Half of all cases happening in care homes

[simplicio]

I think he has ZERO clue how "callings" work -- we trust the Holy Spirit, who gifts us as HE WILL -- to call us to the work for which He has gifted us.

I won't be responding to any more of this incredibly dishonest and mean-spirited perversion of what I said or what I believe.

Good move. You have shown yourself to be less than honest with regard to your opinions of those who work in the most difficult and least recognized setting of health care: Long term care.

You were aware that your own daughter worked at the end of life health care setting, although not quite the nursing home setting. And you did not answer if you thought working in long term care was also a calling.

I argue that it is, even though it is not recognized. "the quality of the employees....." and "if you were any good, you would be working somewhere else".

One is fortunate if one's "calling" is exactly what they want to do. But if the Lord calls one to do the least recognized, the least rewarding or compensated jobs? Ask the Lord for plan B!

[carpedm9587]

Sparko and CP both made some pretty slanderous broad brush comments about those working in homes. Which is surprising since CP has a daughter working in a segmment which is very similar to the long term care, but with important differences.

Get too many incontinent people in one place, and it is very hard to get rid of the smell. They "stinketh". That is the way G-d designed man.

Is it unrelated to the OP? On the contrary, the same things which make nursing homes such "horrible" places also make infection control so difficult. And many homes today in the midst of the pandemic are doing excellent work, clamping down on infection control and keeping infectious cases down. Other homes are seeing the same things which happened on Diamond Princess and the TR aircraft carrier: Once the contagion takes a foothold, it spreads like wildfire.

Why do you attribute my position to hatred, but the positions of posters, Christian posters, as not hatred?

So I read CP and Sparko's comments, and did not come away with the same impression you apparently did. The fact is, nursing homes vary widely from the very good to the truly despicable. The former take excellent care of their patients, have high standards, and maintain a healthy, professional environment. The latter prey on the weak, cut corners, and pay minimal salaries - thereby attracting only those willing to accept those salaries, and they often do not have the best interests of their patients in mind.

This is not a binary situation. Even in the worst nursing homes, you will often find those going the extra mile for their patients - and blowing the whistle whenever they can. But they tend to be exceptions. I have been in and seen both types of care facility, and the difference is amazing. Pointing out the bad apples does not denigrate those who are truly to be admired for their work. I saw CP and Sparko making comments in this vein, not making comments that were a sweeping denigration of all nursing homes and all workers therein.

BTW - on the same foot - pointing out the bad apples in the police force and the places where the police force could "tighten up its act" does not denigrate the majority of honorable men and women who serve on this front - especially in this time. There are well-run police departments with few (if any) bad apples, and their are badly run police departments where the majority of the apples are bad - just like nursing homes.

And with THAT tangent - I'll leave you folks to hammer it out...

[simplicio]

Good point - one I had not considered.

A few weeks ago, patients were admitted who were positive into some homes.

there are very few independent facilities. They are tied into health care consortiums, the nursing home is tied into a regional hospital system, which is vertically integrated. When the patient enters the system, typically through a hospital, there is a placement whether in the hospital or another facility. A separate system is unlikely to accept a patient from another system (except in areas like NYC, I think the health commissioner mandates placements because the system is overburdened). So the placement is made in a suitable facility within the system.

Other states have different rules than NY State.

Since the nursing home deaths have hit the news, I think the practice has stopped. But the homes which have successfully prevented spread are not trumpeting the news, because it may change in a week or two. Surprisingly, hospitals do have extra capacity because all other procedures have stopped and beds are held empty, this has allowed the positive patients to find a bed within the acute hospital.

In normal times, nursing homes are dependent on per diem labor, hired from labor pool companies. So one worker will work in more than one home, increasing the potential for spread. And infection control measures have been relaxed, few hospitals or nursing homes are mainting any strict protocols. There is not the PPE available.

