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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