Yves here. The caliber of American nursing home cares is yet another American disgrace. Admittedly a big part of the problem is the number of elderly people who need care and can’t get it at home or in the home of a relative. This is turn due, at least in part, to neoliberalism. Some home-bound elderly who can no longer care for themselves well (like prepare meals) could have been handled in an extended family setting, where the burden of caring for them could be spread among several relatives. Neoliberalism promoted the nuclear family so as to foster labor mobility.
Another issue is the lack of serious thought and social support to keep as many of the elderly in their homes as possible. One reader described how in Japan, social workers will visit home-bound old people, even bringing a portable bathtub, and with bathe them and provide other support. Once a week might not be enough for many old people, but for some, 2-4 times a week visits might suffice. And keeping them in their homes helps their sense of well-being and cuts out the overhead costs of a nursing home. But a big reason the US won’t go this way is that it would undermine the (generally lousy) home health care industry.
Regarding the lack of enforcement of staffing levels, even lowly Alabama would inspect nursing homes at least every 18 months or so, would publish staffing levels by type of carer (such as RNs and occupational therapist) and would give full details of deficiencies, like vermin in kitchens (!!!!) and overall scores. I have not checked to see if Rhode Island posts this sort of information, but that sort of negative rating does have an impact and generally leads to an effort to correct the problems.
In other words, while there are no simple answers, I suspect there is a lot the US could do to reduce the extent and severity of the nursing home care gap. But there does not seem to be much interest in doing so.
By Jordan Rau, KFF Health News senior correspondent, whose stories have been published by The New York Times, The Washington Post, NPR, the Los Angeles Times, and dozens of other media outlets. Previously, he worked at daily newspapers, including the Los Angeles Times, Newsday, and the Concord (New Hampshire) Monitor. Originally published at KFF Health News
For hours, John Pernorio repeatedly mashed the call button at his bedside in the Heritage Hills nursing home in Rhode Island. A retired truck driver, he had injured his spine in a fall on the job decades earlier and could no longer walk. The antibiotics he was taking made him need to go to the bathroom frequently. But he could get there only if someone helped him into his wheelchair.
By the time an aide finally responded, he’d been lying in soiled briefs for hours, he said. It happened time and again.
“It was degrading,” said Pernorio, 79. “I spent 21 hours a day in bed.”
Payroll records show that during his stay at Heritage Hills, daily aide staffing levels were 25% below the minimums under state law. The nursing home said it provided high-quality care to all residents. Regardless, it wasn’t in trouble with the state, because Rhode Island does not enforce its staffing rule.
An acute shortage of nurses and aides in the nation’s nearly 15,000 nursing homes is at the root of many of the most disturbing shortfalls in care for the 1.2 million Americans who live in them, including many of the nation’s frailest old people.
They get festering bedsores because they aren’t turned. They lie in feces because no one comes to attend to them. They have devastating falls because no one helps them get around. They are subjected to chemical and physical restraints to sedate and pacify them.
California, Florida, Massachusetts, New York, and Rhode Island have sought to improve nursing home quality by mandating the highest minimum hours of care per resident among states. But an examination of records in those states revealed that putting a law on the books was no guarantee of better staffing. Instead, many nursing homes operated with fewer workers than required, often with the permission of regulators or with no consequences at all.
“Just setting a number doesn’t mean anything if you’re not going to enforce it,” said Mark Miller, former president of the national organization of long-term care ombudsmen, advocates in each state who help residents resolve problems in their nursing homes. “What’s the point?”
Now the Biden administration is trying to guarantee adequate staffing the same way states have, unsuccessfully, for years: with tougher standards. Federal rules issued in April are expected to require 4 out of 5 homes to boost staffing.
The administration’s plan also has some of the same weaknesses that have hampered states. It relies on underfunded health inspectors for enforcement, lacks explicit penalties for violations, and offers broad exemptions for nursing homes in areas with labor shortages. And the administration isn’t providing more money for homes that can’t afford additional employees.