[shunyadragon]

So I read CP and Sparko's comments, and did not come away with the same impression you apparently did. The fact is, nursing homes vary widely from the very good to the truly despicable. The former take excellent care of their patients, have high standards, and maintain a healthy, professional environment. The latter prey on the weak, cut corners, and pay minimal salaries - thereby attracting only those willing to accept those salaries, and they often do not have the best interests of their patients in mind.

This is not a binary situation. Even in the worst nursing homes, you will often find those going the extra mile for their patients - and blowing the whistle whenever they can. But they tend to be exceptions. I have been in and seen both types of care facility, and the difference is amazing. Pointing out the bad apples does not denigrate those who are truly to be admired for their work. I saw CP and Sparko making comments in this vein, not making comments that were a sweeping denigration of all nursing homes and all workers therein.

BTW - on the same foot - pointing out the bad apples in the police force and the places where the police force could "tighten up its act" does not denigrate the majority of honorable men and women who serve on this front - especially in this time. There are well-run police departments with few (if any) bad apples, and their are badly run police departments where the majority of the apples are bad - just like nursing homes.

And with THAT tangent - I'll leave you folks to hammer it out...

Like the over all pattern of the infection and fatality rate of COVAG-19, the extended care facilities follow the same pattern. No one has as far as I am concerned demonstrated the difference in quality of care between different extended care facilities, and the elderly and vulnerable outside the facilities. Actually this is true worldwide concerning the fatalities and the severely ill. In every country and region the statistics are consistent. The percentage of the fatalities and severe cases is consistently the same for the majority of the cases proportionally concerning the elderly and vulnerable. Specifically Norther Italy likely has the highest population percentage of elderly and vulnerable, and likewise has the highest fatality and severe cases of COVAG-19. These statistics are consistent worldwide, regardless of the degree mitigation efforts implemented and when.

The only other significant variable are those countries that implemented proactive and aggressive measures early like North Korea, Japan, Taiwan, and to a degree Germany.

Travel restrictions have an effect, but it is limited due to the fact that COVAG-19 spread rapidly from only a small number of cases that entered different countries immediately and prior to any travel restrictions.

[carpedm9587]

Like the over all pattern of the infection and fatality rate of COVAG-19, the extended care facilities follow the same pattern. No one has as far as I am concerned demonstrated the difference in quality of care between different extended care facilities, and the elderly and vulnerable outside the facilities. Actually this is true worldwide concerning the fatalities and the severely ill. In every country and region the statistics are consistent. The percentage of the fatalities and severe cases is consistently the same for the majority of the cases proportionally concerning the elderly and vulnerable. Specifically Norther Italy likely has the highest population percentage of elderly and vulnerable, and likewise has the highest fatality and severe cases of COVAG-19. These statistics are consistent worldwide, regardless of the degree mitigation efforts implemented and when.

The only other significant variable are those countries that implemented proactive and aggressive measures early like North Korea, Japan, Taiwan, and to a degree Germany.

Travel restrictions have an effect, but it is limited due to the fact that COVAG-19 spread rapidly from only a small number of cases that entered different countries immediately and prior to any travel restrictions.

I cannot "demonstrate the difference" Shuny, and I was careful not to cite any statistics since I do not have any. I was speaking from personal experience: I have had interactions with nursing homes and elder-care facilities across the spectrum - from the best to the worst. At least, I HOPE it was the worst - I would hate to think there are places worse than my worst experience.

As for demonstration, I have no way to demonstrate my experience to you. I can only share it and leave you to decide whether or not you believe me. If I had statistics, I would share them.

[shunyadragon]

A few weeks ago, patients were admitted who were positive into some homes.

Curious reference please. Did these patients test positive before they were admitted?

[simplicio]

Curious reference please. Did these patients test positive before they were admitted?

Yes, they tested positive for corona virus before they were placed.

At the time the hospital system of downstate was teetering, and I suppose that the thinking was that it would not be long before upstate was in the same boat. It has not panned out.

