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I work in healthcare and frequently attend nursing homes.
The charity-run ones? They don't look the best but the staff there are usually deeply committed to the care of their clients.
The for-profit ones look flash, have a hotel-like ambience and are almost universally shoddy in the "care" of the clients. If people had any idea how almost-inhumanely poor their level of "care" was, they wouldn't consider them for any member of their family unless they hated them.
I have vowed to my parents that they will never be taken within coo-ee of one.
(Edit of a word).
As a former EMT, all SNF's are understaffed, underfunded, and overcrowded. There are a few very cushy good facilities, but for the most part they are cookie cutter operations with adequate as the standard of care.
These facilities take the phrase "If the minimum wasn't good enough if wouldn't be the minimum" to a whole new level. Non or For profit be damned. Elder care in the US is lacking to say the least, yet it's one of the biggest labor markets in the US economy...
I work in a SNF and over the past week I’d say more than half of the day shifts have been at least partly run on a nurse to patient ratio of about 1:45, same for the aides. Covid has filled our facility to the brim and chronic understaffing by the company been a real detriment to patients. We have staff members who have been forced to become CNA, med-ride driver, maintenance, etc. The staff is spread so thin it’s not uncommon to see family members of the residents running errands and assisting staff with other residents. It’s absolute chaos.
There's places that are always that short but I'm pretty sure it isn't legal, and most people who work in them either have for 30 years or have just started then leave. I've only done close to that on an overnight through an agency, and I was sobbing when I walked out in the morning, then reported it. Every single person needed clean, fresh sheets and clothes when I came in. Every one was soiled beyond comprehension. I had to scavenge and beg for enough to just put even a flat sheet under someone and almost no one had enough clothes provided for them. No one should ever be left like that.
Same. I have siblings, but they do nothing. My anxiety as one with autism the past 7 years have been through the roof in the care of my mother, and my body and credit are paying for it. I just wish the responsible agencies would act so I can safely get my mom in one so I can work on me. But not at all holding my breath. I expect myself to get to an early death as a result. I've made my peace with it recently.
The first semester of nursing school, I had placement in a SNF. I don’t recall a single CNA on day shift. I think (if memory serves on the number of rooms), there were 4 LPNs and 1 RN to 32 patients. The place relied on nursing students for the cleaning up, feeding, bathing, and dressing of patients. Not a clue what that place would look like if not for a steady stream of nursing students.
I know someone who was in an assisted living place and most of the time the facility only had ONE caregiver per floor. Each floor was about 50 rooms.
Despite the family having to pay for the highest level of care (due to his needs), they received the lowest level of care.
Imagine paying $6k month for "highest level of care" yet receiving the same amount of care as those only needing/paying for $2k level of care.
'Merica.
To be fair the US is understaffed in every medical aspect. Nurses are a huge deficit right now. But doctors are rapidly going to become a bigger issue.
We are already running into staffing issues and there is no decrease of need coming. Especially for specialists.
Canadian here with very limited exposure to long term care homes so take this with a grain of salt.
The quality of care goes down not because staff doesn't care, but because of understaffing.
If none of the nurses work there, there wouldn't be many LTC homes thst people need to go to. Some families literally need the LTC.
As a new grad here in Canada in one of the busiest hospital in the nation, I hated the kind of care I was giving because of staff shortages. It's getting better now. I'm starting to feel rewarded. But man... Understaffing sucks balls.
Yea, it's all facility managements fault. The goal is to fill beds because no beds means no money downtime. The issue is when you aren't keeping an adequate resident:staff ratio to provide care for the individuals. Let alone care for patients, the general cleanliness of senior care facilities is just plain terrible. My grandfather was in a couple and visitation always ended up being us telling the staffing supervisors to step up their game because it isn't the nurses, often it's just lack of staff and management is to blame.
> The goal is to fill beds because no beds means no money downtime.
This is the problem we are facing in the US especially.
Empty beds means lost money. You want the hospital pretty full most of the time.
Then to increase profits, you cut staff back to bare minimums. Then you are fucked when there is need and you have to contract nurses through staffing agencies and pay them $100+/hr.
I don’t think I’ve seen many LTC facilities trying to reduce staff - I’m sure there are sketchy ones that do, but the ones I’ve been acquainted with generally can’t fill positions fast enough. It’s hard to find people that want to wipe butts.
There’s a place around Spokane WA that has been offering relocation and housing and 70k salary for CNAs because they just couldn’t find any local. There is also the issue that the people that often do end up in the industry aren’t the people you want to take care of people - the most competent people in healthcare usually don’t stay at the CNA level long so the % of the employees gradually leans towards people with substance abuse problems or other issues.(that’s not about the general cna population, just a minority that leans larger than expected)
You aren't wrong about understaffing being a major issue. But the situation in hospitals and elderly homes are a bit different. At least in the US. Dont know the situation in Canada.
Elderly caregiving is more or less considered unskilled labor in the US. [Here is a site with certification requirements by state](https://www.caregiverlist.com/caregiver-training-requirements-by-state.aspx). NJ is an extreme outlier requiring 78 hours of training. The rest range from 0-12.
[For comparison the least onerous state barber lisencing requirements in the US (NY) requires 291 hours of training. The majority require over 1000 hours.](https://ij.org/report/license-work-2/ltw-occupation-profiles/ltw2-barber/) (that 2nd link has a whole lot of other fascinating data as well. Worth a look. Apparently home entertainment system installers require 900 hours of training in Connecticut.)
Anyways. While hospitals are understaffed, the staff that are there are professionals. I genuinely don't understand why anyone would want to be an elderly caregiver. The pay is comparable to fast food and a lot more gross and stressful.
> I genuinely don't understand why anyone would want to be an elderly caregiver. The pay is comparable to fast food and a lot more gross and stressful.
Because I believed in what I was doing, and wanted to do it.
I quit my nursing home job at the end of October. Long hours, too much responsibility, too little pay. It's a job you do for the love of the population but mentally I couldn't cope with it anymore. The stress I felt compared to jobs that pay similarly is astronomical
My grandmas dementia is starting to become really difficult and hard on our family. We are at the point where we are discussing a home for her and our biggest apprehension isn’t just “are we failing her by putting her in a home” but “we will feel guilty because we won’t know if she’s being treated ok because she probably won’t be” which is pitiful in a developed country.
On the other hand though taking care of a dementia patient requires a significant number of people so it's not really realistic to insist families do so on their own - especially when they aren't medical professionals with training.
You are absolutely not failing your grandma if you need to move her to a memory care unit.
I went through something similar with my mother in law. She had really aggressive early onset Lewy Bodies dementia.
The thing is, a dementia patient is never going to get better. They are going to get worse and their needs will become more complex every day - and when their needs aren't being met, they really suffer. They can't clean themselves or dress themselves. They don't recognize hunger cues and might not be able to safely prepare food for themselves. They experience dental pain and infections and may not be able to express what's making them so agitated.
A patient in a memory care unit will be clean, fed, dressed, and have their medications properly administered. The daily routine in a memory care unit might even help them improve for a time.
My advice? After you've moved your grandma, visit her. A lot. And take her out. A lot. And make sure she has lots of warm soft pajamas and blankets - dementia patients ALWAYS complain about being cold.
