5 ms·

There are indeed excellent facilities for elder care. But there are many horrific ones, and the difference between them can be hard for outsiders to determine

There are indeed excellent facilities for elder care. But there are many horrific ones, and the difference between them can be hard for outsiders to determine (whether for families, or for yourself). Case in point: My parents had one hell of a time finding good care for my grandfolk (incl. siblings of grandparents). In their state, there is an entire industry of corrupt nursing homes, which also have all sorts of "awards" for the excellence of their care. Just the tip of the iceberg: staff physicians who never, ever appear on site, yet who collects a paycheck by prescribing tranquilizing drugs for any resident at the facility's request, all sight unseen. The facility routinely dubs its residents as "troublesome" or "aggressive" to dope them up and 1) mean they have to provide no active care, because turnips in wheelchairs/beds don't do anything and 2) ensure a relatively quick decline in all residents, because total immobility is a great slow-acting poison, especially on the vulnerable elderly. Thus quick turnover and higher profits are ensured, all while labor costs are kept low. Eventually good facilities were found, the best of which was a wonderful VA program in a home with a live-in nurse, specializing in care for those with dementia. But not before the horror shows had taken their toll.

JumpCrisscross 8y ago
> quick turnover and higher profits Why would turnover increase profits for a nursing home?
- MBCook 8y ago
  The quick turnovers are likely caused by being understaffed and underpaying employees. Both of which would help with profits.
- Spooky23 8y ago
  Most people don’t have a lot of assets. Medicare pays a decent reimbursement rate that declines over time. Medicare also pays for rehab tied to outcome, and nursing homes tend to have bad outcomes so they only get 90-180 days of that. Once you’re off Medicare, if you cannot private pay (or once you run out of cash), you go on Medicaid. The county seizes your remaining assets and pays a very low reimbursement. The ideal nursing home patient either has cash or requires short term rehab, and either leaves or dies in <180 days. The old ladies watching judge Judy or playing checkers are low margin.
- extrapickles 8y ago
  Some also charge a $80k+ admittance fee. They try and make it sound nice by saying the fee is so they will never kick them out if they run out of money.
  - 14 8y ago
    I would suspect there must be some fine print somewhere that states that you would be kicked out if you ran out of money eventually. The facility I worked at charged $4500 a month which was considered really cheap as another one near by had no problem charging $6500 a month but provided half the care my facility did, just a nicer setting along a lake with a beautiful view. At even $4500 a month it is $54,000 annually. I can also tell you things can move very slowly in the medical field for these elderly people so say if something big in the family did happen and they suddenly could not pay, that $80k would get eaten up very quickly as they tried to locate additional funds for that individual. The facility that I worked at only required a single months deposit. When people could not afford to pay my boss would often cut them deals to have them stay longer.
- saidajigumi 8y ago
  Often what another poster said: there's a large admittance fee and/or you sign all of your assets over. Combined with the Medicare/Medicaid issues cited by another sibling post, there's a strong financial disincentive to have residents live longer.
colanderman 8y ago
> staff physicians who never, ever appear on site, yet who collects a paycheck by prescribing tranquilizing drugs for any resident at the facility's request, all sight unseen My mother and her siblings have had EXACTLY this experience with my grandfather – and they've had prior experience choosing nursing homes. It's horrible. They dope him up on who knows what medications for perceived illnesses without consulting family. Thank goodness my attentive and no-bullshit aunt discovered they were medicating him for "pneumonia" and "congestive heart failure" prescribed by a call-in quack for what turned out to be a bit of aspirated fluid. She forced them to get him off the meds and he returned to normal (modulo Alzheimer's) in days. The whole industry is based around appearing like they're doing something to oblivious or disinterested families (which unfortunately exist), while doping their helpless patients into a slow meaningless death. There are good individuals (my folks made sure to make ties with them, else my grandfather would quite literally have died due to negligence by now), but the industry as a whole is rotten.

JumpCrisscross 8y ago

> quick turnover and higher profits Why would turnover increase profits for a nursing home?

MBCook 8y ago
The quick turnovers are likely caused by being understaffed and underpaying employees. Both of which would help with profits.
Spooky23 8y ago
Most people don’t have a lot of assets. Medicare pays a decent reimbursement rate that declines over time. Medicare also pays for rehab tied to outcome, and nursing homes tend to have bad outcomes so they only get 90-180 days of that. Once you’re off Medicare, if you cannot private pay (or once you run out of cash), you go on Medicaid. The county seizes your remaining assets and pays a very low reimbursement. The ideal nursing home patient either has cash or requires short term rehab, and either leaves or dies in <180 days. The old ladies watching judge Judy or playing checkers are low margin.
extrapickles 8y ago
Some also charge a $80k+ admittance fee. They try and make it sound nice by saying the fee is so they will never kick them out if they run out of money.
- 14 8y ago
  I would suspect there must be some fine print somewhere that states that you would be kicked out if you ran out of money eventually. The facility I worked at charged $4500 a month which was considered really cheap as another one near by had no problem charging $6500 a month but provided half the care my facility did, just a nicer setting along a lake with a beautiful view. At even $4500 a month it is $54,000 annually. I can also tell you things can move very slowly in the medical field for these elderly people so say if something big in the family did happen and they suddenly could not pay, that $80k would get eaten up very quickly as they tried to locate additional funds for that individual. The facility that I worked at only required a single months deposit. When people could not afford to pay my boss would often cut them deals to have them stay longer.
saidajigumi 8y ago
Often what another poster said: there's a large admittance fee and/or you sign all of your assets over. Combined with the Medicare/Medicaid issues cited by another sibling post, there's a strong financial disincentive to have residents live longer.

colanderman 8y ago

> staff physicians who never, ever appear on site, yet who collects a paycheck by prescribing tranquilizing drugs for any resident at the facility's request, all sight unseen My mother and her siblings have had EXACTLY this experience with my grandfather – and they've had prior experience choosing nursing homes. It's horrible. They dope him up on who knows what medications for perceived illnesses without consulting family. Thank goodness my attentive and no-bullshit aunt discovered they were medicating him for "pneumonia" and "congestive heart failure" prescribed by a call-in quack for what turned out to be a bit of aspirated fluid. She forced them to get him off the meds and he returned to normal (modulo Alzheimer's) in days. The whole industry is based around appearing like they're doing something to oblivious or disinterested families (which unfortunately exist), while doping their helpless patients into a slow meaningless death. There are good individuals (my folks made sure to make ties with them, else my grandfather would quite literally have died due to negligence by now), but the industry as a whole is rotten.