The Corporatization of Nursing Homes

https://prospect.org/familycare/the-corporatization-of-nursing-homes/

by neonate • 6 years ago

91 79 6 years ago

geocrasher2• 6 years ago

When my wife (46) and I found out that she was terminally ill, I promised her that I'd never let her end up in a Nursing/Hospice home. She'll get care at home. When the time comes, she'll die at home, too.

Myself, our adult daughter, and close friends have all banded together to make sure that she never ends up in a home. We reaffirmed this after Covid hit. If she goes into a hospice care facility, I'll never see her again, and she'll suffer even more from lack of care.

I've also seen healthy but less able older folks put in homes so that their kids could collect their inheritances and sell off everything else. In one case, the older woman was forced out of her home into a nursing home. Her quality of life was erased. She went from thriving at at home to dead in just a few months.

These greedy nursing homes are profiting from greedy adults who don't care about their parents and from a system that makes money by warehousing people.

vmception• 6 years ago

that's also happening

did you consider any other reasons why people might be in nursing homes?

uhhyeahdude2• 6 years ago

My condolences to both of you for the years you expected to spend with one another. What world-rocking news for anyone to get, let alone at the age of 46.

As someone who has been through an above-average amount of loss, I want to applaud and encourage the courageous, head-on manner in which you are approaching what is to come. It will pay off immensely down the road. My best to you, your wife and daughter.

redis_mlc2• 6 years ago

I have some experience with this through family and friends.

It's easy to make moral proclamations before spending literally decades attending to somebody with dementia/vegetation, or other chronic conditions. Wasting your own life on somebody who isn't all there is not a great trade-off if there's other options.

(My friend inherited a $2 million house for taking care of his gravely ill elderly relative, but that cost him 20 years of his life and meant he couldn't have a career, family or life outside the house. So a double tragedy.)

Having said that, there are reasons to be concerned about US nursing homes ...

US nursing homes are incentivized on many levels to sedate their normally active patients:

1) easier to control patients with less staff

2) paid for administering the sedative (daily or more frequently)

3) paid for the sedative.

So care bills can be inflated with no benefit to the patient paying for it.

foo_barrio2• 6 years ago

Unfortunately that incentive exists at home too. I, with my mom, were the primary caretakers of my father with dementia. Without any kind of sedation he was actually more mentally aware but also prone to violence, yelling, sprinting (if in the house easy to trip). On the sedative he was more manageable but also clumsier and more prone to slipping and falling. Overall I'd rather deal with that than having to be a referee between him and my mom!

foo_barrio2• 6 years ago

Sorry about your wife. It sucks to go through with that. Let me give you the other side of the story.

My father is slowly succumbing due to frontal-temporal dementia. In the span of 10 years he's gone from a social, independent man to a an extremely mentally challenged man with cognitive capacity of a 1 year old child. He is prone to ever increasing psychotic fits of violence and actual epileptic fits. Medication helps but they bring their own challenging behaviors. His body is still physically strong. He can still run if he so pleases. He has no problems getting into bed and standing but he needs help 24/7 with every single daily task. He cannot use the bathroom well so several times a day there is pee and poo to clean either from a diaper or the floor. Giving him a bath or shower is a delicate dance that 9/10 times is no problem but once in a while he can come out swinging. He has physically struck in the face, bit, headbutted, scratched and kicked all of us during these episodes.

My mom alone cannot deal with him. I, have to sometimes physically restrain him using quite a bit of my strength, in a way that doesn't hurt him. I try to read as much as I can about how to approach him as a patient and learn what triggers him, what scares him, how to calm and distract as an attempt to de-escalate these things. There were times when violent events happened multiple times a day, every day for weeks regardless of what the dosages of his meds were. He is also prone to insomnia and sometimes wakes up at 2-3am and refuses to go to bed disrupting my mother and I's sleep multiple times a week.

