Nursing Homes

Tabby Ann

Tabby Ann

Member
Location
Southern Indiana
After being hospitalized with a broken leg, the doctors were loath to dismiss me from the hospital because I lived alone in my house without household help. The doctors agreed to dismiss me to a nursing home for one week before going to my own house, which would give me time to arrange household help. I had no knowledge of local nursing homes and had to choose from a list provided by the hospital. They all sounded the same in their marketing literature, providing meals, laundry service, and maid service, etc. so I chose one at random. It turned out to be one of the worst experiences of my life. The food was not good or healthy, my laundry disappeared, and the nurse’s aides didn’t listen or respond to patient requests. I couldn’t wait to get out of there. Now that I discuss this, I find many people with relatives who are stuck in nursing home permanently due to permanent disability and are very unhappy with the food and services and attitudes of nurse’s aides. I assume Medicare pays for this and I wonder how difficult it is to change nursing homes if one is unsatisfactory?
 

Actually you are talking about two different types of facilities, depending on what is available in your area. There are convalescent facilities which are different from skilled care nursing facilities.

Convalescent facilities are focused on short- to medium-term patients recovering from injury or illnesses that need more help than they have available at home, but less critical care than skilled care nursing facilities. SCN facilities can also do convalescent care, but not vice versa.

You should NOT assume Medicare pays for "this". It depends on a doctor's evaluation of your post-op or convalescent treatment, prescriptions, need for physical therapy and/or device monitoring, and other factors.

Medicare pays for 120 days of convalescent or SCN care once you are discharged from the hospital, IF you transfer straight to the facility. Spend even 30 mins. at home and they can refuse your claim. You must show improvement during convalescence or Medicare will stop benefits.

Many people - well, most, probably - have no idea what convalescent or SCN facilities are nearby, nor how they rate from the state board of health, or user/resident reviews. Some are good, many are bad, a few (very few, sadly) will be very good.

Assisted Living facilities come in a wide variety of offerings, since unlike countries with universal healthcare, there is no U.S. federal guideline as to what constitutes "Assisted Living". They do not pay for it. Some facilities have AL and SCN; others will have one or the other but not both.

Should you need full-time SCN/convalescence for longer than 120 days, you are responsible for private payment. If you have private insurance that pays for Asst. Living, at-home care, convalescent or SCN, you should file a claim for benefits immediately. Standard healthcare policies these days often include at-home care benefits. Long Term Care insurance (LTCi) generally covers all four types, especially policies written after 1990.

If you do not have such insurance, nor assets to pay for care, you will need to apply to the appropriate State Medicaid office for benefits. Be aware this may take time to process the claim; usually some weeks at best, some months if not.

If you are a Medicaid applicant, the number of facilities available may be limited. Most SCNs only take a limited number - or even none at all - of Medicaid recipients, because state benefits are always inadequate to reimburse the facility for actual costs.

There are Medicaid-only SCN facilities. They are generally very low-rated and have high employee turnover, since pay scales for most caretaker jobs start at minimum wage.

Be aware that if Medicare has been paying your SCN/convalescence bills and you get to the 120-day mark, it is strictly up to the facility you are in as to what they will do. A good quality, caring facility will work with patients to help them find appropriate help. A bad one will - and legally can, in some states - wheel you out to the curb and say "Bye, hope you have somebody to call and come get you!"

What most facilities will do, if you need long-term/forever assistance but cannot pay and thus go on Medicaid, is help you apply for aid, and get you on "the list" for an opening for a Medicaid-paid bed. This means that whenever a bed becomes available and you are next on the list, you get transferred there - and you do not have a choice of where the facility is, although I believe they do try to keep within regional boundaries.

I'm sure it's possible to transfer if you don't like the facility, but what guarantee do you have that the next Medicaid facility that becomes available is any better? And probably to transfer, you might have to go back on the list of applicants, so there's more waiting again....
 
I'm so sorry for your experience. They are profit run and I wonder who keeps getting paid off so they are not required to have more staffing. Paperwork in those places are a nightmare and that seems to be all that matters.
 