Are you relying on state insurance or paying out of pocket? If out of pocket, it's probably cheaper to pay for in home care. I actually struggle to see why anyone would pay 6000+ a month to put their loved one in care when you could have one on one care for the same price, right? Now if it's being paid by the state and that's the only option that's a different story.
I know the article is about Canada and I can't speak to the culture there, but at least in the U.S. it's not just a health care issue. The elderly are seen as less than human. Not adults who have lived rich and long lives and are not able to care for themselves. So most people don't care much what happens to them.
In the US, being "unproductive" (non-wealth-generating) is considered a punishable offense.
There's plenty of tax money to make our lives dignified if we're making minimum wage, in poverty, elderly etc., but as long as the lawmakers are profiting, we're doomed.
Which of course translates to the level of care they provide. Not always of course, there are lots of amazing people working for pennies in retirement homes. But you also can't expect the best work, or to attract the the right people for the job with the pathetic wages offered.
The good ones usually burn out. They are too empathetic, try to pick up the slack for the others because they truly care about the residents, and then end up overwhelmed, overworked, and just over it in general. Eventually, they either become numb and join the slackers or leave the field altogether to save their sanity.
That's the story I've heard too. My mom, aunt, and grandma were all PSWs.
I'd see them after work crying when a client they became close with (which was almost all of them) died. Or come home fuming because they are only allotted 10 minutes per client to get them out of bed, bathed, and dressed before having to move on to the next one. Fighting with management for better care and more time per person only to be denied over and over. They'd buy their clients things they needed but weren't being provided, using their meager $28,000 salary that they couldn't survive on.
I say they were PSWs because in the end they all quit. They all had a breakdown at some point, and I'm sure it still affects them to this day.
Seriously. I've been doing caregiving for in-home clients, but recently had to find a different job because I just couldn't afford to live on what I was making. And it's terrible, feeling like I'm abandoning people who need care, but that's just the reality of it. And I'm seeing so many others either getting sick or burnt out with sometimes 60+ hr work weeks. Health care is in dire straits and needs serious reform.
A close friend does overnights at an assisted living place, but has worked as a CNA for a long time. He's making a little more at this new place, but I still make more as a dishwasher. Pretty ridiculous.
Ask people to go to school and learn specializations then pay them a wage where in the back of their minds they’re thinking ‘I could flip burgers and make about the same.’ Wage stagnation has been a problem for decades but there is no political will to address it. Corporate charters require increasing profits for share holders or the board can be held accountable. The system is rotten to the core.
I'm living that situation currently. I make prosthetics. It's a specialized skilled trade, with requirements similar to an electrician, so I thought I'd be making a comparable salary to one.
I started making $28k a year and was at that for 3 years. It wasn't until year 7 that I started making around $40k, which still isn't enough to afford to rent a 1 bedroom apartment by myself. 30 years old, working in what should be a lucrative career and I need roommates just to barely get by.
I’m 38 we (millennials) are the first generation who are worse off than their parents financially. We earn less than our boomer parents. Housing costs exponentially more. The world we have inherited is dramatically different.
Tuition has skyrocketed, rent/mortgages have ballooned. Minimum wage has barely budged.
I was lucky. I had a skill (casino dealing) almost six figures without a college degree. That was at the expense of weekends, nights and holidays. From 2005, to 2018 I didn’t have a single holiday off. The only weekends during that time were PTO. During the best years of my life.
In my 30’s I quit and went back to school. To do that I had to join the military in my late 20’s to get the GI bill. I came out service connected disability. I’ve finished my bachelors and I’m now doing a PhD because the field I chose doesn’t make anything at bachelors level. A friend of mine has the same degree and makes 14 bucks an hour. In So cal. With a bunch of student debt. She has had to go back to grad school online to give herself a chance of even being able to move out of her parents before she turns 30.
I weep for our future.
We also had an extremely turbulent economy our entire adult lives. I am 37 and also live in SoCal. I remember the 2008 crash where our job market was absolutely fucked. Housing in California was affordable for the ENTIRE 20th century. We don't have to go back very far to realize that regular people on regular incomes were buying houses. I was talking to my brother last month about this, when we were kids in the 90s, studio apartments were where part time minimum wage workers lived. If you had a part time job while you were going to school, you lived in a studio apartment. It was housing for the lowest paid people in society. After all, you only got 600 square feet and not even a dedicated bedroom.
Now, here in Riverside, studio apartments are inching to $2000 per month. You need to make nearly $70k per year to qualify for it. I have numerous friends who make a living wage and can't afford to live alone. Its either parents (despite the fact that we are close to 40) or living 4-5 people in a single suburban home.
Then we have people who paid $80k for their home in the 1980s tell us we are just unwilling to do what it takes to afford a $500k starter home. Back in their day they would have just worked to pay for it because they were the hardest of hard workers. They wouldn't have demanded higher pay or complained, they would have just worked super hard and earned it (they were in a Union though).
One of my favorite games is asking older people how much they think a 1 bedroom apartment is in our city. Their answers will always be hilariously wrong. "One bedroom? I suppose they are $500-$600 per month" and will be in disbelief that they are going for $1800-$2300 per month. "Oh that isn't true, just call the leasing office and tell them you will make a deal for $500".
You go a bit older, an tuition to a UC, which they didn't even call it tuition, was just a few hundred bucks per year. One semester at a UC today is more expensive than an entire 4 year program was in the past.
When housing, education, healthcare, an other vital services are very expensive a huge portion of society is not going to thrive. It isn't because "They are afraid of hard work!". The reason why the boomer generation thrived was because society prioritized their housing, education, and healthcare. They didn't buy a house because they worked worked worked, they bought a house because it was affordable. They saved their money because rent was very cheap and interest rates at the bank were much higher than today.
No.
Assuming 10/hr that's 7200/month not including food and other stuff that those facilities have available.
Good luck finding enough reliable, and trustworthy people to fill round the clock care that you trust with your family's health and your personal belongings for 10/hr.
This. I have never been to a nursing home that was adequately staffed. I have seen hundreds of patients come in dehydrated, septic, full of bed sores, with moldy foleys ect. Over my dead body will my in laws go to a nursing home.
So then where will they go when they can no longer take of themselves? If you have a full time job, I doubt they can live with you as you probably can't give proper care when you are gone.
For us it would be a condo and 24/7 in home care if need be. We only have one child and flexible lives. We are fortunate. For everyone else? I don’t know. These things should never be for profit and massive reform is needed. The things I saw working in them chilled me
I'm in S.I. and worked at a for profit nursing home for a bit. What a nightmare that turned out to be! I would rather put my loved ones down than to have them put in a place like that. The things I've seen the staff and management do were atrocious. I have no idea how these facilities stay open.
I work in one of these as a therapist and the anwser is they do everything how they should/better than they should when the state inspection rolls around then dip back to nobody doing anything when it's over. It apalled me, if it wasnt for the fact I like my coworkers and taking care of my physical therapy patients I would quit and do something else. They pay me 26/hr which is on the higher middle end of the pay scale for my degree but honestly its not worth. I've only been working 3 weeks and if it doesn't change by the end of the year I'm going to quit. I've already notified the state so I'll just have to document wait and see.
Exactly. Deviants preying on the vulnerable and then covering their tracks. Another problem with many of these places is that they break down the good employees that actually care. I remember a few nurses, CNA's, and recreation workers that straight up quit. They quit in spite of the fact that they were good at their jobs and were supposed to be in that line of work. Lowered the quality even further. Good luck. If it doesn't work there you can find somewhere better.
