Etcetera

Put Mom And Dad In The Nursing Home And Hope They're Not In The 94% That Suck

MayorBob.

Posted to Etcetera on Wed Oct 01, 2008 at 12:24:37 PM EST (promoted by port1080). RSS.

More than 1.5 million Americans live in nursing homes.  Because the Baby Boom generation is barreling into its senior years, more of us will begin looking at these facilities as homes for ourselves or our parents.  As a result the number of these facilities can be expected to increase from today's 15,000 over the next couple of years.  Concerns over quality of life standards for residents tend to move people towards what is perceived as higher quality privately-run facilities and away from perceived lower quality public nursing homes.

Beginning in December, the federal government will begin issuing one to five stars to rate the quality of American nursing homes.  But, perception doesn't necessarily equate to facts and the government can probably go easy on the number of stars they have to hand out.  Because a recent federal study reveals that over 90% of all nursing homes have deficiencies and the problems are worse at the private homes than at the public homes.

In order to maintain their eligibility to receive Medicare payments, nursing homes are required to uphold federal health and safety standards and pass an annual inspection.  The recent report (pdf doc) from the Department of Health and Human Services (HHS) casts a dark cloud over this nation's nursing homes.  94% of the 10,000  privately-owned facilities recorded violations of health and safety standards.  88% of the 4,050 non-profit facilities and 91% of the 950 government-run homes recorded violations.  17% of all nursing homes recorded violations which caused "actual harm or immediate jeopardy" to residents.

Inspectors substantiated close to 14,500 complaints about nursing home conditions in 2007 with over 2,900 of them involving some sort of abuse of patients.  Other deficiencies noted in the report include medication mix-ups, poor nutrition, and unsanitary conditions.  HHS Inspector General Daniel Levinson observed that the study's numbers showed things were worse in privately-run homes than in the others:

"For-profit nursing homes had a higher average number of deficiencies than the other types of nursing homes.  In 2007, for-profit nursing homes averaged 7.6 deficiencies per home, while not-for-profit and government homes averaged 5.7 and 6.3, respectively."
Bruce Yarwood, of the American Health Care Association, says the industry knows it "has to do a better job" and has been making improvements in areas like "treating pressure sores, managing pain and reducing the use of physical restraints."  But Yarwood says the inspection system is broken because it "doesn't reliably measure quality" or "create any positive incentives."  He also says that inspectors consistently fail to identify all potential deficiencies because "they interpret federal standards in different ways."  One thing researchers found that is helpful in improving conditions in nursing homes is having adequate staff on hand to serve patients.  Levinson issued a compliance guide which said that some facilities "have systematically failed to provide staff in sufficient numbers and with appropriate clinical expertise to serve their residents."

Tags: edited by Port1080, written by MayorBob, nursing homes, nursing home abuse, Medicare, money, health care (all tags)

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8

No worries here

Lou.

Wed Oct 01, 2008 at 05:07:12 PM EST

5.00 (brilliant, brilliant)

Since there will be -0- people around to take care of me in my dotage and I'm not real keen on living in a elder warehouse where an angry highschool dropout will be in charge of wiping my ass, I plan shuffling off this vale of tears long before I can no longer take care of myself.  And if something should happen suddenly that puts me into a vegetative or semi-vegetative state, I will pray that you, my TnT friends will come find me and put me out of my misery.  You fuckers certainly have enough guns.

It's the end of the world as we know it, and I feel fine

9

^ 8

Re: No worries here

pO157.

Wed Oct 01, 2008 at 05:31:49 PM EST

5.00 (funny)

Apply that shit to me, as well. If I am rotting away in a nursing home expect me to come back and give all you people -1, obnoxiouses from beeeeeeyond the grrrraaaaaaave!

Plus I'll haunt you and whatnot.

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^ 9

Re: No worries here

Lou.

Wed Oct 01, 2008 at 07:20:15 PM EST

5.00 (funny)

Nah...you'll become a Zombie Blogger.

"Living in this grave yard used to mean something!  Now we're overrun by the fully dead and they just lie there...they don't take care of their crypts or anything.  I tell ya, this place...it's almost like it's a dystopian shit hole!  And if that fucker in the next grave over doesn't stop trying to sell me insurance, I'm really gonna get cranky!"

It's the end of the world as we know it, and I feel fine

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^ 11

When He's Tired Of Blogging.

MayorBob.

Wed Oct 01, 2008 at 07:23:26 PM EST

5.00 (funny)

He'll get up from the computer, go to the door and shout, "get off my crypt you goldurned kids."

