Half of all cases happening in care homes

[carpedm9587]

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.

I don't see anything here I disagree with - and I'm not sure how this addresses my point. Bottom line, I didn't see CP and Sparko making a sweeping indictment of end-of-life care. While I may not share their political views on almost anything, I'm reasonably confident that they practice what they preach when it comes to caring for the sick and needy. They just think (I think) that providing such care is not the purview of the government - a point on which we disagree.

[Cow Poke]

I don't see anything here I disagree with - and I'm not sure how this addresses my point. Bottom line, I didn't see CP and Sparko making a sweeping indictment of end-of-life care.

Absolutely not -- THREE of our church members are healthcare workers in nursing homes -- it's part of how we got into "that business". (Two are Nurse's Assistants, one is a Nurse) All three are part of our Nigerian contingent.

While I may not share their political views on almost anything, I'm reasonably confident that they practice what they preach when it comes to caring for the sick and needy.

I find his attacks somewhat psychotic ---- somebody is doing something worthwhile with the residents from a pure motive, and he attacks because we're not focused on the healthcare WORKERS instead of the residents?

They just think (I think) that providing such care is not the purview of the government - a point on which we disagree.

Not sure where you got that part, but on the rest, you're spot on!

[carpedm9587]

Absolutely not -- THREE of our church members are healthcare workers in nursing homes -- it's part of how we got into "that business". (Two are Nurse's Assistants, one is a Nurse) All three are part of our Nigerian contingent.

I find his attacks somewhat psychotic ---- somebody is doing something worthwhile with the residents from a pure motive, and he attacks because we're not focused on the healthcare WORKERS instead of the residents?

Not sure where you got that part, but on the rest, you're spot on!

That was the reason for the "I think." It's been a while since we've discussed any of these things. My memory was that neither you nor Sparko thought it was a proper role for government to be providing a safety net for the sick and needy. Just more "big government." But apparently I'm wrong about that - at least with regards to you.

My apologies.

[Cow Poke]

That was the reason for the "I think." It's been a while since we've discussed any of these things. My memory was that neither you nor Sparko thought it was a proper role for government to be providing a safety net for the sick and needy. Just more "big government." But apparently I'm wrong about that - at least with regards to you.

Yeah, I think you got that wrong, but I can understand why. I think "big government" is incredibly wasteful, and I think that the actual "help" should be closer to home - like block grants to states or counties, where the distributors of the assistance are much closer to the need.

My apologies.

Not necessary, but

[carpedm9587]

Yeah, I think you got that wrong, but I can understand why. I think "big government" is incredibly wasteful, and I think that the actual "help" should be closer to home - like block grants to states or counties, where the distributors of the assistance are much closer to the need.

On THAT we actually agree. I think an enormous part of government is wastefully structured, and more of it should take the form of grants to local entities with the appropriate oversight to minimize the inevitable fraud. It is pretty easy to defraud an anonymous machine. It is much harder to look a neighbor or pastor or friend in the eye and lie.

Not necessary, but

Well...despite what several here believe about me - I'd rather get it right and I actually do apologize when I get it wrong, especially if it misrepresents someone else. But I'm sure someone will come along and label that a "humble brag" or "virtue signaling" or something...

The online format makes it too easy to create bogeymen...

[oxmixmudd]

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.



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.

When was the change. Two years ago when I looked into it Medicare only reimbursed if it was double occupancy.

[simplicio]

I don't see anything here I disagree with - and I'm not sure how this addresses my point. Bottom line, I didn't see CP and Sparko making a sweeping indictment of end-of-life care. While I may not share their political views on almost anything, I'm reasonably confident that they practice what they preach when it comes to caring for the sick and needy. They just think (I think) that providing such care is not the purview of the government - a point on which we disagree.

You did not find the characterizations of employee quality to be an indictment? I know people in that end of the health care industry as does CP. I disagree with those descriptions, some choose it and are able to find work on other areas, nor do I find the quality of the work, the care, given to be so poor.

And there is the pro life angle, something few actually think about. Life has symmetry, man is dependent at both the beginning and the end, but joy at the beginning, sorrow at the end. But at both there is the image of G-d. People are drawn to the baby, repulsed at the elderly. And concentrating too many elderly in one facility is confused as horrid, a description I see as a rejection of man's nature and a rejection of the pro life principles. And maybe it is the most noble profession because it is care which many find repulsive. The job has a unique dignity.