Two granddaughters work in a local nursing home. The 20 year old started working for this facility part time during her junior year in high school. The school offered a program where she could get her CNA. She graduated high school early and will have her RN in about 6 weeks.

She has been paid well, mainly because she shows up... volunteers for additional shifts when she's not involved with class work... and takes a sincere interest in her residents. When just in high school, had to deal with tending to patients who had passed away, cleaning them up before the funeral home arrived to get them. She's been slapped, spit on, cursed at, peed on, pooped on. Yet, she knows the names of the children of most of her residents, etc.

It really bothers her about the facility management and her coworkers. Management... and it is a huge Catholic Church associated conglomerate... is all about profits. Run skeleton crews, over working staff and failing the care the residents deserve.

Her younger sister began work there the day she turned 16. She works with the food service staff. Her first day on the job, she was left by herself to feed an entire ward. No training. No guidance. One of the residents asked for an omelet. Even though this young lady is an accomplished baker, she had never made an omelet. So, she pulled up YouTube on her phone and made an omelet. Once the resident tasted it, he had a number of his friends asking for one! She pulls extra shifts on weekends when schoolwork allows it. Her parents only allow her to work Friday nights and weekends. Management just announced they were cutting food service staff by 30%. They suggest an aide can work two wards instead of just one. The resident are used to eating at the same time each day. Now, if you feed one early and one late, there will be rebellion from the residents. Management doesn't care!!

These girls work so hard to make life comfortable for what will be the last months/weeks/days residents are on this Earth. They try so hard, yet get no backing from management. Management only wants to know where they can cut costs.

The 20 year old will leave the facility immediately upon receiving her RN. She already has offers from a local hospital. The 16 year old will probably continue working there, as she completes high school. She's always wanted to go into esthetics and cosmetology. Hopes when employed, she can do volunteer work doing hair and makeup for those in nursing homes.

With what seems to be an ongoing increase in dementia and Alzheimer's, if I end up in a nursing home I may not know who I am, where I am, or know my family members. If that's the case, I still deserve to be cared for in a professional and kind manner. From what I've seen, locally, there is no guarantee of that!!!
 
Patch said:
Two granddaughters work in a local nursing home. The 20 year old started working for this facility part time during her junior year in high school. The school offered a program where she could get her CNA. She graduated high school early and will have her RN in about 6 weeks.

She has been paid well, mainly because she shows up... volunteers for additional shifts when she's not involved with class work... and takes a sincere interest in her residents. When just in high school, had to deal with tending to patients who had passed away, cleaning them up before the funeral home arrived to get them. She's been slapped, spit on, cursed at, peed on, pooped on. Yet, she knows the names of the children of most of her residents, etc.

It really bothers her about the facility management and her coworkers. Management... and it is a huge Catholic Church associated conglomerate... is all about profits. Run skeleton crews, over working staff and failing the care the residents deserve.

Her younger sister began work there the day she turned 16. She works with the food service staff. Her first day on the job, she was left by herself to feed an entire ward. No training. No guidance. One of the residents asked for an omelet. Even though this young lady is an accomplished baker, she had never made an omelet. So, she pulled up YouTube on her phone and made an omelet. Once the resident tasted it, he had a number of his friends asking for one! She pulls extra shifts on weekends when schoolwork allows it. Her parents only allow her to work Friday nights and weekends. Management just announced they were cutting food service staff by 30%. They suggest an aide can work two wards instead of just one. The resident are used to eating at the same time each day. Now, if you feed one early and one late, there will be rebellion from the residents. Management doesn't care!!

These girls work so hard to make life comfortable for what will be the last months/weeks/days residents are on this Earth. They try so hard, yet get no backing from management. Management only wants to know where they can cut costs.

The 20 year old will leave the facility immediately upon receiving her RN. She already has offers from a local hospital. The 16 year old will probably continue working there, as she completes high school. She's always wanted to go into esthetics and cosmetology. Hopes when employed, she can do volunteer work doing hair and makeup for those in nursing homes.

