# Nursing Homes



## Tabby Ann (Oct 22, 2022)

After being hospitalized with a broken leg, the doctors were loath to dismiss me from the hospital because I lived alone in my house without household help. The doctors agreed to dismiss me to a nursing home for one week before going to my own house, which would give me time to arrange household help. I had no knowledge of local nursing homes and had to choose from a list provided by the hospital. They all sounded the same in their marketing literature, providing meals, laundry service, and maid service, etc. so I chose one at random. It turned out to be one of the worst experiences of my life. The food was not good or healthy, my laundry disappeared, and the nurse’s aides didn’t listen or respond to patient requests. I couldn’t wait to get out of there. Now that I discuss this, I find many people with relatives who are stuck in nursing home permanently due to permanent disability and are very unhappy with the food and services and attitudes of nurse’s aides. I assume Medicare pays for this and I wonder how difficult it is to change nursing homes if one is unsatisfactory?


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## Lethe200 (Oct 22, 2022)

Actually you are talking about two different types of facilities, depending on what is available in your area. There are *convalescent facilities* which are different from *skilled care nursing facilities*.

Convalescent facilities are focused on short- to medium-term patients recovering from injury or illnesses that need more help than they have available at home, but less critical care than skilled care nursing facilities. SCN facilities can also do convalescent care, but not vice versa.

You should NOT assume Medicare pays for "this". It depends on a doctor's evaluation of your post-op or convalescent treatment, prescriptions, need for physical therapy and/or device monitoring, and other factors.

Medicare pays for 120 days of convalescent or SCN care once you are discharged from the hospital, IF you transfer straight to the facility. Spend even 30 mins. at home and they can refuse your claim. You must show improvement during convalescence or Medicare will stop benefits.

Many people - well, most, probably - have no idea what convalescent or SCN facilities are nearby, nor how they rate from the state board of health, or user/resident reviews. Some are good, many are bad, a few (very few, sadly) will be very good.

Assisted Living facilities come in a wide variety of offerings, since unlike countries with universal healthcare, there is no U.S. federal guideline as to what constitutes "Assisted Living". *They do not pay for it. *Some facilities have AL and SCN; others will have one or the other but not both.

Should you need full-time SCN/convalescence for longer than 120 days, you are responsible for private payment. If you have private insurance that pays for Asst. Living, at-home care, convalescent or SCN, you should file a claim for benefits immediately. Standard healthcare policies these days often include at-home care benefits. Long Term Care insurance (LTCi) generally covers all four types, especially policies written after 1990.

If you do not have such insurance, nor assets to pay for care, you will need to apply to the appropriate State Medicaid office for benefits. Be aware this may take time to process the claim; usually some weeks at best, some months if not.

If you are a Medicaid applicant, the number of facilities available may be limited. Most SCNs only take a limited number - or even none at all - of Medicaid recipients, because state benefits are always inadequate to reimburse the facility for actual costs.

There are Medicaid-only SCN facilities. They are generally very low-rated and have high employee turnover, since pay scales for most caretaker jobs start at minimum wage.

Be aware that if Medicare has been paying your SCN/convalescence bills and you get to the 120-day mark, it is strictly up to the facility you are in as to what they will do. A good quality, caring facility will work with patients to help them find appropriate help. A bad one will - and legally can, *in some states* - wheel you out to the curb and say "Bye, hope you have somebody to call and come get you!"

What most facilities will do, if you need long-term/forever assistance but cannot pay and thus go on Medicaid, is help you apply for aid, and get you on "the list" for an opening for a Medicaid-paid bed. This means that whenever a bed becomes available and you are next on the list, you get transferred there - and you do not have a choice of where the facility is, although I believe they do try to keep within regional boundaries.

I'm sure it's possible to transfer if you don't like the facility, but what guarantee do you have that the next Medicaid facility that becomes available is any better? And probably to transfer, you might have to go back on the list of applicants, so there's more waiting again....


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## Remy (Oct 22, 2022)

I'm so sorry for your experience. They are profit run and I wonder who keeps getting paid off so they are not required to have more staffing. Paperwork in those places are a nightmare and that seems to be all that matters.


