a facility that offers benefits. If the Kaiser study does not take this expenditure in to account, then the staffing level would not be accurate for those facilities using agency staff. It is true that there is less staff on the weekends. Physicians do not typically come in on weekends and holidays so there are fewer orders to process. There may be fewer admissions so the workload is not quite the same.
1
Having an agency nurse is cause for additional alarm, not evidence of superior care. When most of your patients have memory problems, incapacitating debility and numerous comorbities and May be taking 20-50 medications per day as well as being diabetic, it is simply Unsafe to rely on agency personnel to fill gaps. Even ‘pulling staff’ from another unit can be unsafe because they don’t know the residents. This is Their Home. They merit better.
2
I spent a week in June with my dad as he recovered from hip surgery in a highly-recommended rehab facility that was clean and bright, had private rooms, pretty decent food. And yet... My dad was a stoic, low maintenance patient, but when his pain came on, it was like a freight train. Many times it took an hour from when we hit the call button until his pain meds arrived -- even with my mom and me walking the halls, desperately seeking help. I can only imagine what others go through, since all the patients I saw were alone in their rooms.
Beyond the "ghost town" problem, there's the money. My dad had an overly-taxing physical therapy session on a Monday, and on Tuesday, I told the next PT that he was exhausted. The guy stalled a bit and then began doing exercises on my dad's legs while he was in bed -- literally, asleep in bed. The chatty PT told me that "the company wants us to hit our minutes" and that it can be really hard to reach Medicare's max thresholds (500 or 720 minutes, I think?) when a patient like my dad has a short stay. He said, "Sometimes I'm doing therapy as they head to their car!" We believe my dad's recovery has taken longer because of his soreness and exhaustion from too much PT in rehab. The occupational therapist was clearly trying to "hit her minutes" too, as she sat and chatted with us for exactly an hour each day -- about children's books, her family, whatever.
The care decisions weren't about the patient's needs. It is profoundly depressing.
31
This makes no sense. In fact more and more post joint replacement and next day, patients are sent home and therapy is outpatient. However having been in two rehab facilities -- food was awful--I lost weight for me a good thing. Usually, meds pre-arranged and came on schedule... including pain killlers. Therapy varied in intensity -- and was about two hours -- maybe 2.5 hours a day. Problem was the lack of cold packs, ice packs in the absence of the cooling machine which really helped with the pain. (I was filling plastic gloves with ice.) Key word here is company --aka middleman with overpaid executives … and a reason healthcare in the USA costs more than elsewhere in the world. (I have no idea why people with joint replacements even need OT --which I was also subjected to.)
4
I’m an RN close to retirement. I’ve worked in nursing homes in 4 different states over the past 30 years. My experiences in each were similar: there was rarely enough staff of any kind (licensed or unlicensed) to meet the needs of people in such dire physical and cognitive decline. The idea that the residents should depend on family to care for them when they visit is Outrageous. Most family are over 60 yrs old and/or disabled themselves!! Many residents are in the facility because they have Outlived their families and friends. This situation continues to be a black eye in our advanced health ‘care’ system. There is No Way to put a smiley face or ‘Star’ on it. We have the answers. We don’t have the means. Wake up people: This is a prime example of why we need government regulations. Left to their own devices, the greed of business owners usually wins.
32
The wages are low, the work physically demanding. Of course there will be staffing problems. Plus - there are some things one can't do properly and profit at the same time. Breeding dogs, educating children and caring for those who need personal care.
19
Understaffed means that the underpaid are being overworked. This is a case of the most vulnerable being cared for by the second-most vulnerable.
17
It's also a case of helpless people being cared for by exhausted people. The way I see it, if there are laws against truck drivers driving too many hours a day, and laws against school teachers having too many kids in a class, then there should be laws against a nurse or an aide having to care for too many patients at once. To put it another way: If you fly on a commercial aircraft, do you want your pilot to be, A) all alone with no co-pilot? And, B) bleary-eyed and exhausted to the point where he is falling asleep in the cockpit? (Of course not.) The same is true of nurses and aides. Exhausted nurses make mistakes! Meanwhile, I've seen facilities get so cheap with staffing that they fall back on "mandating." That's an emergency measure where if the nurse who was supposed to relieve you doesn't show (classic no-call-no-show), the facility can force you to stay and work a double. The law allows management to do this to nurses and aides with zero ramifications, with no limit on how often they can mandate you (although in my state they can't force you to work beyond a double, so triples are illegal). They can do this to you many times per week, per year, forever. And they don't care that it wrecks your body, screws up your childcare schedule, makes you miss dental appointments, maybe even ruins your marriage. This is how they keep payroll costs lean and mean. VERY mean. Worst of all, you can get fired if you tell a visitor "We're short-staffed today." Fired on the spot.
7
The range in the appearance of nursing homes--room size and how many occupants, visible amenities, good things in sales materials--is huge. I've served as a chaplain in past years and visited luxurious looking nursing homes and those in which people are stacked dormitory style. Four people in one small room with four t.v.s blaring and none of the people living there watching--and the smells and dirt! Our elders and our children, our most vulnerable unable to care for themselves, are mistreated by run-away greed by owners who care only for profits and workers who fall into scarcity and a depressed mentality and accept poor care as the accepted status quo without any alternative. It's a disgrace. Even in some of the higher end expensive facilities, care is inconsistent. We can do better!
14
The care at Skilled Nursing facilities has always been under par. They have always been understaffed to boost profits. Profits are much more important then the patients and the staff. These place are horrible to live in and to work in. Only when this industry is regulated properly will we hopefully see improved care. People deserve it. The BEST PLACE to be is at home with a family member--or in their home--with a live-in aide with ONE-on-ONE CARE. When you need something--you get it.
9
My 97 year old Mom is in an assisted living which is very expensive and seems to be well staffed. However most of the nurses aides are Black, from the inner city, have to take public transportation because there is no parking for employees, they have to walk a half a mile over America's Technology Highway to the end terminal MBTA station, plus the home is in one of the top 20 most expensive zipcodes in the US. But the rest of the not as expensive zipcodes, i bet the homes are understaffed, and there is no handy MBTA station a half a mile's walk away.
4
I've worked in various nursing homes for 18 years. The owners maximize profits in any way they can, especially by cutting staffing and the quality of the food. The majority of aides work very hard for low pay under conditions which often lead to permanent physical injuries for them. Equipment and supplies are often in short supply and they cannot do their job properly without it. Most residents in these institutions are total care requiring bathing, feeding or set up, changing diapers, transferring from bed to chair. Many have cognitive issues, resist care and more and more we are seeing morbidly obese younger admissions requiring 2 staff just to turn, clean or Hoyer lift out of bed. Some families have unrealistic expectations and instead of being helpful find fault with anything they can thereby contributing to the staff's stress. Yes, there are always a few lazy people but the majority of aides care about their residents and try to do the best they can with what they've been given which may be 15-20 residents a shift. Blame Medicaid for low reimbursement, greedy owners only interested in looking at their monthly bank statement and lack of strict government supervision. I knew a doctor who was opening a new nursing home with several other physicians. I asked him why he would even consider doing this since hiring and retaining staff was such a problem. His answer was "because the money's so good". I guess that says it all.
44
It is remarkably hard work in a skilled nursing facility. There is chronic underfunding to staff and maintain a skilled nursing facility from medicaid. The rules and regulations have gotten to the point of strangulation and an inability to deliver care. So why work at a skilled facility if your break your back for low pay and risk your license under overbearing regulation when you can work elsewhere for the same or better money, less taxing physically, & fewer overbearing regulations.
9
Agree, but complaints about overbearing regulations worry me -- I want my loved one's medications monitored and recorded; I want his showering to be regular and records kept; in short, I want this industry to be regulated so that we learn about things like the staffing issues discussed in this article. The industry tries to save money on staffing and complains about the need to do work that requires more staff.
17
You really believe it's "over-regulation" or rather it may actually be under-regulation?
14
The reality is that a well run nursing facility requires a lot of money which most residents can not afford, particularly those just receiving Medicare and SS. This country has been facing this crisis for a long time, not dealt with the numbers honestly, and it will only get worse. Back in the day grandma used to live with two other generations that helped her through the day, but no more. In addition, medicine has given us a longer life span but not necessarily a healthy, or even cognitively aware, one. This is an adjunct problem to the country’s health care problem. We need to start taking lessons from other industrialized nations- they have better health care for less money.
4
Elder care in so many places is a disgrace. We have an elderly family member with Alzheimer's (but physically mobile) who is in the memory care unit of a supposedly well run facility. Very often there are few staff people available (weekends are a complete void) to be with these folks so they wander and struggle with the ravages (lack of memory and cognizant thought, confusion, anger, frustration) of the disease that they have no idea they have. We are onsite for a couple of hours a day, 4 days a week so we are able to observe the level of care. Most families cannot do that.
We pay a steep monthly fee (that increases every year due to "cost") for this lack of care. I have no idea what these places spend their money on since those on the front line are paid $10 to $13 per hour. The 70+ million in the boomer generation and those that follow will stress the system to the breaking point. Not a pleasant outlook.
31
I think you might have an idea of what these places spend your money on: It's profit in the owners' pockets and in shareholders pockets -- for the vast majority of facilities.
3
For those who care for our disabled, seniors, children, and animals, (all the most vulnerable among us), we give them some of the lowest wages. I believe the next step would be to compare for-profits to not-for-profits (also noted on the Nursing Home Compare website. And yes, I once worked for a for-profit nursing home company, probably one of the better ones in some ways.
One thing I need to mention, this article spoke about Medicare; however, most nursing home residents are covered under Medical Assistance, although Medicare does set guidelines. MA pays less daily than Medicare...another reason for the lower staff pay.
13
The local homes in our area mostly rate "average" on staffing. But we have our own view at work based on how the places manage to get their residents to medical appointments, how often they forget to order or administer medication; whether the residents show up soiled, without an aide, or with a terrible aide.
And if the places we have seen patients from are "average" we are in a world of hurt.
My mother-in-law was incarcerated, for lack of a better term, for five years, as a result of a combination of physical problems and dementia which required not only 24 hour care, but physical assistance with every task, which catapulted her right out of being cared for by family. She was in a good place, but even there, the main thing that kept her care excellent was one or two dedicated and underpaid aides, and a lot of oversight from family. It cost more than $100K per year.
Home solutions wold have been best, but we had few alternatives, with no one living in a home that was easily convertible to wheel chair accessible, and the need for nursing or help through three shifts. We really need to look at how to fund home care better, and solve the problem of poor care in institutional settings.
23
I worked as a nursing assistant 35 years ago, as a college student earning money and experience working with older people over the summer. I loved the patients but it was very hard physical work for very low money. Most of the people I worked with were not going to school, this was their life job. We were constantly understaffed, there was not enough linens/towels to change beds properly or shower patients. The place was dirty. I was constantly asked to do a double shift. I would come home exhausted, fall into bed and do it again the next day. One day I came into work and the floors were sparkling!, linen carts were full!, we were fully staffed! Then 2 hours later a news crew, looking for a scoop on a poorly staffed nursing home came in. It was obvious that someone had been tipped off and the administration was able to get the resources when they wanted to.
52
Having worked as a nurse in an upscale home some 30 years ago, I can guess that the main problem is what it long has been - money (mainly pay and benefits). Even the best homes don't pay nurses and aids as well as hospitals in the area, which means staff often flee after a while.
Another problem was need to cover when staff called in sick. As one of two evening RNs, I would often find myself at 9PM suddenly required to stay all night when the only night nurse called in sick because the second nurse on my shift worked a second job at another home (many of the foreign nurses employed worked two jobs so that they could send $ to families in their native countries). That meant I worked all night with no sleep and nothing to eat since there was nothing available.
For patients nursing homes are very expensive, but costs of such care are also very high. Until we find ways to better pay for nursing care when it is needed the problems will persist. As in many things, the very well off will afford at least adequate care while the middle class and poor suffer.
Some think that it is greedy investors who are the problem. That may be in some cases, but mostly it's about inadequate funding for very expensive, the time and labor intensive care elderly and disabled people need. We will not get adequate care until we recognize that.
39
Thank you for taking those very long shifts! When we hurt, or we hurt for our loved ones, the nurse is on the front lines dealing with the hurt, the fear, and the confusion. "Love a Nurse PRN."
19
Why aren't financial penalties being imposed for behavior like this?
Where staffing levels have been "exaggerated," and the care offered has not been equivalent to the care promised and advertised, families and the government should be entitled to receive refunds.
22
Over the course of the past 20 years, many nursing home laws throughout the USA have been tweaked (by top-dollar lawyers paid by powerful healthcare companies) so that the liability of patient injury no longer falls on management. The blame has been legally shifted to the nurses and the aides. This lack of repercussion for management, combined with the staggering rise in healthcare costs ($3 trillion a year), has motivated multi-billion dollar healthcare companies to buy up nursing homes everywhere, and re-tool them into lucrative butt-wiping factories. The best cost saving measure is to cut staff, which they do. And yet when mistakes get made, when and patients fall and break hips, management rarely worries because the law has little to say to them. It's the nurses and aides who get investigated and sued and destroyed. Management makes a tidy profit and merely replaces the nurses and aides who either quit or lose their licensure.
STRONG ADVICE: Take note of whenever you drive past a nursing home every day. Take note of the signs on the front lawn of that nursing home. Don't look at the permanent sign declaring the name the nursing home. Instead, pay very close attention to the OTHER sign. The "temporary" sign. The one that's only supposed to be "temporary" but is actually "temporarily permanent." The one that says: "NOW HIRING. NURSES AND AIDES. ALL SHIFTS." It's always there … isn't it? It never comes down. Ever. That's a clue. Stay away from that nursing home.
8
For extreme violations, nursing home operators should be going to jail.
4
Nursing homes are understaffed and staffing levels are under reported. I have had experience with nursing homes as both a family member and in work experiences. I've witnessed under-staffing and hanky-panky with all sorts of record keeping. I brought the issues to the attention to the director of my loved one's nursing home, but the director was a big part of the problem. I brought my concerns to ombudsman, a former nursing home director, and he simply gave me the nursing homes' perspective and took no action. Next, I contacted the state and let them know that the nursing homes knew exactly when they were coming to do a "unannounced" visit.Immediately before an inspection, staffing increased, PEOPLE WERE TAKEN TO THE BATHROOM WHEN THEY ASKED. The facility was cleaned properly,the food listed on the menu was actually was served.Mores snacks were available. Many aesthetic improvements were made.Some people were put in improved wheelchairs. Residents received proper, dignified beauty care, showers were given on schedule and not widely noted as "refused" in the paperwork.The activities that were scheduled actually took place. I explained all this to the state, and they responded with, "We know, that's how it is." When I suggested they be less consistent, and visit a month earlier than expected, they said "That's not how we do it." The problem with officially discovering and documenting problems, you must do something to solve them. But it must be done. The heartache I have seen.
42
Nursing homes are also understaffed for doctors. Just now a friend in an expensive well-rated nursing home has been waiting to see a doctor for four days and keeps being told one is scheduled for today for him. We may take him to emergency nearby instead of waiting for a non-existent doctor to show up.
The aides are generally lazy at this facility too and not understaffed. They like to hangout at the desk and chat rather than check on patients.
14
When nursing home operators are permitted to lie and steal and abuse with impunity, it is no surprise that staffing levels are “overstated”. We have a sickness in this country that springs from greed. We see it in the nursing home “business”; we see it in health care generally; we see it in for profit prisons; we see it in our congress and in our corporations. The government should be providing a balance to the natural inclination toward greed but now that money rules our government, it is hard to see when or if this will change.
