COVID-19 has revealed the stark deficiencies in long-term care facilities regardless of ratings.

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CULater
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COVID-19 has revealed the stark deficiencies in long-term care facilities regardless of ratings.

Post by CULater » Wed Apr 29, 2020 10:45 am

My mother is in a long-term care facility, so I've been acutely aware of how terrible these places have been dealing with the coronavirus. I've looked at many, many facilities over the last couple of years for my mother and have become acutely aware of the untold story of the stark deficiencies of most nursing homes, even the ones that are supposed to be the best and cost the most. Ordinarily, long term care facilities are very non-transparent. In most states, they're not even required to report vital information publicly. The current crisis has pulled away the curtain, and we can all see for ourselves.

There are many of us Bogleheads who are thinking and planning about long term care for ourselves one day. The current situation has made it clear what a challenge we face. It's critical that you and I begin now to apply our due diligence. How can we determine which facilities to avoid? Is there really much difference between facilities, regardless of how much they cost? We have a real challenge ahead of us, I'm afraid. Here's an article discussing some of the current situation and the reasons behind it:
The federal government regulates nursing homes through the Centers for Medicare and Medicaid Services, or CMS. They offer a “compare nursing homes” service in which each home is subject to a five-star rating system.

There are 42 New York state nursing that have admitted to at least 10 COVID-19 deaths so far.
More than half were given four or five stars overall, and just five were rated below average.

The rating system is “totally bogus,” says FATE’s Carol Herman. “I’ve had more problems with facilities that have a five-star rating where they’ve abused patients. I tell my clients, don’t look at the ratings. I never go on the CMS rating.” She says much of the data depends on self-reporting by the operators.

But problems run deep. The pay in the industry is low. The median hourly wage of a nursing assistant in America, says the U.S. Labor Department, is $14 and change.

One thing that’s likely to have helped spread COVID-19 through nursing homes: The parade of part-time staff and orderlies, doing shifts in one place and then another.
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Re: COVID-19 has revealed the stark deficiencies in long-term care facilities regardless of ratings.

Post by go_mets » Wed Apr 29, 2020 11:01 am

I believe that the situation mirrored the society in general.

By the time, the facilities realized that there was a problem, the virus was already here.


.

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Re: COVID-19 has revealed the stark deficiencies in long-term care facilities regardless of ratings.

Post by Dottie57 » Wed Apr 29, 2020 11:11 am

go_mets wrote:
Wed Apr 29, 2020 11:01 am
I believe that the situation mirrored the society in general.

By the time, the facilities realized that there was a problem, the virus was already here.


.
+1

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Re: COVID-19 has revealed the stark deficiencies in long-term care facilities regardless of ratings.

Post by prudent » Wed Apr 29, 2020 11:35 am

The "care" in "long-term care facilities" comes down to people. Policies, guidelines, rules, etc. are good, but it's up to the people working there to make them effective. Relatives who owned such a facility made it a jewel because they had 7 family members working there who demanded the best of the people. They had the advantage of being in a rural area and paying above average, so they could be choosy, and it was considered a good job to get with many of the staff working there for over a decade. My relatives weren't dependent on the income so they didn't pinch pennies when making decisions for the facility. New ownership took over (part of a chain) and my relatives heard from family members of residents that standards had slipped noticeably even though none of the policies, etc. had changed.

We can do all the due diligence possible in selecting a facility, but we don't know if the staff will do what they are supposed to do and/or if the management will cut corners down the road or if ownership changes. Many facilities have job openings so it's easy for workers to bounce around until they get the axe. And when places are short-staffed the tolerance for poor workers increases - should I fire this sub-par person or do I keep them rather than having yet another open position?

People choose a facility based on their evaluation of the facility when the decision is made, but as the poem says, "The moving finger writes; and, having writ, moves on." We can't know if the facility we will live in will be the same as the one on which we based our choice.

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Re: COVID-19 has revealed the stark deficiencies in long-term care facilities regardless of ratings.

Post by tetractys » Wed Apr 29, 2020 11:43 am

Really the only way out of the situation of being set aside in senescence is extraordinary fortune. The majority of us will just have to take our chances and hope for the best, and then take the ride. It would be wise to respect our children, and to be kind to those around us. Historically, useless elders have been thrown over cliffs by their sons, or pushed out of their houses to wander hopeless in the coldest part of winter. Or they would take it upon themselves to sit and freeze outside the village, or to depart to the forest never to be seen again. It couldn’t hurt to view life beyond the elusive points of birth and death, and be ready now.

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Re: COVID-19 has revealed the stark deficiencies in long-term care facilities regardless of ratings.

Post by brandy » Wed Apr 29, 2020 11:46 am

My own health situation---totally, permanently disabled by fumes, gases, smokes from chemicals including personal care and household---puts long term care facilities off limits for me. Even a hospital stay with pinesol etc is impossible. Any one or all body systems can be/are affected by chemicals--physical, mental, emotional, to varying degrees...I also have severe copd. With so damaged a respiratory system, most chemicals first affect that. (not good...)

I am in my home, a sfr with a yard and yard work. I do what I can, it's less than what I could last year. I think I've hired someone to come spread pre-emergent and take care of a few weeds in a couple of weeks. I do what house work I can. I hope I don't have to hire someone for personal care at all, or for a long time, as I have no insurance to cover that.

I get a little occasional help from a volunteer group. It is little. I'm grateful for that. It takes much longer to do even small tasks when I can do them at all. I'm grateful I can do them. Preparation is as about as much mental/psychological as physical due to respiratory challenges. I finally got the kitchen mopped: a few days of pep talks, moving bucket and mop, finally doing it: about 10' long, 6' wide, took most of the day...part of that time sitting to recover breath.
I am still able to take care of my food via pick-up or delivery, but recent purchases have ready made meals whether frozen, or in cans or boxes... Some days I don't have the breath/energy to cook, even opening a can (of soup) is a challenge.

It's probably time to look again into what the city/county/businesses have to offer, and at what cost.
One thing I expect to have to buy is one or two air cleaners, better than the "top-rated" one I have now.

I do hope more help will be available via taxes when I need it.
I do try to remember that facilities are very expensive. That work I hire to do here costs, but not as much. Yet.
Personal care, probably a minimum hours per day, maybe minimum days a week, will also cost.

Once in a while, someone goes missing. I've wondered at the time if that person ..."left"...
I'm not ready, yet.
How are you all approaching this?

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Re: COVID-19 has revealed the stark deficiencies in long-term care facilities regardless of ratings.

