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Assisted Living Facility Evicts Elderly - 8/11/2008 6:11:33 PM   
candystripper


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quote:

A nationwide chain of assisted living facilities promised elderly residents that if money ran out, they could pay for services with Medicaid. A change in policy by the company, Assisted Living Concepts, means Medicaid is no longer accepted and those who cannot pay are being evicted.


http://www.npr.org/templates/story/story.php?storyId=93260987&ft=1&f=100
 
This is a complex and difficult issue.  Years ago, I was deeply involved in the regulation of what are known as 'continuing care facilties' in Florida.  The general concept is that an elderly person or couple would release all their assets to the facility and in some cases pay a monthly fee, and in return they would be cared for, for their lifetimes, at whetever level they needed...assisted living or the attached nursing home. 
 
After 15 or so years' experience, it became apparent many of the facilites had not adequately planned for the actual mobidity and delayed mortality of their residents.  Many more residents lingered on in the expensive nursing facility far longer than had been anticipated.  Equally 'bad', many mainatined sufficient health far longer than expected to occupy the assisted living facility -- preventing the facility from reselling those spots and receiving new cash infusions.  The lack of new cash infusions led to defaults or likely defaults on the ground leases and loans, and the banks were circling like vultures. 
 
Approximately half the facilties in the state were in this financial condition, and yet little was done to prevent new residents from unknowingly turning over their assets and entering precarious financially troubled facilities.
 
When a nursing home or assisted living facility was closed, quite literally residents were turned out -- wheeled out if necessary -- onto the street, staff sent home, etc.  Death rates and morbidity rates soared during such events.
 
Yet the alternatives for the elderly who cannot live alone are so few.  Rare is the family able and willing to take the elderly resident in, and often this is only a temporary solution.  Despite the fact that home nursing is less expensive than admittance to a nursing home, Medicaid and most insurers continue to refuse to pay for home nursing -- which might keep many elderly in their homes for lengthy periods, even until death in some cases. 
 
Long term care insurance is so expensive, so poorly marketed and so rarely considered by consumers it is not even a panacea for a few -- it is a pipe dream for a tiny number of the elderly population.
 
These are our parents....these are human beings...these are among our most vulnerable population.  Something must be done to raise Medicaid reimbursemets to nursing homes to realistic levels and to add home nursing to Medicaid's services.  Other solutions must also be found.  Where proper, criminal charges must be brought and those who profitted at the front end must sit in prison for fraud where it can be proven.
 
I don't know if venaility or criminality is involved in the case discussed in the link.  I only know it happens....as does poor planning, poor regulation, and generally poor response by government to the needs of this segment of our population. 
 
Any thoughts?
 
candystripper

< Message edited by candystripper -- 8/11/2008 6:35:54 PM >
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RE: Assisten Living Facility Evicts Elderly - 8/11/2008 6:24:15 PM   
Gwynvyd


Posts: 4949
Status: offline 		Bless you for posting this.

I was weekend, and night shift for a ALF I lived next to here in Fla. We had 16 beds, and we were always understaffed, and very little money was put back into the facility or for the residents.

I came back from vacation and the facility had been sold, and I was locked out of my job. I had gained the trust of all of the residents.. and I missed them dearly. I would go over and visit.. but it was hard seeing the facility get even worse, and the residents so unhappy.

It is a huge problem esp here in Fla. No one ever plans on needing elder care. No one saves for it.. or realizes just *how* expensive it is. If you have not done so check out the insurance for yourself, and your realitives. It is hard keeping family members who are aging and ill in the home because *everyone* must work and chip in generaly. Many do not have the training, or the fortitude to care for the ill and elderly. God bless those who do it.

Gwyn

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RE: Assisten Living Facility Evicts Elderly - 8/11/2008 6:57:49 PM   
candystripper


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Status: offline 		Another aspect of the problem arises from the legal profession.  I have very mixed feelings about ads by personal injury lawyers soliciting cases against nursing homes for abuse and neglect.  On the one hand, abuse and neglect certainly occur and must be punished, civilly if not criminally. 
 
We had a case in Florida where a nursing home resident died of ant bites...slowly, over a matter of months.  Imagine the cruelty of those charged with her care to allow this to happen. 
 
On the other hand, most nursing home residents are paying the nursing home solely through their eligibility for Medicaid...often artifically engineered by yet another thriving branch of the legal profession who distribute assets in such a way as to put them beyond the reach of the elderly person for purposes of Medicaid eligibity.  Sadly, this is often done in an effort to preserve an estate for the next generation or even for such trivialities as providing for burial expenses (my apologies to those deeply attached to expensive funerals).
 
Medicaid pays so little, an aid can make more working at a fast food resturant as an entry level employee.  Even skilled staff services are very poorly recompensed, and at least in Florida, it is common practice to audit the books of the home on an annual basis with an eye towards disallowing previously-made reimbursements.  Claw-backs can be huge, devastating to the facility and utterly unpredictable. 
 
