The Corporatization of Nursing Homes • Hacker News Board

Re: The Corporatization of Nursing Homes

#71

Post by DrAwdeOccarim » Fri, Oct 30, 2020, 10:22 AM UTC

sector777 wrote: post #34

geocrasher wrote: post #3

When my wife (46) and I found out that she was terminally ill, I promised her that I'd never let her end up in a Nursing/Hospice home. She'll get care at home. When the time comes, she'll die at home, too. Myself, our adult daughter, and close friends have all banded together to make sure that she never ends up in a home. We reaffirmed this after Covid hit. If she goes into a hospice care facility, I'll never see her…

I'm probably similar in age to you and am so sorry to hear what you are going through. Last year, my single mother's health transitioned from self-sufficient, but secretly hiding chronic problems, to completely unable to care for herself in the course of a day (she bore some responsibility for this, it was not completely an accident). I let the US health care system walk us into a nursing home situation. Some of the…

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

Re: The Corporatization of Nursing Homes

#72

Post by michaelt » Fri, Oct 30, 2020, 10:59 AM UTC

chrisseaton wrote: post #17

crispyambulance wrote: post #13

Earlier quoted context omitted.

> also seen healthy but less able older folks put in homes so that their kids could collect their inheritances and sell off everything else... Not sure what you mean by this, but putting someone in a skilled nursing facility costs about 10,000/month nominally. The "Deficit Reduction Act" of 2005 (thanks Bush), requires a 5 year look-back period for transactions to family members. Meaning that if a resident spends dow…

> putting someone in a skilled nursing facility costs about 10,000/month nominally Who on earth is able to afford this? Everywhere I look there are nursing homes full of ordinary people. I can't believe more than 0.1% of these people are literally able to afford $10,000/month. People live in those places for 20 years sometimes. That's $24,000,000. It just doesn't add up, dude. I think the actual cost is way, way, way…

> That's $24,000,000. It just doesn't add up, dude.

You've got an extra 10x in there. 20 years * 12 months * $10000 = $2.4 million

Re: The Corporatization of Nursing Homes

#73

Post by vict00ms » Fri, Oct 30, 2020, 1:13 PM UTC

crispyambulance wrote: post #13

geocrasher wrote: post #3

When my wife (46) and I found out that she was terminally ill, I promised her that I'd never let her end up in a Nursing/Hospice home. She'll get care at home. When the time comes, she'll die at home, too. Myself, our adult daughter, and close friends have all banded together to make sure that she never ends up in a home. We reaffirmed this after Covid hit. If she goes into a hospice care facility, I'll never see her…

> also seen healthy but less able older folks put in homes so that their kids could collect their inheritances and sell off everything else... Not sure what you mean by this, but putting someone in a skilled nursing facility costs about 10,000/month nominally. The "Deficit Reduction Act" of 2005 (thanks Bush), requires a 5 year look-back period for transactions to family members. Meaning that if a resident spends dow…

> Not sure what you mean by this

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

Re: The Corporatization of Nursing Homes

#74

Post by crispyambulance » Fri, Oct 30, 2020, 1:19 PM UTC

chrisseaton wrote: post #21

harryh wrote: post #19

Earlier quoted context omitted.

Medicaid

Do you think most citizens pay in that much tax in their lifetime? How do you imagine this is adding up?

Only a small percentage of people end up in a skilled nursing facility, of these the typical stay is almost always less than 2 years.

The numbers add up in bulk. It's a safety net that not everyone falls into.

