An idea regarding Nursing Homes....

[TPFKA@W]

Oh and with respect to visitors: They step outside while this care is being given, privacy curtains are pulled and doors are closed. All about state mandated maintenance/preservation of dignity for the patient.

I agree with your idea 100% in spirit Joe but I know it has little shot at being a reality.
It would slso stop a lot of the theft that goes on.

Great idea Joe, you deserve a cookie for caring.

Never mind the cookie, you would likely spread Vegemite on it.

[TPFKA@W]

Or maybe their doctors could check on them occasionally.

Most of the doc's are overwhelmed or don't give a rat's rear. I have seen them walk in and write progress notes on a patient without their ever seeing the patient. They get some cash from the gov't. for the visit. Don't count on them to watch out for a patient's well being.

I am working today as a weekend manager at a small rural facility. Doing rounds this am I thought of you Joe when I went into Sammy's room. Bless his sweet old heart he had stripped himself naked and was uncovered. A perfect example of why cameras will (I believe) never be allowed in pt rooms.

[TPFKA@W]

I have to add that I asked Sammy what he was up to as I covered him up and his response was, " I seem to be in a predicament". It made me smile. Eldercare is bittersweet.

[Joe Guy]

Well... so much for that idea.

Maybe I'll try another approach.

How about getting a law passed that requires people to be euthanized if they're deemed unable to care for themselves?

Maybe I should contact Obama about getting those death panels approved.

[Guinevere]

@W, do you see more problems are facilities that tend to have more folks who are only paying through medicare, versus the ones with private pay patients? I'm curious if the level of care depends on how much they facility is being paid.

My aunt has been a hospice/palliative care nurse (and now a nurse manager) for the last 25 years or so. Bittersweet is exactly how she would describe it.

[Joe Guy]

One of the problems with nursing home care is that it's so expensive. You have to use up all of your money, which doesn't take long, before you qualify for Medicaid (Medi-Cal here in Calee-fornia). Medicaid pays the homes less and not so timely.

I know when my Uncle was admitted, they perked up when we told them he was paying cash for his stay at the place in which he would eventually die.

Medi-Cal allows you to keep your home. Ain't that great? But then when you die they come after your estate to recover everything they've paid for your care.

My guess is that quality of care is greatly influenced by where the money comes from, but I don't know that for a fact.

[TPFKA@W]

How about getting a law passed that requires people to be euthanized if they're deemed unable to care for themselves?

I realize that you are kidding Joe. I am pretty steely from years of watching people suffer and die but I know I would have issues leading oldsters to the edge of the ice for polar bears to enjoy.

Keep thinking though maybe you will solve the issue

Guin I will answer you when I have more time to devote.

[Joe Guy]

I realize that you are kidding Joe. I am pretty steely from years of watching people suffer and die but I know I would have issues leading oldsters to the edge of the ice for polar bears to enjoy.

Notice how I didn't choose an age for people to be euthanized? I wasn't just thinking of the elderly. I meant anyone who couldn't take care of him or herself. And no, I wasn't talking about babies or children (or puppies).

But you are right. I was kidding. I have a sick sense of humor.

Anyway, I think it's terrible that we have to be concerned about things like theft, neglect and abuse (and affordable care) when senior citizens are in nursing homes. It's sad enough that they are placed into these homes, some visited rarely or not at all and many are just waiting to die.

[Crackpot]

Generally since the pay package is generous (read: covers everything necessary) hospice/palliative care patients are treated well. Long term nursing home care OTOH is a crap shoot especially the ones that are Medicare/Medicaid only.

[Crackpot]

Joe there are cases of nursing homes going way out of thier way to keep people "alive" just to keep the money rolling in. Persistent vegetative state pretty much equals cash cow as many nursing homes

[Joe Guy]

Joe there are cases of nursing homes going way out of thier way to keep people "alive" just to keep the money rolling in. Persistent vegetative state pretty much equals cash cow as many nursing homes

That's a big problem. When I was visiting my uncle there were a lot of people who seemed to have no idea where they were. One person in the same room as my uncle started yelling a lot and making no sense. Later he stopped and I'm sure he was drugged.