With what seems to be an ongoing increase in dementia and Alzheimer's, if I end up in a nursing home I may not know who I am, where I am, or know my family members. If that's the case, I still deserve to be cared for in a professional and kind manner. From what I've seen, locally, there is no guarantee of that!!!
Click to expand...
How sad, but how blessed you are to have two such wonderfully caring granddaughters. It speaks volumes about you, and the way you raised your children. :love:
 
So sorry you experienced what you did Tabby Ann. When our doctor first said my mom needed to go into a nursing home (won't go into why now)...she went into one that looked nice but our experience was much like yours. The food wasn't so good, when they did her laundry, items got mixed up. One day I went in her room and her roommate was wearing her sleep shirt. And the aides seemed lazy to me. Blessedly, I was able to transfer her fairly easily to a home that was wonderful. I can't remember if her doctor helped with that process.

The food was very good and the staff took excellent care of her. They "fell in love" with my mother and some called her "Grandma". They were so excited and happy when the EMTs brought her back from the hospital after her transfusions. The staff called her a "sweetheart", which she was. Shortly before she passed away, they hired a new dietician to replace the one who'd left and the food wasn't nearly as good. My mother paid for the first few months out of pocket and when her money ran out, blessedly she was switched to Medicaid. I was so thankful that she was able to stay in that facility.
 
Warrigal said:
How sad, but how blessed you are to have two such wonderfully caring granddaughters. It speaks volumes about you, and the way you raised your children. :love:
Click to expand...
Thank you!!! We've been awfully blessed with our kids and grandkids!! All three of our kids on their first marriages, two of them now over 25 years. Life wasn't an easy road, but things worked out.
We had 104 foster children through out home over the years. 1990, I walked on young lady down the aisle. Her biological father began sexually abusing her at age 10. The are still married. Both their kids graduated college. And we have to "foster great grands" with them.
The stories we could tell.....

Also, understand, I have been blessed to spend the last 56 years with a very patient, caring... and beautiful... wife! Her mothering instinct is beyond belief! So much in our lives would not have been possible without this lady!!!
 
I know someone who spent some time in a nursing home while recovering from a bike accident. The care was so bad, he told the administrator, "I'm leaving any way I can to get my affairs in order & off myself."
 
win231 said:
I know someone who spent some time in a nursing home while recovering from a bike accident. The care was so bad, he told the administrator, "I'm leaving any way I can to get my affairs in order & off myself."
Click to expand...

Sadly, most people I talk with who have been in nursing homes have experiences similar to your acquaintance. I guess we should all research what type of decent in-patient 24/7 care is available in our area before the need arises. None of us knows when an accident may happen.
 
win231 said:
I know someone who spent some time in a nursing home while recovering from a bike accident. The care was so bad, he told the administrator, "I'm leaving any way I can to get my affairs in order & off myself."
Click to expand...
Sadly I believe it. The administrator is likely beholden to the corporation that owns the place. Don't please them, unemployed. And the people who are supposed to regulate these places do nothing. They are a big part of the problem IMO.
 
Going into a nursing home isn't something you plan for. Lethe200 hinted at how complicated this can be. I remember getting a list of homes, at the hospital. How are you supposed to decide? Your financial assets are the only thing that matters. Also, there is a misconception of what a nursing home is. Some think they are geriatric spas that will cater to your every whim. REALITY check. And after being in one, they may not be the best outcome, in most instances they are the only outcome.
 
I've had experience with SNF (skilled nursing facilities) via three elderly family members plus one close friend who were patients. Here's what I've gleaned:

The very best of these were barely adequate. They're almost always severely understaffed, patients' clothing gets lost and shows up on other patients (even when marked, PLUS the family says they'll bring laundry home), the food is heavy on starches, fats and sodium, aka institutional fare, and many times the facilities reek of urine or a disinfectant intended to mask that scent.

Medical personnel? One RN or LVN on staff, the "house doctor" shows up now and then - mostly to collect a paycheck from my observation. In all of my loved ones' cases, the house doctor was an uncaring, complete waste of time. The RN/LVNs were harried, overworked and consumed by details the SNF couldn't legally foist on other employees.

Their PT and OTs were all very good though.