Illegitimi non carborundum.

13

damn you all for making me read the report

wetkarma.

Thu Oct 02, 2008 at 03:27:48 AM EST

5.00

94% sounded like an awfully high yet somewhat familiar number. And only after I read the report did I figure out why. The method used for inspection is on a sliding scale ranging from life threatening to deficiency to no actual harm/potential for minimal harm.

Basically with a framework like this, EVERY nursing home is likely to have at least on deficiency. It might range from giving diabetes medication to the alzheimers patient (very bad), to not having charged defribillators every 100 ft.  

This report is not so useful in helping to decide which nursing home you should select -- the most useful statistic for the layperson is that 17% of the nursing homes were cited for actual harm or immediate jeopardy deficiencies. That is bad, but nowhere near the sum 94% figure.

Separately, the NHS in the UK has a similar problem with their healthcare system. The objective quality of care the NHS provides (statistically) is great, however they consistently fail when people are interviewed about whether they thought the care they received was good. The basic gap was that while the NHS does a great job in fixing you up/providing medication/surgery, they do so in run down facilities where you don't get private rooms (in hospital) and its a toss-up which doctor you get to see/treats you. People evidently want personalized care when it comes to healthcare, but thats much more costly to provide than the system the NHS provides.

BTW having been in the UK for a little over a year, my direct experience with the NHS has lead me to conclude that if nationalized health care ever comes to America, the poor and lower-middle class would LOVE it. Unfortunately, anyone with a college graduate level education who wants to take a pro-active self-directed approach to health care would hate it.

Memory is a strange bell, jubilee and knell.

16

^ 13

Lived Through A Few

uncarved block.

Thu Oct 02, 2008 at 10:42:37 AM EST

5.00 (informative, interesting, informative)

    Yeah, state inspections at the home were a royal PITA, and much like police charges, small violations can be made to sound far more ominous than they are. The administration especially hated these yearly visits, because they typically felt like they were getting picked on. Whether or not an adversarial tone between providers and inspectors is a good idea goes far beyond just this topic, and I won't go into it generally now.
    But I can't say it was all that terrible, from my vantage in the kitchen. For one thing, the budget was always too tight to upgrade equipment, or even replace old crap-- until the state inspectors rolled through. When I started, the kitchen still had a small 60s era fridge in use, and the bigger refrigerators were not much different than what you'd find at a house, perhaps even inferior to the top of the line. (The small fridge had even developed a short, so that you'd get shocked if you touched it where the paint had worn off.) After we got a different inspector my second year (how this stuff had passed before I have no idea), though, all that old garbage was gone, and we got equipment more in line with a kitchen that served over 50 residents a day. So while the three days the inspection was going on were nerve wracking, I started looking forward to them after five years, because it meant there was a good chance a problem was going to get fixed the next month or two.
    If you absolutely have to put someone you love in a home, I'd actually suggest using your nose as a guide. All nursing homes will smell like shit once in a while, that's just part of the job, but how quickly the staff appears to be reacting (and how courteously) is the important part, especially as you'll probably be touring with someone in charge*. If the nurse's aides don't appear very able even in the presence of someone who can fire them, chances are you should give the other options on your list a shot-- if there are any. There's a lot of ways short of actual abuse that can make a nursing home miserable for the residents . . well, more miserable anyway.

    *Unassisted visits, at least to start with, will be impossible, or at least it should be. (Bad security would be a good reason to skip a facility.) Scam artists occasionally target residents, and in general having someone unrelated to a resident wandering around is a bad idea. Even family had to check in and out where I worked, though frequent visitors may (may!) have been forgiven if they forgot once in a while.

Ex ignorantia ad sapientiam; e luce ad tenebras

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Re: Lived Through A Few

JimmyHavok.

Thu Oct 02, 2008 at 06:01:50 PM EST

none

If you absolutely have to put someone you love in a home, I'd actually suggest using your nose as a guide.

My girlfriend worked up an ad campaign for a nursing home,  and in the course of her research, that was the number one piece of advice she found.

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^ 13

Re: damn you all for making me read the report

thefadd.

Thu Oct 02, 2008 at 04:20:34 AM EST

none

anyone with a college graduate level education who wants to take a pro-active self-directed approach to health care would hate it.

Why is this?

It is easy to buy small plaster models of what you think life is like.

15

^ 14

Re: damn you all for making me read the report

wetkarma.