Post by randomguy » Wed Apr 29, 2020 12:51 pm

go_mets wrote:
Wed Apr 29, 2020 11:01 am
I believe that the situation mirrored the society in general.

By the time, the facilities realized that there was a problem, the virus was already here.
To some extent, I am not sure what they could have done that would be remotely reasonable. Lets say you have a facility with no residents that are infected. How are you going to keep them that way when they need a steady stream of people coming in and out to keep them alive. You cann't have them sterilize themselves every time they enter a room. I am sure we will learn that they reacted too slowly to close communal areas and didn't have enough masks and the like to go around but in general if your old and frail when a pandemic comes around, your odds of dying are going to skyrocket.

My plan is based on staying out them as long as possible. Healthy living isn't a guarantee by any means but it dramatically increases your chance of being a mobile 80 year who can live on their own. Or at least being in good condition that a kid can help me out for a couple years. And then have enough cash to afford the private room.

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Re: COVID-19 has revealed the stark deficiencies in long-term care facilities regardless of ratings.

Post by brandy » Wed Apr 29, 2020 2:20 pm

One woman I knew had a bedridden parent in Ohio--2000 miles away. She removed all items of value from the house, had a company set up a surveillance system to moniter the parent and activities in the house, and hired a company to provide care. It started as four hour care, then was adjusted as needed --I think later to generally 12 + hour care. Her morning, daytime, and late evening needs were all taken care of.
My friend monitored via computer, and though there were a few glitches, this worked for them for a little over two years before the parent passed.
I imagine this is something I might have to consider, and do if/when...

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Re: COVID-19 has revealed the stark deficiencies in long-term care facilities regardless of ratings.

Post by wfrobinette » Wed Apr 29, 2020 2:35 pm

randomguy wrote:
Wed Apr 29, 2020 12:51 pm
go_mets wrote:
Wed Apr 29, 2020 11:01 am
I believe that the situation mirrored the society in general.

By the time, the facilities realized that there was a problem, the virus was already here.
To some extent, I am not sure what they could have done that would be remotely reasonable. Lets say you have a facility with no residents that are infected. How are you going to keep them that way when they need a steady stream of people coming in and out to keep them alive. You cann't have them sterilize themselves every time they enter a room. I am sure we will learn that they reacted too slowly to close communal areas and didn't have enough masks and the like to go around but in general if your old and frail when a pandemic comes around, your odds of dying are going to skyrocket.

My plan is based on staying out them as long as possible. Healthy living isn't a guarantee by any means but it dramatically increases your chance of being a mobile 80 year who can live on their own. Or at least being in good condition that a kid can help me out for a couple years. And then have enough cash to afford the private room.
I agree with what you say here. Once a person becomes fully dependent on others it's near impossible to prevent this unless you go full on in home care with a live in nurse or 2 that never leave.

My plan is similar to yours but I am stopping eating and drinking once I become bed ridden or have to go full on nursing home. I want quality of life.

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Re: COVID-19 has revealed the stark deficiencies in long-term care facilities regardless of ratings.

Post by quantAndHold » Wed Apr 29, 2020 2:38 pm

tetractys wrote:
Wed Apr 29, 2020 11:43 am
Really the only way out of the situation of being set aside in senescence is extraordinary fortune.

...
And even then, you need someone who can advocate for you. Dad had plenty of money, but we had to move him multiple times (and file a complaint with the state) at the end of his life because of care issues. The amount of money the facility charged was not an indicator of the quality of care provided, although Medicaid facilities and Medicaid floors in facilities that also had private pay were universally awful.
Yes, I’m really that pedantic.

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Re: COVID-19 has revealed the stark deficiencies in long-term care facilities regardless of ratings.

Post by quantAndHold » Wed Apr 29, 2020 2:43 pm

randomguy wrote:
Wed Apr 29, 2020 12:51 pm
go_mets wrote:
Wed Apr 29, 2020 11:01 am
I believe that the situation mirrored the society in general.

By the time, the facilities realized that there was a problem, the virus was already here.
To some extent, I am not sure what they could have done that would be remotely reasonable. Lets say you have a facility with no residents that are infected. How are you going to keep them that way when they need a steady stream of people coming in and out to keep them alive. You cann't have them sterilize themselves every time they enter a room.

...
With all due respect, sanitizing themselves in between patients is exactly what they’re already supposed to be doing.

I think having full time employees instead of the workers having to take shifts at multiple facilities in order to get enough hours to live on might help too.
Yes, I’m really that pedantic.

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Re: COVID-19 has revealed the stark deficiencies in long-term care facilities regardless of ratings.

Post by Jack FFR1846 » Wed Apr 29, 2020 2:55 pm

quantAndHold wrote:
Wed Apr 29, 2020 2:43 pm

With all due respect, sanitizing themselves in between patients is exactly what they’re already supposed to be doing.

I think having full time employees instead of the workers having to take shifts at multiple facilities in order to get enough hours to live on might help too.
They're supposed to use a mask and gloves for one patient visit, then throw them out after leaving that patient's room. The home my wife was nursing at hasn't had ANY gloves or masks available since the middle of April. All the nurses were bringing what they had or could get. I had some masks in my workshop and they got brought in. On top of that, nursing home nurses get paid crap. My wife started her new, home based job Monday at 50% more money, plus bonuses. She still gets texts from her old employer. Out of about 50 patients, 2 are positive for Covid and 2 staff are as well. A third staff member was positive but quit, so their statistic was removed as it no longer counts.
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Re: COVID-19 has revealed the stark deficiencies in long-term care facilities regardless of ratings.

Post by tetractys » Wed Apr 29, 2020 2:57 pm

quantAndHold wrote:
Wed Apr 29, 2020 2:38 pm
tetractys wrote:
Wed Apr 29, 2020 11:43 am
Really the only way out of the situation of being set aside in senescence is extraordinary fortune.

...
And even then, you need someone who can advocate for you. Dad had plenty of money, but we had to move him multiple times (and file a complaint with the state) at the end of his life because of care issues. The amount of money the facility charged was not an indicator of the quality of care provided, although Medicaid facilities and Medicaid floors in facilities that also had private pay were universally awful.
Was referring to good fortune, not monetary fortune. So I agree with you; money isn’t the answer—just look at Howard Hughes.

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Re: COVID-19 has revealed the stark deficiencies in long-term care facilities regardless of ratings.