[simplicio]

So I read CP and Sparko's comments, and did not come away with the same impression you apparently did. The fact is, nursing homes vary widely from the very good to the truly despicable. The former take excellent care of their patients, have high standards, and maintain a healthy, professional environment. The latter prey on the weak, cut corners, and pay minimal salaries - thereby attracting only those willing to accept those salaries, and they often do not have the best interests of their patients in mind.

This is not a binary situation. Even in the worst nursing homes, you will often find those going the extra mile for their patients - and blowing the whistle whenever they can. But they tend to be exceptions. I have been in and seen both types of care facility, and the difference is amazing. Pointing out the bad apples does not denigrate those who are truly to be admired for their work. I saw CP and Sparko making comments in this vein, not making comments that were a sweeping denigration of all nursing homes and all workers therein.

BTW - on the same foot - pointing out the bad apples in the police force and the places where the police force could "tighten up its act" does not denigrate the majority of honorable men and women who serve on this front - especially in this time. There are well-run police departments with few (if any) bad apples, and their are badly run police departments where the majority of the apples are bad - just like nursing homes.

And with THAT tangent - I'll leave you folks to hammer it out...

Remember when discussion of the health care system was all the rage before Obamacare?

Better homes will sort through and pick the least difficult to care for patients, the community hospitals are left with the most difficult, the most incontinent patients. And the price differential follows. Also a home which is tied into a regional health system, which usually has a major hospital as the anchor (and supplies medical expertise) will find itself forced to take in the patients that the hospital is obligated to care for. The better homes, the ones that do not smell or seem horrible, are ones with a lighter case mix index (less sicker patients and more "walkie talkies", pateints which can do some of their care). Somebody has to take care of those patients, and the most difficult patients are too often relegated into the nursing homes which take anybody, regardless of how labor intensive their requirements are.

End of life is the forgotten part of the pro life, its womb to tomb. It is not true at all that the ones working in nursing homes are unable to get a job anywhere else. Many nurses and CNAs (Certified Nurse Assistants) do an excellent job and form bonds with patients. But the community hospitals without the snazzy real estate look run down and have lighting designed in the 50s because there is not money available. The same hospital which looks so horrible often does an excellent job with care.

The nursing homes are at the mercy of the state health department to allocate PPE now that the supply chains have broken down. Infection control standards are out the window, it is a seat of the pants atmosphere. But the lawsuits and criminal charges are hanging over heads. While the CNAs (lowest on the food chain) may be included in the law suits, they are seldom actually included in the settlements. However, the same workers who start at just above minimum wage are held accountable in the criminal probes as well as the state licensing censures. They can lose their licenses and have to find another job.

Long term care is growing and is one of the largest employer of nurses. There are no sexy television shows. Their quality of the work is not always indicative of the cheapest available.

[mossrose]

Yes, they tested positive for corona virus before they were placed.

At the time the hospital system of downstate was teetering, and I suppose that the thinking was that it would not be long before upstate was in the same boat. It has not panned out.

How about a link to the statistics you are referring to.

[oxmixmudd]

Remember when discussion of the health care system was all the rage before Obamacare?

Better homes will sort through and pick the least difficult to care for patients, the community hospitals are left with the most difficult, the most incontinent patients. And the price differential follows. Also a home which is tied into a regional health system, which usually has a major hospital as the anchor (and supplies medical expertise) will find itself forced to take in the patients that the hospital is obligated to care for. The better homes, the ones that do not smell or seem horrible, are ones with a lighter case mix index (less sicker patients and more "walkie talkies", pateints which can do some of their care). Somebody has to take care of those patients, and the most difficult patients are too often relegated into the nursing homes which take anybody, regardless of how labor intensive their requirements are.

End of life is the forgotten part of the pro life, its womb to tomb. It is not true at all that the ones working in nursing homes are unable to get a job anywhere else. Many nurses and CNAs (Certified Nurse Assistants) do an excellent job and form bonds with patients. But the community hospitals without the snazzy real estate look run down and have lighting designed in the 50s because there is not money available. The same hospital which looks so horrible often does an excellent job with care.

