To add a bit of clarity to this article, the lovely community described with
an entrance fee, housing choices, activities, and nursing home facilities, is
called a life care community. There are for profit, and not for profit
versions. One enters while healthy and mobile and as age related disabilities
appear, one moves to assisted living, and then to skilled nursing facilities
within the community. The monthly fee remains the same. It is a really good
solution for people with higher than average incomes. In New York, twenty five
or more years ago, one could be transferred to a highly rated nursing home from
a hospital if one had the funds to pay for at least, the first year of care.
Then, Medicaid took over. Now, it is my understanding that when one's funds run
out, the highly rated nursing home transfers the patient to a lesser quality
nursing home. But it must be added that those highly rated nursing homes are
not all that great. They are, however, clean. In New York, people with incomes
too high to qualify for Community Medicaid, can legally hide their money so
that they can be cared for at home. It's costly, but not as costly as paying
privately for an aide. The problem is that the bureaucratic systems involved,
make getting consistent, quality home health care nearly impossible. Now that I
am old, with multiple disabilities and health issues, and I am dealing with the
problems outlined in this article in my personal life, my feeling is that
although Capitalism is the root cause of the problems that I, and other
elderly people face, there are other cultural and sociological problems
involved. There is a belief that grown children should not have to be burdened
with the care of their aged parents, that it is unfair for them to be
inconvenienced. Furthermore, because of the racism in America, the people who
are tasked with our care, tend to be those who often live the most difficult
lives at the margin of our society, and their ability to provide consisten,
competent care, can be negatively affected by this fact. Forty years ago, many
women were at home after their children were grown, and they became responsible
for the care of elderly parents. Now, most women need to work, not necessarily
because they wish to, but because they have to. Furthermore, extended families
no longer necessarily live in the same community. We live in a society in which
elderly people are encouraged to segregate themselves in "senior citizens"
communities far from their grown children and grandchildren. We live in a
society where it isn't OK to be old, where youth is idealized.
Miriam
-----Original Message-----
From: blind-democracy-bounce@xxxxxxxxxxxxx
<blind-democracy-bounce@xxxxxxxxxxxxx> On Behalf Of Roger Loran Bailey
(Redacted sender "rogerbailey81" for DMARC)
Sent: Friday, March 30, 2018 1:17 PM
To: blind-democracy <blind-democracy@xxxxxxxxxxxxx>
Subject: [blind-democracy] Aging poorly – The class divide and nursing home care
https://socialistaction.org/2018/03/30/aging-poorly-the-class-divide-and-nursing-home-care/
Aging poorly – The class divide and nursing home care
/ 45 mins ago
April 2018 Nursing home handsBy SARAH MILLER
— LANCASTER, Pa. — Another missed call, another voice mail. I look at my phone
and recognize the number. The call was from the daughter of an elderly
hospitalized patient. The social workers have been pushing to get her mother
out of the hospital and to a nursing home, but the daughter wanted to visit
potential facilities before agreeing to placement. I press play. “My mother is
not going to that place. I wouldn’t even put my dog there! Please call me back.”
In hospitals, elderly patients wait in their rooms for days, weeks, and
sometimes months. Cleared for discharge by the physicians, they have no place
to go. Too sick or debilitated to return home and no family willing or able to
care for them, their only option is nursing home care.
Hospital social workers provide a list of local facilities to the families.
Invariably, they choose the highest rated with the best reputations. After all,
they want their loved ones to get the most quality care possible. But that is
out of reach for most. The social worker will call the posh nursing homes to
inquire about admission, but the behind-the-scenes conversation is always the
same: “There’s no way the family can afford that facility.”
It isn’t until the daughters and sons visit the few homes that will accept
patients with low incomes that they fully realize the disparity that exists
between the care provided for the rich and the treatment of the poor. The first
thing that hits you as you walk in the door is the smell. It is a distinct odor
of human urine, processed institutional meals, and old construction. Every
nurse knows about the “nursing home funk.”
Then you see the surroundings—fluorescent lighting, old linoleum, a magnet
board declaring the current weather, “cool, cloudy,” the date, and the next
holiday. The bustling nurse’s station is a flurry of activity—bells ringing,
charts stacked on the counter. Residents yell from various reaches of the
hallways, sometimes words or names but often just screams. The sensory overload
is enough to make you want to turn around and run out the door.
First impressions are not always accurate but state inspections of these
nursing homes often tell harrowing tales. Violations in various for-profit
facilities in 2016 included physician-ordered testing not being completed,
increases in bed sores, residents kept in restraints beyond the legal maximum
time limit, over-medication with anti-anxiety and sedating medications, and
unsafe food storage. Staffing and turnover is also an issue. In one facility,
each resident received 30 minutes of direct care from an RN daily compared to
the state average of 58 minutes.[i]
But what about the other retirement communities? The ones with sprawling
campuses, activities coordinators, and no violations? Families see the
billboards encouraging older people to “Live Life Here” and “Be A Part of Our
Community!” The advertisements don’t lie. There is gorgeous landscaping,
activity buses taking residents to shops and local attractions, multiple
restaurants and spas. For those in need of skilled care, they have private,
well-furnished rooms and private baths, low nurse to patient ratios, and
minimal medication errors. There is no “funk” in the air, just the smell of
freshly disinfected hallways.
