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BootyThunder t1_it8ym5w wrote

Uh, yeah we’re gonna need a full fucking overhaul of the US healthcare system if we want to improve nursing homes. They seem to be one of the most egregious examples of what goes wrong when we combine capitalism and healthcare, but this is just one symptom of a much larger illness. I truly would prefer to die than go to many of the SNFs I’ve passed through in my career and I need to find out how my parents feel about this before it’s their time.


Shrek3TheShrekkening t1_itaocgi wrote

Used to be an EMT and picked up enough folks from SNF facilities to never put my parents in one when they get older.


WhiteHairedWidow t1_itcj1x1 wrote

I worked in the funeral home industry and I’ve been to many nursing homes/retirement/hospice facilities..and now I work in activities at a retirement facility. The amount of complaints from family menders about other facilities is mind boggling. These places pay the least, and charge crazy amount to these residents. The healthcare system really does need to be flipped over and redone because it’s terrible messed up.


Linubix t1_itcwp3n wrote

This is more to do with the for-profit management companies that oversee their facilities.

They set the budgets, occupancy rate, and pay for staff while saying the on-site management have the freedom to run the facility as they see fit since "they know their facility the best".

Meanwhile the executives at the management companies are paying themselves ridiculous salaries and benefits that the facility staff don't get.

The on-site management is incentivized to keep costs as low as possible by tying their bonuses to certain metrics like occupancy and operating costs. They in many ways are simply a buffer between the staff and management company that really runs the show.

If a facility is no longer profitable they'll simply sell it to another management company who will infuse a small amount of funds into the facility at first and then after the grift starts again. These fund address superficial issues like replacing old computers but not systemic problems like failing AC units requiring daily maintenance to work.

I cannot stress this enough the people running these companies are GRIFTERS that live lavish lives at the expense of the vulnerable residents and staff. They will pinch pennies and minimize costs at facilities as much as possible while at the same time get weekly catered lunches and have grand company parties for the management company saff.

Some of the management company staff, such as those overseeing the health services, do have to go on site and see first hand the atrocious state of their facilities, but most never step foot in a facility. Those have plausible deniability of what they are perpetuating allowing them to sleep at night.

I know this because I worked as outsourced IT for a few of these management companies and I couldn't continue to be part of such an awful system.


Tom245332 t1_itepje0 wrote

My parents are friends with one of these types. They waste money on the dumbest things and could give a single shit about anyone.


Cueller t1_itesjnw wrote

Maybe a lot of what you are saying is correct but there is no market for nursing homes. Generally no one wants to buy them and no one wants to manage them. Anyone who can get out of that industry is doing so.

A few groups are making it work by just barely running them and basically making money by selling every medical need possible through an affiliate company. So they make massive peofit outside the nursing home itself.


Miserable_Archer_769 t1_itl10cm wrote

Don't forget the intersection of a vulnerable age group that as a society we have it constructed it to essentially put your older folks out to pasture because the reality is its another system set to just bleed there last dollars. The cost of just a bar is the floor nursing homes is astronomical and a top of the line car facility is more than a mortgage in most HCOL areas or on par.

The world passes them by and nobody seems to care is the real reason it's easy to exploit them.


sephstorm t1_it8rpsh wrote

Without any additional help right?


[deleted] t1_it8txmv wrote



plscallmeRain t1_it8wo4i wrote

this is why PA has elder care laws.


tahlyn t1_it9qwwu wrote

PA's laws aren't better. They force children to pay for their parents' care without regard to the child's upbringing or current circumstances.

Just because someone spent their whole life not preparing for their old age doesn't mean their children should have their own own retirement and their own financial wellbeing destroyed to pay for an entire generation of irresponsible people who decided retirement wasn't a priority for them.