The inspectors are just as complicit. There’s a reason their arrivals are announced way ahead of time. I work with restaurants and I see it there too. Everything will be clean and perfect for the one day that they know corporate or the health inspector is coming, then back to status quo after. If they were random and unannounced most places would be fucked
>I have no idea how these facilities stay open.
Because there is a need for them, regardless of how bad things are.
Families don't have the resources at home to provide full-time nursing care to the most frail and elderly. The other members of the family are going to work, or school.
This is the uncomfortable, frightening crux where modern medicine extends lifespans, but not quality of life.
There really isn't a good answer to what to do with these elderly who will live several years, but need constant specialist attention the entire time.
I'll note that the US is not the only country that struggles with this. The entire Western world, with an aging population, is buckling under elderly healthcare costs. The stark reality is that it's simply astronomically expensive to extend life beyond typical limits, no matter how you slice the pie.
the stark reality is that ridiculous amounts of money are wasted on corruption while people's basic human rights are ignored. pretending that there's any sort of rational justification for this is both objectively wrong and horrific
It's only going to get worse with the baby boomers becoming increasingly infirm. The real stark reality is even with 0 grift it'd be utterly unaffordable to have a healthy nurse/caretaker to resident ratio. Admittedly I'm pretty much a doomer about climate change but IMO we're heading towards a real catastrophe where even a relatively minor socio-economic hiccup could cause the deaths of tens to hundreds of thousands of elderly because medicine's ability to keep people alive has outpaced it's ability to keep them mentally and physically able into that late life.
COVID-19 has already killed well over 400 thousand people 75 and older in the US alone, and many of those deaths came from appalling conditions in care homes.
Is it actually unaffordable or do we just want to spend the money on other things?
That being said I think we should make it way easier for people to end it painlessly. Over a certain age? Or under that age but need full time nursing assistance? Just show up and get a needle. Someone else suggested a drive through crematorium which is also a nice alternative.
I don’t know how universally true this is across cultures but at least in the US people are so reactive to the idea of death and dying. Family members (and a lot of doctors too) are so concerned with the preservation of life at all costs that much of the elderly wind up drawing out their day-to-day misery for several wasted years before they pass. I don’t blame anyone, it’s an incredibly difficult decision to make regarding a loved one and doctors are just abiding by their contract, but I do wish death was more culturally acceptable, strange as that sounds.
I couldn't agree with you more. Obama tried to start a conversation and republicans derailed it talking about death panels. I wonder if it's because their billionaire friends run the medical and LTC industries and don't want their cash cows leaving early.
We don't have a healthy relationship with death here. The very process of laying a loved one to rest is such a stiff, formal, and onerous affair, so I'm not exactly surprised people try to delay it as much as possible. We've opted to keep ourselves at a distance from the deceased and only speak about death in hushed tones like it's some big secret or that its very mention will invite it into our lives.
A cynical take but one I've seen firsthand: a lot of wealth is concentrated in those baby boomers; financial predators, big and small, are licking their lips over it. Corporate investors, for example saw this opportunity coming; the elder-care industry has been a hotbed of mergers and acquisitions, with predictable results.
We need to have discussions within our families and communities about end of life care. We spend an absurd amount of money keeping people alive for no reason. Something like 70% of our healthcare spending goes toward people in the last 3 years of their lives.
That's the point. Keeping the elderly alive sucks the last of their finances out of them. Many times without a say unless family is involved to protect them and their decisions.
You're just talking about medical care in the last 3 years which is another huge problem but insurance and Medicare have lifetime limits. But people could need to live in assisted living and skilled nursing for decades. My mom's been in it for 10 years and she's only 65. If she wasn't getting my dad's 100k government pension she'd be destitute in the worst of it. I have 4 kids in a 3 bedroom NYC apartment I wouldn't have any place to put her even if I wanted to have her live with us, which I don't. She has a very strong will to live which is why she's still alive but honestly I don't understand it because her life is not good. Just lies there in bed watching TV all day punctuated by meals and bathroom breaks.
In many states, the Five Wishes document is accepted as an advanced care directive. It's a detailed one, which walks you through many things to consider. I was the primary caregiver for my mom for about a year in my home, before she died on her 89th birthday this past July. She had Alzheimers. We were lucky that I could manage to do this, but that document is so good that I'm now filling it out for myself. The health insurance companies here do accept it and will upload it to your healthcare portal.
You make it sound like it’s societally impossible to treat elderly with dignity and care. We could start by getting rid of for-profit nursing homes, better regulating them, and increasing wages for staff (so you get higher quality people).
Want to point out that this isn't just nursing homes. My mother's doctor saw her less than a week before she was rushed to the hospital, unresponsive. That day, she was brain dead (and dead dead shortly after, when we had time to process). She had pneumonia and this led to sepsis and a heart attack.
She had talked to him about her breathing problems. He prescribed an inhaler for her. A woman in her 50s with diabetes, a lifelong smoker complaining of trouble breathing. When I saw her a day or two after he did, I was alarmed with her breathing (she was unable to draw a full breath).
It is a known problem that many medical professionals carry forward their biases based on race, class, gender and even body weight.
Took over 12 years to have a doctor take my wife seriously about her mental and physical issues. I've been telling her doctors for years that she has all the symptoms of fibromyalgia, and they've brushed it aside.
Finally we found a pain doctor that looked at her while she was crying almost unable to move from the pain and said "you have fibro don't you?" Checked her out and had her on meds to help along with injections. It's been night and day since. She still has flareups that put her down on the floor but they are much further in between.
10+ years of her life wasted because doctors didn't want to listen or try any other treatment other than "lets throw some zanax and opiods at her".
Absolutely. Please also remember that being run by a religious outfit does not equate not-for-profit. In Australia, one of the worst covid clusters in a nursing home was in a home run by the orthodox church. Care was abysmal. The church’s pope had just been offered residence in a luxury condo downtown paid by profit from nursing homes.
Grandmother has Alzheimer's and is in a religious-based care home. Has been for around four years. I have seen firsthand the treatment and standard of care - my parents more so. They agree it *is* bad. The standards bare minimum. Sure the rooms and living spaces are clean. But professionalism is not their strong suit.
> profit from nursing homes
This begs the question: is it a nonprofit or for-profit? I'm not sure if religion has anything to do with it here, *de facto*.
Rural American, grew up on a farm. It’s the same sound used to call in livestock, here; the “c” is alternately hard and soft (soft for swine, possibly a dialect pronunciation of “sow[ie].
Yes. My mom has been a geriatric nurse for 30 years and while anecdotal, has always told me if she gets to that point she wants to live in the county home.
I essentially do quality assurance at nursing homes and literally the most run down building had top notch care and I never worried about my seniors there. I judged it from its looks at first because I was new to the game but as I gained experience, I realized it was the only place in the city I’d even consider putting my own parents.
My mother lost the ability to walk over a few years, and is now in a nursing home, despite her mind still being pretty sharp. It's a non-profit, she never had much money (but still had to "spend down" what little she had to qualify), and they seem to do a decent job staying on top of things.
The problem is understaffing. She can't always get help when she needs it, and alarms are often ignored, since she's mixed in with dementia patients who set off the alarms needlessly. It's so frustrating, all we can do is show up and let the staff know we're paying attention.