Serious health violations have become more widespread since covid-19 swept through nursing homes, killing more than 170,000 residents and driving employees out the door.
Pay remains so low — nursing assistants earn $19 an hour on average — that homes frequently lose workers to retail stores and fast-food restaurants that pay as well or better and offer jobs that are far less grueling. Average turnover in nursing homes is extraordinarily high: Federal records show half of employees leave their jobs each year.
Even the most passionate nurses and aides are burning out in short-staffed homes because they are stretched too thin to provide the quality care they believe residents deserve. “It was impossible,” said Shirley Lomba, a medication aide from Providence, Rhode Island. She left her job at a nursing home that paid $18.50 an hour for one at an assisted living facility that paid $4 more per hour and involved residents with fewer needs.
The mostly for-profit nursing home industry argues that staffing problems stem from low rates of reimbursement by Medicaid, the program funded by states and the federal government that covers most people in nursing homes. Yet a growing body of research and court evidence shows that owners and investors often extract hefty profits that could be used for care.
Nursing home trade groups have complained about the tougher state standards and have sued to block the new federal standards, which they say are unworkable given how much trouble nursing homes already have filling jobs. “It’s a really tough business right now,” said Mark Parkinson, president and chief executive of one trade group, the American Health Care Association.
And federal enforcement of those rules is still years off. Nursing homes have as long as five years to comply with the new regulations; for some, that means enforcement would fully kick in only at the tail end of a second Biden administration, if the president wins reelection. Former President Donald Trump’s campaign declined to comment on what Trump would do if elected.
Persistent Shortages
Nursing home payroll records submitted to the federal government for the most recent quarter available, October to December 2023, and state regulatory records show that homes in states with tougher standards frequently did not meet them.
In more than two-thirds of nursing homes in New York and more than half of those in Massachusetts, staffing was below the state’s required minimums. Even California, which passed the nation’s first minimum staffing law two decades ago, has not achieved universal compliance with its requirements: at least 3½ hours of care for the average resident each day, including two hours and 24 minutes of care from nursing assistants, who help residents eat and get to the bathroom.
During inspections since 2021, state regulators cited a third of California homes — more than 400 of them — for inadequate staffing. Regulators also granted waivers to 236 homes that said workforce shortages prevented them from recruiting enough nurse aides to meet the state minimum, exempting them from fines as high as $50,000.
In New York, Gov. Kathy Hochul declared an acute labor shortage, which allows homes to petition for reduced or waived fines. The state health department said it had cited more than 400 of the state’s 600-odd homes for understaffing but declined to say how many of them had appealed for leniency.
In Florida, Gov. Ron DeSantis signed legislation in 2022 to loosen the staffing rules for all homes. The law allows homes to count almost any employee who engages with residents, instead of just nurses and aides, toward their overall staffing. Florida also reduced the daily minimum of nurse aide time for each resident by 30 minutes, to two hours.
Now only 1 in 20 Florida nursing homes are staffed below the minimum — but if the former, more rigorous rules were still in place, 4 in 5 homes would not meet them, an analysis of payroll records shows.
“Staffing is the most important part of providing high-quality nursing home care,” said David Stevenson, chair of the health policy department at Vanderbilt University School of Medicine. “It comes down to political will to enforce staffing.”
The Human Toll
There is a yawning gap between law and practice in Rhode Island. In the last three months of 2023, only 12 of 74 homes met the state’s minimum of three hours and 49 minutes of care per resident, including at least two hours and 36 minutes of care from certified nursing assistants, payroll records show. One of the homes below the minimum was Heritage Hills Rehabilitation & Healthcare Center in Smithfield, where Pernorio, president of the Rhode Island Alliance for Retired Americans, went last October after a stint in a hospital.
“From the minute the ambulance took me in there, it was downhill,” he said in an interview.
Sometimes, after waiting an hour, he would telephone the home’s main office for help. A nurse would come, turn off his call light, and walk right back out, and he would push the button again, Pernorio reported in his weekly e-newsletter.