42
This is scandalous and with more aged people in need of this kind of care, it's high time that Medicare got into the trenches and actually inspected these homes unannounced and at least twice a year. All of us can wind up in one of these facilities and so we all should be concerned.
15
This is an excellent article. I am a caregiver for my 84 year old husband who was in a nursing home for over 3 months for rehab about two years ago (he went in with a walker and came out in a wheelchair). I swore that I would never send him back to the same place. However, I needed a temporary place - one month - for "respite." Because this place is so close to where we live and I visit daily he went back to the same place. They definitely don't have enough help and the situation is worse on the weekends. We told the nurse who had come into his room yesterday (Saturday) that he had to get to the bathroom. She said she would send an aide. After waiting about 45 minutes the aide arrived too late. She tried to get assistance but there was no one available - so I assisted her.
From my experience - if you are a patient in a nursing home or a hospital - it can be a negative experience unless you have the help of a good advocate - whether a family member or friend - it's crucial.
29
@jlneidorf
I understand your reasoning. I think these should be paid CNA's and not always family members. With agencies who pay family members the patients are often taken home just so the family "caregiver" can make money. A 20 year old taking in an 70 year old dementia patient. And then the oversight people are completely untrained. It's a mess. I'm telling you Residential homes were wonderful. They have fallen by the way side. They were homes not "Rehab Centers" or "Longterm care facilities" or "nursing homes".
11
The article, and the comments, ignore the issue that matters. Nursing homes are paid for care of Medicaid patients per patient, per day. The payment formula is not related in any way to the quality of care. There is no financial incentive to provide good care. Nursing homes are most profitable when they provide the cheapest care. Lousy care equals a profitable facility. Why would anyone, including NYT, expect a different outcome? NYT should have addressed the Medicaid reimbursement formula, and the large number of extremely wealthy people profiting from it.
58
How about outrageous charges to Medicare by "sacred cow" hospices? For 2.4 years, my wife who has advanced Alzheimer's, has been in an excellent full-care nursing home type facility that charges the same monthly fee for all needed services, even for those who are wheelchair bound. After breaking her hip 10 months ago, she got severe blood clots and seemed to be entering a terminal stage. I engaged a hospice that also serviced about 12 other facility patients. It provided a hospital bed, wheelchair, sporadic minimal nursing care (the facility already provides 24/7 nurses), minimal doctor care by the 86 year-old sole hospice doctor, no more than 7 hours per week of aid care, minimal amounts for medications, and a chaplain who briefly prayed for her weekly. For this, the hospice billed Medicare about $6,000 monthly and was actually paid about $5,800 by Medicare. After about 3.5 months and about $22,000 cost to Medicare , I took her off hospice and do not intend to ever reengage a hospice for my wife
7
From my experience and what I’ve heard from others, you and your wife could be some of the lucky ones.
Hospice operates largely as a black box - you have more information than most on how they realise revenue.
Patients usually go ‘on service’ for three month intervals. Am not sure if they are paid month by month or for the full three month interval (even if appears as a monthly billing to Medicare), but by their behaviour things seem to incentivise a patient going on service and passing away quickly - despite clearly expressed family wishes to the contrary.
That would seem to indicate an up front lump sum payment for a month - or even three, regardless of patient longevity. The shorter the patient lifespan, the higher the net receipts.
In our instance, they proscribed two drugs that are strongly contraindicated in the elderly, and even more so for the diagnosis given to our family member - resulting in a two week hospital stay. One of the two drugs isn’t even generally proscribed any longer because of high rates of morbidity in the elderly.
Our experience dovetails with countless stories from others - including caregivers and a family member doctor that have witnessed these sort of things repeatedly.
Hospice was a means to an end at least - to take our family member out of a LTAC (Long Term Acute Care) hospital that also seemed intent on doing away with them (but not before fully milking their Medicare benefit period of course).
It’s been an education.
My mother paid privately for nursing home care $11,000 a month out of her pocket. Tell me how that is not enough to provide high quality care. It is not Medicaid profiting, it is the greedy owners of these facilities.
2
Elderly people want to live comfortably at the last stage of their lives. Nursing homes should have enough staff to make the elderly feel happy. If they are annoyed with labor shortage, the government should accept more immigrants for the happiness of elderly people.
18
Immigrants are not the answer. The answer is to pay aides a living wage and monitor their performance properly. Neither happens in nursing homes or personal care homes.
1
I recently was sent to the ER and then admitted to the hospital for an unexpected medical emergency and ensuing surgery. Medicare only allowed 6 days in the hospital for this procedure and then I was literally booted from the hospital.
When I was released, I wasn't in the best of condition. I was weak and worried about my ability to care for myself. I was informed that I could go to an SNF to "recover," should I so desire. My reaction to this offer was overwhelming and very telling.
There were NO circumstances under which I would allow myself or any family member to be sent to an SNF. EVER!
Anyone with just a cursory knowledge of this field has heard the horror stories or read about the abuses in the media. I would honestly rather take my chances at home, or fall over dead trying, than allow uncaring strangers to influence my health or recovery.
We know these abuses are happening, and yet, we're allowing them to continue. Why? These patients are our mothers, fathers, aunts, uncles, friends and children. To know they're being ignored or abused and still paid is obscene and unconscionable.
How can we call ourselves "civilized" and allow this to happen?
26
Having been 1 of 2 children responsible for our mother's care in her last 5 years, we were fortunate to understand the other alternative to a skilled nursing facility was available to us. Any hospitalization greater than 3 days opens up 2 months of home health care for Medicare patients. Mom was able to have physical therapy at the house. She had 3 visits a week by a CNA. The nurse visited at least once a week. Blood work was done at the house. Of course we the sons made sacrifices: we either paid for additional home based support (house cleaning, additional care giver support) or took time off from work/family. Of course not every family is in the position to do this, but for the many that may benefit & prefer this alternative to a SNF, they are left in the dark. All hospitals must have a social worker that facilitates the Medicare B home health benefits at "discharge planning". Mom had at least one hospitalization a year in her last 5 years, and each time this was our solution in keeping with her wishes. She had many of the same care givers for each of these occurrences; they were not strangers to her, many keeping contact with her through social media.
10
If you must ask the question then you couldn't possibly accept an honest answer.
2
While the patients suffer, the owners and investors of these facilities profit from the miscare of the patients they are supposed to be in charges of. The hard truth here is that capitalism and patient care are incompatible. Yes doctors and nurses need to paid, but there also needs to be hard edges to profit only systems. And the caring of elderly and the sick are where the edges needs to be drawn, otherwise you create situations where vulnerable people who need support and services are instead neglected for profit.
31
Families don't have long-held suspicions of inadequate staffing, we have eye-witness observations.
38
I graduated from nursing school in 2008, just in time for the Great Recession. Suddenly, no one wanted to hire new nurses. After 10 months of searching, I found a job in a nursing home. I went through 4 facilities in 2 years. I had 15, 17, 25, and (for one horrible night shift) 60 residents. The 60-resident shift was my last shift in a nursing home. If I hadn't found a job in home health, for less money, I would have walked away from nursing altogether.
My mother went to a nursing home for hospice care. She didn't have the strength or dexterity to use utensils, but she still wanted to eat. My siblings and I told the staff several times that Mom had ti be fed. No one did it; someone would drop a tray on her table at mealtimes, then take it back 30 minutes later. If I or a sibling weren't there at mealtimes, Mom didn't eat.
I will sell my body on the street before I work in another nursing home.
35
Yep....I've witnessed this first hand. The only patients/residents who thrived were the lucky ones who had family visiting them religiously on a daily basis during mealtimes to make sure their loved ones were fed, clean, etc. My heart broke for the others who weren't so fortunate. It's an absolutely atrocious system.
4
As a RN, a husband, a father, and a child of two aging parents, I tell my patients and their families that it is absolutely incumbent on families to be present as much as possible for family members who have been placed in nursing homes. These facilities barely make any money from Medicare and they have a difficult time retaining nurses and ancillary staff for what is usually grueling, depressing work. Family members often have this idea that they can place their loved ones in these homes and then visit for an hour once or twice monthly for a stroll down memory lane while someone else bathes, dresses, feeds, and intellectually stimulates their loved one. Unless someone has unlimited funds (in which case they are likely at home with private staff), this will never be the case. One of my Ghanan aides once said it best as we were cleaning a patient who had soiled herself in bed. She said, "In my country we would never treat our loved ones like this. We take care of our parents at home." In other words, despite the best efforts of our healthcare system to care for the aging or infirm, nothing will ever replace family. While some people are exceptions, too often people in Western countries don't want to deal with the reality of sick family members and would rather someone else do the hard work for them. BUT good care costs money, and most people don't want to pay for good care or can't afford good care, so they look to blame the system instead of looking in the mirror.
41
We live too long now too. My 90 year old Mom has a lot of fellow residents at her Assisted Living Facility that are 90-102. Looking at the quality of their lives( usually very diminished cognitive abilities) she tells me at least once a week- people live too long today.
Of course the way things are going and the people who run our country think- Boomers will not have access to the health care that has kept our parent’s generation a live for so long. So it revert back.
10
Many people work and can’t afford to give full-time care to elderly or sick family. Many people don’t have the physical strength to do it. Lifting a disabled person to bathe, or turning a person in bed is physically demanding. It also requires training, in many cases. People with dementia need attention 24 hours a day, keeping family caregivers prisoners in their homes, when they undertake this, until they realize that they are way overburdened and harming themselves. It is unrealistic to think that family members are able to do this, and unfair to make people feel guilty because they are not able to. I babysit my 3 year old grandson a few hours a week and just lifting him to sit at the table can be a strain on my back. I would not want to burden my children to care for me when I am in need of such attention. Your Ghanan aide would not be working in the US if the system were so positive in Ghana. Clearly something breaks in a modern society when people live longer than ever, families are small, and women are not confined to the home and to caring for others for their entire lives.
6
Working as a RN Case Manager, believe me, I understand. I round with physicians and speak with families every day about their difficult living circumstances. But for every one family who is in true need for resources due to a catastrophic illness, it seems I meet two or three families who simply don't want to be inconvenienced with the burden of caring for an aging loved one. The reality is Medicare only pays for acute rehab stays for up to 100 days, Medicaid covers long term care but most people will not qualify due to its strict financial criteria, and most people haven't purchased Long Term Care insurance, which is in my opinion, a golden ticket to aging in place in one's own home. Beyond that, yes, I understand everyone's situation is unique; however, the notion that these institutions are going to care for your family member as well as you could, is simply not realistic given the abhorrent for profit model we have here. As far as my Ghanan aide, she, like other immigrant aides and nurses I have worked with send money back to their families in their villages so they can continue to support large extended families. Yes, all is not rosey in those countries, but at least they have their priorities straightened out. In this country we have tried to shy away from sickness and aging and farmed out the care of our loved ones to strangers, and this is the model of care we can expect because we keep supporting politicians who favor the free market over personal dignity.
3
1. These are your tax dollars at work.
2. Supply and demand applies. If it is harder to fill weekend shifts simply increase weekend pay.
3. Nursing home owners make huge profits. They put family members on the payroll. They also are major contributors to politicians.
30
I have worked as a Geriatric Nurse Practitioner. So much has changed. You can no longer seat a patient with dementia who continuously gets up and falls down at a table. This is considered a restraint. When this was possible I always witnessed staff constantly checking on patients , now it’s medications HOWEVER This is considered chemical restraint. Now staff run around trying to prevent falls. The only way you can put a loose belt on someone is if they can unbuckle it. And folks with a light buckle often treat them almost like a puzzle. Now anyone who is a considered a fall risk in placed in a a bed, lowered to the ground with pads on either side of the bed. Alone and frightened. Staff would come to me frustrated asked me to medicate residents so there was less of a risk of fall. How do you do this without over medicating? Most staff love their residents but it becomes a matter of keeping your license. Rules are strangling many excellent long term facilities. There are bad places. but programs like “money follows the person” have forced closure of many long term residential homes. I watched as Marshall Lane was closed. A place people lived for years and were loved by staff. Later I went to see a patient who had lived for there for 40 years until “MFTP” closed It. Now she is disoriented, sits alone in wet pants because the staff are overwhelmed. My heart broke. I left my job. The long term residential homes supposedly costs to much. This system is so broke it’s tragic
35
Broken is right! I remember when the 'no restraints' law started. We had a temp DON who raced through the building in a frenzy, liberating patients from geri-chair trays and wheel chair seat belts. She didn't know our patients or care. That same evening. two fell and broke hips--one of them was my favorite lady.
I have worked in several skilled nursing facilities and have seen firsthand the neglect that results from chronic understaffing. When inspections occur, facilities "staff up," refuse new admissions, and send residents who might make a scene to acute hospitals. In one SNF that received 5 stars from Medicare, patients complained of sitting 2, 4, even 12 hours in their own waste while they waited to be changed. People went days and even weeks without oral care. Many residents developed pressure wounds; some sores went to the bone. CNAs, who are overworked and underpaid in a physically demanding and often thankless job, regularly turned off residents' call lights without asking why they were pushed. Last winter a woman who pressed her call light too many times had her heat turned off in retribution. Two others complained to me of physical abuse by separate staff members. That's what I heard from residents on my caseload who were able to communicate. What was happening to the many residents whose dementia and other cognitive-linguistic disabilities rendered them unable to tell anyone about their experiences? I had the local adult social services number on speed dial and my calls almost always went unreturned.
30
Anyone who has taken care of an elderly parent knows that $13.23/ hour is not a reasonable wage to pay those nursing assistants.
75
My daughter worked in assisted living as an aide for several years. They expected and encouraged high turnover in staff. That way they were always trying to "hire" but never really got to full staffing.
It would be interesting to have some investigative reporting on profits in this industry.
49
While staffing issues are a serious concern, equally concerning to me is why a 47-year-old man who suffered a stroke a year ago is living in a nursing home instead of in his own home with a personal attendant. There is no reason for him to be institutionalized; data support that caring for someone in their home is less expensive than caring for someone in a nursing home, and Lord knows it is far more independent for the individual.
29
The only reason a person is "institutionalized" in the USA is because his/her family cannot afford homecare. Open your eyes beyond your state border to see what the Affordable Care rollbacks mean for all of us.
3
Perhaps because he does not have the means to own a home or rent a decent apartment?
2
If you have to pay out of pocket for a nursing aide it cost $20.00-25.00 an hour x24 hours. Not many people can afford this.
6
Lying about stafffing is routine, as is forcing nurses to mark they have given pills Even though they weren't available. It didn't look good to have all those blanks when the state came. 40 patients are routine. Nights I had 60 to 120 and a building to manage. Nursing homes don't give pain meds even if a patient has visiting hospice. State inspectors don't care.
26
Not just pills but insulin. Its horrific! Many times I had patients tell me "I've never gotten that before" or "I'm supposed to get twice this amount". I would double and triple check myself. Only logical explanation was that others were signing for medications they never gave. I had multiple nurses tell me "just sign it".
5
I worked as a nursing assistant for two years, starting when I was 18. In the beginning, it seemed like a great way to pay for nursing school--my starting salary was $10.50, much higher than Wisconsin's minimum wage of $7.25, and I would have a chance to get some healthcare experience that would help me as I studied to be a registered nurse. I soon learned that working in a nursing home was far from ideal. A few weeks in, I was "running the unit" by myself due to lack of staff. At 18, I was in charge of a group of 22 elderly people for eight hours at a time. Their needs ranged from simple supervision during potentially risky activities like showering to complete assistance with everything from dressing to eating. Many of my patients had to be fed by hand, turned every two hours, constantly checked for soiled clothing, etc. There was one LPN for each unit, and she was so busy with nursing tasks that she could rarely help with CNA duties. Technically, according to facility policy, there were supposed to be two CNAs on each unit of 22 residents, but it was rare to have another aide with me for more than a few hours each shift. Staffing was so poor that I began desperately to search Wisconsin policy--there had to be some sort of rule for aide to patient ratios, but if there is, I never found it. Eventually, the stress of being an aide was too much, and I quit. I am glad to see this article that finally brings this problem to light. I hope to see better staffing in the future.
