The Nursing Home Nightmare

  Who among us has good things to report about Nursing Homes?  Virtually no one!  Old buildings with drab decor, prison like furniture, dark shared sleeping rooms with cheap privacy curtains and shared institutional bathrooms; “not the first choice for mom’s last home”. So why do these facilities continue to be an important component in our nation’s solution for coping with an aging population?  In one word, “MEDICAID”.  Before 1965, when Medicare became available, there were only a small number of church/benevolent sponsored Nursing Homes.  Only with Government funded support did a widespread private industry respond to the heartbreaking neglect of the nations‘s poor elderly.  Google says that Medicaid is a State/Federal Health Program for the “needy”, but as it has turned out 50 years later, about 90% of Advanced Age Seniors are “needy”, so it’s really a program for all of us except for those few "financially fortunate" families. 

    You see, it costs more than $4000 per month for mom to occupy that 200 square foot curtain defined space in a bleak building that no one wants to call a home.    Given that life expectancies for newly admitted patients are on the rise, and 5 years is often expected....well it’s going to cost around $250,000, for mom to end life in this institutionalized patient model.   Of course, as you well know, exactly none of the 90% happen to have $500,000 available to pay for their parents care....so what to do?  The Answer is:  #1  Take all of mom’s assets  #2  Redirect mom’s Social Security/Retirement checks to the Nursing Home  #3  Have Washington borrow the shortfall from the Chinese and send it to the Corporate Owned Nursing Home.

So what does Mom get for the $250,000, of which about $50,000 will come from Mom’s Social Security/Retirement, and the balance which will come from Beijing by way of Washington Borrowing..  Well she will get the right to put a television on her side of the shared room, but probably not a personal chair, nor will she get an unrestricted telephone. She will get three meals daily, nurse aide support as necessary, an emergency call pendant and weekly/emergency visits from an Vocational Nurse.  Mom will routinely see a Doctor (far more likely a Nurse Practitioner) monthly for a very brief in-room visit. The Doctor will be allowed to bill Medicaid separately for these visits.

Once stabilized as a Nursing Home Patient, Mom will most likely no longer see her Primary Care Physician, nor be taken to the Hospital ER, nor Admitted to the Hospital for Condition Changes arising from general health decline.  Indeed, the Nursing Home will receive funding from Medicaid to fund the cost of educating Patient Families not to insist on Hospitalization except in the most extreme situations.  While the Nursing Homes Management, charged with maximizing census and thereby Medicaid Revenue, cannot prevent families from arranging for Non-Nursing Home Services to be provided for Mom, they often constrain family choices by veiled threats to report alternate choices to local “Senior Abuse Agencies”.  Families in complicated moral situations are fearful of Nursing Homes issuing “AMA”, (Against Medical Advise) Reports to alternative Care providers, as the price to, literally “get Mom out of a horrible place”.

Why do Nursing Homes follow such a Hard Line regarding their control over their patient’s post-admission choices?   The Answer is that it fulfills the basic reciprocity in the Nursing Home's business dynamic with the Hospital.  Under Medicare regulations Hospitals are financially penalized when Seniors repeatedly return to the Hospital with a chronic health issue.  The unacknowledged, but strong understanding between the Hospital and the Nursing Home is that the Hospital will aggressively insist that when discharging an “unstable seniors”, the patient will  be admonished that they absolutely must receive Nursing Home provided Skilled Care.  Admonishments, it is often reported, involve threats of  “Senior Abuse Reporting”.   The Nursing Home reciprocally accommodates this "census driver benefit" by managing Mom’s condition exclusively in-house....less expensive for Medicare/Medicaid, better for the Nursing Home and the Hospital-- for Mom....not so much!  This may be acceptable, even efficient, for “disenfranchised America”, but unfortunately this protocol is applied to all seniors exposed to the system. 

    In summary, as a safety net for the millions of “Advanced Age Seniors with no financial resources to access the private market", the safe and secure, but almost always  dismal and depressing, Nursing Home Option is,a GodSend.  For those families whose temperament, resources and moral imperative compels a better “Advanced Years Lifestyle” for their Mom...well, there are many far better options.  Understand this....Mom does not have to be a “faceless economic pawn” in some Health Industry CEO’s quest for a better bottom line.