On top of that, he is completely vulnerable and helpless just like a 1 year old child. It's heartbreaking to have to deal with him when he gets violent. When he gets a full seizure and falls is always a traumatic thing for us. After talks with his neurologist, psychologist etc we put him in a care home.

It's callous to say, but honestly having him at home was simply not worth the cost to the entire rest of the family. As cold as it sounds, I stand by our decision to get him out of our daily lives. Mine and my mom's mental and physical health has taken a huge in the last 5 years. My career has essentially stopped since our whole day pretty much revolved around his care.

Your comment comes off as a bit too one-sided IMO. I know when my mom and I were at our wits end, she on the verge of a mental breakdown, I watching her slowly unwind, felt like a terrible person for even considering putting my father in a care home when I read comments like yours. My story is neither extreme nor unique. Having reached out to other people caring for dementia patients, caretaker fatigue is a real thing. Dealing with violence is common.

Not everyone who considers putting a loved one in a care home is a terrible person.

watersb• 6 years ago

Totally believe you. You are doing far more than most anyone would be able to do.

wombatmobile• 6 years ago

Yes. It is the most difficult thing.

There are no Hollywood movies about this, for a reason.

geocrasher2• 6 years ago

I so sincerely appreciate your reply. I want to assure you that your experience is not what I was referring to. I would totally back you up in this respect. I was referring only to those who are greedy enough to strip their parent of their assets and put them in a home. See the "manufactured scenario" comment shortly after mine.

Your situation sounds 100% warranted. Again, please do not take my comments as being directed toward anyone in your situation. They most definitely were not.

crispyambulance5• 6 years ago

also seen healthy but less able older folks put in homes so that their kids could collect their inheritances and sell off everything else...

Not sure what you mean by this, but putting someone in a skilled nursing facility costs about 10,000/month nominally. The "Deficit Reduction Act" of 2005 (thanks Bush), requires a 5 year look-back period for transactions to family members. Meaning that if a resident spends down all their money and needs to go on medical assistance, the family members are on the hook to pay the equivalent of whatever property or money they received from the parent going back to 5 years before the application of medical assistance (yes, they look at taxes and all bank account records). This stuff is effectively a financial trap for middle class families that has caused immeasurable grief and hardship. Consulting with an lawyer who specializes in elder law is super important.

As for nursing homes, they are sometimes the only option left. It's heartbreaking to put someone in a nursing home. I have done it but it was absolutely the right thing to do for my family. Everyone's situation is different, every nursing home is different. While I am sure that there is no shortage of greedy people, it's unfair to suggest that every person is equipped to give up their employment and take on 24/7/365 nursing care for a loved one and that not doing so is somehow "greedy".

eppp• 6 years ago

We hired a great person to help take care of a loved one during the day but it was complete luck that that person was available. It was still awful and if he had become any harder to take care of, we would have had to put him in a nursing home. Its a no win option.

chrisseaton2• 6 years ago

putting someone in a skilled nursing facility costs about 10,000/month nominally

Who on earth is able to afford this?

Everywhere I look there are nursing homes full of ordinary people. I can't believe more than 0.1% of these people are literally able to afford $10,000/month. People live in those places for 20 years sometimes. That's $24,000,000. It just doesn't add up, dude.

I think the actual cost is way, way, way less.

cyberdrunk• 6 years ago

In Poland, the rule is that basically if you and sibilings can afford to pay for the nursing home of your parent, there is no state assistance. The state only kicks in if the family is too poor to cover the costs. The rationale behind it being probably that caring for parents is the responsibility of family, not state.

vict00ms2• 6 years ago

Not sure what you mean by this

My grandmother was in good health but my mother didn't want to assist her (Medicare-provided) caretaker anymore and wanted her assets. She and my stepfather manufactured a scenario in which she took a fall, then stuck her in a nursing home and she died within a year. My mother knew the rules and got what she wanted without any repercussions (beyond losing contact with her only son).

sector777• 6 years ago

I'm probably similar in age to you and am so sorry to hear what you are going through.