Put a wing in a hospital full of babies and people smile, put a wing in a facility of elderly, and people see it as horrible. People excrete, hopefully most can deal with it on their own. But not at end of life.

Caring for the sick and needy is a good, something needed, but that is the easy picked, low hanging fruit; and it is human nature to feel good when acting altruistically. Nursing homes have employees who are the working poor, who also have human dignity. Rather than choosing to do something to assist those who are working poor, it is easier to complain about them. Caring for the working poor? That is moving dangerously close to social justice.

But both CP and Sparko noted that a problem in long term care was the employees. If a problem can be identified, then that suggests a solution. Pro life churches are failing the calling to "Choose Life". The elderly are also important.

CP noted it is a calling, but only for a daughter who works in hospice. Nursing home work can also be a calling. I do find it appalling that Christians would characterize those who do that work the way they do. I did notice CP included information to suggest his daughter is able to find employment elsewhere in health care though.

[simplicio]

When was the change. Two years ago when I looked into it Medicare only reimbursed if it was double occupancy.

The old two person rooms will slowly need to be converted to private single occupancy rooms, and new construction needs to be private rooms only, the wards, or twelve person rooms are all long gone, remodeled into smaller rooms. Many facilities are almost entirely two person rooms, it will effectively cut the capacity in half for the facility.

I think it about two years old, and it is driven by the patient rights/ dignity issues. Which doesn't make a lot of sense if patients are out of it.

[simplicio]

Absolutely not -- THREE of our church members are healthcare workers in nursing homes -- it's part of how we got into "that business". (Two are Nurse's Assistants, one is a Nurse) All three are part of our Nigerian contingent.



I find his attacks somewhat psychotic ---- somebody is doing something worthwhile with the residents from a pure motive, and he attacks because we're not focused on the healthcare WORKERS instead of the residents?



Not sure where you got that part, but on the rest, you're spot on!

How would you characterize the church members work quality? Is there work product of such a quality that it indicates the cheapest which can be hired? .smile.

[carpedm9587]

You did not find the characterizations of employee quality to be an indictment? I know people in that end of the health care industry as does CP. I disagree with those descriptions, some choose it and are able to find work on other areas, nor do I find the quality of the work, the care, given to be so poor.

And there is the pro life angle, something few actually think about. Life has symmetry, man is dependent at both the beginning and the end, but joy at the beginning, sorrow at the end. But at both there is the image of G-d. People are drawn to the baby, repulsed at the elderly. And concentrating too many elderly in one facility is confused as horrid, a description I see as a rejection of man's nature and a rejection of the pro life principles. And maybe it is the most noble profession because it is care which many find repulsive. The job has a unique dignity.

Put a wing in a hospital full of babies and people smile, put a wing in a facility of elderly, and people see it as horrible. People excrete, hopefully most can deal with it on their own. But not at end of life.

Caring for the sick and needy is a good, something needed, but that is the easy picked, low hanging fruit; and it is human nature to feel good when acting altruistically. Nursing homes have employees who are the working poor, who also have human dignity. Rather than choosing to do something to assist those who are working poor, it is easier to complain about them. Caring for the working poor? That is moving dangerously close to social justice.

But both CP and Sparko noted that a problem in long term care was the employees. If a problem can be identified, then that suggests a solution. Pro life churches are failing the calling to "Choose Life". The elderly are also important.

CP noted it is a calling, but only for a daughter who works in hospice. Nursing home work can also be a calling. I do find it appalling that Christians would characterize those who do that work the way they do. I did notice CP included information to suggest his daughter is able to find employment elsewhere in health care though.

Again - I did not see Sparko or CP give a sweeping indictment of the end-of-life care system or all (or even most) end-of-life care workers. I saw them call out the bad apples with no comment made as to proportions between bad apples and the good workers. If there is anything I might fault them on, it would be not being explicit that the bad apples and bad care situations are in the minority, which I believe them to be. But I cannot fault them TOO much because I have no data to back up that belief: just a bunch of personal experience which (as I have noted multiple times to Sparko - much to his annoyance) is not adequate evidence to make a statistical claim.

But there are most certainly bad apples in senior living and senior care. If you do not believe that, then I have to assume you've been ignoring a lot of reporting. There are bad apples in ANY context including healthcare, churches, police departments, school systems, government, and pretty much any sector/industry you care to name. It's the nature of the beast.