Post by brandy » Wed Apr 29, 2020 3:40 pm

I think I've read governments etc are more open to and advocating, home care. They offer help from local government via various programs and information resources. Today I got an email from a previous county rep with info:

Initiatives to be operated by the AAA/ADRCs thru this grant opportunity includes:
• Develop a telecommunications program at _____ County Office of Aging (__COA) and ___
Agency on Elder Affairs (AEA) to reduce social isolation, to connect to ADRC/NWD
resources, medical resources, and social (virtual) activities.
• Develop a person-centered emergency care plan for pandemics at __COA. Provide training
and education on staying safe during a pandemic.
• Implement monitoring devices to the frailest homebound participants receiving home delivered meals in ___ County through ___County Office on Aging (__COA). This
technology will ensure that meals are delivered, the traditional meal delivery also included
check on the participant’s welfare.
• Assist ____ Elderly Affairs Division in the enhancement of innovative service structures.

A little more: (I have no idea what other states/counties/cities are doing, I think the area I'm in now also supports home care rather than institutions.) "...These meetings are also a great opportunity for OA (office on aging) to
discuss strategies and assist the counties with any challenges they may be having in the delivery
of long-term services and supports..."

Check with your county office on aging.
Available here;Info on
In-Home Support Caregiver Training Institute (CGTI) ____Care at Home (___CAH)
Neighbors Care Alliance (NCA) Emergency Alert Systems Home-Delivered Meals Help at Home
Home Repair & Adaptation
There's many other resources. Even though there is a possibly cost to most or all of these, at least the information should be somewhat readily available.

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Re: COVID-19 has revealed the stark deficiencies in long-term care facilities regardless of ratings.

Post by WoodSpinner » Wed Apr 29, 2020 4:51 pm

brandy wrote:
Wed Apr 29, 2020 11:46 am
My own health situation---totally, permanently disabled by fumes, gases, smokes from chemicals including personal care and household---puts long term care facilities off limits for me. Even a hospital stay with pinesol etc is impossible. Any one or all body systems can be/are affected by chemicals--physical, mental, emotional, to varying degrees...I also have severe copd. With so damaged a respiratory system, most chemicals first affect that. (not good...)

I am in my home, a sfr with a yard and yard work. I do what I can, it's less than what I could last year. I think I've hired someone to come spread pre-emergent and take care of a few weeds in a couple of weeks. I do what house work I can. I hope I don't have to hire someone for personal care at all, or for a long time, as I have no insurance to cover that.

I get a little occasional help from a volunteer group. It is little. I'm grateful for that. It takes much longer to do even small tasks when I can do them at all. I'm grateful I can do them. Preparation is as about as much mental/psychological as physical due to respiratory challenges. I finally got the kitchen mopped: a few days of pep talks, moving bucket and mop, finally doing it: about 10' long, 6' wide, took most of the day...part of that time sitting to recover breath.
I am still able to take care of my food via pick-up or delivery, but recent purchases have ready made meals whether frozen, or in cans or boxes... Some days I don't have the breath/energy to cook, even opening a can (of soup) is a challenge.

It's probably time to look again into what the city/county/businesses have to offer, and at what cost.
One thing I expect to have to buy is one or two air cleaners, better than the "top-rated" one I have now.

I do hope more help will be available via taxes when I need it.
I do try to remember that facilities are very expensive. That work I hire to do here costs, but not as much. Yet.
Personal care, probably a minimum hours per day, maybe minimum days a week, will also cost.

Once in a while, someone goes missing. I've wondered at the time if that person ..."left"...
I'm not ready, yet.
How are you all approaching this?
Brandy,

I am not ready to leave either.

So far, I have been a glass is half-full kind of guy, make lemonade when life hands you lemons and always look for the silver lining in the stormy clouds. My approach is to find a bit of wonder and joy every day, walk when I can, help when I can and be grateful for what I have. Today, for instance, it was the sight of ducklings nestled tightly together trying to stay warm on a cool morning.

I am hoping that I won’t need to go into a long-term care unit, would much rather stay at home in familiar surroundings with my family. That said, I do have LTC insurance and assets that will hopefully let me have some choice in the matter.

So what brings you joy?

WoodSpinner

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Re: COVID-19 has revealed the stark deficiencies in long-term care facilities regardless of ratings.

Post by CULater » Fri May 08, 2020 7:34 am

Recent news reports have identified two more nursing homes in the area with COVID-19 outbreaks and several deaths. One was rated 5 stars and the other 4 stars on the Medicare website and both have very good reputations as being among the best nursing homes in the area. But apparently, the ratings and reputation don't mean much during this time. Very disturbing.
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Re: COVID-19 has revealed the stark deficiencies in long-term care facilities regardless of ratings.

Post by smitcat » Fri May 08, 2020 9:30 am

CULater wrote:
Fri May 08, 2020 7:34 am
Recent news reports have identified two more nursing homes in the area with COVID-19 outbreaks and several deaths. One was rated 5 stars and the other 4 stars on the Medicare website and both have very good reputations as being among the best nursing homes in the area. But apparently, the ratings and reputation don't mean much during this time. Very disturbing.
We are in the Northeast and have been hit very hard by Covid19 and further along in the cycle then most.
My daughter and many of her friends rotate in and out of many of these homes in our area.
The situation in these homes is likely worse than you can imagine at this point, the supplies have been lacking as FFR1846 has already posted, the death rate is changing by the hour.
I truly hope you can fair better than we did out here.

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Re: COVID-19 has revealed the stark deficiencies in long-term care facilities regardless of ratings.

Post by CULater » Fri May 08, 2020 2:16 pm

smitcat wrote:
Fri May 08, 2020 9:30 am
CULater wrote:
Fri May 08, 2020 7:34 am
Recent news reports have identified two more nursing homes in the area with COVID-19 outbreaks and several deaths. One was rated 5 stars and the other 4 stars on the Medicare website and both have very good reputations as being among the best nursing homes in the area. But apparently, the ratings and reputation don't mean much during this time. Very disturbing.
We are in the Northeast and have been hit very hard by Covid19 and further along in the cycle then most.
My daughter and many of her friends rotate in and out of many of these homes in our area.
The situation in these homes is likely worse than you can imagine at this point, the supplies have been lacking as FFR1846 has already posted, the death rate is changing by the hour.
I truly hope you can fair better than we did out here.
There's so little information available to the public. States are burying this under so-called "medical privacy laws" which are designed to protect the privacy of individuals and not facilities. We only hear about the worst outbreaks probably because a private citizen or a staff member in the facility reports it to the news and then the cat is out of the bag. I'm fearful you are right that it's a lot worse than we know. I have my mother in a nursing home here and worry endlessly what's going on. Ironically, even if we knew her facility were affected I'm not sure I'd know what to do. You can't really move people into another facility right now and you don't know if that would be even worse. If we'd been financially able, I would have wanted to move her to either of two facilities I mentioned above that were highly rated, and we'd be worse off for it.
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Re: COVID-19 has revealed the stark deficiencies in long-term care facilities regardless of ratings.