Last year, my single mother's health transitioned from self-sufficient, but secretly hiding chronic problems, to completely unable to care for herself in the course of a day (she bore some responsibility for this, it was not completely an accident). I let the US health care system walk us into a nursing home situation. Some of the health care workers there went to the wall to do what they could, some had no business being health care providers.

I'll never forgive myself for the how it turned out. I don't think I would have done anything substantially different. She did not go gently, it was unpleasant at times and she fought us more than she fought to get better. She lived for 6 months in the nursing home. Maybe I could have stretched it out a few years if I had quit my job, moved into her home and taken care of her myself, but she never would have been self sufficient again. I'm pretty sure I would not have "made it" though that experience though, not sure how else to say it.

I would absolutely personally take care of my wife in our home if she fell ill, and I'm saying that knowing a lot more about the end of life than I used to, how difficult and long it can be. I do not want my children to do this for me.

DrAwdeOccarim• 6 years ago

Thanks for writing this out, I follow what you're saying and I agree on all three points. That quitting your job to care for your mom's end of life would have been disastrous to your health and well being after she passed, that you will care for your spouse, and that you would want your children to not bear the burden of caring for you at your end of life the same way you saw what that burden would have entailed with your mom. These are all very reasonable positions and I commend you for saying them aloud. I think most people feel the same way but have a hard time articulating it without sounding callous.

jacobwilliamroy• 6 years ago

The other day I heard a story about a man who decided to kill his elderly father as the old man was too weak for productive work and the son considered him to be a burden on himself and his own kids. He built a large box out of wood. The box had wheels and door with a padlock on it. He shoved his father inside and locked him up. He wheeled the box to the edge of a cliff where he intended to toss the box on to the rocks a hundred meters below. As he was about to send it over the edge, his old man piped up from inside.

"You know you can go ahead and toss me off this cliff, but you should really keep the box. Your kids may have need of it when you get to be old like me."

galfarragem• 6 years ago

It's very easy to oversimplify this growing problem. If it was that simple most families would take care of their elders isn't it?

What about that 100% dependent elders that are not terminally ill?

What about single childs that on their late 60s that have to take care of two persons in their 90s?

What about families that don't live from tech money and can't afford to hire a personal caretaker?

Who will caretake the caretaker parents?

(...)

This is still an unadressed problem disguised with cheap morals. Then, when a radical answer appears (euthanasia), everybody pretends not to see.

uhhyeahdude2• 6 years ago

My condolences to both of you for the years you expected to spend with one another. What world-rocking news for anyone to get, let alone at the age of 46.

throwaway-sf• 6 years ago

I'm probably in the minority here but I often think about preventative care like exercise and eating healthy now as insurance against a future where I'd be stuck in a nursing home in my final years.

polishdude20• 6 years ago

Not in the minority at all. Problem is that it's hard to get your rear in gear for something so far away in many people's lives.

nradov3• 6 years ago

Fortunately there are many short-term benefits as well.

crispyambulance5• 6 years ago

exercise and eating healthy now as insurance against a future where I'd be stuck in a nursing home in my final years.

We would all like to think that "the end" would come at a ripe old age with a peaceful death in one's sleep. Sadly that's not usually the case. People who live a long time can expect a cascade of long-lasting chronic health problems leading to their death.

If you're going to focus on diet and exercise do it for your quality of life NOW and not for the distant, unpredictable future.

There's something to be said for dropping dead at around 80 of a massive heart attack.

rhizome2• 6 years ago

Getting really old kinda sucks, healthy people die slowly, dying of old age takes a long time, and I wouldn't be surprised if 99%+ of centenarians are in nursing homes for their nth decade. So...y'know...good luck with your plan.

smabie• 6 years ago

Smoking and drinking a lot are probably the best ways to avoid nursing homes. Living a long time isn't all it's cracked up to be.