While he praised some workers’ dedication, he said others frequently did not show up for their shifts. He said staff members told him they could earn more flipping hamburgers at McDonald’s than they could cleaning soiled patients in a nursing home.
In a written statement, Heritage Hills did not dispute that its staffing, while higher than that of many homes, was below the minimum under state law.
Heritage Hills said that after Pernorio complained, state inspectors visited the home and did not cite it for violations. “We take every resident concern seriously,” it said in the statement. Pernorio said inspectors never interviewed him after he called in his complaint.
In interviews, residents of other nursing homes in the state and their relatives reported neglect by overwhelmed nurses and aides.
Jason Travers said his 87-year-old father, George, fell on the way to the bathroom because no one answered his call button.
“I think the lunch crew finally came in and saw him on the floor and put him in the bed,” Travers said. His father died in April 2023, four months after he entered the home.
Relatives of Mary DiBiasio, 92, who had a hip fracture, said they once found her sitting on the toilet unattended, hanging on to the grab bar with both hands. “I don’t need to be a medical professional to know you don’t leave somebody hanging off the toilet with a hip fracture,” said her granddaughter Keri Rossi-D’entremont.
When DiBiasio died in January 2022, Rhode Island was preparing to enact a law with nurse and aide staffing requirements higher than anywhere else in the country except Washington, D.C. But Gov. Daniel McKee suspended enforcement, saying the industry was in poor financial shape and nursing homes couldn’t even fill existing jobs. The governor’s executive order noted that several homes had closed because of problems finding workers.
Yet Rhode Island inspectors continue to find serious problems with care. Since January 2023, regulators have found deficiencies of the highest severity, known as immediate jeopardy, at 23 of the state’s 74 nursing homes.
Homes have been cited for failing to get a dialysis patient to treatment and for giving one resident a roommate’s methadone, causing an overdose. They have also been cited for violent behavior by unsupervised residents, including one who shoved pillow stuffing into a resident’s mouth and another who turned a roommate’s oxygen off because it was too noisy. Both the resident who was attacked and the one who lost oxygen died.
Bottom Lines
Even some of the nonprofit nursing homes, which don’t have to pay investors, are having trouble meeting the state minimums — or simply staying open.
Rick Gamache, chief executive of the nonprofit Aldersbridge Communities, which owns Linn Health & Rehabilitation in East Providence, said Rhode Island’s Medicaid program paid too little for the home to keep operating — about $292 per bed, when the daily cost was $411. Aldersbridge closed Linn this summer and converted it into an assisted living facility.
“We’re seeing the collapse of post-acute care in America,” Gamache said.
Many nursing homes are owned by for-profit chains, and some researchers, lawyers, and state authorities argue that they could reinvest more of the money they make into their facilities.
Bannister Center, a Providence nursing home that payroll records show is staffed 10% below the state minimum, is part of Centers Health Care, a New York-based private chain that owns or operates 31 skilled nursing homes, according to Medicare records. Bannister lost $430,524 in 2021, according to a financial statement it filed with Rhode Island regulators.
Last year, the New York attorney general sued the chain’s owners and investors and their relatives, accusing them of improperly siphoning $83 million in Medicaid funds out of their New York nursing homes by paying salaries for “no-show” jobs, profits above what state law allowed, and inflated rents and fees to other companies they owned. For instance, one of those companies, which purported to provide staff to the homes, paid $5 million to the wife of Kenny Rozenberg, the chain’s chief executive, from 2019 to 2021, the lawsuit said.
The defendants argued in court papers that the payments to investors and owners were legal and that the state could not prove they were Medicaid funds. They have asked for much of the lawsuit to be dismissed.
Jeff Jacomowitz, a Centers Health Care spokesperson, declined to answer questions about Bannister, Centers’ operations, or the chain’s owners.
Miller, the District of Columbia’s long-term care ombudsman, said many nursing home owners could pay better wages if they didn’t demand such high profits. In D.C., 7 in 10 nursing homes meet minimum standards, payroll records show.