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## Patch (Oct 22, 2022)

Two granddaughters work in a local nursing home.  The 20 year old started working for this facility part time during her junior year in high school.  The school offered a program where she could get her CNA.  She graduated high school early and will have her RN in about 6 weeks.  

She has been paid well, mainly because she shows up... volunteers for additional shifts when she's not involved with class work...  and takes a sincere interest in her residents.  When just in high school, had to deal with tending to patients who had passed away, cleaning them up before the funeral home arrived to get them.  She's been slapped, spit on, cursed at, peed on, pooped on.  Yet, she knows the names of the children of most of her residents, etc.  

It really bothers her about the facility management and her coworkers.  Management... and it is a huge Catholic Church associated conglomerate... is all about profits.  Run skeleton crews, over working staff and failing the care the residents deserve.

Her younger sister began work there the day she turned 16.  She works with the food service staff.  Her first day on the job, she was left by herself to feed an entire ward.  No training.  No guidance.  One of the residents asked for an omelet.  Even though this young lady is an accomplished baker, she had never made an omelet.  So, she pulled up YouTube on her phone and made an omelet.  Once the resident tasted it, he had a number of his friends asking for one!  She pulls extra shifts on weekends when schoolwork allows it.  Her parents only allow her to work Friday nights and weekends.  Management just announced they were cutting food service staff by 30%.  They suggest an aide can work two wards instead of just one.  The resident are used to eating at the same time each day.  Now, if you feed one early and one late, there will be rebellion from the residents.  Management doesn't care!!

These girls work so hard to make life comfortable for what will be the last months/weeks/days residents are on this Earth.  They try so hard, yet get no backing from management.  Management only wants to know where they can cut costs.  

The 20 year old will leave the facility immediately upon receiving her RN.  She already has offers from a local hospital.  The 16 year old will probably continue working there, as she completes high school.  She's always wanted to go into esthetics and cosmetology.  Hopes when employed, she can do volunteer work doing hair and makeup for those in nursing homes.  

With what seems to be an ongoing increase in dementia and Alzheimer's, if I end up in a nursing home I may not know who I am, where I am, or know my family members.  If that's the case, I still deserve to be cared for in a professional and kind manner.  From what I've seen, locally, there is no guarantee of that!!!


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## officerripley (Oct 22, 2022)

Lethe200 said:


> Medicare pays for 120 days of convalescent or SCN care once you are discharged from the hospital, IF you transfer straight to the facility.


I think it's actually only 100 days.


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## Jules (Oct 22, 2022)

@Patch   Lovely to hear about your granddaughters; they’re special young women.


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## Warrigal (Oct 23, 2022)

Patch said:


> Two granddaughters work in a local nursing home.  The 20 year old started working for this facility part time during her junior year in high school.  The school offered a program where she could get her CNA.  She graduated high school early and will have her RN in about 6 weeks.
> 
> She has been paid well, mainly because she shows up... volunteers for additional shifts when she's not involved with class work...  and takes a sincere interest in her residents.  When just in high school, had to deal with tending to patients who had passed away, cleaning them up before the funeral home arrived to get them.  She's been slapped, spit on, cursed at, peed on, pooped on.  Yet, she knows the names of the children of most of her residents, etc.
> 
> ...


How sad, but how blessed you are to have two such wonderfully caring granddaughters. It speaks volumes about you, and the way you raised your children.


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## OneEyedDiva (Oct 23, 2022)

So sorry you experienced what you did Tabby Ann.  When our doctor first said my mom needed to go into a nursing home (won't go into why now)...she went into one that looked nice but our experience was much like yours. The food wasn't so good, when they did her laundry, items got mixed up. One day I went in her room and her roommate was wearing her sleep shirt. And the aides seemed lazy to me. Blessedly, I was able to transfer her fairly easily to a home that was wonderful. I can't remember if her doctor helped with that process. 

The food was very good and the staff took excellent care of her. They "fell in love" with my mother and some called her "Grandma". They were so excited and happy when the EMTs brought her back from the hospital after her transfusions. The staff called her a "sweetheart", which she was. Shortly before she passed away, they hired a new dietician to replace the one who'd left and the food wasn't nearly as good. My mother paid for the first few months out of pocket and when her money ran out, blessedly she was switched to Medicaid. I was so thankful that she was able to stay in that facility.