They strap some of them into their beds or chairs so they can't escape. Of course, they are doing it to prevent them from getting hurt, but nonetheless they are a lot like prisoners on death row.

I'm getting depressed.

[TPFKA@W]

Gah! There are some seriously misguided thoughts being posted. I will address Guin's questions and some of the well intended but horribly incorrect assumptions tomorrow.

[Joe Guy]

Gah! There are some seriously misguided thoughts being posted. I will address Guin's questions and some of the well intended but horribly incorrect assumptions tomorrow.

Apparently, you are unaware of regulation 3.146 of the internet code that says if you don't challenge a statement made in a post within the same day, all assertions, claims and theories put forth in said post are deemed to be true by Internet Authority.

The clock is ticking...

[Jarlaxle]

One reason I'll never see a nursing home. I'll pass on spending my last years shitting my diapers & drooling, just give me a shotgun and a few minutes alone.

[Guinevere]

Jarl, for the sake of those who'd have to clean that up, please, just get Liz to slit your throat with one of her knives.

[TPFKA@W]

Or Jarl you could make a tent out of heavy duty plastic wrap. It makes the clean up a no-brainer.

[TPFKA@W]

@W, do you see more problems are facilities that tend to have more folks who are only paying through medicare, versus the ones with private pay patients? I'm curious if the level of care depends on how much they facility is being paid.

My aunt has been a hospice/palliative care nurse (and now a nurse manager) for the last 25 years or so. Bittersweet is exactly how she would describe it.

My experience with wealthy private pay patients is fairly limited. I worked for a short while in a facility that was completely private pay. A bed in their well appointed Alzheimer's unit started at $4K a month. That was the room and board, showers cost extra, something like $300 a week for 3 showers. (No older folks need more than 2-3 showers a week except under special circumstances. It dries them out badly.) Med pass was an additional cost. These people paid out the whim-wham. The surroundings were opulent, full skin leather sofa's and chairs, nice artwork. The cna care though was just as limited as it was on a medicaid unit. It blew my mind that these people paid out the ass and we still ran short of help. It was no better on the part of the building that was all apartment living. We took their meds in and the cna's showered them etc but essentially the overall care was not superior. The food was slightly better ostensibly prepared by a "chef". *rollseyes* I left this facility after a few months when the DEA showed up and arrested the DON. She ultimately went to prison for Medicare fraud because she had stolen a prescription pad and then a Medicare card from a patient and was going around town filling up her purse with Percocet. Not. Better.

Now in some of the facilities I have worked in the payer sources are separated. Usually you find that Medicare rooms are single occupancy suites of sorts. The relative opulence of these digs vary greatly from facility to facility. These are the money makers, the cash cow patients. They are raking in the cash from Medicare with therapy. There is supposed to be superior staffing but I have never seen it happen. The care is at best a smidge better than elsewhere in the building. There poor people are suckered in with promises of unicorns and fields of sunflowers by the marketing people who go "ambulance chasing" in the hospitals on a daily basis. They are looking for folks who qualify for Medicare and have a 3 day stay which then entitles them to a stay in rehab on the Medicare dime. There marketing people suck up to th hospital discharge planners. It is a very competitive market.

I think it was Crackpot who said persistently vegetative made money? No, they need to be able to document therapy of some sore to get the higher RUG. Don't ask me to explain RUG. It has to do with reimbursement. Ask and MDS nurse they are the experts.

Typically hospice patients are in the mix of the general population. So are other private pay individuals and of course the medicaid patients. They are all getting the same service from the same cnas. There is a slight advantage with the hospice patients because they have an outside cna who comes in to shower them. Otherwise it is all the same.

Hope that answers sufficiently Guin.

[oldr_n_wsr]

The bottom line is "take care of your parent/grand parents' as they took care of you when you were young. I know there are many people who do not have offspring to take care of them, but I know that many an "oldr folks home" do not have children to see for their care. Internet access to only family members might be a way of seeing gthe quality of care, but it might also make for those same children to not come visit. And I have found with my own grandmother that the personal visit is more meaningful than making sure their care is "correct".

