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Old 09-02-2017, 02:17 PM
 
Location: Central NY
4,676 posts, read 3,248,729 times
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Quote:
Originally Posted by GeoffD View Post
I think you're missing the core issue: Medicaid payments to nursing homes. 62% of all nursing home beds are paid for by Medicaid. Even cutting staffing to the bone, nursing homes, at best, break even on Medicaid patients and most lose money.

I do not agree with you. I made the point I intended to make. Feel free to write your own post about it.
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Old 09-02-2017, 02:21 PM
 
2,680 posts, read 1,544,220 times
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Quote:
Originally Posted by NYgal1542 View Post
I do not agree with you. I made the point I intended to make. Feel free to write your own post about it.
You can disagree, although I don't know about what. I happen to agree with your post #3.
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Old 09-02-2017, 03:09 PM
 
Location: Central NY
4,676 posts, read 3,248,729 times
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Quote:
Originally Posted by [B
bigbear99[/b];49397284]You can disagree, although I don't know about what. I happen to agree with your post #3.
Thank you bigbear99. Wasn't disagreeing with my post #3. I was disagreeing with GeoffD, post #6.
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Old 09-02-2017, 03:11 PM
 
2,680 posts, read 1,544,220 times
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My mistake. Thank you.
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Old 09-02-2017, 03:19 PM
 
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I know that the no frills nursing home that operated in my small home for over 40 years closed about 5 years ago. Not sure how many management hands it passed through before that but the last one was Magnum or MagnumCare (Michigan) which seemed to run a lot of small town nursing homes, (all with poor reviews and lawsuits on the internet). Most of my mothers friends had been there before and she assumed she would go there too. It was for many years a local seeming sort of place. But while still in the original 40 or 50 yr old one floor rectangular cinderblock building the price shot up to 7,000 a month and the whole thing felt very scammy when I talked to them on the phone when we started to worry about her being home. Lots of complaints rumbling around town. My mothers neighbor when there a year or so before closing and the daughter had lots of complaints (hard to tell about that).
So even the poor quality but expensive option was closed.

Another friend has other old, but not quite as old, local ladies stay with her mother in her house in shifts, 24/7. She has her mind and isn't quite dead weight so that is manageable for them and a lot less than 7,000 a month.
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Old 09-02-2017, 04:54 PM
 
6,835 posts, read 3,869,983 times
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I've wondered who will care for all the baby boomers when they need it. They tended to have fewer children than past generations, and most of kids and grands work full time.

I know as an RN that caring for frail and often confused elderly is VERY time consuming. Their stiff older joints, tissue paper skin, poor hearing and confusion requires a lot of time and patience. They eventually need to be helped to the bathroom or diapered, and linens need frequent changing.

Many need help eating. They need help walking and/or transferring to wheelchairs. It can take 10+ minutes for them to finally swallow their meds! Some can become combative. It requires A LOT of staff to give good care, and staff turnover is common.

So it's no mystery why good care is expensive! And no mystery why so many receive less than good care unfortunately.

Last edited by Harpaint; 09-02-2017 at 06:07 PM..
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Old 09-03-2017, 12:25 AM
 
6,215 posts, read 2,871,412 times
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Quote:
Originally Posted by Harpaint View Post
I've wondered who will care for all the baby boomers when they need it. They tended to have fewer children than past generations, and most of kids and grands work full time.

I know as an RN that caring for frail and often confused elderly is VERY time consuming. Their stiff older joints, tissue paper skin, poor hearing and confusion requires a lot of time and patience. They eventually need to be helped to the bathroom or diapered, and linens need frequent changing.

Many need help eating. They need help walking and/or transferring to wheelchairs. It can take 10+ minutes for them to finally swallow their meds! Some can become combative. It requires A LOT of staff to give good care, and staff turnover is common.

So it's no mystery why good care is expensive! And no mystery why so many receive less than good care unfortunately.
Nope. Doesn't cost a person more to be kind to humanity. It does cost the elders more to be heard and valued. Sad really.