I also didn't see CP limit the "calling" nature of the work to a single person. Perhaps in his own world the only person he knows that sees this as a calling is one person - but I sincerely doubt he thinks no one else sees this as a "calling." Employees CAN and ARE a problem - that is a fact - but that does not mean ALL or even MOST employees. But if a care facility is offering minimum wage, they are going to get a lot of young people doing the job for the paycheck and without a great deal of care - and that IS a problem.

You are "doing a Pix," Sim. You have your teeth in a bone largely of your own making, and you don't appear to be listening to the person telling you "that's not what I said or meant." You don't even appear to be listening to 3rd parties telling you that. I am not usually aligned with either CP or Sparko on very many topics - so you might want to consider why I am responding to you this way. I suggest you go back and reread the original posts and exchanges.

[simplicio]

Again - I did not see Sparko or CP give a sweeping indictment of the end-of-life care system or all (or even most) end-of-life care workers. I saw them call out the bad apples with no comment made as to proportions between bad apples and the good workers. If there is anything I might fault them on, it would be not being explicit that the bad apples and bad care situations are in the minority, which I believe them to be. But I cannot fault them TOO much because I have no data to back up that belief: just a bunch of personal experience which (as I have noted multiple times to Sparko - much to his annoyance) is not adequate evidence to make a statistical claim.

But there are most certainly bad apples in senior living and senior care. If you do not believe that, then I have to assume you've been ignoring a lot of reporting. There are bad apples in ANY context including healthcare, churches, police departments, school systems, government, and pretty much any sector/industry you care to name. It's the nature of the beast.

I also didn't see CP limit the "calling" nature of the work to a single person. Perhaps in his own world the only person he knows that sees this as a calling is one person - but I sincerely doubt he thinks no one else sees this as a "calling." Employees CAN and ARE a problem - that is a fact - but that does not mean ALL or even MOST employees. But if a care facility is offering minimum wage, they are going to get a lot of young people doing the job for the paycheck and without a great deal of care - and that IS a problem.

You are "doing a Pix," Sim. You have your teeth in a bone largely of your own making, and you don't appear to be listening to the person telling you "that's not what I said or meant." You don't even appear to be listening to 3rd parties telling you that. I am not usually aligned with either CP or Sparko on very many topics - so you might want to consider why I am responding to you this way. I suggest you go back and reread the original posts and exchanges.

If you were any good you'd be working elsewhere. I see that as a sweeping indictment. And something said, but if it was not meant he has not said so, nor tried to explain its context.

I have been in the dingy corridors of a facility which gets insufficient funding. But some of them do a herculean service, and I have also heard the comments about the poor care given in a hospital which has excellent patient outcomes. We are so used to disparaging the work done in nursing homes that the claims are never really examined, and pass as unremarkable. (worms in food? Ever eaten in a restaurant after hearing the horror stories whether true or not?)

A cursory walk through a home seldom gives an accurate picture of the care done, "the quality of the employees indicates a 'let's hire the cheapest labor we can get away with'". But how can you tell exactly? The stench is always in the air and is an (almost) unavoidable consequence of caring for a certain type of patients, whether patient care is kept up with or let slide. I read a study that the most important factor in perception of a facility was its brick and mortar, and was independent of the actual quality. So the community hospital which has a seventy year old building and a decrepit parking lot will have poor perception of the quality; and conversely the facility with nice modern building has a good perception regardless of the care (second in importance was an appealing entrance with a smiling receptionist). Patient outcomes are pretty much irrelevant to perceptions.

If the person at the end of life gets complications, its the nursing home's fault (post 14). Sparko is able to parse and use logic differently if the topic is trump. Its not because people at the end get more complications: the body breaks down, and that is G-d's design.

Many Christians have expressed their views on social justice initiatives. Many of the employees are working poor, who as a group do face significant problems which does affect work and attendance.

I have read back through the thread multiple times. I do not think CP meant it, in spite of Chrawnus' post, but he has not retracted it or explained it, rather he indirectly expanded on it. Notice the pattern starting at post 11: One poster dumps on a group, the next poster tops it. It is about a topic which I feel is about the extension of pro life from just abortion. Human nature, which I attribute to the divine plan, includes the elder care and all that entails. Euthanasia is as important as abortion, and while neither Sparko and CP are not pro-euthanasia, their criticism of nursing homes just happens to substantiate the reasons for euthanasia, namely that old people are difficult to care for.

