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This WILL be You Someday

August 3, 2013

In another entry under the category of doctor-hating:  Propublica, a non-profit investigative journalism website that I like a lot, has been relentless in it’s constant healthcare-bashing stories.  They have done extensive work on physician kick-backs from drug companies, for example.  The newest one is a scathing review of assisted-living facilities, focusing on one large one in particular.   In conjunction with PBS and “Frontline”, the authors describe gross negligence, poor training, false advertising, and general mayhem at facilities run by Emeritus, one of the largest assisted-living parent companies in the states.

Now all my readers know that I am a big advocate of good end-of-life planning.  The assisted-living “movement”, if you will, was started 20 years ago by a lady who’s mother needed care and couldn’t find it.  This person, Keren Brown Wilson, started her own residential facility in which patients were more independent, lived in a more home-like environment, and had their own things from home around them.  People in these facilities tend to need less intensive nursing care than that found in nursing homes.  Sounds great.  My grandmother was in one of those and the staff did a great job by her.  I’m sure there are many facilities that are wonderful, as well as those that are not.

Here’s the problem.  Money.  You see, assisted-living facilities (ALF) are not covered by medicare and medicaid, while nursing homes are.  In order for medicaid to kick in for your ALF you have to beggar yourself first.  So 90% of ALF residents are private pay.  Money in the bank, make no mistake.  Big business.  Even Ms. Wilson eventually expanded her company and took it public and made a boat load of money.  Emeritus has done the same thing.  Who can blame them?  Old age and dementia are lucrative problems, and growing all the time.

Here’s the other problem.  Rules.  I hate rules, but if you’re gonna have them, make them make sense.  Nursing homes are “facilities” and thus subject to all the fees and federal regulations that go along with that designation.  Plus if the federal government is paying for stuff, its generally make a lot of rules that you have to follow in order to get it’s money.  ALFs, despite their name, can be folded in under the term “residence” and thus get out from under the facilities rules.  Plus, since people are private pay, ALFs don’t have to follow federal regulations.  The states have been given the burden of regulating ALFs and the result is generally abysmal.

If you put Money and No Rules together, you get Wallstreet.  You get Emeritus.  You get the Kardashians.  Nothing good comes of that combination.

Look, all of us will be in the position of placing a loved one or being a loved one when things get rough.  In the bad old days it was the families (read “women’s”) responsibility to care for the elderly and to respect them as wise sages or whatever.  This was when the women of the house didn’t “work” but took care of the kids and the old-folks (as well as the men, the cats, the sheep, the laundry, the roast, etc.)  This arrangement had it’s drawbacks but it had one important benefit:  the person taking care of the elderly matriarch was FAMILY.  Just as no one can raise your kids as well as you can, so no one can care for your mother as well as you can.  Not in terms of skill – I know plenty of people who could care for an elderly person physically much better than I, but no one is going to care about my mother as much as I do.  That’s just the way it is.  The aides who work in nursing homes and ALFs might be loving, caring people.  Some are.  But many are aides because that was the job they could get.  Or it was the only job their high school diploma qualified them for.  Or they don’t have a car and so the ALF down the street is the most convenient place to work.  Or their husband got laid off and the ALF offers benefits. Some love their jobs.  Others hate it.  It’s a job.

So now you have Money plus No Rules plus Underpaid High-School Graduates, even the most well-meaning.  Well, now you have either Survivor or an elder-care facility.  This is the way it is.  Plan accordingly.

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