“There’s no staffing shortage — there’s a shortage of good-paying jobs,” he said. “I’ve been doing this since 1984 and they’ve been going broke all the time. If it really is that bad of an investment, there wouldn’t be any nursing homes left.”
The new federal rules call for a minimum of three hours and 29 minutes of care each day per resident, including two hours and 27 minutes from nurse aides and 33 minutes from registered nurses, and an RN on-site at all times.
Homes in areas with worker shortages can apply to be exempted from the rules. Dora Hughes, acting chief medical officer for the U.S. Centers for Medicare & Medicaid Services, said in a statement that those waivers would be “time-limited” and that having a clear national staffing minimum “will facilitate strengthened oversight and enforcement.”
David Grabowski, a health policy professor at Harvard Medical School, said federal health authorities have a “terrible” track record of policing nursing homes. “If they don’t enforce this,” he said, “I don’t imagine it’s going to really move the needle a lot.”
Methodology for Analysis of Nursing Home Staffing
The KFF Health News data analysis focused on five states with the most rigorous staffing requirements: California, Florida, Massachusetts, New York, and Rhode Island.
To determine staffing levels, the analysis used the daily payroll journals that each nursing home is required to submit to the federal government. These publicly available records include the number of hours each category of nursing home employee, including registered nurses and certified nursing assistants, worked each day and the number of residents in each home. We used the most recent data, which included a combined 1.3 million records covering the final three months of 2023.
We calculated staffing levels by following each state’s rules, which specify which occupations are counted and what minimums homes must meet. The analysis differed for each state. Massachusetts, for instance, has a separate requirement for the minimum number of hours of care registered nurses must provide each day.
In California, we used state enforcement action records to identify homes that had been fined for not meeting its law. We also tallied how many California homes had been granted waivers from the law because they couldn’t find enough workers to hire.
For each state and Washington, D.C., we calculated what proportion of homes complied with state or district law. We shared our conclusions with each state’s nursing home regulatory agency and gave them an opportunity to respond.
This analysis was performed by senior correspondent Jordan Rau and data editor Holly K. Hacker.
26 comments
Comments are closed.
My grandmother was in an assisted living place for a time. Her “diabetic diet” that she paid extra for? Smaller portions and no dessert. They forbade her from administering her own (generic) medications on her schedule. They failed to inject her insulin properly. Fortunately, she was able to leave.
My great-grandmother (unrelated) also had diabetes and was in a nursing home. She could not eat unassisted. Staff simply left the food for her. It helped hasten her death.
If you have to put someone in a nursing/assisted living home, the best thing I can say is shop around. There is great, good, horrible, and all in between. And it doesn’t always correlate to price.
A family friend age 68 and bed bound from a severe fall is stuck in Parkhouse Nursing Center- the old Montgomery County, PA county owned home until Josh Shapiro and friends ran a great facility i to the ground and finally then had an excuse tosell it as Attorney General.
The current owners are stripping it bare- the food is inedible. My friend would be dead if I didn’t bring her food. She sits for hours in feces because there are often only 2 aides on the floor for 35 patients- mostly all bedbound. The staff mostly do their best and most are very kind but utterly overworked. They leave constantly because the pay is terrible and working conditions are so dreadful.
Meanwhile the owner is rumored to be conniving to sell off some of the property to build expensive homes and keeps forcing cuts to the facility. During this recent heat wave they had the place so hot people were dropping, and at their own expense had to be shipped to the hospital. I had to cut my visits short because the heat was so oppressive.
My friend is getting little to no care and no rehab because medicare says she should have progressed more. Well she barely got any rehab at all so how could she have progressed??? She can’t even get a doctor to evaluate her hip fractures and why is she, is 2 yrs out from her fall, in severe pain and unable to put weight on and stand. Her life is a living death. A brilliant highly educated professional woman with no living family able to help her fight this is reduced to a living hell. They refuse to listen to me as I am not a blood relative.