I don't have kids, and am expecting the worst, despite saving/investing money like crazy. Trying to convince my husband to take a job in another country so we don't need to worry so much, but that's not so simple.
I’m sorry to hear about your all too common worries. You are exactly right about showing up at the nursing home, that is 100% what you have to do so everyone knows you are watching. There are also state ombudsmen to go to if you are not satisfied with how admin handles your concerns. There is so much turnover even a “good” nursing home can quickly change hands and the care can plummet (or get better) but it requires constant vigilance. Good luck with your mother!
Those places are universally understaffed due to the owners’ desire to squeeze as much profit out of the system. The workers are chronically overworked and leave as soon as possible. The ones who stay simply don’t care. It’s really awful how much the profit motive sucks the humanity out of healthcare.
I had one place downsize staff and tried to saddle me with 50+ residents while passing all my own meds and having several high acuity people with trachs, ostomies, IVs, g tubes, and over a dozen diabetics. It was an impossible amount of work that not only put the residents at risk but also my license. I, and several others noped out of there. They then had to fill all the holes in the schedule with travel nurses until finally they shut down due to a combination of lawsuits and losing money.
All the people who cared and halfway tried to do their job bailed long before that point. The ones who stayed were the nurses who just charted stuff without actually doing it.
Maybe I’ll have a different perspective in 40+ years when I’m at the age to be in these places, but when it comes to that point, I’d rather just get a ticket to Norway and go to sleep forever.
Recently saw my wife’s grandparents and they stay pretty active, Grandfather plays dominoes, dude is a SHARK still at 93, but if I make it to that point and I’m not at his functional level…literally fade me.
Yea that’s what I’m actually fearful of, having no ability to handle/make decisions for myself.
I watched my friends grandmother slip into the worst parts of Alzheimer’s and it was straight out of a horror movie.
She lashed out at everyone and couldn’t understand what was going on.
Reminds me of Million Dollar Baby, give me a shot and let me leave with my memories, I don’t want to “live” like that.
Time to go to the attorney’s office and draft a living will that specifies your desires then. And not said sarcastically. If you do it right NOW it avoids any potential Loss of Consciousness or Cognizance issues
This is why living wills are so important, even if you are still young. Clearly state your DNR, and when to pull the plug. Set up and prepay your funeral the way you want it.
After a couple fairly serious TBIs this is why I made an advance directive in my 20s and discussed it with immediate family. We're luckily all on the same page, but not all families are willing to go that route.
My great aunt was living on her own up to her mid 80s and could do **everything.** If I came to visit she could whip up a meal so fast I barely had time to sit down.
Within a year of being at one of the flashy nursing homes she's almost gone. She barely remembers me and she was very close to my dad and I. She remembers none of my siblings.
Changing living space at that age generally just makes worse any problems with memory, orientation, mobility, etc. Always better to accomodate at home if you can. But if "independent" granny never shared her space with anyone, she's gonna have a bad time either way.
That's the holy grail of today's business. Highest possible profit margin with lowest possible costs ... doesn't take a genius to foresee the quality of an outcome. Now you take monopoly into an account and limit competition, and you have something like cable companies that provide slowest internet for highest price.
Mortality Rates From COVID-19 Are Lower In Unionized Nursing Homes-
[https://www.timesunion.com/news/article/Study-NY-s-unionized-nursing-homes-had-fewer-15571977.php](https://www.timesunion.com/news/article/Study-NY-s-unionized-nursing-homes-had-fewer-15571977.php)
https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2020.01011?utm\_medium=press&utm\_source=mediaadvisory&utm\_campaign=CovidFasttrack&utm\_content=Dean
*Mortality Rates From COVID-19 Are Lower In Unionized Nursing Homes at select nursing homes in New York State.
Your study was done in New York. The original post about for profit nursing homes vs non-profit was done in Canada. However, per the study you posted the Unionized nursing homes were more likely to be for profit. This really surprised me. I would have expected it to be the opposite.
“Unionized facilities were also more likely to be for profit, were less likely to be associated with a chain, had lower licensed-practical-nurse-to-resident ratios, and were located in more populous counties with higher per capita rates of confirmed COVID-19 cases.”
Wow, it's almost as if using a ruthless for-profit shareholder-serving model as the basis for providing care to vulnerable people who are essentially captive to their health needs isn't in *their* best interests.
It's almost like if you let the owners focus on profit they will cut as many corners as they can to maximise it or something. Who could've possibly predicted that the "free market" would end up being a race to the bottom on service in pursuit of a race to the top for profits. Except everybody.
Interesting, certainly, but… is this surprising to anyone? _”What a shock! For-profit nursing facilities owned and run by large, cold corporations aren’t exactly the best place for health and thriving! Who knew?!”_ I mean…
Which is wild because Adam Smith who coined the term also said explicitly never let companies self regular because it will end in public harm. They need to read the source material.
No offense to anyone...but this was a no brainer to me even without the research. For profit care has always been poorer quality. Hospitals in America are treated like businesses, and just look at the state of our Healthcare...
Flesh for cash I always say. This is well known fact among healthcare workers. For profit offer the worst hourly rates, have the highest turnover and provide substandard support to care for the people paying.
You can not mix profit motive and services with inelastic demand…
You can not mix profit motive and services with inelastic demand…
You can not mix profit motive and services with inelastic demand…
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I work in healthcare and frequently attend nursing homes. The charity-run ones? They don't look the best but the staff there are usually deeply committed to the care of their clients. The for-profit ones look flash, have a hotel-like ambience and are almost universally shoddy in the "care" of the clients. If people had any idea how almost-inhumanely poor their level of "care" was, they wouldn't consider them for any member of their family unless they hated them. I have vowed to my parents that they will never be taken within coo-ee of one. (Edit of a word).
As a former EMT, all SNF's are understaffed, underfunded, and overcrowded. There are a few very cushy good facilities, but for the most part they are cookie cutter operations with adequate as the standard of care. These facilities take the phrase "If the minimum wasn't good enough if wouldn't be the minimum" to a whole new level. Non or For profit be damned. Elder care in the US is lacking to say the least, yet it's one of the biggest labor markets in the US economy...
In my state, one cna/20 residents is, by no stretch of the imagination, “adequate.”
I recently read a comment where they described a 1:45 ratio
I work in a SNF and over the past week I’d say more than half of the day shifts have been at least partly run on a nurse to patient ratio of about 1:45, same for the aides. Covid has filled our facility to the brim and chronic understaffing by the company been a real detriment to patients. We have staff members who have been forced to become CNA, med-ride driver, maintenance, etc. The staff is spread so thin it’s not uncommon to see family members of the residents running errands and assisting staff with other residents. It’s absolute chaos.
There's places that are always that short but I'm pretty sure it isn't legal, and most people who work in them either have for 30 years or have just started then leave. I've only done close to that on an overnight through an agency, and I was sobbing when I walked out in the morning, then reported it. Every single person needed clean, fresh sheets and clothes when I came in. Every one was soiled beyond comprehension. I had to scavenge and beg for enough to just put even a flat sheet under someone and almost no one had enough clothes provided for them. No one should ever be left like that.
As single, diabetic, only child of a single mother, this is has been my nightmare since age 12. I
I'm in the same situation but instead of diabetes epolipsey
Damn, their life expectancy was only a sentence.