95
One of the major problems is that although the guidelines for many issues come from a federal entity, some of the staffing regulations
come from the state. Ah, the glory of states rights.
In some states on an RN or LPN can give meds; in others an aide specially trained can.
4
When my mentally fit father entered assisted living, we were advised after an “evaluation” that he would require the highest level of care. For the exorbitant fees we were paying, we were told that two aides would be present for dressing, bathing, etc. He rarely saw more than one.
Similarly, when he went to a Medicare-funded rehab facility, we observed such a large population of patients “treated” by a single physical therapist, that none could possibly make much progress. Lo and behold, after the facility had collected its maximum fee, we were told there was nothing more they could do for him. When we got him back home, we ordered one-on-one therapy and he was up and walking in a few days.
Stringent regulations against these places are long overdue.
73
This is Republican de regulation at it's finest. They certainly have ZERO interest in funding the kind of intrusive inspection regime that would be required to remedy these problems. Meanwhile, the campaign contributions from the industry roll in and some people are getting rich.
3
I was in a nursing/rehab facility for 12 weeks (exactly the Medicare maximum) a couple of years ago. Medicare requires that you have a minimum number of hours of therapy a day. Actual therapy, for either my injury or my underlying condition was way less.
On arrival we were each put on a bicycle for physical therapy or an 'arm cycle' for occupational and ignored for 1/2 an hour. This was our aerobic exercise and 'our' therapist would be either working with another patient or catching up on paperwork during that time. Then we would actually work with the therapist on the condition we were there for for another 1/2 hour. After that we would be sat or stood doing some sort of useful activity, electronic or using other equipment for the rest of our scheduled time. This way the therapist was able to 'work with' 3 patients at once, each for the required time.
For 3 weeks, my mother was in a nursing home with dementia coming every day before and after work. One day I arrived to find notices all over the home alerting the staff that on a specific day, the government inspectors would be coming for a "surprise" visit. All of a sudden, the number of staff tripled. The inspectors came and left - along with the extra staff, and the home got an excellent rating for staffing on the Medicare website.
49
That's what "for profit" facilities get us. Neither healthcare, education nor prisons should be for profit.
99
I am thinking aloud, specifically in response to this article, and please excuse me if this is inane: Mandatory paid public service for all U.S. youth, for six months, at some point after they turn 18 and before they hit 25. (Or half time for 12 months or quarter time for 24 months.) That's upwards of 1.5 million people per year (https://nces.ed.gov/fastfacts/display.asp?id=372) ...and I would imagine that the long list of possible assignments would include tasks that an untrained person could do at these facilities and that would go a long way toward mitigating the effect of staff shortages. (Certainly helping people get dressed is one such task.) Young people who join the military are exempt. Perhaps people over the age of 23 are welcome to sign up. Yes, I don't have any answer at the moment to the question of where the money would come from, to administer the program and to pay the participants.
25
Jonathan, I think you may be misunderstanding patient requirements in a nursing home. I think your idea is interesting but helping an elderly patient with dressing is certainly not a task for an untrained person. Many elderly are wheelchair bound, combative due to dementia, or simply frail due to age, osteoporosis, etc. Helping a patient put their arm into a shirt can easily cause a rotator cuff injury in someone so frail and assisting with pants often requires that the patient stand up, leaning their entire weight on the aid (as they often are unable to support themselves) while the aid tries to get the pants pulled up, buttoned and zipped, often over an adult diaper - not easy with a 180lbs man suffering from dementia. As a large percentage of our population ages, facilities simply need more staff and the staff need to be paid better. As for myself, having seen numerous facilities in my former career, I sincerely hope that, when my time comes, I have the option of a graceful exit.
24
Thank you, H. Maybe it's an idea for a different context, if anything.
Separately, while the industry spokesperson is quoted here providing a rationale for the apparent understaffing, that doesn't excuse the false reporting. I assume this problem could have been addressed long ago if not for that. One of the articles linked from this one (see "...making it possible to game the system"), an August 2014 report, describes how Medicare's five-star rating system has been based partly on unverified self-reporting, so the incentive to lie clearly was there (i.e., to get more stars). The earlier article also discusses the origins of the rating system; I came away with the suspicion that the nursing home industry, which at first was totally against the ratings, let up only after leaning heavily on the government to ensure that the system would be honor-based. (Ugh.)
2
1.Your presumption that no training is required to help some one dress let alone bathe is frightening.
2. You want people with trustworthiness patience, empathy and who genuinely care working with seniors, otherwise. They will see you naked, peeing pooping without teeth - in other words at your mist vulnerable. You want an untrained person??
3. Why are wages lowest for those who care for people (childcare giver , senior caregiver) It echoes the values a society has that they are paid the least.
3
I worked at a local nursing home for 2 months. It was my first job as an RN and I was the only RN in the building for most of my shifts in a 120 bed facility. There would be about 4 LPNs and 6 aides in the bldg. I was responsible specifically 30 patients for medications on a shift, it was absolutely impossible to get everything out in time or at all. It was so unsafe. I quit one night after an 8 hour shift turned into a 11 hr shift with no lunch or bathroom breaks. I not worth my license or the risk of hurting someone.
60
Reality check old age is disease an can be prevented completely.Think of all the adult homes would go broke if people didnt grow old. Foutain of youth is here.
I worked in the office of a local nursing home some years ago. People sat or laid unattended in their own waste for long periods of time while the CEO brought home hundreds of thousands of dollars a year as a bonus for saving the owner money.
65
Being a certified nursing assistant is hard work. It's physically taxing, emotionally draining, and the burnout factor is high. Couple that with the fact that the pay is low, residents are unpredictable, and it's often a truly thankless job, in an economy where many other jobs are available, and ask yourself, why would anyone want this job? Everyone I know in the Baby Boomer generation has extracted promises from their children NEVER to put them into a nursing home. When the time comes, however, will their children be able to keep that promise?
My niece worked for 10 years in a nursing home. She's 37 years old. She needs a new hip, a new knee, has back problems and has vowed never to do that kind of work again. She was often mandated to work double shifts because when your replacement doesn't show up, you can be charged with patient abandonment if you leave. Your license is on the line. One month, she had to work double shifts for 22 consecutive days. She burned out and quit. She went to another nursing home, where they promised no mandated overtime. No such luck.
So tell me again why there are no people working in nursing homes? It's easier to work in other health care settings. Pay is higher, too.
84
Is anyone going to address the obvious trends on the data map of the United States? Texas, Louisiana, Georgia, Indiana, basically all conservative states are almost entirely under staffed for nursing homes. I wonder if that had anything to do with the deliberate destruction of anything resembling society or healthcare when under conservative rule?
85
These nursing homes are not being honest. It is a war of the call bells and checking patients who cant or are too dicouraged to push the call light or have it hidden from them because they push it too much.
Outcomes? The nursing homes consider that if they dont get a bed sore or lose weight that this is actually living? It is just hanging on to existence.
The patients that get taken care of are the ones that have families constantly, 24x7, visiting. Patients need to go to the bathroom which can take a long time, get out of bed once in awhile not just go from bed to a recliner, need food likely fed to them and someone to encourage them to drink water, etc which does not happen with aides taking care of so many patients.
How can an aide hand feed 8 patients even 1 meal when dentures need to come in and out etc? Impossible. But additionally they need to help patients that require 2 aides to help because they are too heavy for one aide to move. And they need to help slow moving patients to the bathroom. What about the many patients
These government reports are just statistics. They do not show the horror and neglect that is rampant in the nursing homes in which I have worked. Nursing homes prep the units when the surveyors are there. And when nurses dont help aides and only pass medications or the charge nurse is not good, it is much worse.
Weekends and nights are only the worst times, not just the times when care is inadequate as the nursing homes claim.
46
Conservatives say families should take care of their own in their own homes if they don't like the conditions in nursing homes.
Would this have come to light without the ACA? Now there is data with which to work. Without regulatory protections from our state and federal governments, most people may find themselves powerless against large private for-profit bureaucracies in all sectors of the economy. The current push for extreme de-regulation may find us all at the mercy of deep pockets corporate malfeasance in so many ways.
79
Thank President Obama for The Affordable Care Act, which shed light, by law, on these sobering facts. I thank him in my heart every day for being a leader that looked out for our interests.
183
Imagine what will happen to the elderly if Trump gets his wish and every part of the ACA is eliminated? Maybe then people will realize what he's done, but by then it will be too late.
3
It's a scandal that we pay less than minimum wage to the people who care for our elderly, yet at the same time, elder care costs more than most of us will make in a lifetime.
100
When my mother had a hospital admission five years ago, we went to a nursing home afterwards for "rehab". It was an extremely expensive nursing home (covered a short time by Medicare). I literally "moved in" with my mom for 7 weeks. I am a healthcare worker. Hear me: if you put a family member in even the best nursing home SPEND THE NIGHT with them, several nights. After 5pm the administration and the staff disappear. One nurse had 200 patients. You will NOT know where you've placed your loved one until you've stayed (and stayed awake) through several nights. It was a shock. And a travesty.
234
My mother was sent to a nursing home for rehab for 6 weeks. The hospital always sent patients there for rehab because Medicare paid for it. In the middle of the night, her roommate got up (my mother believed to go to the bathroom) and dropped onto the floor. My mother rang the bell for 20 minutes before she could get staff to come. By that time her roommate had died of a stroke. The second time my mother went into a nursing home for rehab, after a bladder infection, *she* died of a stroke. After no previous history of strokes.
3
This is sad, appalling, and terrifying all at once. What happens to these vulnerable people? Aside from visiting every day - which is key if you have a loved one in these places - what are family members to do? Not everyone has the ability to care for a sick, disabled relative at home. The fact that the frail elderly are not properly cared for due to nursing home staffing issues is terrible and, as the baby boomers age, this problem will only get worse. Some of these people are going to live a very long time after retirement, too: my local paper recently carried an obituary of an area resident who had died at 105. There are definitely baby boomers out there who live that long and who will probably need skilled nursing care at the end. Who is going to care for them if the nursing homes can’t? Their children, who will be seniors themselves? Their middle-aged grandchildren, if they have any? Our esteemed Republican Party?
This is a very real problem that we need to solve and pronto because, unless we’re unfortunate, we’ll all get old. One day it may very well be us in that wheelchair or that bed, vulnerable and waiting for help that never arrives.
53
The solution is to die before you get old. I'm serious.
5
@True Believer - As someone who’s had a couple of friends and acquaintances die young - one of cancer, the other in a car accident a couple of months after the birth of her daughter - I can assure you that this is no solution. Neither of these people lived to be 30, have long and happy marriages, grow and explore the world or, in the case of the car accident victim, watch her child grow up. (In another decade, that unfortunate woman will have been dead longer than she was ever alive.) They may never have had to deal with the frightening specter of understaffed nursing homes, but they also never had a chance to really live, and their parents and devastatingly young spouses had to bury them. While there needs to be a solution to understaffed nursing facilities and there needs to be better and more compassionate care for our frail elderly, hoping to die before one gets old is not a solution. I’m serious. I’m sure the families of my cancer-stricken friend and the acquaintance lost to an irresponsible driver would have given anything for things to have been different. I’m sure that motherless daughter would have wanted her mother to have lived long enough to grow old.
1
And this study only covers nursing homes, not assisted living with its various levels of care, some quite serious. Thank you for the clear analysis of hard data and insightful actionable next steps - all a breathe of fresh air in an industry driven by money and greed, constantly promising 24/7 care and never delivering.
My parents had dementia and I have seen assisted living - up very close - on both coasts. Aides are, for the most part, heroes and angels, underpaid, kind and skilled. They absolutely should be paid more.
Weekends in assisted living are truly ghost towns. I spent 6-7 nights a week over 6 years with my mom once she lived in my town. I know first hand the conclusions in this report are true.
Yes family are there weekends for lunch, or an outing, but after 7pm? Don’t need help because you might not get it, or you might wait awhile.
Please keep analyzing the data, hopefully sharing improvements, or not, whatever is true.
It is a scandal and a shame, but with good data, there’s hope for delivering the care our parents, and eventually, we, deserve.
59
The institutions charged with protecting this vulnerable population such as State Surveyors, Omsbudman, Prosecutors, AG's Legal Aid, Adult Protection Services, Area Agency on Aging, and more shirk their responsibilities, side with facilities, wether understaffed, under qualified, not even willing or able to offer basic standard care mandated by state and federal code, and in turn causes neglect and abuse! I know, I have lived and still live through this nightmare with my 98 year old Mother that has been under nursing home and assisted living care for over 10 years. The things that Mom and family care advocates have gone through is indescribable!! We have reached out to nearly every resource available to advocate for basic care, safety, food, water, cleanliness. Mother has been let down at every level Staffing is a large part of the problem but certainly not the only problem Oh the stories I could tell!!!
27
I am a state surveyor. We can only enforce the regulations which are nonspecific in staffing ratios. The politicians and lawmakers are the ones who let the business owners off the hook. These homes are businesses and lucrative businesses at that. Deregulation is a big problem. Regulations and laws are necessary to protect these people who are so desperately in need of care.
38
Thanks for speaking your point of view.
Trump will fix this by appointing a Scott Pruitt klepto-clone.
The post that suggested non-profit care has some merit, but it is only money that gets legislators’ and state regulators’ attention.
The trouble now is the shouting of legalized bribery in every area touched by government and gerrymandering silences the cries of the public. Overturning Citizens United matters!
Trends in deficits and health care point to a planned wave of federal, state, and corporate institutional neglect for care in the last years of the baby boom that only thoughtful planning and reform can reverse.
12
These places are profit centers ... period. During the three years my mother was in a nursing home, I routinely witnessed understaffing. I worked a full-time job but made sure I was there every day to help my mom eat dinner. Most of the time, the food was stone cold by the time it was served--or completely inappropriate (huge kielbasa served on fat buns dripping with sauerkraut, really?). On weekends, I showed up at different hours, because the head nurse told me that was the best way to ensure that my mother received adequate care--keep the staff guessing as to when I'd show up. Some patients never had visitors.
My mother was placed in a single room after it became apparent that having a roommate distracted and agitated her, making it difficult for both her and the other resident prisoner to sleep. Then I got a letter from the home's lawyers, stating that because my mother was on Medicaid (after spending down all of her savings), she had to be in a double room. The truth was, they wanted to admit a full-pay patient, and they could get more money for the single room she was in. I did not hire a lawyer but fought them myself, with the assistance of the county ombudsman, and I won.
Many of the nurses and aides did the best they could, given the circumstances, but others were completely incompetent. Some were downright stupid. When I overheard a couple of them speculating as to which patient would die next, I had to restrain myself from slapping them in the face.
85
You are so right that I am crying.
3
Yes, they took less “care” of my mother once her private pay was exhausted.
Then, my family realized the financial staff person was helping herself to payments that should have gone towards staffing.
An administrator also got rid of anything that brightened up the lobby area (e.g., flowers, etc.). Of course he was lining his pockets with anything he could get. Disgraceful. This “nursing home” was in Northern NJ.