I told my husband if one or both of us ever get in that position – before they ship us off to one of these charnel houses we will save pills and kill ourselves. Sorry for the rant- some days I just come home and scream
Parkhouse is no longer a County Home if that wasn’t clear. My friend has money and is on Medicare NOT medicaid but also needs dialysis as her transplant from the 1970’s finally failed a few months before her fall. Bedbound dialysis beds are few and far between and she had to go where there was an opening. Lucky it was close to me. What we do to our older people when things go wrong is APPALLING.
Thank you. Medicare does not pay for extended nursing home care. Medicaid does pay for some care, including medical care, but only if the person has no or almost no financial assets. (Easy to assess the financial limits online.) Medicaid is for the financially indigent.
What you describe sounds very like a legal financial scam to convert a decent middle class care home into an earlier version of the late 19th century and early 20th century poor farm. Lemme tell ya, nobody, and I mean nobody back then wanted to end up in the “poor farm”. Don’t ask me how I know.
Yes, myself and my friend are well aware Medicare does not pay for long term care. That wasn’t the point of my comment. It does however pay for dialysis and also for medical care such as my friend’s hip fractures and for a limited period of rehab after surgery and injury. The point was she is getting stymied by the facility- Parkhouse Nursing and rehab Center 8n Royersford, PA in trying to GET to medical care. She has made appointments with Drs, but the facility will NOT coordinate the transport needed to get her, a bedbound patient who cannot transfer alone to a wheelchair, TO her Dr appt. She is not allowed to arrange her own ambulance transfer. If I could get her to a wheelchair myself I would be allowed to take her but it’s impossible for me to physically do that safely.
I reiterate, she is a highly educated and brilliant woman perfectly in her right mind and working a demanding job up until her injury yet is treated like she is senile there.
Moreover, as I stated she was supposed to be there for rehab of her injuries only- and Medicare pays for that. However whilst there she received 10 minutes of ‘rehab’ maybe once every two weeks. I witnessed this personally.
And when she didn’t ‘progress’ Medicare shut down her ‘rehab’. No one with two shattered hips is ever going to progress with a 10 min rehab once every two weeks. I would bet my house the facility bilked Medicare saying she was getting the intense rehab she was supposed to get.
No one listens to her or me I am afraid to do more and have them take it out on her in some way. She is getting her attorney involved and he has found her an elder care attorney – you are so right that’s what is needed Flora!
But being in this facility regularly there are so many poorer but bot destitute elderly who would never have the financial recourse to hire an attorney. I assume we will shortly be doing what Canada is now doing and encouraging old or sick people to choose what is basically a government run euthanasia scheme.
and adding: it might be worth your friend’s money and while to consult a very good eldercare attorney in their area specializing in the Medicare and Medicaid intracacies. Really. / best.
I tell Phyllis and the kids that if I end up needing “assisted care,” to sit me out in the back yard in my beach chair and keep the ‘medication’ coming until I stop complaining.
This comes from watching both of Phyl’s parents dwindling away in an “assisted living,” apartment building. Her Mom had Dementia for the last year and was a cautionary tale, while her Dad was warehoused along with his wife almost as an afterthought. He visibly gave up and died, before her. While they were there, the place, originally established by a family group, was sold off to a conglomerate. The standard of care noticeably dropped off after that change of administration.
Phyl’s Dad remarked on the deterioration in the quality of the food offered the residents after the change over. Before, the food was, according to him, (all this from memory,) “Bearable. They would also fix stuff differently for me. I got to know the cooks.” After the switch in management, he said that the food became, “Low grade cafeteria food. Take it or leave it was the new rule.”
This was not at all cheap. A hefty profit was made by the original owners and later by the conglomerate.
This couple had four children.
Phyl and I were the “poor relations” in the hierarchy. Living ‘on the edge’ of poverty much of the time, we had little in the way of physical resources to offer them.
One was a working class who had evolved into middle management and lived fairly comfortably. He helped when he could.
The other two were in the low millionaire realms and pushed for the warehousing of the elders. Their ‘solutions’ to the crisis involved “offshoring” the hard bits. Thus, the “assisted living” facility. “End of Life” issues were financialized. Classic Neo-liberalism.