The nursing homes are at the mercy of the state health department to allocate PPE now that the supply chains have broken down. Infection control standards are out the window, it is a seat of the pants atmosphere. But the lawsuits and criminal charges are hanging over heads. While the CNAs (lowest on the food chain) may be included in the law suits, they are seldom actually included in the settlements. However, the same workers who start at just above minimum wage are held accountable in the criminal probes as well as the state licensing censures. They can lose their licenses and have to find another job.

Long term care is growing and is one of the largest employer of nurses. There are no sexy television shows. Their quality of the work is not always indicative of the cheapest available.

Although I don't agree with the sarcastic way you dismissed CP's church's efforts to provide relief in their local nursing home community (If all churches in his area did what they are doing, the picture would be very different in all the homes they minister into - and people that work and have kids and their own, parents to care for can't devote the entirety of their available free time to remedying the problem) - I do agree with you in the general sense that how we as a nation deal with elderly care is pretty horrible.

Sometimes one has no choice but to put a loved one into such care, diseases like dementia and Alzheimer's can create paranoid hallucinations that can precipitate violent behavior beyond the capacity of dealing with at home, especially if the care giver is themselves elderly. And if you have enough money and search them out, it is possible to find decent places. But there is no 'spreading out' of the cost like we have with medical care. There is no useful provision from medicare, it only covers double occupancy and the worst of the worst in care, and that only if the person and their spouse have fully exhausted all resources (so that the well spouse is stuck living in near poverty as well).

It's a pretty bad situation that no one is willing to address. Mind you, it would be impossible to address without almost all of us having to give up a non-trivial percentage of our current wealth or income. But it basically decimates families that reach the age where such care is necessary. Just as schools are a public responsibility, so should elderly care be. It's just part of the cost of living together in a society and a cost most of us are not equipped to bear alone, but it is 100% contradictory to the american ideal of absolute independence where we carry no responsibility to care for the weak among us that are not blood relatives. So the upper middle class and wealthy are cared for more or less, but the lower middle class and the poor languish.

And the reality is, most of us never attain the sort of wealth that would allow us to comfortably care for our parents during the last years of life at such facilities.

In the past we cared for them in our homes along with our children. But that is not who we are anymore. That and the fact we require medical care of a cost and expense for those that are truly feeble that simply did not exist then . Good medical insurance, good life insurance is not affordable after a certain age. And with good reason from a profit perspective.

It's a problem that is mostly ignored until a parent or loved one is in need of such care. And then suddenly we become aware of its reality, and how nearly impossible it is to do what we imagined we would do, and how nearly impossible it is to actually be able to care for them the way we would like.

ETA: I have a close relative that served her state as a social worker inspecting such homes. And CP is right, there are homes where the owners are out to make a buck, and they will cut every corner to put more money in their pockets. That relative had to close many a home down because of things like worms in the meat they would cook for the patients. But then there are also places that are indeed intent on providing the best possible care on the limited resources they have. The problem there is, if you charge what is really needed, only the very rich can use them. But if you lower costs too much to accommodate the less fortunate, you simply can't employ the quality cooks, nutritionists, nursing and janitorial staff required to provide a decent environment for those that are being cared for.

[simplicio]

Although I don't agree with the sarcastic way you dismissed CP's church's efforts to provide relief in their local nursing home community (If all churches in his area did what they are doing, the picture would be very different in all the homes they minister into - and people that work and have kids and their own, parents to care for can't devote the entirety of their available free time to remedying the problem) - I do agree with you in the general sense that how we as a nation deal with elderly care is pretty horrible.

If you interpreted it as sarcasm, then you misinterpreted it. CP called those workers low quality. Yet his response to what his church does to help out only included the ministry to patients, the "fun" things to get volunteers for. But nothing for the root of the problem, the workers and the substandard quality he noted. The "DOH" was echoing his cartoon character emoji.