ChickenSandwich61 t1_itae2jl wrote

I agree. And what about people who are like no contact or estranged from there parents, perhaps due to their parents having been abusive, neglectful, etc. Imagine then being forced to pay for this. Insane.


booksgamesandstuff t1_itary5a wrote

... My divorced, very independent mother worked til she was 78. Her Social Security was max'd out and she had a pension from her years working at Rockwell and Boeing. She thought she would be ok... Yes, she qualified for many of the programs available in PA because of the lottery funding but still didn't have enough for a decent facility in her last years. She spent her last year with me, at my house and I think she resented every minute of it. We had an aide come in twice a week, but I had no help from family. Until you're there, don't judge.


sluttyjamjams73 t1_itcabeh wrote

OP obviously isn't talking about your specific, single case. Unless is't actually an attack on you, don't react.


booksgamesandstuff t1_itcrlfg wrote

That was not an attack, and I do know how this ended up for several senior citizens. My point was to not generalize. Every situation is different, and while most people do try to prepare, the reality at the end becomes the same for all. You’re well-off enough that money isn’t a concern for you or your family…OR what you thought would be sufficient for your needs will always go towards end of life medical needs until they run out. Then you go to whatever facility you and family can afford…and it’s not a pretty picture for anyone.


DrKillgore t1_ita6uwr wrote

What’s the alternative? Euthanasia?


tahlyn t1_ita90gm wrote

A proper pension/social security system.


DrKillgore t1_ita9ke1 wrote

If only they would stop borrowing against SS and increase the maximum income contribution.

I think Canada’s euthanasia program is more likely.


shinra528 t1_itacuua wrote

Or just stronger overall safety nets.


DrKillgore t1_itadfvp wrote

The only safety nets in America today are golden parachutes.


calm_chowder t1_itasj2j wrote

Yes, if warranted. If an elderly person wants to die, it should be an option. Why not? Living should also be an option, but realistically no elderly person is ever gonna get better from being elderly. If their situation is bad enough they want to pass we should let them do it with dignity.

Imagine suffering every day and knowing it'll only get worse every day and can never get any better, but potentially living another 5 or 10 years being more tortured every single day. You've done everything you wanted to/could do in your life and now with nothing ahead of you you're forced to get up each and every day for fresh suffering and to lose another part of yourself, no dignity, no self reliance, no modesty, no independence... just because your shitty body won't quit when your mind and soul are already half gone.


NoodlesrTuff1256 t1_itd0j65 wrote

Assisted suicide is obviously a highly controversial and emotionally charged subject. Those who object to it becoming easier to obtain do have some legitimate concerns so far as fears of greedy relatives pressuring their elderly parent to 'check out' before the inheritance is depleted. But I think that those instances are much rarer than the scare tactics of people like Sarah Palin and her 'Death Panels' propaganda would have you believe.


NoodlesrTuff1256 t1_itd02sf wrote

On a lot of discussion boards (Reddit and others) when the topic of nursing homes, elder care, and dementias comes up, it's amazing how many people say they'd prefer death to winding up in the worst of these nursing homes. Black humor jokes along the lines of "What's your long-term care plan if you're diagnosed with Alzheimer's? -- Answer: "Smith & Wesson" or "Making an appointment with Dr. Kevorkian."


Brix106 t1_it96fvf wrote

PA is still prohibitly expensive.


Cpt_sneakmouse t1_itawdeq wrote

I think from an outside perspective that might be how it appears but in many cases these companies default to operating with skeleton crews because it means better profits. Let's take an example of one wing of a nursing home with 26 residents on it. You can ball park gross revenue for the nursing home for that wing at about 260k per month. Only around 1400 of that will be spent on nursing staff for the residents per day. IN A NURSING HOME, and that expenditure assumes they're paying their staff decently.


cydril t1_ita357b wrote

A lot of facilities will just close. The remainder will be prohibitively expensive. ✨America✨


613codyrex t1_itc56xw wrote

Well most nursing home problems are self inflicted.

The owners and managers refuse to pay for additional quality nurses and care staff while underpaying the care staff they do employ which leads to basically bottom of the barrel staff being tasked with taking care of people.

These nursing homes could just not make as much money as possible and it wouldn’t be as much of a crisis but they won’t.


soodeau t1_it9d8mi wrote

I think this is more like “don’t make promises you can’t keep,” than it is “do something you previously admitted you couldn’t do.”


t4ct1c4l_j0k3r t1_it8qna5 wrote

Good. Seniors and the disabled should not be treated badly.


BoomerTranslation t1_it9btr7 wrote

...and the prices will jump up too, I suspect.

Imagine what insurance will try to change for this kind of care.


Maxpowr9 t1_it9tcqn wrote

Same reason why daycare costs exploded.


The_Yarichin_Bitch t1_ita095w wrote

And it's sad because they literally don't have to by sacrificing 1 of their millions in profits... I'm talking the CEO's.