Bottom line, those in your family should mean more to you than staying at work or hitting the beach. My grandma had dimentia and told me how I should remember the bridge in her home town that was blown up by the fleeing soldiers in WW1. I didn't but nodded in agreement. I still have the photo of that bridge years after it was rebuilt.

Maybe I am a family guy and will always take care of my dad and my aunt (all that's left of the older generation), but family is family.

Don't know the solution for cameras other than those that have a faculties, they should be able to turn on/off the cameras as they see the need.

[Guinevere]

@W, do you see more problems are facilities that tend to have more folks who are only paying through medicare, versus the ones with private pay patients? I'm curious if the level of care depends on how much they facility is being paid.

My aunt has been a hospice/palliative care nurse (and now a nurse manager) for the last 25 years or so. Bittersweet is exactly how she would describe it.

My experience with wealthy private pay patients is fairly limited. I worked for a short while in a facility that was completely private pay. A bed in their well appointed Alzheimer's unit started at $4K a month. That was the room and board, showers cost extra, something like $300 a week for 3 showers. (No older folks need more than 2-3 showers a week except under special circumstances. It dries them out badly.) Med pass was an additional cost. These people paid out the whim-wham. The surroundings were opulent, full skin leather sofa's and chairs, nice artwork. The cna care though was just as limited as it was on a medicaid unit. It blew my mind that these people paid out the ass and we still ran short of help. It was no better on the part of the building that was all apartment living. We took their meds in and the cna's showered them etc but essentially the overall care was not superior. The food was slightly better ostensibly prepared by a "chef". *rollseyes* I left this facility after a few months when the DEA showed up and arrested the DON. She ultimately went to prison for Medicare fraud because she had stolen a prescription pad and then a Medicare card from a patient and was going around town filling up her purse with Percocet. Not. Better.

Now in some of the facilities I have worked in the payer sources are separated. Usually you find that Medicare rooms are single occupancy suites of sorts. The relative opulence of these digs vary greatly from facility to facility. These are the money makers, the cash cow patients. They are raking in the cash from Medicare with therapy. There is supposed to be superior staffing but I have never seen it happen. The care is at best a smidge better than elsewhere in the building. There poor people are suckered in with promises of unicorns and fields of sunflowers by the marketing people who go "ambulance chasing" in the hospitals on a daily basis. They are looking for folks who qualify for Medicare and have a 3 day stay which then entitles them to a stay in rehab on the Medicare dime. There marketing people suck up to th hospital discharge planners. It is a very competitive market.

I think it was Crackpot who said persistently vegetative made money? No, they need to be able to document therapy of some sore to get the higher RUG. Don't ask me to explain RUG. It has to do with reimbursement. Ask and MDS nurse they are the experts.

Typically hospice patients are in the mix of the general population. So are other private pay individuals and of course the medicaid patients. They are all getting the same service from the same cnas. There is a slight advantage with the hospice patients because they have an outside cna who comes in to shower them. Otherwise it is all the same.

Hope that answers sufficiently Guin.

Thanks @W, very helpful.

[Guinevere]

The bottom line is "take care of your parent/grand parents' as they took care of you when you were young. I know there are many people who do not have offspring to take care of them, but I know that many an "oldr folks home" do not have children to see for their care. Internet access to only family members might be a way of seeing gthe quality of care, but it might also make for those same children to not come visit. And I have found with my own grandmother that the personal visit is more meaningful than making sure their care is "correct".

Bottom line, those in your family should mean more to you than staying at work or hitting the beach. My grandma had dimentia and told me how I should remember the bridge in her home town that was blown up by the fleeing soldiers in WW1. I didn't but nodded in agreement. I still have the photo of that bridge years after it was rebuilt.

Maybe I am a family guy and will always take care of my dad and my aunt (all that's left of the older generation), but family is family.

Don't know the solution for cameras other than those that have a faculties, they should be able to turn on/off the cameras as they see the need.

I just have to say, your perspective is rather judgmental. Your way *isn't* the only way.

Not everyone has the ability to take care of family -- and that doesn't mean they are sitting on their asses at the beach. As for working, most of us need to work to be able to keep a roof over our heads, or the heads of family members. Most of us are doing the best we can --- it might be useful to remember that from time to time.