4
Imagine if we ran schools or child care centers as badly as we run nursing homes. Kidnapping old people, stealing their property, drugging them up, abusing and neglecting them in every way. If we treated children as horribly as we treat the elderly, there would be angry national outcry. But the old in the US are treated as disposable people. Don't forget that most of us will be old some day.
65
If there is any way possible to keep your loved one at home, DO IT. My husband is 92 years old and severely disabled. I will NEVER allow him to go into a nursing home, even if I wind up spending every dollar I've saved during our 50 year marriage.
I cared for him by myself for about ten years, but I'm pretty old now, and no longer have the physical strength to do it. I have hired two aides.....one for weekdays and the other for nights and weekends. My husband gets individual personal care, and it still costs me less than a nursing home.
When I hired my two aides (after trying and firing several others), I decided that compassion and care these ladies have is far more valuable to me than any certification they may have. My husband "loves his girls", and I can rest easy knowing he is well taken care of.
111
this is a beautiful, poignant letter. Thank you for writing. I wish there were millions of you out there
11
If you think there is no possible way to keep your loved one at home versus a nursing home ---THINK AGAIN!
My Mom has been gone a year now, but I know I did everything I could to make her comfortable and well cared for in her final years by keeping her at home in Ohio. That's what all her doctors recommended for her and for good reasons. And I have no regrets about that choice.
I hired a private-pay agency for caregiver help in the mornings and then again a shift in late afternoons into early evening, which gave me a chance to rest or shop or just get away for a few hours. It was expensive but less so than a nursing home. But most importantly, it was a better quality of life for Mom. She had multiple medical problems way before cancer finally caught her (including macular degeneration and advancing dementia), so be aware that the risk of falling would have been very high in a nursing home versus staying at home. Not only would a nursing home have been a new, unfamiliar environment, but the lack of adequate staffing there is a huge issue. If you think someone will always be around in a nursing home to help your loved one-- THINK AGAIN!
11
You are fortunate to have the resources to spend a fortune on quality home care.
2
I worked as a nurse for Beechtree. We were always understaffed. It was never a surprise to come to work to find that you would be the only nurse on the floor, 40 residents, to pass meds, do treatments, chart, and help feed. It is deplorable.
82
My dad stayed at a number of nursing homes during his last years.
Most were so short staffed that many workers had double shifts. At the last one where my dad only stayed two weeks, two the staff were hospitalized after they had separate car accidents on their way home...they were too tired to drive. At several of the nursing homes I would wander the halls looking for any worker. Nurses were extremely hard to find.
My dad had a care assistant at home 24 hours a day, so he was only subjugated to this lack of care after major medical care. We were told the 24 hour service was being discontinued due to inability to get enough staff for even 12 hour care.
Almost all of the health care workers were immigrants. The anti-immigrant attitude has caused a major reduction in the number of health care workers, as has the low unemployment rate.
Considering the aging of the baby boomers...who is going to care for those in need of ongoing health care? Does the GOP expect our ill and elderly to be sent out on an iceberg like in mythology? Not even the icebergs are healthy enough for that use!!!
68
GOP demands that abortion clinics need to have associated hospitals,
strange that they have failed to require the same associations for nursing homes.
92
Yes, it is strange that if the problems have been going on for many years, Democrats have never mentioned them and did nothing to fix the problems during the Obama administration.
The system-decades of complicity with pay-to-play owner/operators of these Nursing Home facilities which keep their enablers-our bad pols in office-continues in New York -unaccountable. What should be considered criminal negligence is allowed to be paid off with chump change penalties.
Here it is 5 years later...NYT story-familiar names are still on the current reprehensible 'scene'.
https://www.nytimes.com/2013/06/24/nyregion/reinventing-long-term-care-a...
Or 10 years ago...yes...more of the same...
https://www.villagevoice.com/2010/10/13/the-sick-looting-of-home-health-...
Misdemeanors need be bumped up to felonies!
If Nursing Home owner/operators refuse to protect their patients/residents-they should not be allowed to continue in business. Yet more branches are opened & more certifications are given to the same bad actors!?! Those who would harm patients by understaffed greed should be rewarded by jail time.
Those pols in Albany which abet their gangster owned long term care facilities should also get locked up. Enough already.
44
I first fault the branches of government that allow one, or two, star facilities to stay open, especially with multiple citations and fines. Even if the states and fed. govt. pay, they really don't care.
NFP facilities may not be better, as the profit can get shunted into hefty salaries for management; that is how many NFP hospitals work, even good ones.
Time to instigate minimal staff to patient ratios. Nites are a problem, in good hospitals too, when assistant staffing goes down. Plus, some assistants literally hide because they don't want to do the heavy work. Can't tell you how long it took to get rid of these shirkers when I worked as an RN at an excellent hospital. A bigger problem in nursing homes even with good staffing; need management to make surprise nite visits and catch the staff talking while ignoring call lites. Time to hike the pay scale for staff that perform their jobs properly.
It will take much input from caring family members to insist on more improvements. Yet, at the same time, be honest about the need for a decent profit and/or excellent pay for management. Why else would most people want to take the 24/7 responsibility for running facilities catering to a population that is difficult and exhausting. And more than occasionally some managers spend the nite at the facility they run.
1
After visiting my mother in a nursing home, I walked to the elevator. While waiting for the elevator I looked into a room across the hall from the elevator and saw the body of a woman on the floor. I went into the room and tried to find the alarm button on the bed frame. I could not find the alarm button so I went into the hallway and started yelling so that a staff member on duty could check the condition of the woman. No one came. I went down to the reception desk on the first floor of the nursing home and reported the problem. The receptionist said that the staff was probably at lunch.
72
This reminds me of our local hospital. A sick post-op patient collapsed on the floor of her hospital room, and a member of the hospital staff yelled at her, "get up off the floor!"
36
Too bad our politicians spend so much energy on less important matters. We all grow old!
5
I have retired for more than 10 years and I am lucky able to continue to live in my old home with my family without too much trouble. Our mobility slowed but we are still able to drive around. We visited a number of retired homes and nursing homes in DC, Maryland, and Northern Virginia. We decided to stay put and we hire a part-time caretaker with nurses experiences. Most of these so-called retired homes are poorly staffed and with limited spaces for recreation facilities. One place called Sunrise Nursing Home in Tysons Corner is the worst and most expensive. Another place called Grand Oak which is affiliated with Hopkins Hospital which outrageous expensive and probably is reserved for extreme rich people. We decided to stay in our old but lovely home for as long as we could. All retired people needed helps from our federal government and local governments. But helps are not coming. When you retired you are a past tense. Young people make sure you have a good pension before you decide to retire. There are no second chances. Some retirement homes make people feel depressed. We are still happily spending our remaining years. We have also decided our final resting places which is not too far from our home and our children's homes, This NYT article is very interesting and informative. How many people really cared about old people?
37
The current "old people" did not care about old people back in their day. If they did, they wouldn't have to rely on the current system that maximizes profit through minimizing care.
The cycle continues.
1
These nursing jobs are among the least desirable jobs in the profession, because of pay and the type of work required. Therefore, if a staff member can get a better position they will leave. Same goes for the support staff. So it's not surprising, in this strong economy, the industry faces staffing pressure.
25
"Overstated" is such a polite term. Why not call it what it clearly is: fraudulent misrepresentation!
93
In NY State...we have one of the most shameful US records of state sponsorship of harm to the disabled elderly.
The DOH & its Public Health & Health Planning Commission continue to license mafia-like consortia of predatory owner/operators in the 'business' of long term care facilities. Our state agency tasked w/protecting the frail & vulnerable is complicit. The irony...the shame.
Who calls the shots on Nurse & Aide ratios? Lobbying groups such as Leading Age circling the wagons for their members. Excuses are made ad nauseum to avoid hiring sufficient staff. How can that be? Check out the NYS Board of Elections & follow the money to Cuomo...to many of the pols which refuse!!! to write/enact legislation to protect these elders.
Au contraire-bad behavior is rewarded by this Governor:
https://www.nbcnewyork.com/news/local/Cuomo-Approves-Millions-for-Worst-...
Bedsores...over-medication w/psychotropic drugs to keep these poor souls in docile stupor can be explained because of understaffing-just as the Nursing Home operators want it.
As our growing population of old people and a new generation of the 'old-old' require ever more ethical care...we all need to pay attention.
The public is not doing a good job of demanding accountability.
32
At least nursing homes get scrutinized. I would guarantee that the Assisted Care Industry is far worse. If you pay privately for essentially nursing home care, no one is looking at staffing levels. Even your local Social Services Agency wouldn’t be able to tell you what staffing ratios ought to be at the local ACF.
17
Even before reading the article I could confirm what the title stated. When "shopping" for a residential home for Mom, we were told that the staff to patient ration was 1:5 in this nationally known Memory Care facility we were looking at. After choosing this one based on the tour, many times we arrived at a locked front door to find that only 1-2 people were staffed and couldn't make time to buzz open the door for us. One time there was only one person running around doing everything on a Saturday evening while the other was out in the parking lot smoking a cigarette.
My mother was charged an additional $450 per month for "Oxygen Therapy." When I questioned this charge (because a separate company delivered the oxygen and swapped out the tanks) they told me that it was for someone to make sure that Mom was using it. I told them that every time I arrived for a visit she was NOT using her oxygen and that her portable tank was running low. Their answer was "they couldn't be everywhere at all times checking to see if she was using it or not."
We also found there was rarely enough staff to serve dinner, answer cries (literally) for help in the dining room, and certainly not enough people to tend to the needs of residents still in their rooms during meal times.
New carpet, furniture, large offices, and several layers of management are the norm. Adequate staffing is NOT. And even in a Memory Care facility residents are often aware that there is never enough help.
101
My dad was accidentally placed in a memory care unit after a hip operation. The patients were all circled in a hall with one caregiver who was doing administrative work. The only activities I witnessed during the extensive time I was there was playing a video and tossing a balloon so some residents could bat at it.
One patient continually cried out that she had to go to the bathroom. When I told personnel several times, they said she always says that. She was directly outside my dad’s room: she was NEVER taken to the bathroom in a 3 hour period.
A woman next to her begged for water. She never got water over that same 3 hour period.
Both women were yelled at for daring to state their needs.
This horrible horrible place—run by “devoted” Christians—was rated very highly.
55
Yes, the lobby, offices, and exterior grounds of my mother's nursing home were quite lovely. The residents' rooms, on the other hand, had peeling wallpaper and windows that wouldn't open. The family of any prospective nursing home patient needs to visit the actual nursing floors. Just walk right in the door during mealtimes and other times (if asked, tell the desk you are visiting your aunt), then wander around the hallways and take a look at the actual living facilities. During a cold Ohio winter day I once found a patient wearing nothing but an untied hospital gown, her thin back exposed. Her wheelchair had been parked right next to a picture window that was covered on the inside with frost. I grabbed the wheelchair and moved her, then tied up the back of her gown.
25
I'm curious: was the 450$ surcharge was "accidentally" left off the bid when you were shopping around? Did the management realize their mistake only after you moved mom & got her settled etc? The "bait and switch" is rampant in this industry.
2
They just park residents in wheelchairs and ignore them until they can get around to them.
26
Profits over people. How disgusting can we get? What has happened to us a a people? Have we advanced as a civilization? If companies do this to our seniors, I'm very afraid for what lies ahead for my young children.
33
This fraud affects the entire family. Some of us give up our personal lives to spare our loved one this agony. When our bodies, our sanity, or our money hives out, the decision to place our relative racks us with guilty remorse. I’d love to know what is happening in families of these profiteers.
18
If there are no legalities to prohibit it, you would think that volunteers could be sought after and trained to help.
Hospitals used to have gray ladies sign on to do various tasks.
They were given good looking, crisp uniforms and caps.
Our mother loved her gray lady association. Maybe others might like volunteering and the satisfaction it brings.
6
Why would somebody volunteer to work at a for-profit facility? I'm guessing those hospitals you remember were public hospitals, or run by religious groups.
29
As someone who was involved with recruiting volunteers in a hospital until two years ago, let me tell you why there are fewer volunteers today. The 60 to 75 year old crowd is often providing daycare for their grandchildren today because their adult children can’t afford it. Not everyone certainly, but more than you would think. And, regulations limit what volunteers can do in some states. Even when the hospital I worked in allowed volunteers to feed patients, few volunteers would do it for more than a few days. The only volunteers we could keep long term were the ones working administrative jobs or directing visitors from information desks. We loved the volunteers who would actually visit with patients, engage them in conversation or read to them. We wanted more volunteers like that, but we could never find enough men or women to do all that needed doing. Volunteering with patients is rewarding, but can also be tiring and hard on the spirit. I had plenty of people who volunteered for a while and then stopped when a new grandchild came along.
19
Aides make little money for work that is stressful, difficult and often unpleasant. On average, residents are treated much more kindly than we have any reason to expect, given how little we pay the workers and how little respect they get.
Having said that, woe be to the resident who does not have visitors. Constant monitoring by a person who cares is really a necessary component. Even in good homes, things get overlooked, lost, stolen, forgotten; meds go undelivered; people are sometimes intimidated by staff, left sitting, or lying in bed, or stranded on the toilet. Is it any wonder that no one wants to wind up in one of these facilities?
For most people, there's really no good answer. Cross your fingers and hope you drop over dead in your garden like The Godfather.
53
I have repeatedly contacted the government oversight in California, and was ignored or said that things were normal in this regard. It is all about the money and heads in beds. This is not a business, they are human beings.
14
Are political appointees in charge of oversight and regulation? Perhaps a good place to start changing things is by taking politics out of the picture.
8
So can family members sue for fraud, neglect and malpractice?
21
Theoretically yes, but good luck.The nursing homes are run by huge conglomerates, and have lawyers on staff to harass you into the ground.
3
Unfortunately reality is worse than what this article portrays. As a geriatrician for two decades ive found that less and less doctors, nurse practioners, RNs , LNAs desire to go into this field. There is poor staffing because of lack if interest and lack of salary for anyone to maintain a reasonable standard of living.
65
Nursing homes for the non-wealthy can provide bad service as rich people don’t use them. Same with deteriorating conditions in non-first class air travel, public schools, and affordable housing. If the issue doesn’t hurt elites, it won’t be fixed.
50
I’m an RN. If you know the nursing homes that are on the map from the article you will be surprised that many of the “nice” places are below average. As a new nurse, I naively told management that I could prove that we were understaffed. I was rudely awakened when I became persona non grata and hounded and bullied by the management from then on. Hospitals are just as bad, even worse as the patients are often critically ill. I left nursing because it was dangerous because of the increasing documentation time took from bedside care and physical threats from patients and intimidation from management. If you have a loved one in any care facility make sure you visit often and at various times including night.
25
You are basically right about elites' ability to buy better treatment in other service industries such as air travel, schools and housing. But no one chooses when or where to get sick, or maybe your loved one needs post-op rehab in a SNF and your preferred facility might be at full capacity and you have to make a second choice. So elites do use nursing homes and public hospitals.
One can hire a private-duty nurse or a skilled caregiver to sit with the patient 24-7 in a nursing home or hospital room. That doesn't replace the family's role or necessarily mean all problems are solved, but that's an option for those who can afford it and may be helpful to supplement staffing issues. We all need a patient advocate at some point.
I learned that years ago at a major NYC medical center from a friend who was a former critical care nurse. On her recommendation, I hired a private duty nurse to sit with my loved one for the first overnight in a private room after a long operation and hours in the ICU. Turns out the private duty nurse fell asleep in the room's side chair and didn't realize the patient had fallen asleep on her I. V. line, and the subsequent infection kept her in the hospital even longer. After that experience, I always stay overnight with the patient whenever possible.