NoodlesrTuff1256 t1_itd1g1d wrote

These greedy nursing home CEOs (as well as those in a lot of other industries) need to be named and shamed and pictures of their ill-gotten gains [mansions, yachts, private jets, etc] displayed for all to see.


The_Yarichin_Bitch t1_itgwfpp wrote

Fuck yes they do, the people making money off of people and specifically the elderly in care suffering deserve the worst imo...


NoHalf2998 t1_ita214b wrote

They don’t even offer the insurance my mom bought years ago because it pays out so much


WhiteHairedWidow t1_itcjj0z wrote

At the place I work at, the residents pay upwards to $300 per day to live here.


TheInternetShill t1_itar4hk wrote

Further showing why it’s incredibly dumb to not have single payer health insurance


Cpt_sneakmouse t1_itawl9q wrote

The government ends up footing the bill. The way the system works right now is that you're actually encouraged to go completely broke paying for care and at that point you can qualify for government coverage.


NoodlesrTuff1256 t1_itd1we3 wrote

A lot of older people will start transferring their financial assets to their children and grandchildren before they even need this kind of intensive care. If the transfer process is completed and then more than five years goes by without the senior needing to check into a nursing home, the family is 'home free.' But if the worst happens and they have to check into a nursing home before the five years is up, the government has the right to look back into their finances and demand that they spend down a certain amount of their assets before Medicaid kicks in to pick up most of the nursing home bill.


SaltyTowels t1_itevs1o wrote

So we'll end up with fewer but better SNFs than many shitty SNFs? Sounds like progress to me.


Rave__Medic t1_itbt6fq wrote

As someone who's worked as a medic on an ambulance, they already are treated horribly by the system. The general public would be DISGUSTED at what i've seen in these facilities.


merpitupmerpitout t1_it9kf6c wrote

We need mandated patient caregiver ratios to make any real progress


RustyRapeAxeWife t1_itaialg wrote

It’s already very difficult to hire facility caregivers due to low pay and working conditions. CNAs in my state make only a little above minimum wage. We end up with a lot of poorly trained immigrants who struggle to communicate with the residents.


ragingRobot t1_itcncop wrote

Maybe they should start paying more then and taking less profit


[deleted] t1_itawski wrote



Stargate_1 t1_itban6a wrote

So you are saying we should exploit people's goodwill rather than fight to give these people a decent wage and work conditions?

Fucking cruel and inhuman


clemonade17 t1_itbkvfb wrote

No. It's a job. Like any other job. Stop taking advantage of passion professions because "it's the right thing to do" - we have families. We need to pay our bills, we need insurance and PTO. Do you know how you end up with a bunch of people who don't give a shit about patients anymore? Force them to work unsafe ratios for a few weeks for shit pay.

I work in a hospital as a CNA, and your perspective is a shit take


Then_Campaign7264 t1_it8re3g wrote

While I applaud any measures to improve the quality of care, staffing, and accountability in nursing homes, according to the article, these new measures are only cracking down on enforcement of our nation’s poorest-performing nursing homes. And they absolutely deserve immediate attention.

However, “the new guidelines announced Friday will apply to less than 0.5% of the nation’s nursing homes.” With regard to staffing levels, only 88 facilities are on a watch list.

This is a massive problem as the number of people requiring care will increase exponentially over the next few decades.

I sincerely hope this is the first step in a long line of measures that will require strict compliance, enforcement and prosecution in the nursing care industry.


vexpopped t1_it8nyuo wrote

Why is it always the Democrats jobs to clean up problems like this?


Thatguyxlii t1_it9jl5b wrote

Because Republicans not only refuse to, they cut funding to existing programs. It's all about greed.


WhiteHairedWidow t1_itcjunn wrote

Was it a republican who got rid of all the psych wards in America?

Yes it was Raegan


[deleted] t1_ita6hk4 wrote



Tw0_F1st3r t1_itak9r9 wrote

That's terrifying. I have 3 Lpns working with me for 66 residents and we're all still run off our feet.


BluejayPure3629 t1_itay1iv wrote

Florida doesn't have mandated ratios, I remember being the only nurse for 60 people on multiple occasions, 3-11 shift.


Lostinthisworld313 t1_itazhhd wrote

We actually do have a max of 40 pts : 1 RN.. Let me find the link

Edited with the link :,licensed%20nurse%20per%2040%20residents.

