Imagine that your aging mother had to go to the hospital and is now going to be discharged. The discharge coordinator tells you that your aging parent must get rehab and go to a facility to receive it, as the hospital won’t provide that now. She needs physical and occupational therapy, you’re told. The discharge person doesn’t make any recommendation as to where your aging parent is to go, but she hands you a list of facilities and asks that you decide by two days from now which one you want.

You have no idea how to choose a place. The discharge coordinator used the word “rehab” for describing the kind of place but did not used the words “nursing home”. A rehab facility IS a nursing home. The very thought of it scares a lot of folks, and for good reason.

The nursing home industry sprang up after Medicare and Medicaid became law in the mid 1960s, and soon exploitation followed. About 82% of the funding for nursing homes comes from Medicare (Federal program) and Medicaid (combination of Federal, State and County funding). In other words, we, the taxpayers are paying for most of the care in these homes. Since my own days as a young nursing student working in a nursing home to make a little cash, I noticed an alarming trend. The owners seemed to make money from the constant influx of tax-paid dollars while the residents in these homes did without the basics they needed. One summer when I worked full time in such a home, we did not have enough linens to keep the beds clean. I quickly devised a way to grab some extra sheets from the laundry cart and hide them in one patient’s closet, so they would be available for changing his bed after the inevitable accidents he had every day. Otherwise, no clean sheets! It was awful. That was just a tiny example of what was wrong there.

A recent article re-published by Long Term Care Community Coalition revealed shocking facts from a lawsuit filed in New York by nursing home owners. The prior governor had signed into law a requirement that nursing home owners spend 70% of the income derived from their ownership of the homes on direct patient-related expenses. More than half was to go to direct resident care: salaries for nurses, nurse’s aides, and nutritionists, for example. But enforcement of that law was suspended with various explanations.

A new $10B plan set forth by New York’s governor Hochul requires that $4B be spent on subsidizing healthcare worker salaries. And as with the prior “safe staffing law” that was suspended, the profits the owners would be allowed to reap would be limited. The government would claw back profits above a certain limit. The moguls of the nursing home industry, profit-making titans, filed a lawsuit in Federal court claiming that this limit on their profits would be unconstitutional, a taking of “private property”, despite the fact that the property is actually mostly taxpayer supplied. When they laid out their profit margins in their lawsuit the results were stunning. If the law had gone into effect and been enforced since 2019, the nursing home owners would have had to repay $824M in excess profits, according to that law.

This profiteering is in the face of extreme staffing shortages, resulting resident neglect and a claim by industry owners that they barely break even. By their own assertions in the case, they do far better than breaking even.

What This Can Mean For You, The Consumer

If your aging parent or other loved one must at any time go to a nursing home/rehab facility, know how to make a reasoned decision about where you allow them to go. This means you have to do your research. Medicare created a five star rating system at Nursing Home Compare. The idea was fine except that the majority of the data for that rating comes from the nursing home itself. Inspections of homes that are supposed to take place are not being done as envisioned. I would not rely on that exclusively, as it is suspect just because it’s based on self-reporting of conditions like staffing. That can be manipulated after the fact, once the rating is done. It’s better than no system, so use it as one guide only.

What Families Should Do

Here are some steps you can take, once you have a list of prospects for placing your loved one.

  1. Look up each of the listed places and see how they are rated. A “five-star” may be good or not. A “one-star” is sure to be horrible.
  2. If at all possible, go visit the proposed facility, unannounced. If you see elders lined up along the walls in wheelchairs, doing nothing, sleeping, that’s a bad sign. So is the absence of any staff with them.
  3. If you can’t go yourself, you can find a care manager or placement specialist to give you the rundown on the facility’s reputation. Perhaps for a fee one of them could go visit and see how it looks, reporting back to you.
  4. Be sure a bed is available when you need it for your loved one. With the pandemic, more people are in hospitals and nursing homes recovering from Covid. You may not get your first choice.
  5. Keep close watch over anyone in a nursing home. If you are far away and can’t visit, at least call daily and ask the charge nurse or person caring for your loved one for updates and progress reports. Ask if your aging parent is actually getting the rehab the doctor orders. With staff shortages, they may not be getting it as prescribed and you have to push for it, advocate for your aging parent and hold the home accountable for delivering the care.

The Bottom Line

Nursing homes and “rehab facilities” can be quite dangerous places. Understaffing is widespread and highly problematic. Large, for-profit nursing home chains are among the worst for creating safety risks for your loved ones. If you have a choice, look for a smaller, nonprofit home, some of which are run by faith-based organizations. This is no guarantee, but it is less risk than a massive, profit-driven corporation with hundreds of homes focused on making money from our tax dollars. vulnerable elders’ complex needs. Nonprofit status is not an assurance of quality. Sometimes all it means is bigger profits because owners are relieved of the tax burden they would otherwise pay. Above all, pay attention daily to what is going on with your aging parent in any nursing home. Do not count on the home delivering what it is supposed to deliver. Some do, but many don’t. It is up to family and close advocates to keep aging parents and other family safe in the rehab process.

A checklist with explanations to help you avoid mistakes in choosing a nursing home is available in my eBook, Ten Tips For Checking Out A Nursing Home.



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