Comment by FireBeyond | Hacker News Reader

Comment by FireBeyond | Hacker News Reader

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As a (former) paramedic, PE-run SNFs (skilled nursing facilities) are an absolute evil that absolutely kills people. I do want to be clear before any of the following that while there is a truth that many of the nursing staff at these facilities are often the lower quality tier of nursing care, they often care greatly for their patients/residents.

Staffing/flooring ratios? Laughable correlation to reality. Many a time? A single LPN "supervising" a floor of CNAs. Doctor consultation? The CNA oftentimes leaves a voicemail for the physician to review and care decisions are made without the physician talking to either the patient or a nurse (I'm not sure how this isn't malpractice, and I'm not convinced it's not). Facility "policy", often hidden behind "insurance requirements" have the facility overburdening the local EMS system because "we are required to call 911 for anything larger than a bandaid", and we can find ourselves doing anything from the most basic wound care to pointing out to a sleep-deprived CNA "you know your patient appears to have had a stroke sometime recently, right?". EMS arrives and often gets woefully incomplete or inaccurate history information (often for patients who are unable to be reliable historians themselves).

There is, however, ALWAYS money for the colorful glossy brochures/books at the front desk, or the big shiny billboard or TV ad that talks about "mom being in good hands with round the clock nursing care!" (and of course, a facility fee per month that would make you feel like she has her own personal RN and on-call MD 24/7").

Also a former medic, the best care homes I ever went to were the Jewish Home for the Aged. They were so much nicer and the patients there never had decubitus ulcers or staph infection in skin folds from not being cleaned.

The worst place I ever saw was Atherton Long Care which supposedly is fancy and expensive but they had neglected an old lady so poorly I actually reported them to CDPH and the ombudsman. She had full on necrotized tissue under both her breasts and a rotted unchanged g-tube that you could smell all the way down the hallway to the nursing station it was so sad. John George Psych hospital and Cordilleras MHRC are both also very sad hellholes. Patients sleeping laying on the floor in the hallways with a blanket because the rooms are full etc. We had a lady who purposely stabbed herself in the eye so she could go to the ER to get out of Cordilleras because it was so awful.

What I found if you ever need to place your loved on in a care home is the sniff test is the best assessment of how well it's run and if the patients are cared for. If patients are cleaned regularly and not left to sit in their own diapers it really shows there is enough staff ratio and attention given to the patients. Go on a random evening or day and at different times. Food quality is also a good indicator - eat lunch with your parents there. Would you eat this yourself voluntarily? If yes, it's probably a good place not run on a shoestring budget.

Also - hn readers - if your mom is in a care home please always check under her breasts to ensure she is clean and dry there every time you visit. Far far too many old ladies get candida and bacterial infections under their breasts that are never cleaned or taken care of because it's embarrassing to check or clean and dry so then it just gets wet and rots and is painful, sad and gross and can lead to even worse things like cellulitis or an abscess.

> There is, however, ALWAYS money for the colorful glossy brochures

OMG, so much this! One of the things that happened after the acquisition is that they changed the phones to play a marketing pitch whenever you were on hold. (They even did this on the resident's phones!) One of the things the pitch said was that the place featured "chef-inspired meals" which was about as disconnected as you could possibly get from what I knew first-hand to be reality. It was one of the most bald-faced lies I have ever heard in my life, and it really steamed my clams because I knew there was nothing I could do about it.

Aren’t these kind of borderline fraudulent business practices the sort of thing state attorney generals are supposed to investigate?

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