Post by NHRATA01 » Fri May 08, 2020 2:36 pm

COVID might reveal it more broadly, but I think almost anyone who has an experience with a loved one in a SNF of some sort is aware of how atrocious elder care is in this country.

My father was only 70 when he went into one for rehab after a fall (facility chosen by him due to proximity from his house). As a 36 year old I could have in no way prepared for how aghast I was the first day I visited him. The putrid odor, the residents just randomly stacked up in hallways without oversight. Clearly understaffed and clearly discontent staff. The rehab dept repeatedly lying to me about his participation in PT, as he declined further every week instead of any improvement. In hindsight what was excessive use of opiate painkillers. I moved him after about 2 months but by then his decline, both physical and mental now, accelerated. The new place with notably better ratings was realistically only a very marginal improvement, perhaps solely because his attendant nurses seemed newer and more pleasant (perhaps not yet beaten down). But by that point he was too far in decline, and passed a few weeks later. He was just short of his medicare coverage expiring where we would have to private pay to the tune of 10.4k per month. For the extreme expense in exchange for very minimal care it seems these places are basically meant to bleed off whatever assets a senior has and then stick the state with the balance.

His mother, my 97 year old grandmother, fortunately still has virtually all of her mental facilities, but she had part time care until about 3 years ago at her own home, and now has almost full time care living in her daughter's house.

I hate to be callous or blunt but at 40 now, I sincerely hope there is an increased openness to right to die laws when I hit the point of no longer being able to do a majority of basic tasks on my own sometime down the road. I really have no desire to finish my life out as I saw many of those nursing home patients doing so during that experience.

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Re: COVID-19 has revealed the stark deficiencies in long-term care facilities regardless of ratings.

Post by smitcat » Fri May 08, 2020 2:51 pm

CULater wrote:
Fri May 08, 2020 2:16 pm
smitcat wrote:
Fri May 08, 2020 9:30 am
CULater wrote:
Fri May 08, 2020 7:34 am
Recent news reports have identified two more nursing homes in the area with COVID-19 outbreaks and several deaths. One was rated 5 stars and the other 4 stars on the Medicare website and both have very good reputations as being among the best nursing homes in the area. But apparently, the ratings and reputation don't mean much during this time. Very disturbing.
We are in the Northeast and have been hit very hard by Covid19 and further along in the cycle then most.
My daughter and many of her friends rotate in and out of many of these homes in our area.
The situation in these homes is likely worse than you can imagine at this point, the supplies have been lacking as FFR1846 has already posted, the death rate is changing by the hour.
I truly hope you can fair better than we did out here.
There's so little information available to the public. States are burying this under so-called "medical privacy laws" which are designed to protect the privacy of individuals and not facilities. We only hear about the worst outbreaks probably because a private citizen or a staff member in the facility reports it to the news and then the cat is out of the bag. I'm fearful you are right that it's a lot worse than we know. I have my mother in a nursing home here and worry endlessly what's going on. Ironically, even if we knew her facility were affected I'm not sure I'd know what to do. You can't really move people into another facility right now and you don't know if that would be even worse. If we'd been financially able, I would have wanted to move her to either of two facilities I mentioned above that were highly rated, and we'd be worse off for it.
Your observations are very accurate - we just asked our daughter if it was any better an our ago. All of the supplies and protection are much better now but the staff is pretty much spent at this point, time and emotion have them drained. Many of them are working 10-12 hours a day on 6-7 days a week the past 5-6 weeks. Even the 'tough' ones are showing some signs that are disturbing. With that said all of the numbers are now dropping: positives, admissions, ICU, vents, and deaths all down. I do hope it continues this downtrend as it greatly helps all that need the attention. Good luck with whatever you decide.

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Re: COVID-19 has revealed the stark deficiencies in long-term care facilities regardless of ratings.

Post by smitcat » Fri May 08, 2020 2:56 pm

NHRATA01 wrote:
Fri May 08, 2020 2:36 pm
COVID might reveal it more broadly, but I think almost anyone who has an experience with a loved one in a SNF of some sort is aware of how atrocious elder care is in this country.

My father was only 70 when he went into one for rehab after a fall (facility chosen by him due to proximity from his house). As a 36 year old I could have in no way prepared for how aghast I was the first day I visited him. The putrid odor, the residents just randomly stacked up in hallways without oversight. Clearly understaffed and clearly discontent staff. The rehab dept repeatedly lying to me about his participation in PT, as he declined further every week instead of any improvement. In hindsight what was excessive use of opiate painkillers. I moved him after about 2 months but by then his decline, both physical and mental now, accelerated. The new place with notably better ratings was realistically only a very marginal improvement, perhaps solely because his attendant nurses seemed newer and more pleasant (perhaps not yet beaten down). But by that point he was too far in decline, and passed a few weeks later. He was just short of his medicare coverage expiring where we would have to private pay to the tune of 10.4k per month. For the extreme expense in exchange for very minimal care it seems these places are basically meant to bleed off whatever assets a senior has and then stick the state with the balance.

His mother, my 97 year old grandmother, fortunately still has virtually all of her mental facilities, but she had part time care until about 3 years ago at her own home, and now has almost full time care living in her daughter's house.

I hate to be callous or blunt but at 40 now, I sincerely hope there is an increased openness to right to die laws when I hit the point of no longer being able to do a majority of basic tasks on my own sometime down the road. I really have no desire to finish my life out as I saw many of those nursing home patients doing so during that experience.
I am sorry to hear the descriptions you provided as they are very concerning. We are in the same relative area and have had parents in both assisted living facilities and the extended nursing care that they provide. Our experiences were pretty good with the centers that we utilized - one of them was the Bristol. It was not cheap but they provided a very good environment all the way around.

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Re: COVID-19 has revealed the stark deficiencies in long-term care facilities regardless of ratings.

Post by Katietsu » Fri May 08, 2020 3:06 pm

Trying to keep up full infection control if you have a patient population that is fully dependent on assistance for everything is not only difficult but makes every task significantly harder and takes longer. I do not know how they are going to keep this up long term, especially in places that have chosen to “reopen” despite still having a high number of new cases.

smitcat
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Re: COVID-19 has revealed the stark deficiencies in long-term care facilities regardless of ratings.