There is dignity in caring for the least of these. But pro life Christians look at people at the end of their life and see inconvenience and burdens, not the image of G-d. It is easy to find pro life volunteers to comfort the sick baby. It is much more difficult to enlist pro life Christians to volunteer to provide care and comfort to the elderly. Real ministry to working poor is just too much like social justice and avoided because it is hard.

Sometimes one has no choice but to put a loved one into such care, diseases like dementia and Alzheimer's can create paranoid hallucinations that can precipitate violent behavior beyond the capacity of dealing with at home, especially if the care giver is themselves elderly. And if you have enough money and search them out, it is possible to find decent places. But there is no 'spreading out' of the cost like we have with medical care. There is no useful provision from medicare, it only covers double occupancy and the worst of the worst in care, and that only if the person and their spouse have fully exhausted all resources (so that the well spouse is stuck living in near poverty as well).

It's a pretty bad situation that no one is willing to address. Mind you, it would be impossible to address without almost all of us having to give up a non-trivial percentage of our current wealth or income. But it basically decimates families that reach the age where such care is necessary. Just as schools are a public responsibility, so should elderly care be. It's just part of the cost of living together in a society and a cost most of us are not equipped to bear alone, but it is 100% contradictory to the american ideal of absolute independence where we carry no responsibility to care for the weak among us that are not blood relatives. So the upper middle class and wealthy are cared for more or less, but the lower middle class and the poor languish.

And the reality is, most of us never attain the sort of wealth that would allow us to comfortably care for our parents during the last years of life at such facilities.

In the past we cared for them in our homes along with our children. But that is not who we are anymore. That and the fact we require medical care of a cost and expense for those that are truly feeble that simply did not exist then . Good medical insurance, good life insurance is not affordable after a certain age. And with good reason from a profit perspective.

It's a problem that is mostly ignored until a parent or loved one is in need of such care. And then suddenly we become aware of its reality, and how nearly impossible it is to do what we imagined we would do, and how nearly impossible it is to actually be able to care for them the way we would like.

ETA: I have a close relative that served her state as a social worker inspecting such homes. And CP is right, there are homes where the owners are out to make a buck, and they will cut every corner to put more money in their pockets. That relative had to close many a home down because of things like worms in the meat they would cook for the patients. But then there are also places that are indeed intent on providing the best possible care on the limited resources they have. The problem there is, if you charge what is really needed, only the very rich can use them. But if you lower costs too much to accommodate the less fortunate, you simply can't employ the quality cooks, nutritionists, nursing and janitorial staff required to provide a decent environment for those that are being cared for.

Yes, there are homes where that stuff happens, however sufficient oversight is needed. In New York State those horror stories are becoming rare.

We expect the workers to do a better job with our parents and grandparent than we could do ourselves, with reimbursement rates which are unrealistic. But just what is the difference between a home which does a good job and one that doesn't? Too often it is difficult to discern the difference from the outside. We too often look for the superficial aspects.

Medicare is mandating single occupancy, private rooms. The segment which is drawing the best and brightest, the highest potential incomes, is the nurse-consultant who can accurately navigate the byzantine regulations which allow the home to collect the highest possible payments from medicare.

[shunyadragon]

Yes, they tested positive for corona virus before they were placed.

At the time the hospital system of downstate was teetering, and I suppose that the thinking was that it would not be long before upstate was in the same boat. It has not panned out.

Reference explaining this and what isolation was implemented?

[Cow Poke]

Good move. You have shown yourself to be less than honest ...

Wow, I've been called "less than honest" by Tweb's newest and most outrageous

[Cow Poke]

How about a link to the statistics you are referring to.

You mean, like, back it up with them fact thingies?

[Cow Poke]

If you interpreted it as sarcasm, then you misinterpreted it.....

Apparently, you seem to be quite in the minority on this. Perhaps it's time to adjust your perception.