The nightmare of nursing home care

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vito

Hunter
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Jan 2, 2005
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Northern Illinois
I'll start this by saying that for 23 years I worked as a Nursing Home Administrator, and only was associated with homes considered of the highest quality, all in the not-for-profit sector. My last job before retiring was as the VP, Nursing Home Operations for a multi billion dollar Catholic health care corporation where I managed a dozen skilled nursing homes, almost all of whom were considered the best in their respective markets.

Even in the best of times, nursing home care is far from what most people envision as the care that they hoped for their loved one. Staffing is always inadequate to really meet the needs of the residents, and the quality of the staff is ALWAYS less than what is desired. With the strains of the pandemic, things are even worse, much worse, in skilled nursing home care. Since most nursing homes are dependent upon government programs for their revenue, primarily Medicaid and to a lesser extent Medicare for post-hospital care and rehab, inflation and labor cost increases have left nursing homes even less competitive than in the past for quality employees and for enough of these employees to provide quality service. This is the reality of this industry today and there is nothing on the horizon to think that it will get better.

The few places that offer truly top quality care are those that do not accept the low reimbursement rates paid by the States under the Medicaid program. That means that they are self pay, or private pay only entities. Depending on where in the country you reside, the cost of such facilities ranges considerably, but $300 per day is a good ballpark figure to think about. While that is far less than the cost of a hospital bed, no one lives in a hospital for months or years. $300 per day comes to around $110,000 a year, and that's just for the basic care services. While the length of stay for residents in a skilled nursing home is much shorter than it was decades ago when there was no assisted living industry, stays of about three years are not uncommon. The most typical reason for needing a skilled nursing home is advanced dementia, such as Alzheimer's Disease that renders the individual unable to function without 24/7 care but can occur in a person still reasonably fit physically and capable of living for several years. How many in our society can afford this level of care? Relatively few, especially if the family resources are still needed for the spouse who is still living in the community.

What prompted this thread today is a reality affecting my sister in law. Her husband really needs to be in a nursing home, yet she is nowhere close to being able to afford private pay care. If she seeks Medicaid coverage, she faces a double challenge. For one, the facilities that will accept her husband with Medicaid as the payor will be those of far lesser quality where he will share a room with a stranger and receive likely marginal care. Second, his income, less only a small stipend, will have to go to the nursing home for Medicaid to cover the remainder of the costs, leaving my sister in law unable to afford to continue to reside in their home that is mortgaged to the hilt. There really is no solution to this nightmare for my sister in law that will allow her to continue to maintain her home and even get minimal quality care for her husband, let alone good nursing home care for him.

I really don't have much in the way of advice other than to save and invest while you can to put aside $500,000 or so just for nursing home care for a few years, and separate from whatever funds you have put aside for the remaining spouse to continue to live as they have been used to in the community. An alternative is to purchase comprehensive long term care insurance, the premiums for which can be very, very high unless you start with such a policy no later than when in your 40's. And some of these policies have very strict limits and little or no protection for inflation. Not so many years ago a long term care policy might have seemed good that allowed for up to $150/day for skilled care, but today that amount would be a joke.

The real answer is to stay healthy, then die without the need for going into a nursing home. Probably 50% of us will be lucky this way, but the other 50% will not be.
 
Joined
Dec 3, 2021
Messages
237
Location
Georgia
A financial nightmare for sure, Linda and I had both our Mothers in assisted living. I will say the UPMC facility up in Pittsburgh where Linda's mother was, I was impressed, it is and was a top notch facility. It took everything she had plus an extra twelve hundred dollars a month to provide her with good care. We were able to rent my Moms house to help provide some of the additional monthly cash for her cost here in GA. but it still wasn't enough. We were paying out an extra twenty five hundred a month for some time. My Mon finally said to hell with this activity if she couldn't return home to live she was outta here, 7 days later she was gone, Linda's Mom lived to 100 plus 6 months.

It put a crimp in our savings plan for a number of years but what do you do. Wife has a long term go into a assisted/nursing home living plan but it cost a boat load on dollars and goes up by at least 12 to 15% every year. If I go haywire she is going to restrain me in the out building and leave me to all the tools and devices to do myself in. No home for me please, I hope and pray I'll fall into the lucky 50% but you just don't ever know.
 

turd

Blackhawk
Joined
Jan 8, 2012
Messages
851
Location
Sioux Falls, South Dakota
Vito - thank you for this post. Folks, all of this is true. Level of care is always an issue, and the expense is encompassing. My mom was in a skilled nursing home for four years with a private room, and dad was in an independent living facility for three years. It cost them more than a half million $ all told, so Vito is right on. We live in a lower cost midwestern state, so it is like $6-7,000/mo for skilled nursing, and $3-4,000/mo for independent living. They were very conservative and had saved slightly less than 1 million $.

