I often find myself wondering, while visiting a nursing home, how our healthcare system for the elderly ended up this way. I have become very good at ignoring the smells, sounds, cries and staff’s freguent insensitivities and focusing on my client. I also have to help the family with the emotional, physical, psychological and financial burden.
Let me say, I have never met a nursing home that is user friendly to the family. There is much lip service at admission but the family and advocate, if involved, have to forge the relationship. I would like to think, there is a meeting of the minds, but there is not. It is a treaty, of sorts, and the family has to be vigilant that the institution lives up to their end. There are smiles and pleasant talk but it doesn’t always translate into appropriate action.
This all said, and probably not news to anyone, I ask how did we get here, why is it allowed and why do we ignore it?
The obvious: People are living longer with complicated medical problems. Many are unable to care for themselves. Families struggle to care for an aging member, while keeping an ailing person home is not often, a viable solution. The cost for an aide is exorbitant. Our culture is based on a singular family unit, everyone lives in their own house or apartment. We Americans are fiercely independent and that translates to our living situations. Nobody ever wants to give up that freedom of their own house even when it is not medically safe. Nobody wants to give up that control.
Most of us have never experienced institutional life, of being one amongst many. In these situations, individual needs are less important while the running of the institution is paramount. The systems in place at each facility are the base by which all must adhere to. It has to be this way to maintain safety, security and minimize liability.
Elder care is a booming business. Nursing homes are being bought up by corporations and profits are rising. It is difficult to find a locally owned institution with ties to the community. Many administrations are based out of state resulting in longer times to resolve conflicts or implement new policies. In Massachusetts, the monthly cost is between $6500.00-11,000.00. Some people augment the cost with long term life insurance. These policies cover between 40-60% and the rest is out of pocket. Life savings are drained and then Medicaid will pay, which is not universally accepted.
It is becoming more difficult to find a long term available bed in a nursing home. They are filled to the brim. How can this model be sustained ?
One of my thoughts is, if Accountable Care Organizations (ACO) or medical home work, it may be a jumping off point for change. How great would it be to have a community multidisciplinary health team overseeing nursing homes? Imagine, when a center patient needs to go to a nursing home, each ACO has an affiliated group of homes. This would mean that the care team would be the same. It would eliminate a change in care plan, medications and medical staff. Relationships and trust would already established with the patient as well as the family.
The question is can it be economically feasible? I would suggest in order to begin Medicare/Medicaid support full reimbursement to an ACO and medical homes that include nursing homes as an integral part of their system. This approach currently exists in insurance companies that offer policies with the three tier reimbursement concepts. This could also apply to skilled nursing reimbursements for rehabilitation through Medicare (Medicare does not pay for any long term care).
No doubt, many questions remain. Something has to change in elder care and nursing homes. It is a model that continually reminds me of something out of a Dickens novel. Time to start thinking about change.