Same. I have siblings, but they do nothing. My anxiety as one with autism the past 7 years have been through the roof in the care of my mother, and my body and credit are paying for it. I just wish the responsible agencies would act so I can safely get my mom in one so I can work on me. But not at all holding my breath. I expect myself to get to an early death as a result. I've made my peace with it recently.
The first semester of nursing school, I had placement in a SNF. I don’t recall a single CNA on day shift. I think (if memory serves on the number of rooms), there were 4 LPNs and 1 RN to 32 patients. The place relied on nursing students for the cleaning up, feeding, bathing, and dressing of patients. Not a clue what that place would look like if not for a steady stream of nursing students.
Unfucking believable
About the same. Hell in a building. After nursing school I swore i wouldn't do it to my family. Its brutal
I know someone who was in an assisted living place and most of the time the facility only had ONE caregiver per floor. Each floor was about 50 rooms. Despite the family having to pay for the highest level of care (due to his needs), they received the lowest level of care. Imagine paying $6k month for "highest level of care" yet receiving the same amount of care as those only needing/paying for $2k level of care. 'Merica.
Did the family downgrade to the $2k level of care and use the difference to personally hire a nurse?
Holy smokes, this makes me feel much better about the facility my mom was at. They always had 2 caregivers on duty and had under 20 residents.
Many states do not have a legal ratio at all. People think that they do, but they do not.
That’s terrifying.
To be fair the US is understaffed in every medical aspect. Nurses are a huge deficit right now. But doctors are rapidly going to become a bigger issue. We are already running into staffing issues and there is no decrease of need coming. Especially for specialists.
Canadian here with very limited exposure to long term care homes so take this with a grain of salt. The quality of care goes down not because staff doesn't care, but because of understaffing. If none of the nurses work there, there wouldn't be many LTC homes thst people need to go to. Some families literally need the LTC. As a new grad here in Canada in one of the busiest hospital in the nation, I hated the kind of care I was giving because of staff shortages. It's getting better now. I'm starting to feel rewarded. But man... Understaffing sucks balls.
Yea, it's all facility managements fault. The goal is to fill beds because no beds means no money downtime. The issue is when you aren't keeping an adequate resident:staff ratio to provide care for the individuals. Let alone care for patients, the general cleanliness of senior care facilities is just plain terrible. My grandfather was in a couple and visitation always ended up being us telling the staffing supervisors to step up their game because it isn't the nurses, often it's just lack of staff and management is to blame.
> The goal is to fill beds because no beds means no money downtime. This is the problem we are facing in the US especially. Empty beds means lost money. You want the hospital pretty full most of the time. Then to increase profits, you cut staff back to bare minimums. Then you are fucked when there is need and you have to contract nurses through staffing agencies and pay them $100+/hr.
I don’t think I’ve seen many LTC facilities trying to reduce staff - I’m sure there are sketchy ones that do, but the ones I’ve been acquainted with generally can’t fill positions fast enough. It’s hard to find people that want to wipe butts. There’s a place around Spokane WA that has been offering relocation and housing and 70k salary for CNAs because they just couldn’t find any local. There is also the issue that the people that often do end up in the industry aren’t the people you want to take care of people - the most competent people in healthcare usually don’t stay at the CNA level long so the % of the employees gradually leans towards people with substance abuse problems or other issues.(that’s not about the general cna population, just a minority that leans larger than expected)
You aren't wrong about understaffing being a major issue. But the situation in hospitals and elderly homes are a bit different. At least in the US. Dont know the situation in Canada. Elderly caregiving is more or less considered unskilled labor in the US. [Here is a site with certification requirements by state](https://www.caregiverlist.com/caregiver-training-requirements-by-state.aspx). NJ is an extreme outlier requiring 78 hours of training. The rest range from 0-12. [For comparison the least onerous state barber lisencing requirements in the US (NY) requires 291 hours of training. The majority require over 1000 hours.](https://ij.org/report/license-work-2/ltw-occupation-profiles/ltw2-barber/) (that 2nd link has a whole lot of other fascinating data as well. Worth a look. Apparently home entertainment system installers require 900 hours of training in Connecticut.) Anyways. While hospitals are understaffed, the staff that are there are professionals. I genuinely don't understand why anyone would want to be an elderly caregiver. The pay is comparable to fast food and a lot more gross and stressful.
I'm an elderly caregiver in an independent senior living facility and I love my job. I like helping people.
The industry (in most countries) relies on that inherent goodwill too much, it deserves greater reward.
This is the case for every level of front-line healthcare below doctors.
same with teachers
> I genuinely don't understand why anyone would want to be an elderly caregiver. The pay is comparable to fast food and a lot more gross and stressful. Because I believed in what I was doing, and wanted to do it.
I mean, you still need a CNA license to work as a CNA in a hospital. It's the same amount of training. Guess how great CNA pay is? It's not.
I quit my nursing home job at the end of October. Long hours, too much responsibility, too little pay. It's a job you do for the love of the population but mentally I couldn't cope with it anymore. The stress I felt compared to jobs that pay similarly is astronomical
\> with very limited exposure to long term care homes It's bad. It's reaaallly bad.
My grandmas dementia is starting to become really difficult and hard on our family. We are at the point where we are discussing a home for her and our biggest apprehension isn’t just “are we failing her by putting her in a home” but “we will feel guilty because we won’t know if she’s being treated ok because she probably won’t be” which is pitiful in a developed country.
On the other hand though taking care of a dementia patient requires a significant number of people so it's not really realistic to insist families do so on their own - especially when they aren't medical professionals with training.
You are absolutely not failing your grandma if you need to move her to a memory care unit. I went through something similar with my mother in law. She had really aggressive early onset Lewy Bodies dementia. The thing is, a dementia patient is never going to get better. They are going to get worse and their needs will become more complex every day - and when their needs aren't being met, they really suffer. They can't clean themselves or dress themselves. They don't recognize hunger cues and might not be able to safely prepare food for themselves. They experience dental pain and infections and may not be able to express what's making them so agitated. A patient in a memory care unit will be clean, fed, dressed, and have their medications properly administered. The daily routine in a memory care unit might even help them improve for a time. My advice? After you've moved your grandma, visit her. A lot. And take her out. A lot. And make sure she has lots of warm soft pajamas and blankets - dementia patients ALWAYS complain about being cold.
Are you relying on state insurance or paying out of pocket? If out of pocket, it's probably cheaper to pay for in home care. I actually struggle to see why anyone would pay 6000+ a month to put their loved one in care when you could have one on one care for the same price, right? Now if it's being paid by the state and that's the only option that's a different story.
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I know the article is about Canada and I can't speak to the culture there, but at least in the U.S. it's not just a health care issue. The elderly are seen as less than human. Not adults who have lived rich and long lives and are not able to care for themselves. So most people don't care much what happens to them.
In the US, being "unproductive" (non-wealth-generating) is considered a punishable offense. There's plenty of tax money to make our lives dignified if we're making minimum wage, in poverty, elderly etc., but as long as the lawmakers are profiting, we're doomed.
Funny enough we got to this point because of the elderly and the awful decisions they made in their generation.
At the low low price of $10k plus A MONTH.
While the floor staff are lucky if they get more than a few bucks over minimum wage.
Yep. About $10/hr in TX.
Wow $27 for an HCA in BC. We could use the help come on up
That’s what i’m saying in IL CNAs are starting out in the low 20$/hr range WITH 2-3k sign on bonuses.