Post by smitcat » Fri May 08, 2020 3:08 pm

Katietsu wrote:
Fri May 08, 2020 3:06 pm
Trying to keep up full infection control if you have a patient population that is fully dependent on assistance for everything is not only difficult but makes every task significantly harder and takes longer. I do not know how they are going to keep this up long term, especially in places that have chosen to “reopen” despite still having a high number of new cases.
"I do not know how they are going to keep this up long term"
Where we are they do not allow any visitors - none.

Katietsu
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Re: COVID-19 has revealed the stark deficiencies in long-term care facilities regardless of ratings.

Post by Katietsu » Fri May 08, 2020 3:15 pm

smitcat wrote:
Fri May 08, 2020 3:08 pm
Katietsu wrote:
Fri May 08, 2020 3:06 pm
Trying to keep up full infection control if you have a patient population that is fully dependent on assistance for everything is not only difficult but makes every task significantly harder and takes longer. I do not know how they are going to keep this up long term, especially in places that have chosen to “reopen” despite still having a high number of new cases.
"I do not know how they are going to keep this up long term"
Where we are they do not allow any visitors - none.
I understand. However, we are not quarantining the staff in dormitories as they have done at times in other countries. Visitors were stopped more than 2 months ago here. However, that has not eliminated outbreaks. There have been discussions about instituting a White House like protocol where staff would be tested with a rapid test before each shift. But at this point, that is not feasible. Therefore, continued high community numbers result in continued higher risk of a staff member bringing it in.

pshonore
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Re: COVID-19 has revealed the stark deficiencies in long-term care facilities regardless of ratings.

Post by pshonore » Fri May 08, 2020 3:19 pm

Nursing homes account for about 60% of the Covid-19 deaths in Connecticut. (1627 out of 2718 in total as of 5/6) That may sound high but officials have been very vigilant about counting properly . I think all the folks working there are trying their best but its a very difficult and sad situation.

smitcat
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Re: COVID-19 has revealed the stark deficiencies in long-term care facilities regardless of ratings.

Post by smitcat » Fri May 08, 2020 5:12 pm

Katietsu wrote:
Fri May 08, 2020 3:15 pm
smitcat wrote:
Fri May 08, 2020 3:08 pm
Katietsu wrote:
Fri May 08, 2020 3:06 pm
Trying to keep up full infection control if you have a patient population that is fully dependent on assistance for everything is not only difficult but makes every task significantly harder and takes longer. I do not know how they are going to keep this up long term, especially in places that have chosen to “reopen” despite still having a high number of new cases.
"I do not know how they are going to keep this up long term"
Where we are they do not allow any visitors - none.
I understand. However, we are not quarantining the staff in dormitories as they have done at times in other countries. Visitors were stopped more than 2 months ago here. However, that has not eliminated outbreaks. There have been discussions about instituting a White House like protocol where staff would be tested with a rapid test before each shift. But at this point, that is not feasible. Therefore, continued high community numbers result in continued higher risk of a staff member bringing it in.
I do not think I understand....
Your thoughts are that we could/would mandate quarantining anyone in the facility from leaving that facility for the foreseeable future?

Reubin
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Re: COVID-19 has revealed the stark deficiencies in long-term care facilities regardless of ratings.

Post by Reubin » Fri May 08, 2020 6:10 pm

I am planning to stay in my home to my last day. If someone tries to alter my plan I will hire a lawyer to protect my rights.

Katietsu
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Re: COVID-19 has revealed the stark deficiencies in long-term care facilities regardless of ratings.

Post by Katietsu » Fri May 08, 2020 7:31 pm

smitcat wrote:
Fri May 08, 2020 5:12 pm
Katietsu wrote:
Fri May 08, 2020 3:15 pm
smitcat wrote:
Fri May 08, 2020 3:08 pm
Katietsu wrote:
Fri May 08, 2020 3:06 pm
Trying to keep up full infection control if you have a patient population that is fully dependent on assistance for everything is not only difficult but makes every task significantly harder and takes longer. I do not know how they are going to keep this up long term, especially in places that have chosen to “reopen” despite still having a high number of new cases.
"I do not know how they are going to keep this up long term"
Where we are they do not allow any visitors - none.
I understand. However, we are not quarantining the staff in dormitories as they have done at times in other countries. Visitors were stopped more than 2 months ago here. However, that has not eliminated outbreaks. There have been discussions about instituting a White House like protocol where staff would be tested with a rapid test before each shift. But at this point, that is not feasible. Therefore, continued high community numbers result in continued higher risk of a staff member bringing it in.
I do not think I understand....
Your thoughts are that we could/would mandate quarantining anyone in the facility from leaving that facility for the foreseeable future?
No, I do not think that is a possibility in the US nor was I suggesting that it should be.. (I believe that there were situations in other countries where they set up a dormitory for the caregivers and essentially isolated both the staff and residents from the outside world.)

My point is that as long as the staff is going home to their families and stopping for food, the rate of infection in the community will impact the risk of an outbreak in the nursing home. In a nursing home setting, even a very conscientious staff does not reduce the risk of spread to zero. And that extra level of care comes with extra time, extra effort, and extra fatigue.

Look at the interview with the head of Sweden’s coronavirus response plan. He speaks about how he was surprised by the spread and death toll of coronavirus in the nursing homes. He thought they would be better able to better protect the nursing home residents from the Covid-19 in the community.

InMyDreams
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Re: COVID-19 has revealed the stark deficiencies in long-term care facilities regardless of ratings.

Post by InMyDreams » Fri May 08, 2020 8:00 pm

quantAndHold wrote:
Wed Apr 29, 2020 2:43 pm

With all due respect, sanitizing themselves in between patients is exactly what they’re already supposed to be doing.
Care facilities have long had a problem with patients acquiring infections, whether that's C Dif or MRSA - hospitals have it too, but they have more resources to deal with the problem. And Medicare added some sting a while ago for some hospital acquired infections - the hospital became responsible for the cost of treating certain infections.

But a care facility has fewer resources for training and monitoring, and staff are overworked and underpaid.

It is one of the issues that makes me reluctant to commit to a CCRC - even if they have an excellent care facility now, will it be as good when I need it in a decade or two?

ballons
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Re: COVID-19 has revealed the stark deficiencies in long-term care facilities regardless of ratings.

Post by ballons » Fri May 08, 2020 8:18 pm

CULater wrote:
Wed Apr 29, 2020 10:45 am
There are many of us Bogleheads who are thinking and planning about long term care for ourselves one day. The current situation has made it clear what a challenge we face. It's critical that you and I begin now to apply our due diligence. How can we determine which facilities to avoid? Is there really much difference between facilities, regardless of how much they cost? We have a real challenge ahead of us, I'm afraid. Here's an article discussing some of the current situation and the reasons behind it:
There are two different LTC experiences:

1. Residents are still spry and just need some monitoring.
2. Skilled Nursing / 24/7 care monitoring.

#2 is where bad things happen.