The most expensive retirement community in Lancaster County, Pa., charges an
entrance fee between $99,000 and $419,000 depending on the amenities and type
of residence chosen. Monthly fees range from $1814 a month for a studio
apartment to $5004 per month for a two-story town home. If a spouse or
significant other is also residing there, an additional $26,000 to $45,000
entrance fee and another $1226 per month applies. Community members can be
moved to skilled care if the need arises without any additional costs.[ii]
Another private, church-affiliated facility charges $439 per day for skilled
care or
$13,170 per month.[iii]
Daily nursing-home care in Pennsylvania averages at $228 a day for the least
expensive facilities. Most of the residents choose these facilities because
they have no other choice. The entire cost is paid for by Medicaid.
Reimbursement rates are determined by the state and are often less than what
the facilities normally charge and sometimes much less than what it costs to
provide care.[iv]
So one would think that it would be advantageous and more cost-effective to
provide in-home assistance. The average rate for a home health aide is
$20/hour. These aides are non-nurses and are trained to help with tasks like
bathing, dressing and light housekeeping. Having an aide eight hours a day
averages to be $160/day or $4800/month. Compared to $6840/month for
nursing-home care, it seems like the obvious choice.[v]
But private insurance, Medicare, and Medicaid pay nothing for in-home care.
Financial assistance exists only for those in poverty. To qualify for home-care
waivers in Pennsylvania in 2016, the recipient must earn less than $2205 a
month and own less than $8000 in assets. There are waiting lists in areas where
demand outnumbers availability, causing many in higher populated cities to be
without help.[vi]
Most patients I have encountered in my years of nursing only want one thing—to
be at home. Elderly women in dementia wards will grab me by my arm, pull me
close and, in an urgent tone, ask me when they are going home. When I ask
patients in the ICU what they want to see happen with their care, they say, “I
just want to go home.”
I listen to children of sick patients tearfully tell me that they want to care
for their ill parent, but they have to work or they do not have anyone else to
rely on. After all, no one person can provide care 24/7.
Help is needed to both provide quality home care and maintain the caregiver’s
well-being.
Why doesn’t the state and, more broadly, the nation, advocate for patients? Why
won’t they pay for the sick and elderly to be cared for at home? In a
word—capitalism. No one benefits from for-profit nursing-home care except the
companies who own the facilities. A 2011 study showed that the 10 largest
for-profit nursing homes had the greatest number of violations, the lowest
nurse to patient ratios and, often, the sickest patients.[vii]
Gone are the days of the “county home” or the “poor house.” For-profit nursing
care facilities dominate the field. Locally, the Lancaster County “almshouse”
was sold by the county in 2005 for $13.8 million. In response to local
controversy over the sale, county commissioners quipped, “The County shouldn’t
be in the health-care business.”[viii] What they meant was, “We are losing
money by caring for our most vulnerable people.”
The daughter who left me a desperate voice mail did eventually agree to place
her mother in a different, yet still substandard, nursing home. In a country
where some can spend millions on comfortable retirement and quality care,
daughters should not lie awake at night, wondering if their mothers are being
mistreated.
The class divide is laid bare in the nation’s nursing homes. The rich plan to
retire with the rich while the poor are forced to have inadequate care
alongside the poor. There is no reason why we cannot provide for the elderly,
regardless of class status and income. Without equal health-care availability
to everyone, our society cannot improve.
Daughters will continue to cry, the sick will perish in greater numbers, yet
profits will continue to increase. Elderly people are our parents,
grandparents, neighbors and fellow humans. They are not a source of capital.
[i] “Nursing Care Facility Information.” Accessed June 4, 2017.
https://sais.health.pa.gov/CommonPOC/content/publicweb/nhinformation2.asp
[ii] “Fees & Services.” Willow Valley Communities. Accessed June 04, 2017.
http://www.willowvalleycommunities.org/a-wise-investment/fees-services/
[iii] “Rates.” LandisHomes. Accessed June 04, 2017.
http://www.landishomes.org/living-choices/residency-planning/rates/
[iv] “How to Pay for Nursing Home Care.” Paying for Nursing Home
Care: Medicare, Medicaid & Other Assistance. Accessed June 04, 2017.
https://www.payingforseniorcare.com/longtermcare/paying-for-nursing-homes.html#cost-table
[v] “Calculating the Cost of Assisted Living vs. Home Care.”
Assisted Living vs. Home Care Affordability Calculator. Accessed June 04, 2017.
https://www.payingforseniorcare.com/longtermcare/home-care-vs-assisted-living.html
[vi] “PA.Gov,” PA DHS – Aging Waiver. Accessed June 05, 2017.
http://www.dhs.pa.gov/citizens/alternativestonursinghomes/agingwaiver
[vii] Kaye, H. Stephen, Charlene Harrington, and Mitchell P. LaPlante.
“Long-Term Care: Who Gets It, Who Provides It, Who Pays, And How Much?”
HealthAffairs 29, no. 1 (2010): 11-21
[viii] Harris, Bernard. “Nothing can stop Conestoga View sale, Shaub told.”
LancasterOnline, September 27, 2005. Accessed June 4, 2017.
http://lancasteronline.com/news/nothing-can-stop-conestoga-view-sale-shaub-told/article_e1eee7ac-f567-5b24-bb38-ffebd2158f3f.html
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March 30, 2018 in Health care.
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