I don't have anywhere near that much, so I only hope I won't need that level of care. Beware of old age, save now, and save much.
 

Pat-inCO

Hawkeye
Joined
Oct 17, 2009
Messages
5,922
Location
In the AZ oven (Phoenix basin)
It seems your first bit of advise is to PAY OFF YOUR HOUSE. With the house paid off, the
cost of living goes down NOTICEABLY. - - - My first ex is in a care facility in Mesa AZ, and
my daughter is paying a LOT for said care. Her mother wasted her retirement funds (a trip
to Australia, and several other stupid items) and has only her SS funds to live on (as you
noted, the costs are FAR above what any of us can get in SS funds). - - - My bet is that the
care facility is doing its part to shorten the ex's life by grossly over feeding her (she gained
twenty five pounds in the first six months there). - - - In perspective, I'm over weight. She
is a foot shorter than I am and weighs almost thirty pounds more than I do.

One other thing to keep in mind is that you can NOT put in a supply of things like toilet paper,
tissues, etc. because they will be stolen by the staff. As if that were not enough, they also
pilfer medication. My SIL bought her a pill dispenser to make sure the meds (laundry list
of them) are taken on time. That also keeps the meds from going "off location" as they say
in the warehouse business.

So far I'm lucky in that my house is paid for, my vehicle was paid for the day I picked it up,
and I manage to live off of one third of my income. Additionally, I have ONE prescription
medication (for blood pressure). :wink:

This thread is a reminder, I'm going to put in more time on my recumbent exercise bike
and the "total gym" in the other room. 8)
 

fiasconva

Single-Sixer
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Jan 14, 2011
Messages
402
Location
York County, Virginia
Vito, if she hasn't consulted an elder care attorney she needs to do so ASAP. They have solutions that she may not know about. It certainly helped us and was well worth the money.
 
Joined
Nov 5, 2007
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Location
Dallas, TX
Vito, thanks for this post. My parents go to physical therapy. And as they live by themselves, the physical therapists are suggesting they might be better off in some sort of old folks home of some kind. They are thinking about it and I’m kind of glad, as they don’t really have family close to help out day to day.
 

vito

Hunter
Joined
Jan 2, 2005
Messages
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Northern Illinois
Kevin said:
Vito, thanks for this post. My parents go to physical therapy. And as they live by themselves, the physical therapists are suggesting they might be better off in some sort of old folks home of some kind. They are thinking about it and I’m kind of glad, as they don’t really have family close to help out day to day.

It is important, for many reasons, that they consider group living appropriate for their level of independence. If they do not need actual nursing care, and are capable of doing the basics of their daily living like preparing meals, bathing, dressing, taking their medications as prescribed, etc. than some type of independent living facility would be both the least costly option and would allow them the highest level of independence and quality of life. A retirement home at this level might offer things like a meal plan so that they do not need to prepare all of their own meals, and a communal dining room where socialization is possible. Maintenance of their apartment would be by the facility and most likely housekeeping services would be included or at least offered. If they need more care, possibly assisted living where there is some degree, often minimal, of health care staff in the building, and where help with things like setting up their meds would be possible. This level is more expensive than is independent living, but often is the level at which people can remain often until the end of life. Only if absolutely needed should skilled nursing home care be considered. At that level the quality of life possible is very limited, and the costs are the highest. Not all "old folks homes" are alike, not by a long shot. Determine the level of care that they need, if they need care at all, and keep them at the most independent level possible, and this will also be the least costly option.
 

vito

Hunter
Joined
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Messages
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Northern Illinois
fiasconva said:
Vito, if she hasn't consulted an elder care attorney she needs to do so ASAP. They have solutions that she may not know about. It certainly helped us and was well worth the money.