Plan for in-home, skilled nursing today. Move in with your kids or move them into your place. Go live with friends in a similar situation in a private residence and pool resources. Also you do not want to enter a nursing home if you are unconscious or on a vent under any circumstance. Put that in writing.

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ThereAreNoGurus
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Re: COVID-19 has revealed the stark deficiencies in long-term care facilities regardless of ratings.

Post by ThereAreNoGurus » Fri May 08, 2020 8:56 pm

CULater wrote:
Fri May 08, 2020 2:16 pm
There's so little information available to the public. States are burying this under so-called "medical privacy laws" which are designed to protect the privacy of individuals and not facilities. We only hear about the worst outbreaks probably because a private citizen or a staff member in the facility reports it to the news and then the cat is out of the bag. I'm fearful you are right that it's a lot worse than we know. I have my mother in a nursing home here and worry endlessly what's going on. Ironically, even if we knew her facility were affected I'm not sure I'd know what to do. You can't really move people into another facility right now and you don't know if that would be even worse. If we'd been financially able, I would have wanted to move her to either of two facilities I mentioned above that were highly rated, and we'd be worse off for it.
To the credit of LA County, they produce and update stats, daily, regarding cases and fatalities at residential congregate settings with one or more positive COVID-19 Cases: http://www.publichealth.lacounty.gov/me ... ations.htm (You need to scroll over half-way down to see it).

Using that data, 50% of c-virus deaths, in LA County, occurred in those congregate settings!
Trade the news and you will lose.

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Re: COVID-19 has revealed the stark deficiencies in long-term care facilities regardless of ratings.

Post by go_mets » Fri May 08, 2020 10:28 pm

ballons wrote:
Fri May 08, 2020 8:18 pm
Plan for in-home, skilled nursing today. Move in with your kids or move them into your place. Go live with friends in a similar situation in a private residence and pool resources. Also you do not want to enter a nursing home if you are unconscious or on a vent under any circumstance. Put that in writing.
You are still going to have risks with the in-home skilled nursing via the nurses that come into the home.
Unless you are talking about live-in.

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Re: COVID-19 has revealed the stark deficiencies in long-term care facilities regardless of ratings.

Post by tvubpwcisla » Fri May 08, 2020 10:29 pm

The only LTC facility I want to be at is my home. I feel so bad for the folks there. They need a lot of help...and fast.
Stay invested my friends.

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Re: COVID-19 has revealed the stark deficiencies in long-term care facilities regardless of ratings.

Post by go_mets » Fri May 08, 2020 10:31 pm

tvubpwcisla wrote:
Fri May 08, 2020 10:29 pm
The only LTC facility I want to be at is my home. I feel so bad for the folks there. They need a lot of help...and fast.
Are you planning on holding the nurses and aides hostage in your home?
They're going to go back home to their families.
And since they do, you will be exposed.

.

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tvubpwcisla
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Re: COVID-19 has revealed the stark deficiencies in long-term care facilities regardless of ratings.

Post by tvubpwcisla » Fri May 08, 2020 10:33 pm

go_mets wrote:
Fri May 08, 2020 10:31 pm
tvubpwcisla wrote:
Fri May 08, 2020 10:29 pm
The only LTC facility I want to be at is my home. I feel so bad for the folks there. They need a lot of help...and fast.
Are you planning on holding the nurses and aides hostage in your home?
They're going to go back home to their families.
And since they do, you will be exposed.

.
Only if they are cute. :) No, I was just saying that I hope I can remain in my home. I feel bad for the folks at the LTC facilities and hope they are getting proper care and help.
Stay invested my friends.

go_mets
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Re: COVID-19 has revealed the stark deficiencies in long-term care facilities regardless of ratings.

Post by go_mets » Fri May 08, 2020 10:35 pm

tvubpwcisla wrote:
Fri May 08, 2020 10:33 pm
go_mets wrote:
Fri May 08, 2020 10:31 pm
tvubpwcisla wrote:
Fri May 08, 2020 10:29 pm
The only LTC facility I want to be at is my home. I feel so bad for the folks there. They need a lot of help...and fast.
Are you planning on holding the nurses and aides hostage in your home?
They're going to go back home to their families.
And since they do, you will be exposed.

.
Only if they are cute. :) No, I was just saying that I hope I can remain in my home. I feel bad for the folks at the LTC facilities and hope they are getting proper care and help.
:happy

What is your avatar?

curmudgeon
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Re: COVID-19 has revealed the stark deficiencies in long-term care facilities regardless of ratings.

Post by curmudgeon » Fri May 08, 2020 11:05 pm

pshonore wrote:
Fri May 08, 2020 3:19 pm
Nursing homes account for about 60% of the Covid-19 deaths in Connecticut. (1627 out of 2718 in total as of 5/6) That may sound high but officials have been very vigilant about counting properly . I think all the folks working there are trying their best but its a very difficult and sad situation.
In my county, it's about 20% of total cases, and 45% of deaths, maybe a bit higher statewide. I do think that state and local health officials fell down badly on this, but it's a similar situation all around the world. My state (CA) mandated that nursing facilities accept COVID-positive patients - https://www.nytimes.com/2020/04/24/us/n ... virus.html

It's a tough situation with no easy answers. Working in nursing homes is not an especially fun job even in good times, and staff is often part-time and move around a lot. One thing that I think should have been implemented very early on is limiting workers to working in only ONE facility, in addition to the visitor limitation most places adopted.

I have an acquaintance in another state who spent two weeks on a ventilator in his battle with COVID. Recovery from that much time on a ventilator is a difficult, extended process, and a nursing/rehab facility would be appropriate. He was still testing positive for COVID, though not considered likely infectious, and it was very hard to find a rehab facility. In his case, he ended up going home (his wife is able to help him through this stage), but many others may not have that option.

I think most CCRCs have done much, much better than nursing homes in this outbreak. The nursing section of a CCRC is part of the larger, integrated facility and is more likely to have stable employment and the ability to draw on resources from the larger facility in emergency. I think there would also be less turnover in patients, and they would be coming from the limited pool of residents.

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Re: COVID-19 has revealed the stark deficiencies in long-term care facilities regardless of ratings.