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## Patch (Oct 23, 2022)

Warrigal said:


> How sad, but how blessed you are to have two such wonderfully caring granddaughters. It speaks volumes about you, and the way you raised your children.


Thank you!!!  We've been awfully blessed with our kids and grandkids!!  All three of our kids on their first marriages, two of them now over 25 years.  Life wasn't an easy road, but things worked out.
We had 104 foster children through out home over the years.  1990, I walked on young lady down the aisle.  Her biological father began sexually abusing her at age 10.  The are still married.  Both their kids graduated college.  And we have to "foster great grands" with them.
The stories we could tell.....

Also, understand, I have been blessed to spend the last 56 years with a very patient, caring... and beautiful... wife!  Her mothering instinct is beyond belief!  So much in our lives would not have been possible without this lady!!!


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## win231 (Oct 23, 2022)

I know someone who spent some time in a nursing home while recovering from a bike accident.  The care was so bad, he told the administrator, _"I'm leaving any way I can to get my affairs in order & off myself."_


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## Tabby Ann (Oct 23, 2022)

win231 said:


> I know someone who spent some time in a nursing home while recovering from a bike accident. The care was so bad, he told the administrator, _"I'm leaving any way I can to get my affairs in order & off myself."_



Sadly, most people I talk with who have been in nursing homes have experiences similar to your acquaintance. I guess we should all research what type of decent in-patient 24/7 care is available in our area before the need arises. None of us knows when an accident may happen.


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## officerripley (Oct 23, 2022)

Tabby Ann said:


> Sadly, most people I talk with who have been in nursing homes have experiences similar to your acquaintance. I guess we should all research what type of decent in-patient 24/7 care is available in our area before the need arises. None of us knows when an accident may happen.


So, so true; thanks for posting.


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## Remy (Oct 23, 2022)

win231 said:


> I know someone who spent some time in a nursing home while recovering from a bike accident.  The care was so bad, he told the administrator, _"I'm leaving any way I can to get my affairs in order & off myself."_


Sadly I believe it. The administrator is likely beholden to the corporation that owns the place. Don't please them, unemployed. And the people who are supposed to regulate these places do nothing. They are a big part of the problem IMO.


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## officerripley (Oct 23, 2022)

Remy said:


> Sadly I believe it. The administrator is likely beholden to the corporation that owns the place. Don't please them, unemployed. And the people who are supposed to regulate these places do nothing. They are a big part of the problem IMO.


Also so true.


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## fuzzybuddy (Oct 25, 2022)

Going into a nursing home isn't something you plan for. Lethe200 hinted at how complicated this can be. I remember getting a list of homes, at the hospital. How are you supposed to decide?  Your financial assets are the only thing that matters. Also, there is a misconception of what a nursing home is. Some think they are geriatric spas that will cater to your every whim. REALITY check. And after being in one, they may not be the best outcome, in most instances they are the only outcome.


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## StarSong (Oct 26, 2022)

I've had experience with SNF (skilled nursing facilities) via three elderly family members plus one close friend who were patients.  Here's what I've gleaned:

The very best of these  were barely adequate.  They're almost always severely understaffed, patients' clothing gets lost and shows up on other patients (even when marked, PLUS the family says they'll bring laundry home), the food is heavy on starches, fats and sodium, aka institutional fare, and many times the facilities reek of urine or a disinfectant intended to mask that scent.

Medical personnel?  One RN or LVN on staff,  the "house doctor" shows up now and then - mostly to collect a paycheck from my observation.   In all of my loved ones' cases, the house doctor was an uncaring, complete waste of time.  The RN/LVNs were harried, overworked and consumed by details the SNF couldn't legally foist on other employees.

Their PT and OTs were all very good though.

My advice is to have family members visit daily, and when on premises be sure to check in with those who are responsible for their loved one's care. Bring food if there aren't dietary restrictions.

It's helpful to arrange a visit during their scheduled PT or OT session to see the progress or limitations for yourself, and to learn the objectives (walking 30 feet with a walker, or being able to get dressed without help, or transferring from bed to wheelchair, for instance).

Once those objectives are reached _OR_ progress has stalled, the patient is released even if the patient or loved one doesn't think the patient is ready to go home.