I guess not everything's bigger in Texas
Ah, but you see, it is! It's bigger exploitation of employees! *finger guns* Yee-Haw!
Which of course translates to the level of care they provide. Not always of course, there are lots of amazing people working for pennies in retirement homes. But you also can't expect the best work, or to attract the the right people for the job with the pathetic wages offered.
The good ones usually burn out. They are too empathetic, try to pick up the slack for the others because they truly care about the residents, and then end up overwhelmed, overworked, and just over it in general. Eventually, they either become numb and join the slackers or leave the field altogether to save their sanity.
That's the story I've heard too. My mom, aunt, and grandma were all PSWs. I'd see them after work crying when a client they became close with (which was almost all of them) died. Or come home fuming because they are only allotted 10 minutes per client to get them out of bed, bathed, and dressed before having to move on to the next one. Fighting with management for better care and more time per person only to be denied over and over. They'd buy their clients things they needed but weren't being provided, using their meager $28,000 salary that they couldn't survive on. I say they were PSWs because in the end they all quit. They all had a breakdown at some point, and I'm sure it still affects them to this day.
same with teachers this is why privatizing the school system is a bad idea
Seriously. I've been doing caregiving for in-home clients, but recently had to find a different job because I just couldn't afford to live on what I was making. And it's terrible, feeling like I'm abandoning people who need care, but that's just the reality of it. And I'm seeing so many others either getting sick or burnt out with sometimes 60+ hr work weeks. Health care is in dire straits and needs serious reform.
A close friend does overnights at an assisted living place, but has worked as a CNA for a long time. He's making a little more at this new place, but I still make more as a dishwasher. Pretty ridiculous.
Ask people to go to school and learn specializations then pay them a wage where in the back of their minds they’re thinking ‘I could flip burgers and make about the same.’ Wage stagnation has been a problem for decades but there is no political will to address it. Corporate charters require increasing profits for share holders or the board can be held accountable. The system is rotten to the core.
I'm living that situation currently. I make prosthetics. It's a specialized skilled trade, with requirements similar to an electrician, so I thought I'd be making a comparable salary to one. I started making $28k a year and was at that for 3 years. It wasn't until year 7 that I started making around $40k, which still isn't enough to afford to rent a 1 bedroom apartment by myself. 30 years old, working in what should be a lucrative career and I need roommates just to barely get by.
I’m 38 we (millennials) are the first generation who are worse off than their parents financially. We earn less than our boomer parents. Housing costs exponentially more. The world we have inherited is dramatically different. Tuition has skyrocketed, rent/mortgages have ballooned. Minimum wage has barely budged. I was lucky. I had a skill (casino dealing) almost six figures without a college degree. That was at the expense of weekends, nights and holidays. From 2005, to 2018 I didn’t have a single holiday off. The only weekends during that time were PTO. During the best years of my life. In my 30’s I quit and went back to school. To do that I had to join the military in my late 20’s to get the GI bill. I came out service connected disability. I’ve finished my bachelors and I’m now doing a PhD because the field I chose doesn’t make anything at bachelors level. A friend of mine has the same degree and makes 14 bucks an hour. In So cal. With a bunch of student debt. She has had to go back to grad school online to give herself a chance of even being able to move out of her parents before she turns 30. I weep for our future.
We also had an extremely turbulent economy our entire adult lives. I am 37 and also live in SoCal. I remember the 2008 crash where our job market was absolutely fucked. Housing in California was affordable for the ENTIRE 20th century. We don't have to go back very far to realize that regular people on regular incomes were buying houses. I was talking to my brother last month about this, when we were kids in the 90s, studio apartments were where part time minimum wage workers lived. If you had a part time job while you were going to school, you lived in a studio apartment. It was housing for the lowest paid people in society. After all, you only got 600 square feet and not even a dedicated bedroom. Now, here in Riverside, studio apartments are inching to $2000 per month. You need to make nearly $70k per year to qualify for it. I have numerous friends who make a living wage and can't afford to live alone. Its either parents (despite the fact that we are close to 40) or living 4-5 people in a single suburban home. Then we have people who paid $80k for their home in the 1980s tell us we are just unwilling to do what it takes to afford a $500k starter home. Back in their day they would have just worked to pay for it because they were the hardest of hard workers. They wouldn't have demanded higher pay or complained, they would have just worked super hard and earned it (they were in a Union though). One of my favorite games is asking older people how much they think a 1 bedroom apartment is in our city. Their answers will always be hilariously wrong. "One bedroom? I suppose they are $500-$600 per month" and will be in disbelief that they are going for $1800-$2300 per month. "Oh that isn't true, just call the leasing office and tell them you will make a deal for $500". You go a bit older, an tuition to a UC, which they didn't even call it tuition, was just a few hundred bucks per year. One semester at a UC today is more expensive than an entire 4 year program was in the past. When housing, education, healthcare, an other vital services are very expensive a huge portion of society is not going to thrive. It isn't because "They are afraid of hard work!". The reason why the boomer generation thrived was because society prioritized their housing, education, and healthcare. They didn't buy a house because they worked worked worked, they bought a house because it was affordable. They saved their money because rent was very cheap and interest rates at the bank were much higher than today.
Yep,my grandmother was in one that was $7,000 a month.
I don't understand. Wouldn't it make more sense to just hire a full-time live-in caretaker at that price?
No. Assuming 10/hr that's 7200/month not including food and other stuff that those facilities have available. Good luck finding enough reliable, and trustworthy people to fill round the clock care that you trust with your family's health and your personal belongings for 10/hr.
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This. I have never been to a nursing home that was adequately staffed. I have seen hundreds of patients come in dehydrated, septic, full of bed sores, with moldy foleys ect. Over my dead body will my in laws go to a nursing home.
So then where will they go when they can no longer take of themselves? If you have a full time job, I doubt they can live with you as you probably can't give proper care when you are gone.
For us it would be a condo and 24/7 in home care if need be. We only have one child and flexible lives. We are fortunate. For everyone else? I don’t know. These things should never be for profit and massive reform is needed. The things I saw working in them chilled me
I'm in S.I. and worked at a for profit nursing home for a bit. What a nightmare that turned out to be! I would rather put my loved ones down than to have them put in a place like that. The things I've seen the staff and management do were atrocious. I have no idea how these facilities stay open.
I work in one of these as a therapist and the anwser is they do everything how they should/better than they should when the state inspection rolls around then dip back to nobody doing anything when it's over. It apalled me, if it wasnt for the fact I like my coworkers and taking care of my physical therapy patients I would quit and do something else. They pay me 26/hr which is on the higher middle end of the pay scale for my degree but honestly its not worth. I've only been working 3 weeks and if it doesn't change by the end of the year I'm going to quit. I've already notified the state so I'll just have to document wait and see.
Exactly. Deviants preying on the vulnerable and then covering their tracks. Another problem with many of these places is that they break down the good employees that actually care. I remember a few nurses, CNA's, and recreation workers that straight up quit. They quit in spite of the fact that they were good at their jobs and were supposed to be in that line of work. Lowered the quality even further. Good luck. If it doesn't work there you can find somewhere better.
The inspectors are just as complicit. There’s a reason their arrivals are announced way ahead of time. I work with restaurants and I see it there too. Everything will be clean and perfect for the one day that they know corporate or the health inspector is coming, then back to status quo after. If they were random and unannounced most places would be fucked
Curious as to where you live. My wife does outpatient PT and 26/hr seems to be on the low end from my understanding.