Post by Spirit Rider » Fri May 08, 2020 11:48 pm

pshonore wrote:
Fri May 08, 2020 3:19 pm
Nursing homes account for about 60% of the Covid-19 deaths in Connecticut. (1627 out of 2718 in total as of 5/6) That may sound high but officials have been very vigilant about counting properly . I think all the folks working there are trying their best but its a very difficult and sad situation.
NH has far fewer total deaths (121 as of 5/8), but > 75% have been from LTC facilities. The nursing home deaths have been accelerating. Once there are a few cases within a facility, there are many more.

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Re: COVID-19 has revealed the stark deficiencies in long-term care facilities regardless of ratings.

Post by alpine_boglehead » Sat May 09, 2020 12:13 am

I think the only surefire way to find out about the quality of a nursing home is to personally visit it and also talk to residents (who are mentally still ok) and their relatives.

When we had to move a close relative to a nursing home some time ago, we talked with quite some people upfront (even in Europe/Austria, there are stories of nursing homes with residents just getting sedated away for the rest of the their lives), fortunately the closest one also happened to be a good one.

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Re: COVID-19 has revealed the stark deficiencies in long-term care facilities regardless of ratings.

Post by Tellurius » Sat May 09, 2020 1:16 am

tetractys wrote:
Wed Apr 29, 2020 11:43 am
Really the only way out of the situation of being set aside in senescence is extraordinary fortune. The majority of us will just have to take our chances and hope for the best, and then take the ride. It would be wise to respect our children, and to be kind to those around us. Historically, useless elders have been thrown over cliffs by their sons, or pushed out of their houses to wander hopeless in the coldest part of winter. Or they would take it upon themselves to sit and freeze outside the village, or to depart to the forest never to be seen again. It couldn’t hurt to view life beyond the elusive points of birth and death, and be ready now.
I would say most societies were more respectful of their elders than now.
La nuit semblait profonde. L'hiver interminable.

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Re: COVID-19 has revealed the stark deficiencies in long-term care facilities regardless of ratings.

Post by Dottie57 » Sat May 09, 2020 6:40 am

Reubin wrote:
Fri May 08, 2020 6:10 pm
I am planning to stay in my home to my last day. If someone tries to alter my plan I will hire a lawyer to protect my rights.
If you can’t take care of yourself (physical or mental problems) you may have no choice.)
I hope you have resources to hire 24/7 home care.

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Re: COVID-19 has revealed the stark deficiencies in long-term care facilities regardless of ratings.

Post by Mr. Rumples » Sat May 09, 2020 6:57 am

I have neighbors using in home long term care. In one, the wife has dementia and her husband who is in his mid-70's and has bought some rental properties. They pay $20 an hour for people to come by for 10 or so hours a day to cook, clean and help out; they have no medical training.

In the other, both neighbors are in their 90's and need 24 hour care (she can't walk and he has dementia); they also pay $20 an hour, all their help are certified nurses aides. Regarding the latter, it was a difficult adjustment for the folks who got the 24 hour care to have someone in their house all the time, its still a loss of independence, but better than the alternative. Its a small family owned care service and I have gotten to know the owner who is one of the care givers; at least they get the same three people so their caregivers are not going to numerous homes.

Another neighbor got in-home care help through their church; they pay a bit less but the care is also not as good and the aides go from home to home.

In home care has a lot of other expenses: getting to and from medical facilities, cleaning, property maintenance, food. Surprisingly to me, the post office now takes their mail to the front door even though we have our mailboxes on the street.

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Re: COVID-19 has revealed the stark deficiencies in long-term care facilities regardless of ratings.

Post by ScubaHogg » Sat May 09, 2020 7:05 am

CULater wrote:
Wed Apr 29, 2020 10:45 am
The federal government regulates nursing homes through the Centers for Medicare and Medicaid Services, or CMS. They offer a “compare nursing homes” service in which each home is subject to a five-star rating system.
https://www.marketwatch.com/story/the-n ... home-page
My wife has worked in a ton of nursing homes, aka “Skilled Nursing Facilities.” She can tell you from personal experience the CMS ratings are pointless. The facilities know how to game the system. One example, the facilities always seem to know when the inspection is so the facility will markedly increase their staffing for that day so they have a high aide/nurse to resident ratio.

In Boglehead speak, anecdotally there is zero correlation between the quality of a facility and its CMS rating.
“There is no problem so bad you can’t make it worse.” - Chris Hatfield, Astronaut mantra

ScubaHogg
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Re: COVID-19 has revealed the stark deficiencies in long-term care facilities regardless of ratings.

Post by ScubaHogg » Sat May 09, 2020 7:07 am

Reubin wrote:
Fri May 08, 2020 6:10 pm
I am planning to stay in my home to my last day. If someone tries to alter my plan I will hire a lawyer to protect my rights.
I’m not a lawyer so take this for what you will, but personally I might hire the lawyer before you need them. Have that relationship established before crunch time. Best of luck.
“There is no problem so bad you can’t make it worse.” - Chris Hatfield, Astronaut mantra

Dottie57
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Re: COVID-19 has revealed the stark deficiencies in long-term care facilities regardless of ratings.

Post by Dottie57 » Sat May 09, 2020 7:19 am

ballons wrote:
Fri May 08, 2020 8:18 pm
There are two different LTC experiences:

1. Residents are still spry and just need some monitoring.
2. Skilled Nursing / 24/7 care monitoring.

#2 is where bad things happen.

Plan for in-home, skilled nursing today. Move in with your kids or move them into your place. Go live with friends in a similar situation in a private residence and pool resources. Also you do not want to enter a nursing home if you are unconscious or on a vent under any circumstance. Put that in writing.
A group of friends and I have talked about this. Mostly pie in sky talk. But as single women with no kids we are at a disadvantage.

smitcat
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Re: COVID-19 has revealed the stark deficiencies in long-term care facilities regardless of ratings.

Post by smitcat » Sat May 09, 2020 7:26 am

Katietsu wrote:
Fri May 08, 2020 7:31 pm
smitcat wrote:
Fri May 08, 2020 5:12 pm
Katietsu wrote:
Fri May 08, 2020 3:15 pm
smitcat wrote:
Fri May 08, 2020 3:08 pm
Katietsu wrote:
Fri May 08, 2020 3:06 pm
Trying to keep up full infection control if you have a patient population that is fully dependent on assistance for everything is not only difficult but makes every task significantly harder and takes longer. I do not know how they are going to keep this up long term, especially in places that have chosen to “reopen” despite still having a high number of new cases.
"I do not know how they are going to keep this up long term"
Where we are they do not allow any visitors - none.
I understand. However, we are not quarantining the staff in dormitories as they have done at times in other countries. Visitors were stopped more than 2 months ago here. However, that has not eliminated outbreaks. There have been discussions about instituting a White House like protocol where staff would be tested with a rapid test before each shift. But at this point, that is not feasible. Therefore, continued high community numbers result in continued higher risk of a staff member bringing it in.
I do not think I understand....
Your thoughts are that we could/would mandate quarantining anyone in the facility from leaving that facility for the foreseeable future?
No, I do not think that is a possibility in the US nor was I suggesting that it should be.. (I believe that there were situations in other countries where they set up a dormitory for the caregivers and essentially isolated both the staff and residents from the outside world.)