When staff know they're being observed on a regular basis, they step up their game. Frequent visits also sends the message to staff that this patient is someone of value.

Of course, the main reason to visit is that SNFs are mind-numbingly boring. Yes, there's TV, but patients mostly sit in bed all day long with the exception of a 45 minute PT/OT session. Loved ones want and need those visits. Put them in a wheelchair and go for a walk around the block, sit outside, or do whatever will bring a change of pace and fresh air.


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## Remy (Oct 26, 2022)

StarSong said:


> I've had experience with SNF (skilled nursing facilities) via three elderly family members plus one close friend who were patients.  Here's what I've gleaned:
> 
> The very best of these  were barely adequate.  They're almost always severely understaffed, patients' clothing gets lost and shows up on other patients (even when marked, PLUS the family says they'll bring laundry home), the food is heavy on starches, fats and sodium, aka institutional fare, and many times the facilities reek of urine or a disinfectant intended to mask that scent.
> 
> ...


Much truth to your post. Regarding PT, OT. They have the time to work with the patient and then they get to just quit. Patient falls during therapy, gets a skin tear, decreased oxygen level or blood pressure, the therapist will bring the patient to the nurse and if there is an incident, that nurse will have a s**t load of paperwork to do. The therapist will walk away. This is 100% true. 

Family showing up is important. But please remember, that for some staff, all patients are important. And for others, sadly not. Some staff are just there for a paycheck. And they may also be harassed by administration about over time.


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## Frank Smith (Oct 26, 2022)

My Uncle was in a Nursing home and he loved it. A woman there thought he was her husband and he went along with it. When he died her family had to take her home for a while because she was grieving his loss.


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## Aneeda72 (Oct 26, 2022)

Nursing homes are horrific.  I spent almost 2 days in one and will die before I go again.  Because of that I totally understood why my mother never wanted to be in a nursing home, and wanted to die instead.

Which is why I am so  when I was notified, by my brother’s wife, that they had dumped mother into a nursing home.  I hope they live long enough for their children to do the same thing to them.


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## Lethe200 (Oct 26, 2022)

Let me speak up for a GOOD experience with a SCN facility. I have outlined this before and will try to keep it shorter. We needed a nearby facility for my MIL who had mild/moderate dementia. After much research we picked one, a full-service facility on a 5-acre closed campus with its own senior center. We made 2 visits without MIL over a few months, and 2 more with MIL. We ate lunches and dinners at their DR which was excellent; in fact one Christmas my entire family came to the facility to celebrate with her.

She went into Asst. Lvg; we also investigated/approved their SCN and Memory Care units, including watching class activities. They publish a list of activities every day, including off-site trips and shopping. They have a hairdresser, library, exercise gym, and snack store on-site. MIL's own geriatrician was the doctor associated with the facility, by sheer luck. The facility celebrates every holiday, monthly birthdays, and has a regular in-house concert schedule for residents to attend.

The facility is one of the top three most highly-rated facilities in the state, and has one of the very lowest turnover ratios as well.

The hallways are clean and brightly lit; big windows bring in daily sunshine. The building is a moderate hi-rise, rectangular in shape, and both sides enjoy views: either of the San Francisco Bay or the East Bay Hills. The staff is always pleasant, well-mannered and considerate; the management of this non-profit are excellent.

Despite my MIL's passing, we still keep in touch with the facility. She was incredibly happy there; she made many friends - people we didn't know came up to us afterwards to tell us how much they missed her cheerful presence. She loved it when she won at bingo and we were astonished when she became their group's bocce ball champion!

We picked the facility because we had no doubts that their Memory Care unit would be able to take good care of her as her dementia increased. As it turned out, she died before needing such care, but we remain confident that it was a decision that had to be made, and that our choice was the correct one. It says a lot that my spouse feels that if anything happens to me, he will sell the house and enter that same facility himself.

There are many bad facilities, and sadly, the amount charged is not an indication of good care. You cannot tell what a facility is like from just looking at the reception area and getting the 'sales talk'. Doing research into eldercare facilities is time-consuming and tiring - just as it is to carefully select any other professional service - but leaving it to chance and 'the last minute' is likely to cost you, one way or another.

