The Corporatization of Nursing Homes
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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.
did you consider any other reasons why people might be in nursing homes?
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.
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.
I was mainly talking about non-medical, billing-only use of sedatives decided by home administrators when the family is not around to make an informed decision.
If you're not outraged, you should re-read the above paragraph again. That's been reported in local SV newspapers and online.
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.
There are no Hollywood movies about this, for a reason.
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.
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".
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.
https://www.thebalance.com/u-s-federal-budget-breakdown-3305...
>Mandatory expenditures, such as Social Security, Medicare, and the Supplemental Nutrition Assistance Program account for about 60% of the budget.
Technically Medicaid is from state governments or at least some portion of it, but it probably looks the same there.
The breakdown of single-earner families means kids and seniors get institutional care. And there isn’t enough money to socialize care as good as your family.
I guess we'd save a lot of money if we just had family structures more like people in asian countries.
If people are better off doing something for themselves, then it is a net win if they do. The nursing home employees can go and do something else.
"in some sense" really means in a collective sense. Not everyone falls into the safety net, but those that do certainly could exceed, in expenses, what they paid into the system. That's OK and totally fair.
Obviously, some people will need school and care that family can't give, and I'm not against paying for it.
But these policies encourage assets to be wasted so that you can get in the safety net.
For a fraction of them to need long-term care at some level, mostly not the nursing level, for on average around 2-3 years? Yes, easily.
The numbers add up in bulk. It's a safety net that not everyone falls into.
A substantial majority of nursing home patients in the US are paid for by Medicaid; people who have assets often shed them to qualify for Medicaid if they need nursing care.
> People live in those places for 20 years sometimes
IIRC, the average length of long-term care stay is a more like 2 years, with a fairly small fraction over 5 years. And I would think the longer stays tend to be skewed toward assisted living (which is significantly less expensive), not nursing homes.
A nice assisted living facility might be $8,000 a month.
A retirement community will be less yet.
* pension and social security (nursing case security) * income of the children * sale of real estate and other property of the invalid person
Yes, nursing facilities are damned expansive. But 10,000 USD/month, that's something almost nobody would be able to pay here.
You've got an extra 10x in there. 20 years * 12 months * $10000 = $2.4 million
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).
The vast majority of people admitted to nursing homes have loving decent families.
I have seen other situations where the family tries to take care of someone that really needs to be in a nursing home and ends up neglecting them. I think neglect is far more common-- and more indicative of greed.
The vast majority of people do NOT have loving, decent families. You are lucky to have that world view but you should consider the possibility that it is quite flawed.
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.
"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."
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.
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.
[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...
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.
If this concerns you and you are a programmer or similar, you may be able to contribute to such solutions.
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.
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.
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.
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.
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.
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!
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.
Is it not socially unacceptable for men to abuse their wives? Yet it still happens. So I don’t know what you’re going on about atomism and whatnot, but I’m happy my sisters and my daughters will have the ability to stand on their own.
And if women’s freedom causes the problem of parents not having enough time to spend with children, then that has something to do with minimum wage and overtime/maximum hours at work laws than it does women’s freedom.
I certainly would’ve resented it too.
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.
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.
Personally, dying at 70 seems about ideal to me. Of course maybe I'll change my mind if/once I reach 70.
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.