Personally, dying at 70 seems about ideal to me. Of course maybe I'll change my mind if/once I reach 70.

novok2• 6 years ago

There is a concept of healthspan, and elderly in their 70s who just have weak muscles & less energy with no mental or other physical health conditions or medication requirements.

phobosanomaly• 6 years ago

70 is younger than you think it is.

My dad is in his seventies, and just built an addition on the house alone, by hand in his free time while working a full-time job. From pouring the slab, to framing, to roofing, to electrical just because he was bored.

I think there's a lot to be said for arriving at your seventies still being the kind of person who goes, 'I'm bored, I need to go and build something with my hands.' There's obviously a lot of luck involved in not having any major health complications, but fortune favors the prepared.

Being relentlessly active and curious is a really, really big deal as you age and it's so easy to fall in the trap of retiring, and sitting on the couch with a beer watching Fox news.

Teknoman117• 6 years ago

My grandfather died in one of these facilities earlier this year from COVID. My great grandmother (his mother-in-law) died of a kidney infection in one about 15 years ago.

He had a heart attack in 2019 that crippled him, so he was in a physical rehabilitation facility because he could barely move on his own. He was making progress right up until the pandemic started. No visitation, and then the staff neglected him, which resulted in him developing pneumonia from laying in bed so much. He recovered somewhat, but then the pandemic hit the facility. He died a few weeks later.

I'll miss the time that stubborn man and I spent together. Rest in peace Pépère.

Hopefully by the time my parents are unable to care for themselves I'll be financially well enough off to make sure they never end up somewhere like this unless I truly can't provide the care they need.

DoreenMichele• 6 years ago

On the upside, modern tech is a potential antidote to this. Some elderly are able to keep their freedom and the dignity and quality of life that go with it by using tech to stay connected, provide reminders and alarms and so forth to mitigate some of the issues that cause us to think they would be better off with supervision in a nursing home.

If this concerns you and you are a programmer or similar, you may be able to contribute to such solutions.

rhizome2• 6 years ago

Some elderly are able to keep their freedom and the dignity and quality of life that go with it by using tech to stay connected, provide reminders and alarms and so forth to mitigate some of the issues that cause us to think they would be better off with supervision in a nursing home.

Yeah. My 83 year old Mom with multiple issues views those tools as something only an old lady needs, and so rejects them. She can use Facebook with the same level of skill as it takes to make and receive the phone calls that the social internet supplanted.

Right now, "elderly" is largely people who were born before most people owned televisions, and technological solutions aren't always greeted with a "yay, more!" attitude. I'm sure a lot of prewar and boomer people stopped wanting to learn yet another piece of "modern tech" somewhere between TiVo and smart phones.

TimTheTinker• 6 years ago

There are some good communities/homes for the elderly. Here's a great example (note these are pretty expensive): https://www.humangood.org/

I'm super grateful my grandmother was able to move to one of these communities while she was still on her feet and doing well. She started in a standalone house that she lived in by herself for about 10 years. With each subsequent step of her eventual decline, there was a smooth transition to a setup that was comfortable to her, and they took excellent care of her until she passed away.

alf365• 6 years ago

I remember watching a 20/20 Barbara Walters special years ago on the poor conditions of nursing homes.. fast forward to 2020... My former colleague and I built a QR app-based check-in system for nursing & assisted living - home caregivers to ensure they physically check on each resident as required. I was disheartened & dismayed most facilities just want to turn a blind-eye on the under-staffing issues of their facilities and could care less about improvement...There has to be market-demand to demand change and transparency! I'll keep pushing for change. That 20/20 special motivated me.

SargeZT2• 6 years ago

I don't work in a long-term care facility (I do acute geriatric psychiatric care), but I do work next door to one. We're non-profit so we don't exactly fit the mold, but understaffing isn't something that we are aiming for. We're offering incredible hiring bonuses, reaching out on every single avenue. Our problem is retention - we can get a few people hired, but maybe 1/5 CNAs stay, and 1/4 of the nurses. The long term care center probably has slightly better ratios, but most people don't have the ability to compartmentalize or the resiliency to last in the chronically understaffed units. You end up doing the work of 3 people with people who at best are demanding and at worst are physically attacking you and others.