2
Vicki - the 'rehab' situation happened to me, mostly because I had to be totally non-weigh bearing for 8 weeks and the underlying condition that caused my fall made that impossible to do in my home. There was only one facility taking new patients on a holiday weekend. There were reasons they had openings.
We, the rehab patients, had slightly better facilities in our own new wing, and slightly better staffing levels. It looked to me like that was in large part because most of us were younger and better able to articulate our complaints and advocate for ourselves. The facility had far more regular nursing home patients than rehab or skilled ones. If I'd know that my stay would be 12 weeks instead of the original 4 week estimate I would have tried to
transfer.
The scary part is that on the map the totally awful place I was in has an 'above average' rating. Most of the others are 'much above average'. The thought of staying at one of the Eastern below and much below average places is truly frightening.
Try checking out how Often incontinent patients have the bed clothes and sheets changed during the night. At one point In New York State,the law was changed, letting nursing home owners off the hook, by going after nurses aids and orderlies if patients were not cared for. It rather confirmed the practice of those facilities who routinely are understaffed and do not have proper training and supervision of staff. If this law has not been changed, the situation will remain the same.
23
There are so many thoughtful comments on this article, both from patients & family members and clinicians--mostly nurses, based on a quick scan of the comments.
For anyone who'd like to research nursing home quality, using the data *currently* available from Medicare.gov, here's the url:
https://www.medicare.gov/nursinghomecompare/search.html
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US News and World report also has a nursing home review site. At least as of two years ago, they got their data from Medicare.
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On a related note to the discussion here: based on our family's experience, there don't seem to be very many board-certified gerontologists.
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I would also like to see a work-study program where students interested in any healthcare field could work in a long term care or skilled nursing facility while completing their undergrad degree or before pursuing graduate studies. This might not be feasible in all curricula, of course, given coursework demands.
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And, why not expand the AmeriCorps / Vista programs to include service in healthcare supporting roles? OK, because the AmeriCorps / Vista program funding was among those targeted for reductions by the current administration.
Never mind.
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PS: I haven't yet discovered how to include paragraph breaks in the comments here. Just picture a paragraph break at each asterisk.
22
Hit the return arrow twice.
5
I'm an RN and work in a skilled nursing facility. It differs from many as it's attached to a senior retirement community. The staffing is excellent, on nights, there is 1 RN & 2 aides. On days it is 3-4 aides and 1 RN. I admit it's unusual.
When looking at skilled nursing facilities, use your senses. Especially, sense of smell. There should no odors and patients shouldn't be parked in wheelchairs, in need of care. Ask admin about prevalence of skin tears, falls and bed sores. There should be few adverse events. I will say Medicare offers important protections for patients, especially in the grievance process. Regulations are your best friends. However, the paperwork is burdensome and takes away from providing bedside care.
31
As a former clinic director and person who spoke at the state level and testified in DC, the Medicare grievance process is a joke. Systems are broken, period.
21
Susan: it sounds nice. How much does your facility charge for this? It sounds like it is part of a CRCC.
I went on a tour at my local CRCC, which was very pleasant and nice. But you can't access their AL or nursing home unless you move in as an "active senior" years in advance. This requires a "buy in" of a couple of hundred thousand dollars (for a couple), PLUS you must prove to them a net worth of MILLIONS OF dollars over your lifetime. For my mother in law, who is 85, they wanted proof she had $1.2 million assets. I joking asked about myself, age 62 and in good health -- they said I would need to prove I had $9 million in assets.
This is beyond the reach of of 99% of the population.
3
When my mom was in a nursing home, I went to see her daily. I made sure she was happy. We paid for her phone, made sure she had food from restaurants she liked, made sure everything was taken care of - and we also tried to do little things for the people who cared for her. She gave them cookies and candies, and we gave them Christmas gifts. Most of them were very nice but totally overworked. I always felt that the way we treated them was reflected in the way they treated her. I have no idea what it would be like to be in such a place with NO one visiting from the outside. That place cost eight thousand dollars a month - $96,000 a year!! They took all her income and allowed her to keep $50.00 monthly. If I had a handicapped accessible place to live I could probably have arranged her care for that amount myself.
32
Sharon, your visits certainly must have meant a lot to your mom, and I'm sure the staff greatly appreciated her / your kindnesses to *them*, too.
**
Dad visited Mom *almost* every day when she was in skilled nursing and eventually long term care -- aka, a nursing home. The staff there often told him that he was among the very few relatives to visit their loved one so consistently. We kids visited just occasionally, which was primarily due to Mom and Dad "not wanting to be a burden". So, we honored their wishes and visited at lunchtime every few weeks.
**
The staff were really nice, and I would guess similarly overworked. I wouldn't be able to do their jobs.
12
I'm at the age when friends are looking starting to look seriously at assisted care type places for their parents. Having already been through this with 3 grandparents, here is my warning: It does not matter how much money you pay. Somebody HAS to visit frequently and keep tabs -make sure medicine is being given as prescribed, Mom is eating regularly etc. You will be scheduling the medical appointments, and you will be doing the transportation. In short, it is delusional to think any of these places will truly take care of your parent.
126
There is a significant difference between skilled nursing facilities and nursing homes, by practical and CMS standards. Story needs to be updated.
7
Folks, this is the perfect place to implement and run a Federal Training Program for Certified Nursing assistants. Not only would many unemployed and underemployed persons gain valuable skills, they would absolutely acquire the ability to greatly increase the quality of care and satisfaction of Patients, under the supervision of Licensed Nurses. A relatively small investment would provide dividends for decades, especially as we Boomers retire and possibly need care. Also, the predatory
" schools " would be out of business, quickly. This should absolutely be in the Democratic Party Agenda for 2020. Seriously.
56
This is already being done by the nursing homes in our rural area, with big graduation bonuses and guaranteed jobs with higher pay than any other 'unskilled' jobs. The nursing homes still can't maintain staffing levels.
The work is miserable; changing diapers with the needed cleanup involved, lifting patients, rolling them over, feeding them. The aides who signed contracts to work for a period of time leave exactly when that time is completed. How are we going to hire enough employees when all of us - the boomers - reach the age when we need care?
North Dakota does pay for house cleaners and scheduled minor personal care like bathing and hair care and visits by the county nurse for meds tracking counting out our pills in weekly amounts and checking or minor problems that could become major, to help us stay in our homes longer, But there still comes a time when that isn't enough.
1
For a decade I helped oversee the care of my partner's father while we lived a couple states away. After several years trying hard to keep him in the home that he loved on the outskirts of Santa Fe, his father agreed, at 92, that it was time to make the move to a senior living residence where he could still be fairly independent but have access to an in house nursing staff. All went well for awhile. We loved visiting there and dining with the distinguished elders who had become his friends. Later we switched him to a "gold plan" to include full nursing assistance. They then neglected 3 life threatening bed sores he developed under their care. We had to hire round the clock, outside care, just to save his life. Fortunately, we found angels who healed horrible wounds. But it should never have come to such a crisis where it took us $30,000 extra a month to pay for outside care on top of their so called "gold" plan that failed him miserably.
93
That is the cruz of the matter -- gold care or whatever they choose to call it -- is pretty meaningless, a way to up the charges the family pays.
The entire industry is an "extraction business" -- some bean counting genius figured out they could use the miseries of old age to funnel the entire wealth of GENERATIONS from families to nursing home operators.
People are put into care facilities -- from Assisted Living to skilled nursing care -- precisely BECAUSE their families cannot manage their medical care and everyone believes the FACILITY will care for the patient -- like a hospital -- with nurses around 24/7 and compassionate "carers" (aides) to attend to the patient.
This is a false belief. Not even the fanciest "chandelier" building has staff to assign aides to one patient -- not even one aide to 3-4 patients. Its more like a 12 to 1 ratio.
And if you have to hire "round the clock" aides .... at $25 an hour or $500 a day or $3500 a week or $15,000 a month....you might as well KEEP the senior in their beloved home, with their possession and pets!
To pay the nursing home AND pay for outside help is an insane bankrupting expense. In fact, most people simply cannot afford it -- either one family member give up their life (and job) to do the caretaking OR the senior slips into the vortex of neglect and indifference and loss of personal dignity that for-profit nursing care represents.
This is the truth, and I had to find it out the hard way.
4
This is why I would rather die than live in one of those places. Seriously. If I get to the point where I'd be going in, never to be expected to come back out ... I'd rather just, well ... go out. My long-term-care plan will need to include assisted suicide.
1
Everybody talks a good talk but does nothing. Even in the the Netherlands, slippery slope, only 100 people out of 45K with Alzheimer's uses medical aid in dying. You have to be extremely determined, pragmatic and selfless and 99% of people are not.
Thanks for raising awareness to this important issue. Understaffing has been a major problem in nursing homes for several decades. Leading national experts such as Toby Edelman, Center for Medicare Advocacy, asserts that it is the number one problem and barrier for real change in these care settings.
For example, my recently published study in the Journal of Elder Abuse & Neglect has shown that lack of supervision of residents with dementia underlies a substantial number of otherwise avoidable deaths of elders as a result of resident-to-resident incidents in long-term care homes. Link to PubMed abstract: https://www.ncbi.nlm.nih.gov/m/pubmed/29851550/
And we haven’t started talking about lack of tracking of staffing levels in assisted living residences (and the “memory care” units operated within them), which are the fastest growing residential care option for elders in the the U.S. — with an estimates of over 40% of residents with Alzheimer’s disease or other form of dementia and many more with undiagnosed cognitive impairments...
30
One of the most common jokes among experienced bedside nurses is 'Well let's have another million dollar research study about bedpans'. We've seen research study after research study, year after year,about all the same things - but they have absolutely no effect on boots on the ground.
This is ridiculous and is just another scam in effect. Researchers probably make two to three times what direct care nurses make.
The solutions to these problems aren't hard to identify. The problem is nobody wants to pay for them. The health care 'industry' is all about one thing: profit. Profit for Big Pharma ( most of the elderly are on multiple drugs), Nursing home owners or executives, equipment companies, technology companies, insurance companies. All these guys make upwards of 100k a year or more.( A lot of times MUCH more) None of them truly care about the quality of care - but they all say they do.
My god. Look at the cost of one month in a nursing home.
$30,000! It's outrageous. And yet no one has the will to seriously protest or to change this broken system. It's too lucrative for too many.
10
" Medicare only recently began gathering and publishing from more than 14,000 nursing homes, as required by the Affordable Care Act of 2010. Medicare previously had been rating each facility’s staffing levels based on the homes’ own unverified reports, making it possible to game the system." Let's work to be sure this is not changed by Trump and his slashers.
56
Having read many of the comments here I must now play devil's advocate and point out the obvious. People simply live too long today as a result of medical "miracles" that intervene and interfere with more sensible, compassionate and natural death. I have visited such facilities many times - including those with is truly enough caring staff. Elderly family members of a succeeding generation push their forbears in wheelchairs, looking all the way as though they are but an inch away from the same fate. And for what? I see no quality of life with or without adequate staffing.
26
I'm 77, live in a continuing care community, lobby for political causes, tutor, donate, and am not a result of a medical miracles, happy to be alive, and look forward to more years of a life of ideas and pleasures as I age and become more frail. btw, no younger family members to push me around, in any sense; am about to buy my own power chair to buzz about!
32
A CCRC as you describe is NOT a nursing home or ALF, even though some CCFCs have these attached and one can move downstream to the nursing area when needed. The photos and story clearly discuss issues of the frailest patients with Alzheimer's, stroke, etc. The people in an independent living CCRC are not the issue (my dad lived in a very nice CCRC and enjoyed it.) It is entirely possible to live too long.
3
My mother is 101, is reading the new book on Rogers and Hammerstein on her Kindle, is in the skilled nursing unit of a Continuing Care Facility she has lived in for 15 years. She has lost her husband and a daughter and her close friends. She is fully competent mentally. But she is "ready to go" and has been for at least 2 years. She is surrounded by people with dementia. She has a myriad of physical problems that make her miserable but will not kill her. I have put my own life on hold to mostly move 200 miles to be with her because I cannot bear the thought of letting her die with no one around who is anything more than a paid helper. Extreme old age is hard, and the quality of life is not very good, even for people like her who made it to 100 in an independent living apartment.
47
The quality of care in any nursing facililty, be it hospital or nursing home, is directly related to the number of nursing and assistant staff on duty. Well overdue analysis, which just might make some family start a campaign of complaining. And note also that the lack of staff is detrimental to the performance of those on duty.
46
The excuse that they need less staffing because there are fewer activities and there are family members around is bogus. They don't charge less for the weekend days. The family members should not be doing the work of the nurses and CMAs. Why are there fewer activities on the weekends? Are the residents worn out from the excess of stimulation during the week? Many nursing homes are run by companies listed on the stock exchange. This means their primary purpose is to satisfy the shareholders even if they have to shortchange their customers. As with everything else in medicine; follow the money.
226
They do it because they CAN do it -- because they are permitted to do it. Nobody really brings down the hammer, or fines them. There is no oversight of costs, and no way to complain about the CONSTANT cost gouging -- i.e.,the published "fees" never include "personal care" which can be something as minor as giving a resident their vitamins (and of course, even if you are 100% in your right mind, you are not permitted to take vitamins or anything else on your own). My aunts facility charged her $700 a month "medicine administration" to give her a single thyroid pill each day. (The pills themselves cost pennies.)
Even if you see a list of "scheduled weekday activities"...if you really visit randomly throughout the week, you quickly see about 50% of it is bogus. If you drop in without notice, you will find that most of the day is spent with seniors in wheelchairs, parked in front of a TV, watching crummy daytime talk shows or soap operas for hours at time, often left in soiled diapers. (And I have seen this in the most upscale suburban facilities!)
The reason for less stuff on the weekend is that A. fewer staffers want to work then -- including administration -- they have THEIR OWN families & lives and B.the cost. The easiest way to cut costs is cutting staff hours.You can't do much to cut maintenance, utilities, heat, A/C, etc. So what can be cut? the number of aides per resident and the number/type of activities.
1
A senior care facility that is bold enough to publish its staffing levels and staffing patient ratios real time and historical data at the shift levels online would have a competitive advantage. Currently there is no incentive for them not to game the system for higher profits. Unfortunately in our current era of political decay I have very little hope.
18
As an ER RN for 40 years, I oftens receive telephone reports from Rn's who tell me they have been responsible for up to 50 patients overnight, with the help of one assistant.
I am sure the patients are paying plenty to have that nurse's one minute an hour of care. And the strain on the nurse is immeasurable.
136
And those are well paid RNs with nursing degrees. The average starting salary for an RN today is $70,000 and can top $10Ok as a specialist in a big city.
We are talking here about nursing homes, and the "staff" are very rarely nurses -- maybe 1 per facility or part time -- but CNAs, nurses AIDES -- low paid, $9-$12 an hour aides with little education or medical knowledge. They are grunt workers, who serve food and change diapers -- bathe and dress the residents. They do not do ANY medical care whatsoever.
2
The New York State Department of Health is the exemplar of passivity and uselessness in addressing the needs of family members of people in nursing home care. Form letters with a tone of total detachment was what I received after making a complaint about a relative of mine. Cuomo is a disaster when it comes to healthcare in this state.
10
New York - one of the wealthiest states in the union, treats its overburdened taxpayers like dirt. And it's probably even worse in New Jersey.
As mentioned in the article, the data for this important report came out of requirements from ObamaCare. There are many unrecognized benefits from Obamaca other than just expanded coverage. If we had a functional government, it could do what is typically done with any large and complex law that has been passed historically...adjust it incrementally to improve flaws, omissions, or unintended consequences. But that requires a functional government that is actually interested in creating a better life for its citizens, rather than slogans that win the next election.