The reason, btw, that I bring up full service facilities, is that almost all of them at times have vacancies in their SCN units. When that happens, they waive their usual interview procedures and will accept convalescing non-residents. So they are a resource that MAY be available if you need them - but you have to know they exist, and call to see if there is an opening.


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## Book Worm (Oct 27, 2022)

So many older adults are alone. Some people have adult children who estranged from the parents. Some never had kids. I worked in hospitals and it was common for people to have no help at home. The younger ones got sent home anyway. We’d have older adults who refused to leave our hospital and we’d have to fight with them over leaving. That was awful and why I quit that job. But I realized how many of us are alone. It worries me at times because 2 of my 3 adult children don’t care and have gone “no contact” so they certainly can’t be counted on to help. My husband’s son is so self absorbed, he won’t be of help either.


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## Alligatorob (Oct 27, 2022)

I think I posted about this before, but I'll do it again.  

After my knee surgery I went to a rehab facility for a few days.  This is a small town so it was a combo rehab and nursing home.  There were more nursing home folks than people like me in rehab.

  I think the place was relatively well run, a bit disorganized but not awful.  It was clean, food was good, and nicely decorated.  Some of the staff were pretty young and inexperienced, but most tried.

None the less I found it a depressing place, so many people who seemed to me to be just waiting to die.  And many could not do many of the basic necessities for themselves.  That has to be demoralizing.  

I wasn't there long enough to meet many of the patients, but I did talk with a few of them.  They were surprisingly friendly and humorous.  At one point I was having trouble getting my lunch in the cafeteria.  An elderly lady, I am sure she was in her 90s and confined to an electric wheel chair, heard me grumbling and brough me her food.  I was both humbled and embarrassed.  

Anyway it reinforced my conviction that I don't want to live my last days in a place like that, no matter how well run.  When it gets to that point I hope I can find a way to gracefully end things when I want to.


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## Giants fan1954 (Oct 28, 2022)

1- Many facilities have turned space into rehab units,the reimbursement from whatever insurance is being billed is higher.
2- the pay rate is abysmal, the work is back breaking and the turnover is huge,resulting in short staffing situations which results in more work.
1 facility I worked at,we were forbidden to tell a resident we were working "short". The state,specifically, in my case NY,appears to be clueless about what the staff to resident ratio should be.


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## officerripley (Oct 28, 2022)

Book Worm said:


> So many older adults are alone. Some people have adult children who estranged from the parents. Some never had kids.


Very true. Or even if they do have kids, they only had one kid. In the past, people usually had more than 1 kid--sometimes a lot of kids--so there was usually at least one daughter or daughter-in-law (almost never a son) who ended up taking in and taking care of the old person. Things have really changed in that respect


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## Alligatorob (Oct 28, 2022)

Giants fan1954 said:


> Many facilities have turned space into rehab units,the reimbursement from whatever insurance is being billed is higher.


Did not know that, must explain what I saw.  A lot of the needs for rehab are similar to nursing homes.  All they have to do is add some physical therapy.


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## StarSong (Oct 28, 2022)

@Lethe200, both my mom and my FIL spent the last periods of their lives in assisted living facilities.  My mom was in memory care, my FIL's Alzheimer's didn't get that bad before he died of an upper respiratory infection.  (Both lived to 92.) They were in different ALs because their needs were different.  Both facilities were excellent though, and I have highly recommended them to others.  

ALs were a godsend to my mother and my father-in-law. The ALs provided far better care than I could have, plus much better socialization opportunities along with time with people in their own generation.


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## officerripley (Oct 28, 2022)

StarSong said:


> @Lethe200, both my mom and my FIL spent the last periods of their lives in assisted living facilities.  My mom was in memory care, my FIL's Alzheimer's didn't get that bad before he died of an upper respiratory infection.  (Both lived to 92.) They were in different ALs because their needs were different.  Both facilities were excellent though, and I have highly recommended them to others.
> 
> ALs were a godsend to my mother and my father-in-law. The ALs provided far better care than I could have, plus much better socialization opportunities along with time with people in their own generation.


Too bad that the AL's are so expensive, around here anyway AL's start at close to $5,000/month.