Additionally, even for a CNA, training takes months and months. We get them out on the floor as soon as possible now, which isn't helping with out retention, but reflects the reality that our residents need care. Most of us are pulling 80+ hour weeks just to meet the federally mandated minimum staffing for how many residents we have at a given moment.

joeseppy• 6 years ago

Have you tried paying higher than the market rate ( like what you would pay a travelling nurse/CNA) instead of signing bonuses? CNAs make less than amazon warehouse workers in my area. If I'm a nurse, it's only natural I'm going to seek a less demanding patient population asap unless there is a significant incentive not to do that, especially given that every hospital in the country is hiring nurses at all times.

rland• 6 years ago

It's mind-blowing that we live like this.

We forced every adult into being a single atomic worker by completely eliminating jobs and benefits that enable single earners to care for their entire family (through the "unpaid" domestic work of the wife). Then, when we need to actually care for our families, we outsource that to the private sector, so that other atomic worker units can do the job for us. We have to do this, because nobody has time to care for our parents; we all have to work!

What did we get for doing this? What life improvements were gained?

The collective grief of the millions of people who have died alone is not worth any of this.

bluedino2• 6 years ago

Very few people want to take care of their parents

paulryanrogers• 6 years ago

I've seen our family share the burden among siblings over time. My SO's family often rotated duties too. This was more practical when there were many kids and the elderly didn't have as many years in need of assistance.

In hindsight it looks like it was a blessing and a curse. More time with them but weighed heavily on the mothers and daughters of all ages.

seibelj2• 6 years ago

In the golden olden days in which you allude, no one was paid to take care of children and parents. It's an argument to say we should subsidize those that care for their own parents and children (and there are numerous government programs and tax breaks that already do), but you are undercutting your thesis with this bizarre assertion.

Many old people never had kids, and don't have any family. They need paid workers to take care of them. Many readers of this comment are perhaps planning on not having kids, or even not getting married. Just imagine yourselves in 40 to 60 years - this will be you!

shadowmore• 6 years ago

And why are we now comfortable with not having kids? Because of atomism.

The "golden age" argument is flawed. No one seriously argues that literally everything was better in the past. Rather, the criticism is that it's absurd to have gotten rid of something positive we already had, only to replace it with something worse and gain no net benefit as a result.

It's all a matter of interconnected systems, including systems like social shaming. If it's unacceptable socially to not have a family, you'll have one. If it's unacceptable for women to work and compete with men for wealth and power, men will make enough to support their entire families, allowing at least one parent to always be there to raise children properly, instead of outsourcing that to strangers -- same for elderly care.

At the end of the day, atomism harms everyone and everything.

lotsofpulp4• 6 years ago

Women gained freedom, aka ability to earn income.

User232• 6 years ago

The freedom to work for a boss that sees her as just another disposable "human resource" instead of working for a family that sees her as it's essential heart.

tonyedgecombe• 6 years ago

Women also lost freedom. They went from not having the choice to work to not having the choice to not work.

Hnrobert42• 6 years ago

Of course to the extent that this is true, it is very sad. The plight of the elderly is so tough, it is the reason I volunteered at old folks homes in college.

But I don’t find this article very credible. It lacks objectivity and first hand sources. We must demand real journalism and acknowledge that just because a story is compelling doesn’t mean it is news.

emptybits• 6 years ago

Timely. In Canada today, the leader of the federal opposition party talked about the possibility of ending for-profit care homes nationally[1][2] and some provincial parties are very bullish on the idea.[3]

[1] https://toronto.citynews.ca/video/2020/10/29/ndp-calls-for-f...

[2] https://ipolitics.ca/2020/10/29/singh-joins-ontario-counterp...

[3] https://www.cbc.ca/news/canada/toronto/ontario-ndp-plan-chan...

The Corporatization of Nursing Homes

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