"A minimum of 1.0 hour of direct care by a licensed nurse per resident per day. A facility may not staff below one licensed nurse per 40 residents'

You should never accept an assignment of more than 40. It's illegal and you can end up thrown under the bus if something goes wrong. Don't think for a minute that your facility will defend you.


sarcago t1_it8sde4 wrote

Is there a way to see which facilities are a "special focus facility"?

All I can say is that nursing home administrators are succubi. They don't hire enough staff, they don't pay them enough, they don't stock enough supplies, they don't take care of the building, and they don't fire the bad staff that mistreat people. I saw people rotting away in their beds. I heard resident complaints get completely ignored by staff. This was during a CNA class.

Edit: Found the list. The one I did my hours at is somehow not on the list. 6 others owned by the same company are on their in various capacities though (candidates/shows improvement/graduates).


mokutou t1_itaohgw wrote

One of the reasons I quit the nursing home I worked as a CNA at was the administrators informing the CNAs that they would be given a predetermined number of adult incontinence briefs per resident, and it was on us to make that allotment stretch through our shift. They said we changed briefs too frequently and it was costing too much money. And this facility was one of the “good ones.” But we were having to stuff briefs with towels because adequate and dignified incontinence care was cutting into administration’s bottom line.


lajih t1_itb32nv wrote

They said the same thing to my friend. She was reprimanded for changing diapers too often, changing gloves too frequently. There was no soap or hand sanitizer. She was bringing in all of her own cleaning supplies. They let her go for not lifting the 300lb disabled guy herself. They paid $8/hr and wanted her to do insulin shots with no certifications. It's just a temporary holding facility until people die.


rainafterthedrought t1_it8wivn wrote

Do you have a link?


sarcago t1_it8xaiu wrote


Noritzu t1_it8xxst wrote

I worked at two long term care centers as a nurse and they were absolute dumpster fires. As you said the administration and owners were all leeches wanting max profits for minimum care. Can’t believe neither of those facilities are on this list


sarcago t1_it8y60c wrote

Yeah it's really scary something can be THAT bad and still not be in the worst .5% of all nursing homes.


rainafterthedrought t1_it8y566 wrote

Thank you! Found two I’ve worked at on the list and they are both owned by GENESIS HEALTHCARE


mokutou t1_itap428 wrote

Genesis is utter garbage. I will dance the day I hear they go out of business. I’m permanently injured due to their shitty staffing policies, which they tightened even more after I quit.


Velkyn01 t1_itama51 wrote

Ya'll would be horrified if you saw the things that go on in "skilled" nursing facilities.


Cpt_sneakmouse t1_itav7tn wrote

There are two issues at play. One, many of these facilities have been bought up by large chains that tend to have the strategy of sucking as much funding out of resident services as possible to maximize profit, and two the laughably inadequate government funding for long term care. If they are going to mandate staffing ratios it's going to require turning shitty jobs into good ones and that is going to mean providing better wages and conditions for everyone. Many of these places are staffing their nurses at 25+ patients and their cna's at 15 or more. It doesn't take a fucking genius to do the math here. A nurse on a 12 hour shift with 25 patients has a grand total of 27.5 minutes to dedicate to each of their patients. That's all in, meds, charting, phone calls, etc. So let's figure at best 10 minutes of charting per patient. Now we're at 17 minutes for meds and any coordination and care a patient might need. That is fucking absurd. A CNA on an 8 with 15 has 30 minutes to spend with each resident. That means incontinence care, turning, feeding, toileting answering call lights etc. Again it's fucking absurd. Read the reviews of almost any nursing home and youre gonna see comments that say something along the lines of "the staff doesn't care" Well that's because they literally don't have time to care. So the federal government needs to hurry the fuck up with making some standards because everyday they burn doing nothing represents more nurses and cna's who are saying fuck this and finding other jobs.


jwmarley t1_itaje77 wrote

A lot of things need to change about end of life care, especially the families that advocate for needless treatment


trextra t1_itaz7qx wrote

But, you know, keep cutting their reimbursement until they figure out how to take care of patients with less money than they’ve already failed on.


Dr-P-Ossoff t1_iteohci wrote

I’m under the impression they assassinate patients who are on a less profitable plan.


DistractedADD t1_itgqz20 wrote

Rather than penalize them, we should be provider more support. Compensation increases, focused specifically for nurses and caregivers