My advice is to have family members visit daily, and when on premises be sure to check in with those who are responsible for their loved one's care. Bring food if there aren't dietary restrictions.

It's helpful to arrange a visit during their scheduled PT or OT session to see the progress or limitations for yourself, and to learn the objectives (walking 30 feet with a walker, or being able to get dressed without help, or transferring from bed to wheelchair, for instance).

Once those objectives are reached OR progress has stalled, the patient is released even if the patient or loved one doesn't think the patient is ready to go home.

When staff know they're being observed on a regular basis, they step up their game. Frequent visits also sends the message to staff that this patient is someone of value.

Of course, the main reason to visit is that SNFs are mind-numbingly boring. Yes, there's TV, but patients mostly sit in bed all day long with the exception of a 45 minute PT/OT session. Loved ones want and need those visits. Put them in a wheelchair and go for a walk around the block, sit outside, or do whatever will bring a change of pace and fresh air.
 
Last edited:
StarSong said:
I've had experience with SNF (skilled nursing facilities) via three elderly family members plus one close friend who were patients. Here's what I've gleaned:

The very best of these were barely adequate. They're almost always severely understaffed, patients' clothing gets lost and shows up on other patients (even when marked, PLUS the family says they'll bring laundry home), the food is heavy on starches, fats and sodium, aka institutional fare, and many times the facilities reek of urine or a disinfectant intended to mask that scent.

Medical personnel? One RN or LVN on staff, the "house doctor" shows up now and then - mostly to collect a paycheck from my observation. In all of my loved ones' cases, the house doctor was an uncaring, complete waste of time. The RN/LVNs were harried, overworked and consumed by details the SNF couldn't legally foist on other employees.

Their PT and OTs were all very good though.

My advice is to have family members visit daily, and when on premises be sure to check in with those who are responsible for their loved one's care. Bring food if there aren't dietary restrictions.

It's helpful to arrange a visit during their scheduled PT or OT session to see the progress or limitations for yourself, and to learn the objectives (walking 30 feet with a walker, or being able to get dressed without help, or transferring from bed to wheelchair, for instance).

Once those objectives are reached OR progress has stalled, the patient is released even if the patient or loved one doesn't think the patient is ready to go home.

When staff know they're being observed on a regular basis, they step up their game. Frequent visits also sends the message to staff that this patient is someone of value.

Of course, the main reason to visit is that SNFs are mind-numbingly boring. Yes, there's TV, but patients mostly sit in bed all day long with the exception of a 45 minute PT/OT session. Loved ones want and need those visits. Put them in a wheelchair and go for a walk around the block, sit outside, or do whatever will bring a change of pace and fresh air.
Click to expand...
Much truth to your post. Regarding PT, OT. They have the time to work with the patient and then they get to just quit. Patient falls during therapy, gets a skin tear, decreased oxygen level or blood pressure, the therapist will bring the patient to the nurse and if there is an incident, that nurse will have a s**t load of paperwork to do. The therapist will walk away. This is 100% true.

Family showing up is important. But please remember, that for some staff, all patients are important. And for others, sadly not. Some staff are just there for a paycheck. And they may also be harassed by administration about over time.
 
Nursing homes are horrific. I spent almost 2 days in one and will die before I go again. Because of that I totally understood why my mother never wanted to be in a nursing home, and wanted to die instead.

Which is why I am so 🤬 when I was notified, by my brother’s wife, that they had dumped mother into a nursing home. I hope they live long enough for their children to do the same thing to them.
 
Let me speak up for a GOOD experience with a SCN facility. I have outlined this before and will try to keep it shorter. We needed a nearby facility for my MIL who had mild/moderate dementia. After much research we picked one, a full-service facility on a 5-acre closed campus with its own senior center. We made 2 visits without MIL over a few months, and 2 more with MIL. We ate lunches and dinners at their DR which was excellent; in fact one Christmas my entire family came to the facility to celebrate with her.