Re: The Corporatization of Nursing Homes

#75

Post by geocrasher » Fri, Oct 30, 2020, 1:21 PM UTC

foo_barrio wrote: post #10

geocrasher wrote: post #3

When my wife (46) and I found out that she was terminally ill, I promised her that I'd never let her end up in a Nursing/Hospice home. She'll get care at home. When the time comes, she'll die at home, too. Myself, our adult daughter, and close friends have all banded together to make sure that she never ends up in a home. We reaffirmed this after Covid hit. If she goes into a hospice care facility, I'll never see her…

Sorry about your wife. It sucks to go through with that. Let me give you the other side of the story. My father is slowly succumbing due to frontal-temporal dementia. In the span of 10 years he's gone from a social, independent man to a an extremely mentally challenged man with cognitive capacity of a 1 year old child. He is prone to ever increasing psychotic fits of violence and actual epileptic fits. Medication hel…

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

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

Re: The Corporatization of Nursing Homes

#76

Post by crispyambulance » Fri, Oct 30, 2020, 1:23 PM UTC

vict00ms wrote: post #73

crispyambulance wrote: post #13

Earlier quoted context omitted.

> also seen healthy but less able older folks put in homes so that their kids could collect their inheritances and sell off everything else... Not sure what you mean by this, but putting someone in a skilled nursing facility costs about 10,000/month nominally. The "Deficit Reduction Act" of 2005 (thanks Bush), requires a 5 year look-back period for transactions to family members. Meaning that if a resident spends dow…

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

... so what's the point? That it's possible to find horror stories everywhere?

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.

Re: The Corporatization of Nursing Homes

#77

Post by SargeZT » Fri, Oct 30, 2020, 1:28 PM UTC

joeseppy wrote: post #56

SargeZT wrote: post #35

Earlier quoted context omitted.

I don't work in a long-term care facility (I do acute geriatric psychiatric care), but I do work next door to one. We're non-profit so we don't exactly fit the mold, but understaffing isn't something that we are aiming for. We're offering incredible hiring bonuses, reaching out on every single avenue. Our problem is retention - we can get a few people hired, but maybe 1/5 CNAs stay, and 1/4 of the nurses. The long te…

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

We do offer higher than market rates; people just don't want to do the work. CNAs and nurses are very well compensated at my hospital -- however, we are a regional hospital for a fairly rural area, so it's hard to attract talent. The majority of our staff has a 30 minute drive to get to work - if it's any further than that, they'll tend to go to the large city in the opposite direction and get a job there for less money but more amenities. Finding nurses and CNAs that are passionate about geriatric and particularly dementia care is difficult in the best of circumstances.

Re: The Corporatization of Nursing Homes

#78

Post by vict00ms » Fri, Oct 30, 2020, 1:31 PM UTC

crispyambulance wrote: post #76

vict00ms wrote: post #73

Earlier quoted context omitted.

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

... so what's the point? That it's possible to find horror stories everywhere? 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.

Your response was dismissive of the possibility that families could throw a family member into a nursing home to raid their savings, etc. I'm telling you that this happens and providing a real-world example from my own life, just like you did.

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.

Re: The Corporatization of Nursing Homes

#79

Post by nradov » Fri, Oct 30, 2020, 1:58 PM UTC

jcampbell1 wrote: post #38

dragonwriter wrote: post #23

Earlier quoted context omitted.

> 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. 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-…

I have seen financials for a number of nursing homes owned by friends. They get paid by Medicare for short term rehab in their facility and the rate is about $400/day. The majority of the people are long term on Medicaid and the reimbursement is between $120-200 per day depending on case difficulty. There are certain games they play to increase the reimbursement such as getting most of the patients diagnosed with dep…

I think most of us would legitimately meet the diagnostic criteria for clinical depression if we were trapped in one of those places.

Re: The Corporatization of Nursing Homes

#80

Post by nradov » Fri, Oct 30, 2020, 2:02 PM UTC

cyberdrunk wrote: post #68

crispyambulance wrote: post #13

Earlier quoted context omitted.

> also seen healthy but less able older folks put in homes so that their kids could collect their inheritances and sell off everything else... Not sure what you mean by this, but putting someone in a skilled nursing facility costs about 10,000/month nominally. The "Deficit Reduction Act" of 2005 (thanks Bush), requires a 5 year look-back period for transactions to family members. Meaning that if a resident spends dow…

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

Does the state expect children who have emigrated to also contribute toward those costs? I know many younger Poles have moved to other EU countries for better job opportunities.