In the environment, nursing home adminsitrators, who must be licensed in Florida and face civil and criminal liability on a personal basis, must attempt to recruit, train and retain staff to perform tasks such as bathing, changing diapers, montitoring the senile and psychotic, cleaning the facility, etc.  Yes, there have been regulations requiring background checks but not every predator has a criminal record and not every criminal record is going to correctly appear in a background report.  So abuse does occur as well as neglect....much of which could be avoided if reimbursement levels were raised so that nursing homes could better compete for staff.
 
In Florida, last I knew, Medicaid funds gobbled up fully one third of the state's budget and these general revenues are matched by federal funds.  When a nursing home is sued and loses or settles a case, its insurer eiher raises the home's rates or drops it as an insured -- which often leads to closure of the facility. 
 
The personal injury lawyers who target this industry are fully aware of the consequences of what they do, but the law suits are so lucrative more and more lawyers are attracted to it. 
 
With reluctance, I would support some form of legislation aimed at controlling both the personal injury bar and the insurers involved, so that nursing homes are less financially stressed by these suits....but in exchange I would want to see criminal charges laid against serious absusers at the very least.
 
candystripper
 
 

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RE: Assisted Living Facility Evicts Elderly - 8/11/2008 7:20:05 PM   
TheHeretic


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Joined: 3/25/2007
From: California, USA
Status: offline 		        This is a very good, hard question, Candy.  Thanks for posting it.

       Yeah.  And it's only going to get worse as the baby-boomers become the geriatric generation. 

      I see two big elements to the spike in cost.  The first is technology, and the cost of bringing that into play, turning the elderly into energizer bunnies.  A diabetic used to need little dip-strips for their pee.  Now, it's high tech electronics.  A pile of pillows to prop was cheap, hospital beds cost thousands.  Countless medications, and the tests to make sure the medications aren't interacting badly.

      Then we have the social aspect of families expecting their elderly relatives to be someone else's problem.  When a situation becomes inconvenient, or hard, it's off to the home.  Then, when the situation becomes impossible, the money has run out, and the government needs to do something.  Pure selfish, short-term thinking

      Among the gone and going in my family, only one spent any length of time in long-term care.  7 months is the 2nd longest.  Alzheimer's, cancer, stroke, they all came home, and stayed there as long as possible.  All had what they needed left, when it really was time.  The exception lives today in a really nice little place, owned and operated by the church she has belonged to for over 70 years.

      I once made a very dark joke to my father, about finding him a nice iceberg.  He looked me square in the eye, and said "damn right, you better."

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RE: Assisted Living Facility Evicts Elderly - 8/11/2008 8:10:37 PM   
nejisty


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Joined: 7/11/2006
Status: offline 		  I have worked in both nursing and assisted living homes.  My responsibility now is taking care of my Mother in law in my home.  The companies that started opening nursing and assisted living homes did so thinking they were going to tap into all the money the elderly have worked their whole lives to save.  They just did not forsee all the other companies and people wanting to tap into that same resource.  The elderly are just like any other business.  Look at the price of care, meds, Drs visits are over 100 bucks just for 5 minutes. 
  It would cost my MIL 3 grand a month in an assisted living facility and that does not include any personal items she may need, ie: Depends, meds, shampoo, deoderant, transportation to Drs, haircuts, etc.  My MIL is considered low end care.  Now a nursing home would be more expensive just because they have more skilled care.  For nursing home insurance it would cost my MIL the same 3 grand a month.  She does not even get that much money a month.  Her life savings would be gone in  a year.  Then it would be state assist.  If she got lucky.   
What is the answer?   I don't know because greed has already eliminated most of them.     nejisty

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RE: Assisted Living Facility Evicts Elderly - 8/11/2008 8:56:45 PM   
pahunkboy


Posts: 33061
Joined: 2/26/2006
From: Central Pennsylvania
Status: offline 		http://www.npr.org/templates/rundowns/rundown.php?prgId=2   <--  the show is called "All things considered".  It is on NPR- you can listen to it online.

Great show. It really is better then TV.

As to aging.   No one has the answeres.  Now as to the report- these places lobbied to come into xyz state- then once in that state- the business sold and new owners then CHANGED the policy to which the company had agreed to.  

There-in lies the rub. 

I think we need to learn from this when ever xyz company is lobbying- for anything!


=> solution,

Kill the attorneys- kill the lobbyiests.  they are ruining this country. 


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RE: Assisted Living Facility Evicts Elderly - 8/11/2008 10:18:08 PM   
DarkSteven


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Status: offline 		TheHeretic, there's a third element, and it's purely financial.

Our economy is undergoing a transition, towards businesses that thrive on risk.  That are built to prosper today and the hell with tomorrow.

It is way too easy for a business to make a lifetime commitment and then later announce bankruptcy.  Once it does, its previous commitment is null and void.  If the company officers took huge salaries and made horrible decisions and drove the company to BK - too bad.

Rates of return that were adequate previously are no longer sufficient.  Companies have striven for higher rates while misstating the resultant risks.  When the bubble pops - get a government bailout.