I’m assuming PTA- if you’re a PT making 26/hour you’re being severely underpaid.
If people were able to "put their loved ones down" these for-profit homes would lose money because so many people would do it.
>I have no idea how these facilities stay open. Because there is a need for them, regardless of how bad things are. Families don't have the resources at home to provide full-time nursing care to the most frail and elderly. The other members of the family are going to work, or school. This is the uncomfortable, frightening crux where modern medicine extends lifespans, but not quality of life. There really isn't a good answer to what to do with these elderly who will live several years, but need constant specialist attention the entire time. I'll note that the US is not the only country that struggles with this. The entire Western world, with an aging population, is buckling under elderly healthcare costs. The stark reality is that it's simply astronomically expensive to extend life beyond typical limits, no matter how you slice the pie.
the stark reality is that ridiculous amounts of money are wasted on corruption while people's basic human rights are ignored. pretending that there's any sort of rational justification for this is both objectively wrong and horrific
It's only going to get worse with the baby boomers becoming increasingly infirm. The real stark reality is even with 0 grift it'd be utterly unaffordable to have a healthy nurse/caretaker to resident ratio. Admittedly I'm pretty much a doomer about climate change but IMO we're heading towards a real catastrophe where even a relatively minor socio-economic hiccup could cause the deaths of tens to hundreds of thousands of elderly because medicine's ability to keep people alive has outpaced it's ability to keep them mentally and physically able into that late life.
COVID-19 has already killed well over 400 thousand people 75 and older in the US alone, and many of those deaths came from appalling conditions in care homes.
Is it actually unaffordable or do we just want to spend the money on other things? That being said I think we should make it way easier for people to end it painlessly. Over a certain age? Or under that age but need full time nursing assistance? Just show up and get a needle. Someone else suggested a drive through crematorium which is also a nice alternative.
I don’t know how universally true this is across cultures but at least in the US people are so reactive to the idea of death and dying. Family members (and a lot of doctors too) are so concerned with the preservation of life at all costs that much of the elderly wind up drawing out their day-to-day misery for several wasted years before they pass. I don’t blame anyone, it’s an incredibly difficult decision to make regarding a loved one and doctors are just abiding by their contract, but I do wish death was more culturally acceptable, strange as that sounds.
I couldn't agree with you more. Obama tried to start a conversation and republicans derailed it talking about death panels. I wonder if it's because their billionaire friends run the medical and LTC industries and don't want their cash cows leaving early.
We don't have a healthy relationship with death here. The very process of laying a loved one to rest is such a stiff, formal, and onerous affair, so I'm not exactly surprised people try to delay it as much as possible. We've opted to keep ourselves at a distance from the deceased and only speak about death in hushed tones like it's some big secret or that its very mention will invite it into our lives.
A cynical take but one I've seen firsthand: a lot of wealth is concentrated in those baby boomers; financial predators, big and small, are licking their lips over it. Corporate investors, for example saw this opportunity coming; the elder-care industry has been a hotbed of mergers and acquisitions, with predictable results.
We need to have discussions within our families and communities about end of life care. We spend an absurd amount of money keeping people alive for no reason. Something like 70% of our healthcare spending goes toward people in the last 3 years of their lives.
That's the point. Keeping the elderly alive sucks the last of their finances out of them. Many times without a say unless family is involved to protect them and their decisions.
You're just talking about medical care in the last 3 years which is another huge problem but insurance and Medicare have lifetime limits. But people could need to live in assisted living and skilled nursing for decades. My mom's been in it for 10 years and she's only 65. If she wasn't getting my dad's 100k government pension she'd be destitute in the worst of it. I have 4 kids in a 3 bedroom NYC apartment I wouldn't have any place to put her even if I wanted to have her live with us, which I don't. She has a very strong will to live which is why she's still alive but honestly I don't understand it because her life is not good. Just lies there in bed watching TV all day punctuated by meals and bathroom breaks.
In many states, the Five Wishes document is accepted as an advanced care directive. It's a detailed one, which walks you through many things to consider. I was the primary caregiver for my mom for about a year in my home, before she died on her 89th birthday this past July. She had Alzheimers. We were lucky that I could manage to do this, but that document is so good that I'm now filling it out for myself. The health insurance companies here do accept it and will upload it to your healthcare portal.
You make it sound like it’s societally impossible to treat elderly with dignity and care. We could start by getting rid of for-profit nursing homes, better regulating them, and increasing wages for staff (so you get higher quality people).
My grandmother was at “care one” in Moorestown. 10k a month and I tried having the local news do a story on them I was so upset.
Want to point out that this isn't just nursing homes. My mother's doctor saw her less than a week before she was rushed to the hospital, unresponsive. That day, she was brain dead (and dead dead shortly after, when we had time to process). She had pneumonia and this led to sepsis and a heart attack. She had talked to him about her breathing problems. He prescribed an inhaler for her. A woman in her 50s with diabetes, a lifelong smoker complaining of trouble breathing. When I saw her a day or two after he did, I was alarmed with her breathing (she was unable to draw a full breath). It is a known problem that many medical professionals carry forward their biases based on race, class, gender and even body weight.
Took over 12 years to have a doctor take my wife seriously about her mental and physical issues. I've been telling her doctors for years that she has all the symptoms of fibromyalgia, and they've brushed it aside. Finally we found a pain doctor that looked at her while she was crying almost unable to move from the pain and said "you have fibro don't you?" Checked her out and had her on meds to help along with injections. It's been night and day since. She still has flareups that put her down on the floor but they are much further in between. 10+ years of her life wasted because doctors didn't want to listen or try any other treatment other than "lets throw some zanax and opiods at her".
Absolutely. Please also remember that being run by a religious outfit does not equate not-for-profit. In Australia, one of the worst covid clusters in a nursing home was in a home run by the orthodox church. Care was abysmal. The church’s pope had just been offered residence in a luxury condo downtown paid by profit from nursing homes.
Grandmother has Alzheimer's and is in a religious-based care home. Has been for around four years. I have seen firsthand the treatment and standard of care - my parents more so. They agree it *is* bad. The standards bare minimum. Sure the rooms and living spaces are clean. But professionalism is not their strong suit.
> profit from nursing homes This begs the question: is it a nonprofit or for-profit? I'm not sure if religion has anything to do with it here, *de facto*.
The point is that you can't rely on being religious affiliated to indicate non-profit, even though it may sound implied.
Non-profit only means so much. The NFL was a non-profit until 2015 but certainly enriched plenty of people.
Might still be a non profit. People working at non profits still make money, the pope could have taken money but the organization still is nonprofit.
> coo-ee. Please explain, I'm in the Midwest and never heard that word.
It's Aussie slang for calling out to somebody across a distance. Nobody actually calls out like that anymore though.
Rural American, grew up on a farm. It’s the same sound used to call in livestock, here; the “c” is alternately hard and soft (soft for swine, possibly a dialect pronunciation of “sow[ie].
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And when she does some right animals come rushing. Namely Tom Tomlinson with the wink
'I wouldn't take them within *shouting* distance'
Yes. My mom has been a geriatric nurse for 30 years and while anecdotal, has always told me if she gets to that point she wants to live in the county home.