107
Obamacare went into effect on January 1, 2014 (some elements went into effect even earlier than this).
It is now July 2018; if Obamacare was making noticeable landmark changes in the quality of nursing home care...wouldn't everyone here be NOTICING the changes?
The individuals I know today in nursing home care (from AL to dementia care) are if anything worse off than years ago, as the facilities are more overcrowded and the staffing is less -- less in both quantity and quality.
So tell me: how did Obamacare HELP?
1
It required the reporting of the conditions described in the article. Although at this point there are things that need to be fixed, identifying the problem is the way to start the fix.
This is in stark contrast to our current administration's reluctance to be transparent. Specifically, in releasing tax returns that could tell the electorate who the president and staff members are beholden to.
As well as letting reporters observe the centers where migrant children have been warehoused. Who knows exactly what is going on at any time of night or day.
1
My mother died last year at 95 after living 2.5 yrs in a nursing home. Weekends were also bad with agency CNAs and low staffing levels. I was there every day to visit her and help her with daily needs. So what will happen over next 25 yrs as we baby-boomers age - it will get much worse.
This is one of the reasons we need (legal) immigrants in the US because US born people do not want these jobs. There will be a much bigger problem for us down the road and the medical field will need a lot more CNAs and nurses. Can't our current administration see this?
59
Plenty of US citizens want those jobs. The pay is usually minimum wage and they can't afford to take those jobs. They don't have the extended families that immigrant families have where multiple people contribute to the rent or mortgage. But plenty of US citizens want those jobs.
9
US born citizens might want to these jobs if they paid well, but the pay is usually minimum wage. I'm a retired RN and have worked both hospitals and nursing homes and all of what is said in this article is true. There are many reasons for high turnover but the most common is low pay, no respect, stress and and staffing issues. Doesn't matter where you go in medicine these days, staffing is bad and the stress levels extremely high. I've been saying since I started nursing that aids need higher pay and staffing needs to meet the needs of the patients. But as usual, greed rules. Private nursing homes are the worst. I left nursing before retirement age because I could and I'm happy I wasn't forced to stay longer because some jobs will destroy your soul.
As far as our current administration understanding these issues; who are you kidding? I have zero faith in this administration.
1
One of the reasons the current administration does not see this is because this presidential cabinet is comprised of secretaries that combined are the most wealthy in history. They are not personally affected by the same struggles as the majority of citizens in the country.
They can pay to get all the care they need. Now that they have all been part of the federal government, they have access to the best health care for life. At no cost to them, to boot! They never have, nor ever will struggle with coordinating care for elderly relatives while arranging daycare for children, while trying to make a living.
If anyone in this administration had a clue as to what most people deal with, they would not separate children from parents. They would try to improve our health care system under the ACA, not destroy it without a replacement. They would support clean water and air and industries that create the jobs that maintain them.
But we already know they don't care. Choosing Scott Pruitt to dismantle environmental protections made it clear. Trying to put Dr Ronny Jackson in charge of the VA with no relevant experience made it clear. Making Bill Shine his latest communications guru makes it clear. Putting Betsy De Vos in charge of education, when she has spent minimal time in a classroom made it clear.
Melania's jacket made it crystal clear, as do all the actions that have occurred since this president's inauguration.
24
When my husband’s Alzheimer’s progressed to the point where I couldn’t keep him at home, I finally had to place him in a care facility. I did a lot of research before placing him. This article describes one of many issues I encountered in supposedly highly rated facilities. One one weekend evening, a single registered nurse and a young assistant were trying to care for 40 people with Alzheimer’s. The nurse was very upset and confessed she was afraid she might lose her license if something happened to one of the residents on her shift,
The tragedy is that when a family member complains to the state agency, the management will do everything possible to get rid of the resident. As a result, my husband ended up in three different memory care facilities before he died. We found staffing problems in both for-profit and non-profit facilities.
I’m glad that staffing is being re-examined, but we need to do so much more to protect vulnerable elderly family members.
110
"The tragedy is that when a family member complains to the state agency, the management will do everything possible to get rid of the resident>" I removed my mother from three nursing homes and brought her to my apartment for the last year of her life because the long term care experiences were inexcusable. Now that many have become privatized, the situation is ten times worse. To ignore this societal scandal is to have it repeated on oneself.
65
It's worse because when making money is the purpose of providing care, the priority becomes the profit, not the care.
21
Given the high cost of skilled nursing care -- and the low quality of most facilities -- a person who has THE MONEY to stay in their own home with 2-3 shifts of home health aides, is probably better off. The cost is high, yes, but so is skilled nursing care -- about $12K vs. $15K here.
If family can do some of the care at nights and on weekends, you could cut that back about 50%.
But it requires the desire and commitment, plus having a house or apartment suitable for frail senior -- handicapped bathroom, hallways wide enough for a wheelchair, ramps, etc.
The problem is that by the time a senior winds their way through Assisted Living to dementia care to skilled nursing care...their money is all gone. At that point....they have to move to a Medicaid facility. Medicaid is the "payer of last resort" and they pay a fraction of what families pay -- about $1700 a month. At that rate, no "fancy chandelier" facility will take an indigent senior -- so they must go to a third rate Medicaid facility. These are usually in rural areas or "the bad part of town", and put seniors in double rooms (with a roommate) -- very small rooms that cannot accommodate much in the way of personal effects -- and no private bathroom.
That is what happens to people who run out of money, which is almost every senior who is not a millionaire.
1
Having had an elderly parent in a nursing facility for nearly seven years, and having had two stops in rehab nursing facilities [different ones] I know how frustrating it can be to wait for someone to do things for you that under normal circumstances you do for yourself. How about this for a possible solution: When nursing home residents require hospitalization for things like dehydration, bedsores, falls, and like preventable issues, why not have the resulting hospital charges billed directly to the nursing home? When the nursing industry finds it cheaper to give better care to its clients than to pay the hospital bills, things are more likely to change.
95
"When nursing home residents require hospitalization for things like dehydration, bedsores, falls, and like preventable issues, why not have the resulting hospital charges billed directly to the nursing home? When the nursing industry finds it cheaper to give better care to its clients than to pay the hospital bills, things are more likely to change." Great idea. Fat chance that healthcare lobbyists in the Swamp will let it happen.
29
There are many provisions in the ACA that work that way. For instance, if a patient has a urine catheter placed in the hospital and there is a resulting infection because of it, Medicaid does not pay whatever the hospital bills for treating that infection. I believe there are similar provisions in place for bedsores/decubitus ulcers that are acquired as the result of poor care in the hospital.
Generally, poor care goes hand in hand with low staffing levels.
10
Edsan: the problem is that if you put punitive pressure on for-profit nursing homes -- they would go out of business and/or find a new business model.
THEN WHAT? do you take your 92 year old mother back to YOUR house? and care for a dementia patient who is incontinent the rest of their life?
The reason nursing homes CAN do this, is that families are desperate and can't DO this level of skilled nursing care themselves. They know that families can't or won't diaper an adult with dementia.
Incontinence is the bright line in the sand that divides the active senior with a meaningful life from the dependent hopeless senior who has lost all autonomy and dignity in a nursing home. And I don't see an easy cure for that.
2
When humanitarian services that should be publicly subsidized (e.g. health care, public transportation, education) are turned into for-profit ventures, this is what happens: cheating and degradation. How many times do we have to see this to learn?
451
And thank you Mr. Obama for instituting better monitoring of these for-profit companies by medicare. Think what could have been accomplished if his full health care system went into effect, not undercut and compromised into inefficiency by the GOP.
3
Unfortunately, the greediest of the financial predators are running all three branches of our government and make the rules to benefit themselves.
1
Unfortunately, a lot of conservatives don't know about this until faced with it within their family, then become outraged and flip their opinion about universal health care.
1
Take a very hard look at the people you have elected on all levels of political offices. For the elected it is about power, control and staying on top--not problem solving with effective solutions. We know the need for national health care, quality education, and effective and enforced safety and health standards. Yet we watch all that erode as we elect those who continue to do nothing. When will enough be enough? Wishing will not make it better, but voting for those that share your values may.
66
"but voting for those that share your values may." And who would "those" be, pray tell? Steven Brill in a recent issue of Time magazine states that there are 20 lobbyists for every one politician in Washington. And then, of course, there are the State level lobbyists....
10
Who runs for office who cares for us? I live in a blue state, and you have to be rich. The party that claims to care for us isn't any better than the GOP. So it looks like we have to get rid of both political parties to get anything done. But if everyone voted for third parties, would their votes actually be counted?
After my mother in law had a stroke that left her unable to care for herself, my wife and I visited and carefully evaluated quite a few care facilities in Florida and Ohio. Without exception we found that facilities operated by non-profit organizations were better staffed and had more pleasant atmospheres than those run by for-profit companies.
When it comes to care-giving, introducing the profit motive inevitably causes owners to cut corners, reduce staffing and do everything possible to squeeze every penny out of occupants or those who are paying for the occupants' stays.
Looking at Medicare/Medicaid ratings may be a good starting point, but there is no substitute for actually visiting prospective care facilities and talking with the director and staff. You should also ask to have a meal there, too; observing the dining dynamic can tell you a lot about how the facility operates and how the occupants are treated.
67
Almost every facility will offer families a "tour" which includes a meal. I've been on many of these.
What they do is put you in the REHAB dining room. Rehab pays much more than AL, so the residents get nicer suites and better food. The facility admitted as much to me.
So I placed my family member in a facility, thinking she would eat in a pleasant sunny dining room with fresh flowers and get nice homestyle foods. Boy was I mistaken! The actual AL dining room for residents was squalid -- grossly understaffed (two aides for 22-24 residents) -- food was steam table mush, nothing fresh -- the overworked aides could not get meals out on time, or hot, or manage to put water or coffee on the tables. They ignored crying residents whose meals were FORGOTTEN and regularly served special needs residents the wrong foods (like sugary treats to a diabetic, even though the facility charged $700 a month for "meal requests").
They have skillful marketing, trust me, and know how to make the place look like a resort when it is more like a minimum security political prison.
1
There seems to be a shortage of nurses.
On on hand, we have people who can't find work.
On the other hand, we have a shortage of skilled workers.
Similar is seen in high-tech with shortages and bringing in people on H-1B visas.
10
While there may be a shortage of nurses, there's a far greater shortage of nurses willing to work in 'skilled nursing.' The nurse-patient ratios are terrifying, there are never enough CNA's, and the MD's are often unreachable.
As an RN who has worked in this setting, myself and many others fear for the health of our patients as well as our own licenses.
48
There's no shortage of Americans with tech skills - that's a lie told by employers because they would rather bring in young people from Asia on H1B visas than pay American workers decent salaries.
Meantime, US-born tech workers are made to train their replacements just prior to getting laid off - especially if they've reached the "ancient" age of 40.
We DO have a shortage of nurses and elder-care workers. The latter are nearly all immigrants and very poorly paid for their difficult work.
3
Not really -- there are a shortage who want these miserable gigs with lack of staffing and patients who are zoned out with dementia. It is not satisfying nursing, like caring for mostly healthy people with elective surgery or for children.
Nurses are well paid, and the problem is that nursing homes don't WANT to pay $70K a year for a NURSE -- so they substitute $9 an hour "aides" whenever possible.
There is no real shortage of aides either, but the facilities don't even want to pay THEM the measly $9-$12 they earn. They demand long shifts and miserable work conditions with heavy patient loads and not enough staff. The turnover is HUGE.
I can tell you very simply why it harder to find good aides -- the lousy pay plus it requires workers to change diapers and clean up feces & urine. There is no putting a good spin on such a job.
2
Memory care facilities . Epidemic level of challenges. Comparable to homeless crisis. Most entry level staff are one job away from fast food job. Heavy lifting, hourly drugs, changing briefs, and then residents emotions are a lot to manage at minimum wage. Many caregivers have more than one job. Very very challenging business that is not regulated. Families are not able to address and are not aware of problems. Critical epidemic level / dying in America...it’s not a family matter...
Note- daylight saving time changes wreck havoc on residents who rely on medicine. That hour change can be deadly.
21
I am not surprised and thank you for this reporting, please don't stop.
My significant other is a nurse who worked at a nursing home, working second shift (3-11). The problem with understaffing is an epidemic, not a week goes by that she was required to work a double shift (sometimes on back-to-back days), leading to exhaustion and fatigue. Increasing the risk of poor performance and losing her license with an error due to extended work hours. She'd work extensive hours, and to be honest, the pay was far from great.
On weekends off, therewere texts and phone calls asking her to come in, I eventually got her to agree to turn her Smartphone off and buy a cheap pay as you go phone for family and close friends to use if needed during her time off.
To fill vacant positions, nursing homes will hire agency nurses---contractors, to come in. While many are good, a lot of them are punching a ticket and not applying the dedication needed for such a profession. Just filling a spot, not really helping the quality of care.
In general, there is a shortage of nurses (hospitals offering signing bonuses, etc.), but for geriatrics it's an epidemic because very few nurses want to do such a job, it takes a special breed.
So you have a critical position, with epidemic shortages, limited interest and an uninspiring pay scale. That is a recipe for disaster and doomed for failure. Get used to it America, especially with the aims of this Administration and our Health Care System.
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RE: "David Gifford, a senior vice president at the American Health Care Association, a nursing home trade group, "On weekends, for instance, there are fewer activities for residents and more family members around, he said. While staffing is important, what really matters is what the overall outcomes are," he said.
Mr. Gifford implies that family members are acceptable substitutes to provide medical and activities of daily living care to loved ones on low staff days?! What about the numerous residents in long term care who have no family "visiting" on weekends?! What other job expects non-employees to "fill in" for employees, due to "low staffing"?
Long-term care facilities are notorious for low staffing because many residents are vulnerable and unable to complain and defend themselves. Low staffing is due to a combination of very difficult work and low pay, and always has been and will be unless permanent changes (laws) are enforced.
I am an RN and begin my medical career as a nurse's aid in a long term care facility more than 50 years ago, and working conditions were the same as mentioned in this article. Management begged staff daily to work "double shifts." This was unsafe for the residents and staff.
Constantly re-training new staff is more expensive than paying a wage commensurate for the intense physical and emotional work done by medical staff, and retaining staff.
Shame on "experts" with no reality of bedside care determining what is acceptable staffing.
172
The argument that you need less staff on weekends and holidays because there are more visitors is bogus. Family visitors do not tend to cope with nursing tasks and often people under care actively do not want their family or friends to help them dress, eat or go to the bathroom. And there are many who do not get visitors very often or at all. Staffing levels should be at routine/normal levels on holidays and weekends. Hospitals are the same, inadequate and delayed care on weekends and holidays with few senior physicians around and greatly reduced support staff despite the fact that patients’ do not have lesser needs on these days.
83
Thank you for the article and especially for the map. I am struck how poor staffing appears to be so much more prevalent in certain parts of the country. Is there some correlation with the opiate epidemic? The maps look so similar.
It doesn't seem random to me. Parts of our country seem to be falling into an abyss.
29
I wish reporting to state and local agencies worked. I work in a hospital and we see a steady stream of SNF residents with pneumonia and sepsis. The sepsis usually results from bed sores and other untreated wounds. Some bed sores are so horrific (to the bone) that the patient will need colostomy bag for life. We report, and report. Months later we get a form letter with the findings and they NEVER find anything wrong. You feel so defeated but we must all keep trying. For profit healthcare results in tremendous suffering of our most vulnerable and kills thousands each year.