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RE: Assisted Living Facility Evicts Elderly - 8/12/2008 12:51:43 AM   
candystripper


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Status: offline 		DarkSteven, I could not agree more.  And this is precisely the sort of conduct I would class as 'fraud' under the penal law....march everyone from the banker to the financial planner off to prision, and this crap will stop.
 
Yes, there was some element of surprise...back in the day.  But we certainly know now that people live longer in stable, well appointed facilities with adequate assisted living and attached nursing homes.  We know that as they decline in health they can be sustained longer, but only at a much higher price.  We grow closer and closer to a cure for Alzheimers and other geriatic illnesses....these people are 'naughtily' going to gobble up resources during their extended lifespans.  There is no excuse now for failing to plan for these costs......nor is is proper to require people to be asset-free after entering into a contract in which the lifetime promise of care is rendered illusory by bankruptcy laws which are amenable to change.
 
candystripper

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RE: Assisted Living Facility Evicts Elderly - 8/12/2008 1:15:31 AM   
Lockit


Posts: 11292
Joined: 5/7/2007
Status: offline 		They wanted to put my son in a nursing home.  No facility in the state would take him.  Too young, too healthy except for his brain, needs too much care and medication to control him makes him hallucinate, so they would then have to strap him to a bed for the rest of his life at at 22 years old... that would have been a long time.  Medicaid would rather pay huge amounts to a facility, rather than pay me just enough to get by to keep him at home.  I could get seven days a year of him in a hospital if I wanted to take a break and I could get no relief other than that. 

What happens when I can no longer do this and that time is coming faster than I am comfortable with?  They told me that if I let him be placed, medicaid would be paying and therefore would have say over his life and all that would be done.

The whole system is off.  We need other solutions.  Yet those that could do something about it, won't need to worry about it in their elder years and don't care.  I lived in a building for the elderly and disabled.  There I saw more pain than anywhere else I ever experienced.  The men had the hardest times of it.  It was depressing and one step away from a nursing home and yet they clung to that place, knowing what came next if they were not lucky enough to die in their sleep.  They felt forgotten and many had lived lives that were amazing in family, career and experience.  Families were too busy, friends were all dying... no one cared and they knew it.  You could walk past a room and hear the crying and watch as some slowly died in their pain.

These people cannot fight for themselves... cannot go out and create more income and spend all they had on health care, often going without food, even with food stamps some got... in the form of maybe $13. a month because they had some income.  Watching someone walk in the snow, with their oxygen tanks, weak and in pain and waiting to die was something I will never forget.

I used to have a patch that said something like this... A nation that forgets those that served it, would soon be forgotten.  (Sorry, can't remember it exactly)  We are a sad, sad people and place to forget or ignore... but we might not think of that, until we are living it. No one gets out alive... just hope you die quick, because otherwise... no matter how you prepared, something might whittle away at your savings, etc. and you might be living what no one should have to live.

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RE: Assisted Living Facility Evicts Elderly - 8/12/2008 1:52:04 AM   
Hippiekinkster


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Status: offline 		http://www.thefarm.org/charities/roc.html

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RE: Assisted Living Facility Evicts Elderly - 8/12/2008 4:25:50 AM   
Vendaval


Posts: 10297
Joined: 1/15/2005
Status: offline 		This is one of the most critical issues facing America today.
 
One local resource I was referred to is a lawyer who specializes in elder law.  The woman is amazing!  Her Web-site has links to other resources throughout the US.

http://www.ca-elderlaw.com/

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RE: Assisted Living Facility Evicts Elderly - 8/12/2008 7:26:21 AM   
pahunkboy


Posts: 33061
Joined: 2/26/2006
From: Central Pennsylvania
Status: offline
quote:

ORIGINAL: DarkSteven

TheHeretic, there's a third element, and it's purely financial.

Our economy is undergoing a transition, towards businesses that thrive on risk.  That are built to prosper today and the hell with tomorrow.

It is way too easy for a business to make a lifetime commitment and then later announce bankruptcy.  Once it does, its previous commitment is null and void.  If the company officers took huge salaries and made horrible decisions and drove the company to BK - too bad.

Rates of return that were adequate previously are no longer sufficient.  Companies have striven for higher rates while misstating the resultant risks.  When the bubble pops - get a government bailout.


Bottem line:   the aged and weak have a duty to die in a timely manner.  Timely for finance that is.

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RE: Assisted Living Facility Evicts Elderly - 8/12/2008 9:19:22 AM   
DominaYork


Posts: 49
Joined: 7/19/2008
Status: offline 		Sadly, there aren't any easy answers. Today's life doesn't make it easy for families to care for their ill relations, husband and I have been in that position several times. He had to take family leave to care for his dying mother. When she dared to live longer than the offered time he lost his job. We're going through this all again with his father this time and the help and guidance of an elder care nurse consultant and an elder care lawyer has made all this somewhat easier.

It would be great if you could wave a wand and know what to do. To live in a community where everyone looks out for everyone else. Living longer is a good thing, I'm grateful for it but the care side of longer lifespans hasn't caught up with medical science. The way things were done was made for care for short term. You fell ill, had to go into nursing care and generally didn't last much longer. With the baby boomers adding on birthdays, solutions will have to be found.

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