She went into Asst. Lvg; we also investigated/approved their SCN and Memory Care units, including watching class activities. They publish a list of activities every day, including off-site trips and shopping. They have a hairdresser, library, exercise gym, and snack store on-site. MIL's own geriatrician was the doctor associated with the facility, by sheer luck. The facility celebrates every holiday, monthly birthdays, and has a regular in-house concert schedule for residents to attend.

The facility is one of the top three most highly-rated facilities in the state, and has one of the very lowest turnover ratios as well.

The hallways are clean and brightly lit; big windows bring in daily sunshine. The building is a moderate hi-rise, rectangular in shape, and both sides enjoy views: either of the San Francisco Bay or the East Bay Hills. The staff is always pleasant, well-mannered and considerate; the management of this non-profit are excellent.

Despite my MIL's passing, we still keep in touch with the facility. She was incredibly happy there; she made many friends - people we didn't know came up to us afterwards to tell us how much they missed her cheerful presence. She loved it when she won at bingo and we were astonished when she became their group's bocce ball champion!

We picked the facility because we had no doubts that their Memory Care unit would be able to take good care of her as her dementia increased. As it turned out, she died before needing such care, but we remain confident that it was a decision that had to be made, and that our choice was the correct one. It says a lot that my spouse feels that if anything happens to me, he will sell the house and enter that same facility himself.

There are many bad facilities, and sadly, the amount charged is not an indication of good care. You cannot tell what a facility is like from just looking at the reception area and getting the 'sales talk'. Doing research into eldercare facilities is time-consuming and tiring - just as it is to carefully select any other professional service - but leaving it to chance and 'the last minute' is likely to cost you, one way or another.

The reason, btw, that I bring up full service facilities, is that almost all of them at times have vacancies in their SCN units. When that happens, they waive their usual interview procedures and will accept convalescing non-residents. So they are a resource that MAY be available if you need them - but you have to know they exist, and call to see if there is an opening.
 
Last edited:
So many older adults are alone. Some people have adult children who estranged from the parents. Some never had kids. I worked in hospitals and it was common for people to have no help at home. The younger ones got sent home anyway. We’d have older adults who refused to leave our hospital and we’d have to fight with them over leaving. That was awful and why I quit that job. But I realized how many of us are alone. It worries me at times because 2 of my 3 adult children don’t care and have gone “no contact” so they certainly can’t be counted on to help. My husband’s son is so self absorbed, he won’t be of help either.
 
I think I posted about this before, but I'll do it again.

After my knee surgery I went to a rehab facility for a few days. This is a small town so it was a combo rehab and nursing home. There were more nursing home folks than people like me in rehab.

I think the place was relatively well run, a bit disorganized but not awful. It was clean, food was good, and nicely decorated. Some of the staff were pretty young and inexperienced, but most tried.

None the less I found it a depressing place, so many people who seemed to me to be just waiting to die. And many could not do many of the basic necessities for themselves. That has to be demoralizing.

I wasn't there long enough to meet many of the patients, but I did talk with a few of them. They were surprisingly friendly and humorous. At one point I was having trouble getting my lunch in the cafeteria. An elderly lady, I am sure she was in her 90s and confined to an electric wheel chair, heard me grumbling and brough me her food. I was both humbled and embarrassed.

Anyway it reinforced my conviction that I don't want to live my last days in a place like that, no matter how well run. When it gets to that point I hope I can find a way to gracefully end things when I want to.
 
1- Many facilities have turned space into rehab units,the reimbursement from whatever insurance is being billed is higher.
2- the pay rate is abysmal, the work is back breaking and the turnover is huge,resulting in short staffing situations which results in more work.
1 facility I worked at,we were forbidden to tell a resident we were working "short". The state,specifically, in my case NY,appears to be clueless about what the staff to resident ratio should be.
 
Book Worm said:
So many older adults are alone. Some people have adult children who estranged from the parents. Some never had kids.
Click to expand...
Very true. Or even if they do have kids, they only had one kid. In the past, people usually had more than 1 kid--sometimes a lot of kids--so there was usually at least one daughter or daughter-in-law (almost never a son) who ended up taking in and taking care of the old person. Things have really changed in that respect
 
You must log in or register to reply here.

Back
Top