159
Ditto. If patients don't have family who visit and advocate there is no safety net. For profit corporations making big profits while elders and disabled suffer.
50
The very state oversight inspections are corrupt; they have a "hand in glove" relationship with nursing homes. And I strongly suspect, some money crosses palms at some point. I've complained and complained, to no avail -- emails, letters, phone calls.
Among the problems: they will ONLY take complaints from the responsible party for a patient....the spouse or adult child or whoever has POA or guardianship. If you are a friend or relative, or just a visitor who sees terrible stuff -- nothing is every done. I've entered Assisted Living units, in the evening -- staff it at its lowest then for some reason -- only to find the TVs off (approx 7-8PM!) -- no lights on in the common areas -- no food or snacks available -- water dispensers without cups -- and a couple of absolutely confused residents, in wheelchairs just wandering around lost, unable to find their rooms. (Yes, this as AL, not dementia care -- the line between them is VERY blurred.) I tried to alert authorities and was told "if it wasn't YOUR RELATIVE, we don't have to acknowledge your complaints!"
1
Up until recently I worked ten years for a senior care management company, processing payroll and general bookkeeping for assisted living/dementia care communities around the country. From what I have experienced, I would say the majority of people employed in the senior care industry genuinely care about the senior residents and their welfare. But over the last decade or so with the surge in retiring and ailing baby boomers this has become a huge for profit industry, with powerful investment groups buying up scores of these facilities to cash in on. Not surprisingly, the investors’ main priority is profit, and the largest drain on their profits is labor. It is therefore common practice in this industry to run extremely lean with the absolute bare minimum of employees they can get by with. This results in staff that are overstretched and under paid, creating chronic turnover industry wide, and critically delayed services for the seniors patients. And when outraged and frightened family members confront the facility directors, many I have worked with silently share the family’s frustrations because they aren’t allowed to adequately staff all shifts. As long as senior care remains a lucrative business venture, investment groups will continue to put profit ahead of human beings, and see senior citizens as nothing more than numbers on a census report.
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This is another reason that for-profit medicine and medical care is ethically dubious and socially harmful.
67
I saw evidence of the staffing shortages first hand when my father was in a memory care facility for 22 months. My mother, who visited every day at dinner time, would feed my dad his dinner and then do the same for two or three other patients who would’ve otherwise waited an hour or more until a CNA could get to them. The bedtime routine would stretch out for hours due to a lack of CNAs, while patients in the main room would get increasingly upset and agitated having been parked in their wheelchairs and ignored for hours. Also the Medicare/Medicaid star rating system grossly overstated levels of care across the board.
158
This was our experience with my father when he was in memory care a few years ago. He didn't have much of an appetite and was also having difficulty using knives and forks, but there wasn't enough staff to assist him eat. Also, sometimes the staff forgot to give him something to drink with his meals, which likely led to dehydration. Family members of a resident need to watch these matters matters very closely. To ensure that a resident is properly fed, it may be necessary that they be present at every meal. This is what we learned a little late, unfortunately.
10
I'm so sorry about your mom -- I've seen the same thing. And it happens even in ASSISTED Living, which is the 2nd least restrictive care (after independent living).
My relative was often left in dirty clothing for days at a time. I questioned if she was bathed on the schedule that I paid for -- twice weekly, including shampoos. Her hair was often greasy.
My relatives building had 22 residents, and the dining area had 4 people to a table. The building had only TWO full time aides round the clock (plus cleaning staff). Imagine two people to serve TWENTY TWO residents! and they had to get residents in to the dining room 3 times a day, set up the tables, serve food, deal with problems and then BUS the tables and clean up! including running china and silverware through the dishwasher! Each resident had meal sheets, where they supposed "selected" from a menu with 4-5 items -- but it was a farce, as the food served rarely matched the menu.
I routinely saw them inefficiently serve one resident at a time randomly -- never managing to serve water, coffee, beverages -- often items out of order (dessert before salad?) -- constant mistakes giving people with diabetes sugary treats or denying salt to people WITHOUT restrictions -- missing some residents meals ENTIRELY, while they cried pitifully they were hungry. And I saw this over and over, for 3 years at the same facility -- despite my almost weekly complaints.
Price for this "luxury" was over $4000 a month in 2015.
1
Since Republicans have little concern for elderly Americans, or care that they have the care they need, red states can expect these shortfalls, and future threats to health care, to put your loved ones at terrible risk. I'd like to see a study of the number of deaths that coincide with these low staffing periods, like weekends, and have Medicare hold facilities to account. This is another extremely important voting issue. Nov. 6th. Be there and be square.
50
I would end my own life before going into such a place. Those ratios of staffing are a danger to the patients. It's risking your life to go in there. I'd rather risk it at home or end it altogether.
178
After seeing the neglect and misery my dad endured in a nursing home that's my plan
11
My mother in law was in a nursing home for several years, and in assisted living for several years before that. As noted by other commenters, there are really two issues: Hard of hearing seniors cannot understand and properly respond to the aides, many of whom have only a limited command of english; secondly, the staffing at night and weekends is usually 50% of the week daytime staffing.
With regards to the language problem, this often results in the senior becoming frustrated and lashing out at the aide, which then results in the aide being reluctant to care for the senior. Minimum language skills, and ability to deal with hard of hearing seniors must be required training for an aide to be hired.
With regards to staffing, most of the seniors in the nursing home require the same level of care every day, not just on week days, so I don't understand why it is even permissible to significantly reduce the weekend staffing. Often my mother in law would be left lying in bed until lunchtime on the weekends because there was insufficient staffing to move her to a wheelchair.
I pray I never have to use such a facility, not because of the cost (I have insurance to cover myself and my spouse), but because there is no regulator that actually appears to be effective in making these places provide the quality of care that the dollars charged should deliver.
111
My son took a job in a nursing home with a good reputation directly upon graduation from nursing school. He found he was the only RN on a shift with over 40 patients. Recognizing that he simply could not provide adequate care, he immediately resigned rather than find himself forced into malpractice. And this was in the best facility in that town.
207
When my husband finished RN school he too got a job at a lauded (on Google) facility in northern NJ. You could not be a patient there without decent insurance. Needless to say, he encountered similiar staffing nightmares. As a physician listening to his workplace woes, I feared for patient safety in addition to his license! The staffing turnover was at a breakneck speed. If only patients and families knew the dirty truth...
62
Hugh--These are more FOR PROFIT facilities, who want to lower their costs as much as possible, and raise profits as much as possible. Not a formula for good health care for anyone. This is why we need universal health care as a human right. Take the profit out of health care, and pay professionals higher wages. Nurses, firefighters, police, first responders, and teachers are among the most important people in our society. They should be paid accordingly.
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That is the norm in a nursing home. 40 residents on a floor, 1 RN, 2 LPNs, 4 CNAs. When fully staffed.
10
This has been obvious to those of us in Healthcare, for years. It's all about profits, hiring the least qualified, for the lowest cost, and not even bothering to cover THAT when shortages occur. THIS is exactly what happens with less regulations, and especially little to no enforcement of the regulations. The Managers and/or Owners of the cheaters should go to PRISON, in addition to huge fines. They consider fines to be just an unfortunate cost of doing business, IF they are caught. LOCK THEM UP.
Seriously.
309
There are some felonies pending for patient neglect due to poor staffing here in Otsego County, NY. It gives me some hope.
10
Thank you for this great reporting, akin to "Ten Days in a Mad-House" by Nellie Bly. Surely the nursing home industry ranks among the most greedy; if they paid decent wages AND hired sufficient staff, everyone would be happier and healthier.
My mother-in-law spent her entire life savings ($300,000) to spend her final years in a nursing home, flat on her back, helpless and miserable. How much nicer to fly to Switzerland and choose assisted suicide a la Dignitas. I'm putting aside money for the air fare, because when you've seen one bedsore, you've seen them all.
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I agree Karen, we need to make some progress on physician assisted suicide in this country. As a geriatric social worker, I have seen 5 star nursing homes with beautiful lobbies and fountains, but the staffing levels are inadequate for proper treatment. Quality of life is more important than quantity, for a lot us, and we should be able to make these decisions with our physician.
31
" .. if they paid decent wages AND hired sufficient staff, everyone would be happier and healthier .."
OK. When are y'all going to show them, how to do it?
So many keyboardists claiming "simple" solutions .. zero/none actually going hands-on, with hard issues.
"Overstated staffing?" Is that like "you can keep your doctor?" Oh, my ..
I placed my mom in a small home, in a small town. Not great. But nice people.
1
I'm a nurse in geriatrics, so I know what nursing home and assisted living care is like. This article is accurate. It's disappointing, but after spending my life caring for others, I'll head for Switzerland myself, rather than endure the indignities of the greedy profiting off the end of my life.
17
This shouldn't be a surprise! NYS Department of Health notifies nursing facilities before they do inspections. There has been many times I knew when DOH was coming because we were working with acquit staff. We didn't know How too! I have been in nusinng for over 30 years and nothing has changed. If you want to change staffing, how about not notifying a facility that there being investigated beforehand! Then maybe this will be fixed!
46
I am appealing to the Times to keep on doing research in this area. I know through first hand experience that these facilities are not only understaffed but also staffed with incompetent care givers. There is no other way to put this other than to say our most vulnerable seniors are neglected to the point of abuse. I will not mention the names of the facilities, but I will tell you that presently in both Sonoma and Alameda Counties institutions which charge as much as $11,000 per month (yes, you heard right) are being sued for the very reasons above...both private and class action suits. My own husband with advanced Parkinson's - yet whose mind remains lucid - was one such victim...gashes on his leg, a broken rib, not taken to the rest room in a timely manner, not bathed or cleaned adequately. It is absolutely heartbreaking.
That was just my husband. However, the cases are endless here in Northern California. If anyone is faced with the situation of placing his or her loved one in a SNF, Assisted Living and/or Memory Care facility, I urge you to ask questions and do your research. Then please visit the resident often. And if you see problems which are not being solved by the staff and administration, notify your state. Our seniors deserve to live their remaining years in dignity and respect, with loving care. Nothing less will do.
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These care facilities are for-profit entities. Maybe they shouldn't be. Other comments allude to corruption in cases the facilities know about upcoming inspections when thy shouldn't.
2
Another thought--"surprise" inspections never seemed to be surprises, as wards were suddenly fully staffed before the inspectors arrived. A staffer told me word generally got out ahead of time.
60
My mother was at two top-rated nursing homes over 7 years, and I visited every day. I frequently saw residents whose pleas for help went unanswered because of understaffing. It's a crime, or should be.
352
I also visited a family member in a nursing home, daily, for many years. I became familiar with some of the patients. I observed some patients crying out incessantly, never seeming to be satisfied by any attention that they might receive, since they appeared to be suffering from some form of dementia. However, in that same facility, I also witnessed patients being cruelly ignored when they needed more medical attention, due to the limits of staffing. I wish that every resident in an institution that does not have a regular family visitor had a volunteer friend in the community that they could count on to pop in regularly to look after them and their care.
In what ways are nursing homes, a diverse system of complex goals, techniques, activities, sites, upsetting as well as joyous sights, “accommodations, conceptual and theoretical underpinnings, and ranges of effective-ineffective regulations, enabled to becomes "warehouses" for the unpredictable- end-of-life? Rather than being helped to function, daily, as an opportunity for relatively successful personal pain control- physical, psychological, social, existential, etc.? Rather than planning, implementing, assessing and learning for, and about, types, levels and qualities of viable, nuanced, individualized-well-being? Enabling "exiting" with experienced, achievable dignity? When "nursing" and "home" are enabled to be little more than semantic surrealism, void of clinical and administrative personal accountability, all of us face a chronic and not an acute issue and problem!
9
Get a clue, America. This is the future more of you will experience. I have visited and audited a number of care facilities with costs ranging between $4k (for semi-independent living) to $10K per month. Most care was provided by non-native English-speaking immigrants. Fortunately, those I met were generally kind, caring, and skilled--despite low wages and the difficulty of the work. Some challenges for seniors included not being able to understand their heavily accented English and for women, not wanting to be bathed or taken to the bathroom by a night-time male attendant.
Aging Americans need to ask will take care of them, how and where? Especially if immigration limits the workers who normally fill these jobs and keeps care affordable. I applaud Mr. Vandemart, Mr. Hugo and others who recognized the needs and stepped up. As I held a role as a senior advocate--in better staffed facilities--I know it requires vigilance and constancy.
308
"Most care was provided by non-native English-speaking immigrants. Fortunately, those I met were generally kind, caring, and skilled--despite low wages and the difficulty of the work."
And there's a very good reason for that --
Most (if not all) of those "non-native English-speaking immigrants" come from countries where the priority for taking care of the elderly and disabled is deeply rooted in their family-oriented culture -
My wife - who is from the Caribbean - has taught this very important concept to me - and whenever I show her articles like this one, she just shakes her head and replies --
"Only in this country, do people view the care of their elderly parents and family members as being a 'problem' -- for us, it's a privilege and an honor" --
Even a third cousin or other distant relative will be cared for, should the need arise -
Yes - they do have "Nursing Homes" in her country - but those are reserved for people who have no family at all to look after them - the equivalent of geriatric orphans -
Just like the rest of "Health Care" in this country - the Nursing Home Industry is a profit-making enterprise --
And - Everyone in this country who has a family member living in a nursing home or other care facility should be very, very grateful for those "non-native English-speaking immigrants" who are there to lovingly do the jobs that the adult children and other family members are unwilling to accept and view them for what they are - acts of love and gratitude...
43
It is the future for everyone eventually. But why would foreigners leave their elderly and come to take care of those in the U.S. on the cheap? Isn't it also a little prejudiced to expect foreigners to get paid less for doing such trying jobs?
In addition to quantity, staff quality in a nursing home is also important. Achieving and maintaining good quality includes ongoing training. And cultural or racial differences are not necessarily a barrier to good care. Some of the best care I've seen has been provided by individuals from other cultures where greater reverence for elderly individuals is obvious.
Eldercare is often such a difficult job to perform. It almost demands a calling on the part of the caregiver.
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It is truly a calling to take care of the elderly and disabled. There are true angels doing this work. It takes a high level of emotional intelligence and a compassionate heart, traits that unfortunately are not recognized and valued financially in our society. Pray that you get cared for by one of these angels if you end up dependent on others for your care, and hope that they can afford to live decently.
23
I assure you that even illegal aliens DO IT FOR THE MONEY and have no calling for this very difficult job.
Americans do this work -- can do it -- will do it-- if they are paid fairly for this very difficult job.
I think you could easily prove that over the whole nation (excluding crazy nutjob Sanctuary California!), most health aides in nursing homes and AL homes are younger, poor black unwed mothers trying desperately to make a living in something other than fast food or retail work.
1
Concerned Citizen, I have seen you make a good point of stating the job of CNA would be more desirable for all if the pay was raised significantly. There are many jobs that take a special sort of person to do well. Nursing, teaching and therapy in particular come to mind.
Your point does get lost in the way you've pointed out that even "young, black, unwed mothers" are willing to do the job over working in fast food for more money.
1
As a registered nurse for almost 40 years, I know the difference that good nursing care can make on patient outcomes. Nursing is a science; I teach advanced practice nurses and know how much research and knowledge exists to improve care. I am embarrassed that these facilities call themselves "nursing" homes, when very little nursing goes on. I call on all nurses and healthcare professionals to keep refusing to be part of the problem. Report poor patient care and do it loudly! Refuse to work in conditions that are unsafe for patients. I am sickened by the greed driving healthcare.
383
Bless you for choosing your profession and practicing it with such care and high standards. Nursing is a science, and I think, a calling.