Thu Oct 02, 2008 at 05:03:28 AM EST

5.00 (informative, informative)


Why is this?

The NHS model presupposes that people are stupid and know nothing about health care. It is very similar to a low-rent HMO plan in the states.  Every request for health care must go through a GP (who is kind of like a doctor, except the qualification here is to have a bachelors degree rather than a master).

So lets say you pull a muscle in your back and now can't walk. In the states you could (with a good health plan) make an appointment directly with a physiotherapist and get sorted out. In the UK you have to go to the GP first who then approves you for an appointment with the physiotherapist (not in the same building or even the same area). Skin Rash and want to see a dermatologist? Same deal. Everything must first go through the GP who will then refer you to the appropriate specialist. The GP however doesn't actually DO anything other than look stuff up in their computer -- the amount of time spent at the GP waiting to be merely referred to someone who is elsewhere is colossal.

Now say you recently got diagnosed with cancer. When you go to the GP, the GP will consult her computer and says 'your cancer would best be treated with drug X which is the standard medication given by the NHS'. If you say 'well I've read research that drug Y would be better for me and has 25% better effectiveness than drug X', their response will be you can't have drug Y -- its not approved by the NHS because its too expensive.

Oh and if you go out on your own and see a doctor who prescribes you drug Y? Well then you have to pay 100% of all your prior NHS care. For basic healthcare the NHS is the bees knees, but the moment you want something which is  non-standard, or want to apply your own knowledge to your health, things go all squirrely.

Memory is a strange bell, jubilee and knell.

18

^ 15

Re: damn you all for making me read the report

thefadd.

Thu Oct 02, 2008 at 01:44:22 PM EST

none

That is what I thought and it's why I've come around to adamant opposition to socialized medicine. It's a god awful system designed to enrich drug companies and hmo executives. Without choice, people are a slave to the system. You will have universal coverage but it will be coverage you'd be better off not having.

or want to apply your own knowledge to your health, things go all squirrely.

The system is specifically designed against you applying any personal knowledge or taking accountability for your own health. That would lead you away from the treatment cycle.

Everything must first go through the GP who will then refer you to the appropriate specialist.

The PPO employer system I was in several years ago worked the same way. I could "pick a doctor" but the only doctor available for picking was this guy so green out of medical school he only had 10 clients. You know how doctors have rows and rows of client files? He had an empty book shelf with a few folders. I could see him any time I wanted but he was completely useless. I had several seemingly disconnected medical problems that he couldn't for the life of me figure out so he sent me to a couple specialists. They would see me for five seconds and say, "you need to see an internest." I'd say, "an internest sent me to you." They'd so, "Oh, well, bye got another client." So eventually I started finding things out on my own and telling my primary care physician what he should do and where he should send me. He'd always hem and haw about what the book said so I'd have to argue with him but eventually he'd give in. It still didn't work out, though, and I ended up in the alternative medicine basket where everything was cleared right up. Of course, now they're trying to outlaw all that. Fun stuff.

It is easy to buy small plaster models of what you think life is like.

19

^ 18

Re: damn you all for making me read the report

JimmyHavok.

Thu Oct 02, 2008 at 05:58:55 PM EST

4.00 (astute)

He'd always hem and haw about what the book said so I'd have to argue with him but eventually he'd give in.

Sounds good to me.  Can I get a reference?

17

^ 13

Re: damn you all for making me read the report

pO157.

Thu Oct 02, 2008 at 12:20:02 PM EST

none

Unfortunately, anyone with a college graduate level education who wants to take a pro-active self-directed approach to health care would hate it.

A subset of the above group would really enjoy it: Physicians. Why do you think the AMA is pushing for single payer healthcare so badly?

1

don't take the brown vitamins

gerrymander.

Wed Oct 01, 2008 at 12:53:02 PM EST

4.33 (funny, funny, funny)

Other deficiencies noted in the report include medication mix-ups, poor nutrition, and unsanitary conditions.

Bad food, bad hygiene and wonky drugs? That's an opportunity, not a problem. Label it "A chance to re-live the Woodstock Experience!" and up the rates.

2

Re: Put Mom And Dad In The Nursing Home

skeptic.