So, my takeaway from this, at least in America, is to avoid the “assisted living” industry like the plague and do for yourself.
Finally, to interject a little ‘light’ politics into the mix; when it comes time to “go,” don’t just follow Neo-liberal Rule #2 and “Go die.” Be a bit creative and ‘take’ a CEO of an assisted living complex or a for profit hospital with you. You’ll be glad you did.
and it’s because of private equity. nursing homes were actually what got me into private equity in the first place, i was on r/nursing during covid and heard a nurse who used to do bookkeeping explain how private equity uses all those shell companies and limited liability to underfund and understaff hospitals while putting all the money into the pockets of billionaires. this then puts undue amounts of stress on hospital staff. nurses obviously, but also cleaning staff, techs, and other auxilliary staff. which both lessens the quality of care and pushes nurses towards other jobs, as this article explained. i enjoyed brendan ballou’s plunder, which featured a few case studies.
most recently on my radar, i’ve been following the steward health care saga. steward was bought out by cerberus capital, loaded up with junk fees, staffing ratios were cut because staff was one of the biggest expenses, and all the money went to the shareholders. the company filed for bankrupcy, and massachusetts (my home state and where several of steward’s facilities are located) is refusing to bail them out. there are also some fascinating allegations of steward spending more money on surveillance operations to shut down any criticism of them instead of paying their employees. massachusetts DA is currently investigating them.
the solution is pretty obviously public healthcare. the private equity run hospitals keep begging the government for money because they are an essential service, but giving them the money just encourages them to keep running these exploitative practices. states are wisening up as seen by massachusetts’s crackdown on steward, but it becomes a matter of enacting further policies to prevent this from happening again.
Thanks very much for this post. My family was very, very lucky to find a place in a church affiliated senior care home for a parent. There was more consideration at work there than the financial bottom line.
What was it that Shakespeare guy said:
“There are more things in heaven and earth, Horatio, than are drempt of in your philosophy.”
Where Horiatio was/is a Wall St goomba. / :)
I worked in nursing homes, off and on, for years. All were bad, even the ritzy ones, and some were appalling. If you need help with a resident’s care, I would talk to the DON (director of nursing) who bosses the nurses, or the building manager. I am mostly familiar with PA. A unit, here, has around 40 pts per nurse and 4 nurses aides–on a good day. On a bad day, it could be 80 patients if a nurse doesn’t show and often short aides, of course. I worked down south awhile and was shocked to be routinely assigned 60 patients, and got stuck with 120 when the other nurse went home sick. Nursing homes are always short on supplies, equipment, blankets, ad even pharmaceuticals. Forget about inspectors–they only look at nursing notes in hope of taking someone’s license. I tried to get an inspector to look at a patient stuck to their soiled sheets. Not interested! For my trouble, I was screamed at and threatened.
Standard operating procedure here in South Florida.
Overworked nurses and aides The DON avoid relatives of patients like the plague. Avoid relatives at all costs. Corporate sets strict guidelines to the DON or they get terminated.
Well, i think that the longer range solution, lies in a reconfiguration in how we deal with the elderly.
Society, i think, can keep the elderly inside the community for a lot longer, at home, especially. Children should have the capability to mix with the elderly.
i don’t mean retrofitting a neolithic culture, but the elderly can play a part in the community and it would be healthy for all.
Seems light years away, but may be the financial burden of nursing homes, might force society to generate new solutions.
er, um, “how we deal with the elderly.” Uh,,, are the elderly something to be dealt with? Are older citizens merely a ‘something’ to be ‘dealt’ with? / inquiring mind want to know. As the saying goes. / ;)
I am talking about people unable to care for themselves, partly or fully.
Thanks. That makes more sense. And in that case it’s not necessarily just the elderly.
Very accurate and makes my blood boil, but honestly, identical pieces were linked here five and ten years ago. As a hospice social worker from 2011-2016 I saw it all, the dedicated wonderful staff and the ones who were too burned out to give a f*ck.