[Cow Poke]

Again - I did not see Sparko or CP give a sweeping indictment of the end-of-life care system or all (or even most) end-of-life care workers. I saw them call out the bad apples with no comment made as to proportions between bad apples and the good workers. If there is anything I might fault them on, it would be not being explicit that the bad apples and bad care situations are in the minority, which I believe them to be. But I cannot fault them TOO much because I have no data to back up that belief: just a bunch of personal experience which (as I have noted multiple times to Sparko - much to his annoyance) is not adequate evidence to make a statistical claim.

I actually didn't think it should be necessary to point out that 'bad apples' are, indeed, the minority. You are 'receiving' the totality of my messaging pretty much spot on with what I intended.

But there are most certainly bad apples in senior living and senior care. If you do not believe that, then I have to assume you've been ignoring a lot of reporting. There are bad apples in ANY context including healthcare, churches, police departments, school systems, government, and pretty much any sector/industry you care to name. It's the nature of the beast.

EGGzackly!

I also didn't see CP limit the "calling" nature of the work to a single person.

Absolutely not. In my Christian experience, one's "calling" is not necessarily his occupation, but it's great when both are one in the same. While I ENJOY doing the Nursing Home Ministry, I have a guy in my church who thrives on it - loves it - he's the one who does most of the coordinating with other Churches, and volunteers to fill in when one of them can't make it. It's is "calling".

Perhaps in his own world the only person he knows that sees this as a calling is one person - but I sincerely doubt he thinks no one else sees this as a "calling." Employees CAN and ARE a problem - that is a fact - but that does not mean ALL or even MOST employees. But if a care facility is offering minimum wage, they are going to get a lot of young people doing the job for the paycheck and without a great deal of care - and that IS a problem.

You're hitting it on the head. There are some facilities where it seems that money is the major motivator, and they will operate as absolutely 'on the cheap' as they can to focus on the "bottom line". It's strange, because other facilities seem to understand that paradox that if they focus on patient care, and the best facilities and personnel they can afford, the money will come.

You are "doing a Pix," Sim. You have your teeth in a bone largely of your own making, and you don't appear to be listening to the person telling you "that's not what I said or meant." You don't even appear to be listening to 3rd parties telling you that. I am not usually aligned with either CP or Sparko on very many topics - so you might want to consider why I am responding to you this way. I suggest you go back and reread the original posts and exchanges.

Simp seems to have the extraordinary 'gift' to drive my 'enemies' (used VERY generically, and certainly not in your case) to defend me. It's always a good sign that one is way off base.

He's also making me realize what an incredibly sensible guy Ox is.

[Cow Poke]

I also didn't see CP limit the "calling" nature of the work to a single person. Perhaps in his own world the only person he knows that sees this as a calling is one person - but I sincerely doubt he thinks no one else sees this as a "calling."

I thought I'd elaborate on this, since you seem far more interested in understanding than attacking. I gave ONE example of my own daughter, because she is an excellent example of somebody who works in health care, and can do just about anything (she has multiple endorsements and specialties) as a nurse, but recognized that labor and delivery was something she LIKED to do, but Hospice is something she feels CALLED to do.

Her first degree was in criminal justice, because she wanted to be in law enforcement like her dad, but (I cover this elsewhere) she went through the very tragic death of her first husband to pancreatic cancer. He was in Hospice, and she learned from the Hospice nurses how to care for him. Through this, she felt that God was calling her into a ministry of Hospice, so she went back to school, got another degree in nursing, then finished some additional training to qualify her for several other aspects of Hospice care.

She is only one of MANY people I know who sought God's "calling", and responded accordingly. I loved police work, but that was not my "calling". It's still in my blood, and I'm still involved in it in a number of ways, but it's because I LIKE it, not because I feel "called" to it.

I think one of the greatest tragedies for a Christian is not understanding this.

[Cow Poke]

I'll ignore the other tripe you posted, but this part screams "false"....

The stench is always in the air and is an (almost) unavoidable consequence of caring for a certain type of patients, whether patient care is kept up with or let slide.

FOUR of the six nursing homes I am in REGULARLY do not even have a hint of this "stench". They have sufficient staff to manage the residents, and procedures to efficiently and effictively deal with issue.

[NorrinRadd]

The stench comes from incontinent people at the end of their lives. The condition of building is a result of those who occupy it. ...

Also, "old people smell" is a thing.