My point is that as long as the staff is going home to their families and stopping for food, the rate of infection in the community will impact the risk of an outbreak in the nursing home. In a nursing home setting, even a very conscientious staff does not reduce the risk of spread to zero. And that extra level of care comes with extra time, extra effort, and extra fatigue.

Look at the interview with the head of Sweden’s coronavirus response plan. He speaks about how he was surprised by the spread and death toll of coronavirus in the nursing homes. He thought they would be better able to better protect the nursing home residents from the Covid-19 in the community.

"My point is that as long as the staff is going home to their families and stopping for food, the rate of infection in the community will impact the risk of an outbreak in the nursing home"
These data points may help with understanding the problem as a whole...
- patients do come and go in assisted care and nursing homes all the time
- covid19 is/was non determinable as an admit
- all of the assisted/nursing homes we know of already have/had at least one case prior to the quarantine
- there are no infectious wings in these facilities, no positive air separation
- for the most part these facilities initially lacked PPP and many other supplies as they are not typically utilized at all
Most anything is reasonably solvable when you look in the rear view mirror.

"Look at the interview with the head of Sweden’s coronavirus response plan. He speaks about how he was surprised by the spread and death toll of coronavirus in the nursing homes. He thought they would be better able to better protect the nursing home residents from the Covid-19 in the community."
I am curious about all the changes they will make in their facilities, systems and protocols to eliminate and or reduce this possibility in the future and how they will pay and enforce them.

Mr. Rumples
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Re: COVID-19 has revealed the stark deficiencies in long-term care facilities regardless of ratings.

Post by Mr. Rumples » Sat May 09, 2020 7:34 am

ScubaHogg wrote:
Sat May 09, 2020 7:07 am
Reubin wrote:
Fri May 08, 2020 6:10 pm
I am planning to stay in my home to my last day. If someone tries to alter my plan I will hire a lawyer to protect my rights.
I’m not a lawyer so take this for what you will, but personally I might hire the lawyer before you need them. Have that relationship established before crunch time. Best of luck.
Couldn't agree more. Just before this whole COVID-19 thing started, I redid my estate plan with an elder law attorney. Highly rated by both peers and the public and sitting on many professional boards, and obviously knowledgeable, I would not go back; there was no empathy - it felt like a factory - and I am not sure I would feel comfortable when I get very ill. I am however very glad I started the process and learned a lot about what I am looking for, can reasonably expect and need.

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Re: COVID-19 has revealed the stark deficiencies in long-term care facilities regardless of ratings.

Post by Dottie57 » Sat May 09, 2020 7:50 am

Spirit Rider wrote:
Fri May 08, 2020 11:48 pm
pshonore wrote:
Fri May 08, 2020 3:19 pm
Nursing homes account for about 60% of the Covid-19 deaths in Connecticut. (1627 out of 2718 in total as of 5/6) That may sound high but officials have been very vigilant about counting properly . I think all the folks working there are trying their best but its a very difficult and sad situation.
NH has far fewer total deaths (121 as of 5/8), but > 75% have been from LTC facilities. The nursing home deaths have been accelerating. Once there are a few cases within a facility, there are many more.
Minnesota - 80% of. Deaths are from LTC. Terrible situation.

TN_Boy
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Re: COVID-19 has revealed the stark deficiencies in long-term care facilities regardless of ratings.

Post by TN_Boy » Sat May 09, 2020 9:51 am

ballons wrote:
Fri May 08, 2020 8:18 pm
CULater wrote:
Wed Apr 29, 2020 10:45 am
There are many of us Bogleheads who are thinking and planning about long term care for ourselves one day. The current situation has made it clear what a challenge we face. It's critical that you and I begin now to apply our due diligence. How can we determine which facilities to avoid? Is there really much difference between facilities, regardless of how much they cost? We have a real challenge ahead of us, I'm afraid. Here's an article discussing some of the current situation and the reasons behind it:
There are two different LTC experiences:

1. Residents are still spry and just need some monitoring.
2. Skilled Nursing / 24/7 care monitoring.

#2 is where bad things happen.

Plan for in-home, skilled nursing today. Move in with your kids or move them into your place. Go live with friends in a similar situation in a private residence and pool resources. Also you do not want to enter a nursing home if you are unconscious or on a vent under any circumstance. Put that in writing.
Ah, your kids and friends might not be interested in that plan .......

The main reason people are in situation #2 is that their family is unwilling/unable (or both) to handle taking them in.

You want the best for family but you'd also like a life of your own without the 24x7 responsibility of housing a very sick elder. I wouldn't want to be stuck in a poor quality facility. I'd want even less to devastate the life of children by forcing them to take care of me all the time.

TN_Boy
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Re: COVID-19 has revealed the stark deficiencies in long-term care facilities regardless of ratings.

Post by TN_Boy » Sat May 09, 2020 10:22 am

Dottie57 wrote:
Sat May 09, 2020 6:40 am
Reubin wrote:
Fri May 08, 2020 6:10 pm
I am planning to stay in my home to my last day. If someone tries to alter my plan I will hire a lawyer to protect my rights.
If you can’t take care of yourself (physical or mental problems) you may have no choice.)
I hope you have resources to hire 24/7 home care.
My guess is that 90% of the people in care facilities said "I am planning to stay in my home to my last day."

But unless they have vast sums of money and somebody willing to coordinate care (which can be a major responsibility even if somebody else is doing the day to day caretaking) they will, in fact, be moved to a care facility.

If you can't take care of yourself .... you can't take care of yourself.

I know more than one person who tells a story that goes something like "I *had* to move my {dad|mom|both parents} to a care facility against their wishes." Failure to realize that fact -- sometimes due to dementia, sometimes due to stubbornness or selfishness -- causes so much stress on families.

It's very obvious to me that many elders get to a point where they have no concept of how much effort is being expended to keep them safe and as comfortable as possible.

There is really no alternative to a care facility in many situations. We must all deal with this reality.

Actionable: understand you may have to go to a facility. Make plans for selection of said facility. Have appropriate end of life directives, etc.

Locked