We as a society in the US must do MUCH more to treat it with the respect and appreciation it deserves.
14
Why would an illegal alien ever report poor working conditions? For those of you who favor light border controls because there are many 3rd world people who want a chance to better themselves working here illegally, this is what the result looks like.
6
Really? It sounds as if you are blaming poor care on the immigrants rather than the owners and bosses who control them. Nice diversion from the truth.
Medicare’s oversight is based on the honor system in an age where honor no longer exists, at least where profit is at stake. This is why it looks so “efficient” reporting implausibly low levels of fraud waste and abuse while entire sectors of the health care industry exist primarily through fraudulent rackets with false record keeping becoming the norm as shown here. It is not complicated. Lying to get money is fraud.
250
Yes, the true Medicare and Medicaid frauds are nursing home corporations, large doctor practices, DME companies, and the health insurance industry.
3
My first job out of nursing school in 1997 was in a rehab facility wherein I was the only RN on a 42 bed unit with two aides. After my first shift I spoke the the Director of Nursing about my concern that I was not able to provide proper care for that many patients. I was told that fewer staff was needed because the residents of that unit were ambulatory. After the nightly med pass, I would then start on the resident’s dressings, which meant I was waking these poor people to take care of wounds. I rarely finished my 3-11 shift before midnight and seriously considered leaving nursing.
As difficult as that job was, and nursing remains, I am in awe of what CNAs do on a daily basis, usually with great kindness and humor. The pay they receive is a disgrace. Something has to change in the way we provide health care and take care of the most vulnerable in this country.
570
Maggie- I am in agreement totally with your well written post. After 40 years of long-term care nursing, I had finally had enough of doing more with less and less, and left skilled nursing care 2 years ago. I just couldn't take it anymore. Staffing in nursing facilities is a HUGE issue and resident care suffers greatly. CNAs are amazing and deserve so much more and nurses/CNAs who stay in the field are extremely rare. CMS needs to really look a the staffing criteria and base it off of resident ADL scores from required assessments (MDS) and not base staffing on a daily facility census.
38
I also work the 3-11 shift. At that time of day, even the most able and alert of residents are tired physically and mentally and need more assistance to care for themselves; residents with various forms of dementia experience sundowning and need more attention as well. We have one RN or LPN plus 2 CNAs for 25-26 residents of mixed abilities. That's better than one nurse and one aide for 42 residents, not too bad, right? Half of those 26 residents require two aides to transfer from chair to bed or toilet and back again, often with assistance from a machine lift; one third require partial or total assistance with feeding themselves. Imagine, for a moment, what supper and bedtime look like for us-- a mad scramble to get things done, to get people cared for in a minimally adequate way. Some nurses help the aides out as they can but some are so overwhelmed with their own tasks that they offer us no help at all. Often I work with an agency CNA, some of whom work very hard and some of whom do very little. Well, I could say the same of staff CNAs. A lot of staff CNAs leave to work for agencies because agencies pay more than facilities. Speaking of pay: including my shift differential, I make all of two cents per hour more than my friend, a cashier at a big box retailer, and he started that job at about the same time as I started working as a CNA. We need higher mandated minimum staffing levels and better pay if we really want higher quality care.
42
Sheryl, as a fellow nurse, I know you are an angel among many in our profession. To have worked for 40 years in Skilled Care, you are rare and deserve many thanks for an extremely stressful and under appreciated job.
You are also correct about the. CNA's who are under appreciated and under paid as well.
Jeff Sessions and Donald Trump do a disservice to all the immigrants who are clamor in to come to this country and fill the jobs taking care of so many of our seniors. Unfortunately, as I said in a previous post, I don't think they care.
Certainly not as much as someone like you.
12
I am a recently retired RN who worked for 40 years as a bedside nurse. Most of my experience was in hospitals but I did a couple of short stints in nursing homes in recent years.
I can affirm all the other comments made by nurses in this column and have only a few few things to add.
1. Poor management. Although this is endemic in nursing it is worse in nursing homes. Favoritism and poor management skills are the rule not the not the exception. The best people at all levels tend to leave and go to more lucrative jobs in hospitals.
2. Over regulation. Their are so many stupid rules and reams of documentation to fill out that that nurses spend a lot most of their time doing paperwork rather than attending to patients.
3. All sorts of demeaning policies that assume staff will be irresponsible unless their behavior is closely monitored and punished . One can be fired for the slightest infraction. This creates an environment of fear and low moral.
4. Low pay. Nursing home RN's make half what hospitals pay. CNA pay is minimum wage in spite of the fact that they do most of the heavy lifting.
5 Low status. Caretakers are not valued in a country where tech, business, and entertainment jobs are lauded and highly payed.
6. Most nurses don't want to do direct patient care anymore. Young RN's do bedside nursing for a couple of years and then move on to more lucrative desk jobs or PA and specialty positions.
248
No. It isn't money that motivates us in this field. The truth is a lot of us nurses and aides would gladly take a major pay cut if it would guarantee more people on the clock. We want what's right for our nursing home residents. No one does this job for the money. What we really want is to be better nurses and aides, in the best possible caretaking environment, a healthy workplace that fosters humane, quality medical practices. Money? A lot of us go to the store before work, and buy stuff like Lorna Doone cookies and apple sauce cups with money from our own pockets, because at the end of the month, when the delivery truck still hasn't come, that one little old lady in Room 130 will be so crushed if she can't have her Lorna Doones. And we NEED apple sauce when we crush up pills for people who have swallowing difficulties. We even buy shampoo when the facility runs out because we want to give real showers where people actually come out smelling clean. We text each other before work as far as who is going to pick up what.
We want to do this whole taking-care-of-our-elders thing right. Those people built this country, fought in 4 wars, spent a lifetime paying taxes and raising the likes of us. They deserve so much better than this. We deeply love these old people. And I curse the selfish healthcare executives who take home millions of dollars via the current business model, while I am digging through the ashtray of my car for enough loose change to buy a box of Lorna Doones.
112
My daughter is a CNA 2. She works in one of the better long-term care facilities in Portland. We have talked about all of these issues.
She often calls me after a shift when her floor is under staffed. The guilt of not being able to care for her clients, like they deserve, is soul crushing.
In addition to better pay at hospitals, they also help jump the line to get into nursing programs and pay the raising costs of nursing programs.
35
Thank you for your comments. Fundamentally, as others have noted, this is a matter of money. If RNs and LPNs were paid a much better wage in these homes (maybe $100,000+ per year for RNs and $50,000 per year for LPNs) there would be an abundance of workers. But nobody wants to pay the taxes for this type of compensation (or transfer monies from the excessive defense spending). Of course, if these salaries were raised, over the short term (10 years or so?) it might cause a transfer of workers away from hospitals and doctor's offices which would just add to medical inflation as they too would have to increase wages. But over time if these incomes held you would eventually see many more workers entering this field, particularly as LPNs.
1
If you have a parent or other loved one in a US nursing home, you must go there EVERY DAY to visit - and make sure the administrators know you are there. There are enough abandoned elders in these places that the owners figure they can increase their profits by skimping services, since mostly no one knows what is going on. Make sure they know that you know.
265
Carmine, You are absolutely correct. This is also true if you have a loved one in the hospital. Make yourself present and involved in your loved one's care. The staff is keenly aware that a patient's family is present and will put forth extra effort.
52
And go at different times of the day, so they don't know when you'll be there, even late night.
Your advice is absolutely correct. That is the baseline.
When I was a teenager, I worked as a box boy at a supermarket. When we had produce that was past date we threw it in the trash bin. I used to see a guy with a van pulling it back out of the trash bin. It turned out to be a manager from a nursing home. Nursing homes are one of the best examples why we need universal health care that is accountable to the voters. The first right named in the Declaration of Independence is the right to life. That right applies just as much to the people who have fed us and clothed us and served in our police and our military and paid the taxes to keep this nation running all their lives as it does to a viable fetus. Profitability should not be the decider of life versus death.
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Do we have the financial and human resources to take care of the coming baby-boomer wave? I think not.
A quality care facility for full-care dementia is at minimum $7,500 per month. Some live in this state of being for more than a decade. How many children cared for, how many college educations lost?
It's a difficult choice--but our resources and financial assets are not unlimited.
Talk to God if you need help in dealing with the reality. Been there--it is not easy by any measure.
15
And yet it seems that we can give unlimited tax breaks and subsidies to bloodsucking capitalists and churches. If we made the rich pay their taxes and made the churches pay too, our society would not be too poor to care for its elderly. We are apparently not too poor to pay taxes to support billionaires.
14
I wish people like you were the ones people who make the decisions for the rest of us listened to. Profitability is ALL that seems to matter anymore to those that shape our world. I'm at a loss as to how begin to change that.
17
I was in a nursing home at 55 after a car accident. Spent a lot of time observing. It's a totally no-win situation. I can't believe the CNA's have to be licensed so they can take the abuse of the demented patients who hurl racist slurs at them. The CNA's deserve so much more money than they are paid, because it is EXTREMELY difficult and depressing work. I hope the number of residents will be stable over the next 20 years if more people might have home care help. But if the large boomer population, including me all need nursing home care, we are definitely up the creek.
117
I guarantee more people are NOT going to have home care, unless they buy it themselves. Though I don't believe Medicare's home health benefits have been cut, in fact agencies that provide those benefits (like Visiting Nuse of NY) have been cutting back on what they provide & denying based on "lack of medical necessity" even tho that is often not true, & can only assume because they are required to provide 24 hr benes to many ultra low income people who also qualify for Medicaid & aren't adequately reimbursed for THAT. I dread day I might need such benes, based on my observations over 15 yrs supervising care of my parents, & am considering moving far away from NY to a place where middle class people are treated better.
On nursing homes, I never worked harder (& ultimately lost my regular, paid job) when my late mother was sent for "rehab" to one of Manhattan's "top" such places following serious illness/surgery. She was there 99 days & there wasn't a day I felt they were correctly staffed. While CNAs seemed to do the best they could,"RNs" were often overseas temps from agencies & unfamiliar with American culture & language. When my mother once challenged the medication an RN was about to give her, saying she didn't recognize as something her doctor had prescribed, "nurse" yelled "medicine make you feel good, lady!" without coming close to addressing issue my mother had raised. I once had to go up there at 11 at night to sort things out (& call facility director at home)
Gone forever are the halcyon days of America's "Marcus Welby/"General Hospital" era of healthcare. Gone is the charity hospital where local rich ladies volunteered, their rich businessmen husbands all sat on the board for a salary of $1 a year, and the running of the hospital itself fell to the wisdom and experience of dutiful doctors who rendered care. The entities once known as "charity hospitals," as well as their sisters, the "municipal hospitals," are all fading away, falling victim to the for-profit model. Even the Catholic charity hospitals and nursing homes have almost all been bought up by for-profit healthcare companies. Don't be deceived by the religious-sounding names of the companies that took over ... they are indeed for-profit entities.
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Today's healthcare landscape is a Potemkin Village full of beautifully decorated facilities whose interiors have undergone profession makeovers right out of the pages of home design magazines. And behind each deceptive façade of pretty wallpaper and freshly painted crown molding and exquisite wall sconces, there sits a high-powered board of directors full of men wearing $3,000-dollar suits, each making millions of dollars per year (no more $1 per year). These men are now in charge of running that place, and their greed overrides all medical ethics.
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Meanwhile, faced with this powerless and hopeless new normal, American doctors are committing suicide in record numbers, and nurses are hitting burnout in two years or less.
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What!? The man wearing the $3000 suit is going to change the bedpans?? COME ON!
1
The man wearing the $3,000 suit needs to find something useful to do in life besides undermining the integrity and mission of modern medicine.
Meanwhile I am a CNA, and I am the one who changes the bedpans.
I want all of the sycophants to get out of this industry and let the General Hospital rich ladies and their husbands back into all of the boardrooms again. The local community hospital, as well as the local community nursing home, needs to be under the full control of the local community. And $1 a year for each board member is plenty. As for shareholders who get stock dividends? -- that needs to be made illegal! Profiting off of other people's misery merely incentivizes the perpetuation of more and more misery!
The First Rule of Medicine is "Do No Harm." And these for-profit corporate people who now run the for-profit American healthcare system are nothing but harm-doers.
I worked at a nursing home in Arkansas and then in emergency response in Virginia after that, and I have observed that the care of your loved ones all boils down to money. You can get great care and compassion if you have lots of money. If the home is mostly funded by the government - your loved ones will be left in need multiple times over and over again throughout the week. The CNA's are horribly mistreated. Low pay, long hours, physical labor and no appreciation. They are often treated like dirt by the other nursing staff. Let us see how well you would do being paid minimum wage, changing adult diapers, working sixteen hour shifts and being mistreated by {often} mentally deficient residents and condescending staff. But where are the families? Sometimes I wouldn't see a Resident's son or daughter until the day we were taking the Resident to the morgue. The way we treat out elderly and disabled makes me ill. We really have lost all compassion, empathy and decency - and our current political climate reflects our {lack of} morals magnificently. The treatment of children, the elderly and the disabled are a reflection of who we are as a nation - and we have failed them all.
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This reflects my observations as an elder care attorney. The wealthy private facilities are better, but even there the CNAs are overworked and underpaid. For many residents, especially those with cognitive deficits, the reality is far different. In Medicaid heavy facilities the problem is exacerbated. In both settings marketing literature paints a rosy picture of care rarely achieved in reality. Evenings, weekends and holidays are times of special risk. Frequent visits from family helps keeps everyone on their toes, but understaffing is a persistent problem. Private companions who care for my long-term clients report disturbing observations regarding other residents who have no visitors and often no memory of their mistreatment.
4
Spot on !
I agree with you. Well said!
1
Sadly, these unfortunate issues happen at hospitals too. A lot
On a Saturday afternoon, we found our elderly mother in her very hot (91 temp.) hospital room. She was complaining of thrist and hunger. Her untouched meal tray was five feet away from her hopital bed. She was lying in dried urine.
When I sought help-and asked for an explanation- from the staff at this hospital in Denville NJ, they said it was the "weekend."
Bottom line: The elderly need an advocate (protector) whereever they may be.
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A friend's mother, whose family members spent hours each day with their elderly mother would come in and find that almost every day some member of the staff always put the wrong hearing aid in each of their mother's ears even though they were clearly marked R and L. Pointing this out did nothing to fix this. The family member/s had to fix it when they got there.
2
Agreed, hospitals have been decimated by the for-profit corporate vultures right along with every other aspect of health care. My father, who just passed away on June 25th from frontal temporal lobe dementia, was shuttled back and forth between facility after facility after facility for a year from the time he had to be removed from the home for physically attacking my step-mother. Instead of being brought to the local ER for a psych eval, he was treated as a criminal and thrown into a county jail for two months while the state of SC sicced DSS on him and her, demonizing her and totally bungling his care. While in Spartanburg Regional's Behavioral Unit, he was neglected to the point of developing bedsores on his bottom and his right heel - IN THE HOSPITAL! Never mind the urinary tract infections he kept getting for not being hydrated enough. Thankfully, he had the best care that anyone can get once he was transferred to Smith Phayer Hospice House in Landrum for the final two weeks of his life. All of the staff were fabulous and provided the best care I've ever seen in my 20 year career as a social worker and my previous work as a medic in the Army and doing home health work.
1
The Ombudsman is the resident advocate. You can call them, and they will go assess the situation, however, it's not going to change anything in the skilled nursing facility. All it's going to do is cause more stress for an already overworked and underappreciated staff because the slave drivers (Director of Nursing and Administrator) will tell the staff to work harder and faster.