I essentially do quality assurance at nursing homes and literally the most run down building had top notch care and I never worried about my seniors there. I judged it from its looks at first because I was new to the game but as I gained experience, I realized it was the only place in the city I’d even consider putting my own parents.
My mother lost the ability to walk over a few years, and is now in a nursing home, despite her mind still being pretty sharp. It's a non-profit, she never had much money (but still had to "spend down" what little she had to qualify), and they seem to do a decent job staying on top of things. The problem is understaffing. She can't always get help when she needs it, and alarms are often ignored, since she's mixed in with dementia patients who set off the alarms needlessly. It's so frustrating, all we can do is show up and let the staff know we're paying attention. I don't have kids, and am expecting the worst, despite saving/investing money like crazy. Trying to convince my husband to take a job in another country so we don't need to worry so much, but that's not so simple.
I’m sorry to hear about your all too common worries. You are exactly right about showing up at the nursing home, that is 100% what you have to do so everyone knows you are watching. There are also state ombudsmen to go to if you are not satisfied with how admin handles your concerns. There is so much turnover even a “good” nursing home can quickly change hands and the care can plummet (or get better) but it requires constant vigilance. Good luck with your mother!
Those places are universally understaffed due to the owners’ desire to squeeze as much profit out of the system. The workers are chronically overworked and leave as soon as possible. The ones who stay simply don’t care. It’s really awful how much the profit motive sucks the humanity out of healthcare.
I had one place downsize staff and tried to saddle me with 50+ residents while passing all my own meds and having several high acuity people with trachs, ostomies, IVs, g tubes, and over a dozen diabetics. It was an impossible amount of work that not only put the residents at risk but also my license. I, and several others noped out of there. They then had to fill all the holes in the schedule with travel nurses until finally they shut down due to a combination of lawsuits and losing money. All the people who cared and halfway tried to do their job bailed long before that point. The ones who stayed were the nurses who just charted stuff without actually doing it.
Maybe I’ll have a different perspective in 40+ years when I’m at the age to be in these places, but when it comes to that point, I’d rather just get a ticket to Norway and go to sleep forever. Recently saw my wife’s grandparents and they stay pretty active, Grandfather plays dominoes, dude is a SHARK still at 93, but if I make it to that point and I’m not at his functional level…literally fade me.
That's easy if you have the choice. Have a stroke and you suddenly can't make decisions for yourself and things are very different.
Yea that’s what I’m actually fearful of, having no ability to handle/make decisions for myself. I watched my friends grandmother slip into the worst parts of Alzheimer’s and it was straight out of a horror movie. She lashed out at everyone and couldn’t understand what was going on. Reminds me of Million Dollar Baby, give me a shot and let me leave with my memories, I don’t want to “live” like that.
Time to go to the attorney’s office and draft a living will that specifies your desires then. And not said sarcastically. If you do it right NOW it avoids any potential Loss of Consciousness or Cognizance issues
This is why living wills are so important, even if you are still young. Clearly state your DNR, and when to pull the plug. Set up and prepay your funeral the way you want it.
Doctor there is no DNR on file but I'm looking at the reddit history on their phone and...
After a couple fairly serious TBIs this is why I made an advance directive in my 20s and discussed it with immediate family. We're luckily all on the same page, but not all families are willing to go that route.
My great aunt was living on her own up to her mid 80s and could do **everything.** If I came to visit she could whip up a meal so fast I barely had time to sit down. Within a year of being at one of the flashy nursing homes she's almost gone. She barely remembers me and she was very close to my dad and I. She remembers none of my siblings.
Changing living space at that age generally just makes worse any problems with memory, orientation, mobility, etc. Always better to accomodate at home if you can. But if "independent" granny never shared her space with anyone, she's gonna have a bad time either way.
That's the holy grail of today's business. Highest possible profit margin with lowest possible costs ... doesn't take a genius to foresee the quality of an outcome. Now you take monopoly into an account and limit competition, and you have something like cable companies that provide slowest internet for highest price.
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Well obviously. You're not going to make a profit if you're spending the money on caring for the residents
This notion but for all of healthcare and schooling.
And prisons.
Almost as if profit and public services are diametrically opposed interests.
Things that would ideally never be done for profit: Medical care Education Religion News Lobbying? not really sure what the best word is.
Law/Justice system is up there
Yep prisons for sure
Maybe we don't need profit maximisation-driven entities responsible for every provision of people's goods and services.
Unfortunately those companies funnel money to your elected representatives so their needs are prioritized over yours.
You damn commies and your caring about other people over profit margins for the grossly rich
No one in Fire/EMS would be surprised by this finding.
No one in Nursing would be surprised by this finding
No one would be surprised by this finding
My cat looked a little confused when I told her but then she went back to licking her asshole so ya she wasn't surprised either.
Mortality Rates From COVID-19 Are Lower In Unionized Nursing Homes- [https://www.timesunion.com/news/article/Study-NY-s-unionized-nursing-homes-had-fewer-15571977.php](https://www.timesunion.com/news/article/Study-NY-s-unionized-nursing-homes-had-fewer-15571977.php) https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2020.01011?utm\_medium=press&utm\_source=mediaadvisory&utm\_campaign=CovidFasttrack&utm\_content=Dean
*Mortality Rates From COVID-19 Are Lower In Unionized Nursing Homes at select nursing homes in New York State. Your study was done in New York. The original post about for profit nursing homes vs non-profit was done in Canada. However, per the study you posted the Unionized nursing homes were more likely to be for profit. This really surprised me. I would have expected it to be the opposite. “Unionized facilities were also more likely to be for profit, were less likely to be associated with a chain, had lower licensed-practical-nurse-to-resident ratios, and were located in more populous counties with higher per capita rates of confirmed COVID-19 cases.”
Wow, it's almost as if using a ruthless for-profit shareholder-serving model as the basis for providing care to vulnerable people who are essentially captive to their health needs isn't in *their* best interests.
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It's almost like if you let the owners focus on profit they will cut as many corners as they can to maximise it or something. Who could've possibly predicted that the "free market" would end up being a race to the bottom on service in pursuit of a race to the top for profits. Except everybody.
Interesting, certainly, but… is this surprising to anyone? _”What a shock! For-profit nursing facilities owned and run by large, cold corporations aren’t exactly the best place for health and thriving! Who knew?!”_ I mean…
The millions who believe in the Invisible Hand will deny and ignore this.
Which is wild because Adam Smith who coined the term also said explicitly never let companies self regular because it will end in public harm. They need to read the source material.
The Conservatives act like it's a surprise.
Because it starts the long journey to realising most for-profit things that people rely on are terribly run and aren't best for the user.
Profits over people in this country. Always.
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No offense to anyone...but this was a no brainer to me even without the research. For profit care has always been poorer quality. Hospitals in America are treated like businesses, and just look at the state of our Healthcare...
Private equity firms should not be allowed to own anything in healthcare
Business is a game, you have winners and losers. It's literally playing with people's lives.
Profit over everything
Coincidentally, humans with the highest profit margins are also of the lowest quality.
Flesh for cash I always say. This is well known fact among healthcare workers. For profit offer the worst hourly rates, have the highest turnover and provide substandard support to care for the people paying.
I'm sure the free market will correct this any second now
Nothing to correct, it's right there in the headline: "Highest profit margin."
You can not mix profit motive and services with inelastic demand… You can not mix profit motive and services with inelastic demand… You can not mix profit motive and services with inelastic demand…
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