I agree, and have urged her to do so as soon as possible. What complicates her situation is that she is also the guardian and caregiver for her 14 year old grand daughter ever since her only child, her son, died at age 39.
 

contender

Ruger Guru
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Lake Lure NC USA
vito,, I agree with 99% of what you said. About 39 years ago,, I was single,, and dating. I met a girl,, who was a CNA,, running a 25 bed facility in a nearby town. We moved in together,, and she was with me for 7 years. I put her through nursing school. She worked,, AND went to school. I was able to visit her in the facilities where she worked while we were together, and especially on the very first date night,, I went to pick her up from work. I was introduced to some of the residents by her.
She impressed me with the loving care she showed these people.
And over the 7 years, I got to see AND hear about "her" residents. I caused me to volunteer at times to serve meals during special events, or along with a few others,, perform a show of song & dance. She was truly an angel in her calling to help the elderly.
So not ALL staff are "less than desired."

Now,, the other 99% of what you say,,I fully agree with. I like to tell folks that God put me with her long enough to see what could happen when my folks got older,,and how to deal with them. Plus,, it helped me understand & know what to do and what NOT to do if it comes to that with Penny or myself.
 

blackhawknj

Buckeye
Joined
Apr 22, 2010
Messages
1,945
No easy answers, IIRC a frequent complaint about nursing homes is the over reliance on mood altering drugs, sedatives, etc. In addition it is an extremely physically demanding occupation. And they don't always get the nicest clientele.
 

JFB

Hunter
Joined
Sep 7, 2005
Messages
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Eastern Piedmont NC
Vito, thanks for posting and all the replies.
my vary limit exposure is still too painful to comment (or want to remember)

any possiblity of "in home" assistance. Ie hospice
 
Joined
Oct 26, 2006
Messages
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Woodbury, Tn
As a nurse of 50+ years my extra job was Sat night on an Alzheimer’s ward in an NHC facility. At night I gave meds, charted, and assisted my one CNA for 30 patients. The state decided in it infinite wisdom to BAN restraints. Consequently patients were falling out of bed. So the facility took away the beds, and placed mattresses on the floor. The number of employee back injuries skyrocketed. Later in life my mother in law stroked after a Coronary Bipass graft. She was in an out of rehab, but we found keeping her at home with physical therapy home visits, and paying for CNA’s a couple of shifts/day was the most efficient way. My wife moved in with her parents to provide assistance. While My wife and I were gone for one weeks vacation, her two sisters put Mom in the nursing home. Mom went down hill from there. Stay healthy my friends.
gramps
 

vito

Hunter
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Jan 2, 2005
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Northern Illinois
The trouble with that sentiment is that you have to do it well before the end comes, or you will be unable (mentally or physically) to make that decision or to carry it out. I had a friend who had Lou Gehrig Disease, and he knew what awaited him as the disease progressed. He told his wife that he would end his own life before he reached the end of this terrible disease, but near the end he cherished being alive "for just one more day". When he finally decided it was time to go, he physically did not have the ability to do it, and asked his wife to kill him. She, of course, did not do it, and this all added terribly to the inevitable end of his life. But I certainly understand what you are expressing.
 

blackhawknj

Buckeye
Joined
Apr 22, 2010
Messages
1,945
There are people who should be in some sort of care or assisted living facility, but their children do not want to spend their inheritance-in some case, no inheritance, or they were such lousy parents that their children do not care about them.
 

warren5421

Single-Sixer
Joined
Jan 11, 2009
Messages
220
Location
Indy
In my late 50's I had a hernia that was cut on then got infected and they took a couple of pounds of muscle from my stomach. The area muscle was so thin they could not close it. 4 weeks in hospital before they could transfer me to a extended med care for 3 weeks. From there they moved me to a "very good" nursing home for 3 weeks, at 2 weeks I started on the doctor to send me home. There I had a visiting nurse 3 days a week to change the dressing and make sure the area was healing right, 5 weeks. The 3 weeks in the nursing home sure opened my eyes. I could not get out of bed and to the bathroom as my legs would not carry my body. Several times the help was busy and could not get to me till after the bed was wet. On IV's it goes in but has to come out also. The help was giving the best help they could but budget said only X number of people per shift!
 
Joined
Nov 15, 2005
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Greenville, SC: USA
Hospitals are no different.... back in 2019 I was in for 5 days after having the very big one.... the first three days I was in cardiac icu and had my own nurse. I think I had to push the call button one time in those three days.... if I needed something the nurse was there before I realized I needed it. Then they moved me up to a regular room.... put me in a bed and about a half hour later I needed a urinal I pushed the call button... someone answered on the intercom about 2 minutes later and I told them what I needed.... someone showed up 30 minutes later.... now that I type that I wonder if it is actually planned this way to make you want to get out of the hospital... I sure did after 2 days in a regular room.

Wife and I are putting her sister in a memory care facility tomorrow... it will be interesting to say the least.
 

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