Profiting off another's natural life progressions. Alf's are money makers ..
I've yet to see the admins living meagerly...But their residents sure are.
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Old 09-03-2017, 07:34 AM
 
2,952 posts, read 1,640,257 times
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Quote:
Originally Posted by Coloradomom22 View Post
What Medicare pays to hospitals versus what Medicaid pays to nursing homes (for the destitute) is vastly different. That's why there are many nursing homes that do not even accept Medicaid.
This should be a big wake up call for the numbers of people who think all is rosy in the medicaid world.
I saw my grandma go into one that took medicaid only. What a hell hole and this was the 70's.

People think things are going to get better in this area? A nice home I'd want to be in wouldn't accept medicaid. Its be a for profit endeavor.

One of the screening tools I'd use is do you take medicaid patients? If so, that place is not for me.
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Old 09-03-2017, 07:56 AM
 
15,323 posts, read 4,040,543 times
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Quote:
Originally Posted by crusinsusan View Post
I too think that CR could have titled it better, as it is misleading.

I do like seeing the heat map of the average costs in 2016 for an assisted living apartment in all states. Not useful, really, but a curiosity for me. I pulled out the 3 cheapest as (I'm rounding) Missouri ($30k), Oklahoma (33k), Georgia ($34k). The top 3 most expensive were Massachusetts ($65k), Alaska ($69k), and DC ($80k).

No surprises in where they fall I guess, but man, those politicians pay a lot in their dotage. I wonder if the care is actually better than in Missouri.
Well, just to be very basic about it, MA has the highest income, best medical care and best education in the USA......

So it would certainly make sense that educated and wealthier and smarter clients AND caregivers would both spend more and ask for more.

Your query is sorta like asking if public schools in Texas are worse than in MA. They are. TX ranks near the bottom and MA at the top. Big difference.

You do get what you pay for.

That said, I think the best solution(s) to this whole thing would be contained in a good universal health care system...other countries do it, why can't we? This could be supplemented by payments from the clients who desire a higher standard (single rooms, better located facilities, etc.).
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Old 09-03-2017, 09:04 AM
 
Location: Silicon Valley
3,617 posts, read 1,631,616 times
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Quote:
Originally Posted by GeoffD View Post
I think you're missing the core issue: Medicaid payments to nursing homes. 62% of all nursing home beds are paid for by Medicaid. Even cutting staffing to the bone, nursing homes, at best, break even on Medicaid patients and most lose money.
Don't be so quick to bash the unpopular messenger here.

When people receive acute hospice, they get time in a facility from Medicaid. There's also a few days that can be utilized. If you are a medical provider, you have a cash price that is sky high, you have pricing with insurance companies that probably runs in the 60% range of the cash price and finally you have Medicaid that pays slow and you're likely very happy to get 30% of the cash price. Additionally, providers have to be careful not to "bend" the rules in order to collect medicaid or they will jeopardize their payments. Care options are certainly restricted for them.

It's also a 24-7 facility. You need medical staffing and all the related costs. Your inherent competition for the same labor are hospitals and clinics. You may also need food prep and other expenses of a cafe, as well as the lodging expenses of a hotel....important in that, for the talent pool, you're competing against hospitals that have similar expenses, but a higher degree of insurance paying people, and specialty clinics that don't have the other items. Nursing homes don't get the best talent on a regular basis.

So for a nursing home to be profitable, you need cash or insurance paying customers that effectively subsidize the remaining population. However, you do need that flow of Medicaid patients to fill the beds and absorb some of the overhead of the facility as they will otherwise sit empty. Make no mistake though, if your Medicaid only, you are not the VIP wanted by these places. You're the cannon fodder that allows the profitable patients to be able to be cared for. It can affect your discharge.

People tend to think the government will provide for them at this stage. They've got a placard out there, but I'd definitely incorporate a different plan prior to retiring.
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