Wed Oct 01, 2008 at 01:44:48 PM EST

none

In the old days, before nursing homes. the elderly were generally cared for (well or badly) by their relatives - indeed, this was long considered to be one of the most important reasons for having children, so they would be there when you needed them.  And in our increasingly troubled world, we may be heading toward a time when society at large can no longer afford nursing homes, and the old traditional approach will be depended upon again.  And for those who do not have relatives to take care of them, and no nursing home to go to, there is always homelessness and probably a shorter lifespan.  Life was once described as nasty, brutish, and short, and it may be that way again.  I have a pessimistic streak.  But on the other hand, maybe technologically advanced robots will take care of all of us, and it will all work out well.  

3

^ 2

Re: Put Mom And Dad In The Nursing Home

thefadd.

Wed Oct 01, 2008 at 01:49:46 PM EST

5.00 (astute)

The nursing home was largely a construct of the self-centered baby boomer generation that hated their parents and wanted them the hell out of the house. Now that boomers themselves are reaching that age, generally healthier and more well off than their parents I'd suspect the economics of the industry to change greatly. There are many more wealthier older folks who want care but also independence and also people are going to be broken by the economy and unable to afford such luxuries. Consequently, I'd expect to see greater and greater fragmentation of the elder care industry. The traditional nursing home setting both eats up too much money on the one hand and also doesn't provide enough of what an active generation is going to demand on the other.

It is easy to buy small plaster models of what you think life is like.

10

^ 3

Re: Put Mom And Dad In The Nursing Home

JimmyHavok.

Wed Oct 01, 2008 at 06:32:51 PM EST

5.00 (interesting)

My wife and I are in a care-giver position right now, with her parents.  It's damned stressful, more on her than on me, I'd say, but still stressful.  I can easily understand the decision to put a parent who needs 24-hour care into a nursing home, even though we have decided not to take that route.

When a parent needs 24-hour care, are you going to give up your career until they die?

4

^ 3

Re: Put Mom And Dad In The Nursing Home

skeptic.

Wed Oct 01, 2008 at 02:00:38 PM EST

none

I agree that there are lots of people who want, or who at some future date will want both to be cared for and to be independent, but it is a paradoxical desire.  To be independent means not to depend upon others, and if you need to be cared for by others, you depend upon them. Still, we would all like to be as independent as it is possible for us to be, given our circumstances.  When you depend upon others, very often the result is unfortunate.  It would be a great understatement to note that others often do not meet our needs as well as we would like them to.  The only person I really trust is myself.  

5

^ 3

Re: Put Mom And Dad In The Nursing Home

port1080.

Wed Oct 01, 2008 at 02:32:47 PM EST

none

Now that boomers themselves are reaching that age, generally healthier and more well off than their parents I'd suspect the economics of the industry to change greatly.

This is a good point.  I also wonder if there's anything to the anecdotal accounts that Gen X & Gen Y folks are living longer with their parents before moving out, and also generally have a better relationship with their parents.  If that's true, perhaps they'll also be more willing to take care of their parents in their old age?

7

^ 5

Willing Vs Able

uncarved block.

Wed Oct 01, 2008 at 04:11:38 PM EST

5.00 (informative)

    The question isn't always one of willingness. The title of a popular book about home Alzheimers care is The 36 Hour Day, which in my experience is very accurate. Even mild cases can be difficult, both practically and emotionally, and after a certain point home care is essentially a full time job-- and not one everyone is cut out for.
     I think the difference to keep in mind is between elder care and total care; there's a lot of difference between having a nurse stop by a couple times a week, and a persistent vegetative state, but you rarely hear too many horror stories about the former. I wasn't around for all of it, but my grandmother (mom's mother) went through many of the stages: minimal care by a visiting nurse, followed by more direct involvement by family (my mother and her siblings), until finally she required pretty much round the clock care and started living in a small (6-8 residents) total care house. Every step down the ladder (to use loaded language) was only taken after it was clear the current state of affairs was no longer tenable. In retrospect, everyone involved- including my grandmother- would probably have been happier if she'd taken up assisted living (NOT a nursing home) much earlier on, mainly because grandma would have had a lot more company nearby once she could no longer drive. As Michel Foucault pointed out decades ago, there actually are upsides to the new industry centered on aging . . .
    Sorry, this is drifting a bit too much. Short message? I don't believe parent-child relationships have deteriorated nearly so badly that things will look much different a decade or two from now.

Ex ignorantia ad sapientiam; e luce ad tenebras

6

^ 3

Yes And No

uncarved block.

Wed Oct 01, 2008 at 03:39:07 PM EST

none

self-centered baby boomer generation that hated their parents

    Had much experience with Alzheimer's patients? Or Parkinsons disease?

Ex ignorantia ad sapientiam; e luce ad tenebras

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