But they were all caught up in a system much larger than the industry: here in the land of plenty we throw pennies to “the undeserving poor” to feel virtuous and to establish that we are not them—not to provide adequately for them. If we we did that, then how would we know we are not them? Plus ça change.
The only time I had even a remote hope of things changing was when Bernie ran for prez (oh, and for about a minute in 2008 before Obama showed his true colors).
Many here are done with Bernie because in the end he wasn’t willing to go for the jugular, but let’s not forget DWS et al in 2016 and the night of the long knives in 2020.
People I know are upset about the debate and its aftermath and seem to take offense that I am not exercised. “Say, how’s about those Democrats,” I quipped to a friend, who replied reprovingly, “I don’t think it’s funny.”
Me neither, but I was plenty exercised in 2016 and then just profoundly depressed in 2020. I really don’t have a dog in this fight so why should I be all doom and gloom?
I am struggling to determine if Bernie is a very clever pol who values self preservation above anything else or a completely naive idiot. Witness his recent ringing endorsement of Biden. Who asked him to do this? Amazing. And not to mention AOC as well. I can only interpret thus to meam a ringing endorsement of Bidens forever war policy.
I was an aide for a few years. It’s incredibly difficult work for terrible pay, and residents pay through the nose for it. It’s a massive grift.
Does anyone know when, how and by whom the legislation allowing Medicare and Medicaid to go after people’s private property was passed?
Medicaid, not Medicare. But I don’t have the answer to your question.
Thanks Yves.
Medicaid took everything you owned from the beginning. We ended up on Medicaid in 1971, when my husband got cancer. We had to sign over the car–didn’t own property. Welfare actually did come and snoop through our house, now and then. I had Medicaid, briefly, in 1992, and that was no longer true. At that time, you could get just Medicaid, not welfare, if your income dipped below $600 a month. Clinton pretty much destroyed Medicaid and welfare. When Mom ended up on it in the 2000s, they were back to taking everything if they went in a nursing home. Obamacare improved on that by taking everything, period, not just if you went in a home.
A rational solution one seldom hears mentioned is the ethical suicide parlor as described in Kurt Vonnegut, Jr.’s 1968 short story Welcome to the Monkey House.
I’m fairly sure that Vonnegut got that idea from Robert W Chambers’ story “The Repairer of Reputations.” From the collection “The King in Yellow.”
The passage describing how the “problem” was seen in 1920, [written in 1895, date of publication.]
“The Governor was finishing his reply to the short speech of the Surgeon-General. I heard him say: “The laws prohibiting suicide and providing punishment for any attempt at self-destruction have been repealed. The Government has seen fit to acknowledge the right of man to end an existence which may have become intolerable to him, through physical suffering or mental despair. It is believed that the community will be benefited by the removal of such people from their midst. Since the passage of this law, the number of suicides in the United States has not increased. Now that the Government has determined to establish a Lethal Chamber in every city, town and village in the country, it remains to be seen whether or not that class of human creatures from whose desponding ranks new victims of self-destruction fall daily will accept the relief thus provided.” He paused, and turned to the white Lethal Chamber. The silence in the street was absolute. “There a painless death awaits him who can no longer bear the sorrows of this life. If death is welcome let him seek it there.” Then quickly turning to the military aid of the President’s household, he said, “I declare the Lethal Chamber open,” and again facing the vast crowd he cried in a clear voice: “Citizens of New York and of the United States of America, through me the Government declares the Lethal Chamber to be open.”
Why is the situation here in Germany no different? As a specialist in geriatric care, two of me are responsible for 90 people at night. I was of the opinion that it would be better in the USA.
A place in a nursing home here costs €3500 a month. Since the average pension is 1500 € and is paid by the care insurance fund depending on the level of care (300-1000 €), the social welfare office pays the rest. However, if you have sold a house and something 10 years ago, this will be reversed. My opinion, there is money for illegals, but for old people, those who have provided wealth for the current generation, there is not even a clean diaper.
Beste Grüße Mirko