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## OneEyedDiva (Oct 28, 2022)

StarSong said:


> I've had experience with SNF (skilled nursing facilities) via three elderly family members plus one close friend who were patients.  Here's what I've gleaned:
> 
> The very best of these  were barely adequate.  They're almost always severely understaffed, patients' clothing gets lost and shows up on other patients (even when marked, PLUS the family says they'll bring laundry home), the food is heavy on starches, fats and sodium, aka institutional fare, and many times the facilities reek of urine or a disinfectant intended to mask that scent.
> 
> ...


Thank God the nursing home my mother lived in for most of her time having to be in one didn't have the issues you speak of, at least not on her "side". There was an East & West. My (half) sister's aunt was on the opposite side from my mother and my sister wasn't pleased with her care at all. 

I started out visiting my mother three times a day (when I wasn't sick due to my A-Fib). Then I cut it down to twice a day...morning and late afternoon or evening. Most of the time my uncle visited her at dinner time (when he wasn't sick). Sometimes we'd be there together.  Thing is, they never knew when I'd pop up, which I'm sure helped but basically it was a nice, clean place and she was tended to well. I liked the activities as well. I feel for those who are stuck in nursing homes like you described Star. I know there's far too many of them.


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## Lethe200 (Oct 28, 2022)

Sadly, when it comes to eldercare in the U.S. we can easily see the difference between the "haves" and the "have nots".


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## StarSong (Oct 28, 2022)

Lethe200 said:


> Sadly, when it comes to eldercare in the U.S. we can easily see the difference between the "haves" and the "have nots".


Very true.  Both my mom and my FIL had sufficient assets to cover their monthly rent ($3000-ish) which wasn't terribly expensive given the care they received, but it would difficult for many to cover using SS alone.  I'm sure it's quite a bit more now because everything has gone up in price.


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## Lethe200 (Oct 29, 2022)

StarSong said:


> @Lethe200.... ALs were a godsend to my mother and my father-in-law. The ALs provided far better care than I could have, plus much better socialization opportunities along with time with people in their own generation.


Your last point is excellent, StarSong. My MIL's experience really struck us. All her old friends had either died or moved away, or were in SCN already. It was the socialization *with her peers *that made the difference in changing her from isolated/depressed into cheerful/busy. 

It got to the point where we had to make appointments to come see her because she was having such a good time with her new friends and activities!

It's one of the biggest drawbacks of the whole "stay at home until you die" argument. I love my home, but I don't want it to be a prison. The highlight of one's day should NOT be the arrival of the mailperson! 

One's family and friends may no longer be able to come visit you on a frequent or regular basis. Isolation is not good for anyone, even those of us who enjoy time spent alone.


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## officerripley (Oct 29, 2022)

Lethe200 said:


> It's one of the biggest drawbacks of the whole "stay at home until you die" argument. I love my home, but I don't want it to be a prison. The highlight of one's day should NOT be the arrival of the mailperson!
> 
> One's family and friends may no longer be able to come visit you on a frequent or regular basis. Isolation is not good for anyone, even those of us who enjoy time spent alone.


So true and something I'm already worried about (just wish I could get my huzz to see this).


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## StarSong (Oct 30, 2022)

Lethe200 said:


> Your last point is excellent, StarSong. My MIL's experience really struck us. All her old friends had either died or moved away, or were in SCN already. It was the socialization *with her peers *that made the difference in changing her from isolated/depressed into cheerful/busy.
> 
> It got to the point where we had to make appointments to come see her because she was having such a good time with her new friends and activities!
> 
> ...


Exactly.  They listen to music from their glory days, enjoy movies from the 1930s forward, and don't feel old because almost everyone is a similar age.  There's no embarrassment about slow maneuvering with canes, walkers or wheelchairs because many are in the same boat.  The fully able-bodied have patience for those who took a little longer to get around.  Staff are schooled in safe transfers and physical assistance for those who need it.  

The biggest merit of nicer ALs is that the employees work 8 hour shifts. They go home after work and come back the following day fully rested. Caregivers don't clean the rooms, cook, do laundry or manage other housekeeping chores. Meds are dispensed by a med team. Even so, when someone on another team comes across a resident in need of assistance, they lend a hand. 

Attempting to create this kind of environment in one's home is an exhausting, resentment-creating, 24/7 ordeal that takes a huge toll on the person who needs the care as well as the caregiver.


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