Started By
Message

JBE, the COVID After Action Report (AAR) and the case against Nursing Homes...

Posted on 4/18/20 at 12:02 pm
Posted by GFunk
Denham Springs
Member since Feb 2011
14966 posts
Posted on 4/18/20 at 12:02 pm
It's readily apparent that Nursing Homes are huge liabilities as we look back from the plateau we currently seem to be experiencing here in Louisiana. They house huge concentrations of at-risk populations and even mild outbreaks of diseases, viruses and infections that as a whole our society has a good handle on can decimate the folks crowded into them during the end stages of their lives.

I had an octogenarian (person in their 80's) Grandmother who became a nonagenarian (person in their 90's) when she had to briefly stay in a nursing home after a spill in her home and a transition to stay with my Mother two years back.

Until her final week of life, she remained mentally sharp as a tack. Could remember and recite poems she wrote as a child in rural Mississippi, tell stories about her neighbors and family growing up in the Rural South during the Depression, talk to you about what Trump said on TV that day and had an uncanny ability to kick the tires and translate to you her green thumb in the flower beds while watching you do the work LOL.

This woman wouldn't have been best served in a Nursing Home. Thankfully she had multiple generations of her family that cared for her at the end that spent quality time with her. Yet in Louisiana, the Nursing Home Lobby spent $6,000,000.00 over the last 15 years supporting campaigns of candidates that helped spike reform legislation like SB 357 back in 2018 which would help divert more funding to Louisiana Home Health Care options for Seniors.

To think about how powerful this Lobby and the Special Interest Group it represents is, think about this:

For every Medicaid dollar spent in Louisiana on the elderly and physically disabled, 77 cents goes to a Nursing Home. This is while Home-Based care is cheaper and more popular by a large margin.

In the last 10 years, Nursing Home Rates in Louisiana have risen over 50% (54 to be exact as of 2018). While Home Health Care averages between approximately $13,500 and $33,100 annually for the elderly and physically disabled, nursing homes care costs the state $47,300+ per year per resident.

As we look at the grim statistics and rates of fatality for our most at-risk population and hear horror stories from Nursing Home Facilities across the State, including the Tragic Stats from Lambeth House in New Orleans alone, at what point do we admit that whether we are talking about quality of life, dignity, family and personal choice, good government, fiscal responsibility or reasons of public health...Nursing Homes should only be part of the answer for elderly and physical disability care. Not the only one.

...and before we talk partisanship, solidly conservative politicos from places like Houma, Livingston Parish and Governor's including both Bobby Jindal and JBE have accepted multiple millions in contributions from the Nursing Home Lobby. It's not a partisan issue.

We need to do better.
Posted by LSUJML
BR
Member since May 2008
45585 posts
Posted on 4/18/20 at 12:20 pm to
What chaps my arse is how the nursing home owners also own the local hospice, physical therapy group, mobile x ray company....
We busted them a few months ago for charging Humana around 600.00 for speech therapy
My Grandpa complained about sinus drip & it making it hard to swallow
They wrote orders for a speech therapist to watch him eat but from a distance so he wouldn’t know they were watching because if you know someone is watching you act different

He pays 200.00 a day & they still scam the system

ETA
If they paid the workers a decent wage & they cared about their jobs & wanted to be there it would be one thing but that’s not the case (at least in our area)
This post was edited on 4/18/20 at 12:23 pm
Posted by doubleb
Baton Rouge
Member since Aug 2006
36049 posts
Posted on 4/18/20 at 12:41 pm to
Excellent analysis.
Thus situation has nothing to do with the virus, but it is timely because of how these homes designed to care for the elderly have become havens for disease.

La. Nursing home rules make the nursing home business very lucrative. There’s big money people supporting governors and legislators to keep the status quo which is designed to put more folks in a home instead of at home.

Again, great analysis.
Posted by RedFoxx
New Orleans, LA
Member since Jan 2009
6005 posts
Posted on 4/18/20 at 12:49 pm to
Its the politicians in Louisiana they don't give a shite about the elderly or any of the citizens. Louisiana ranks 50th in nursing home patient quality of care. All the politicians care about is protecting their personal interests and making money.

There is little to no eithics. Fred Mills is the senate committee chair of health and welfare, where SB 357 died, he owns a stake in a nursing home.

Jay Luneau who opposed the At Home care option received $57,000 in campaign contributions from the hospital and nursing home industry.

Former State congressmen who all were pro nursing home business have magically leveraged their past legislative positions into high paying nursing home industry jobs.

Jim Tucker (former Speaker of the House) is now CEO of a company that runs 13 nursing homes in Louisiana.

Joe McPherson (former health and welfare committee chair) is a part owner of a nursing home.

Sherri buffington (former health and welfare committee co-chair) is a lobbyist for nursing home businesses.

If that bill would have passed our broke arse state would have made about $100million since it charges at home providers a 5.5% tax.

The ethics are non existent.
Posted by whatchamacallit
Moulin Rouge
Member since Nov 2012
632 posts
Posted on 4/18/20 at 12:49 pm to
I have been wanting to post about this for weeks. This is an absolutely accurate assessment of them wretched state the nursing home lobby has put our nursing homes. I tried for a long time to get funding to keep my parents at home and have home health so that they would not have to go into a nursing home. Fortunately, if you will, they passed before they required a nursing home situation but they would have never been able to stay home if they had lived much longer. Only because they wouldn't have been able to receive the money necessary to keep themselves home with a home health worker. It's awful what this state does to families and their elderly because of the nursing lobby. It truly is the most evil lobby in the state. All politicians are worthless and shameful on this topic.
Posted by GFunk
Denham Springs
Member since Feb 2011
14966 posts
Posted on 4/18/20 at 12:59 pm to
Thanks for the feedback, all. I think my experience can only be considered anecdotal, but I had a hunch that others had either personally experienced it or had better insight than I did.

The Legislature is far more independent than ever before. They signaled this with the move for insurance and tort reform for the automobile industry headed into this session.

I think we need to pressure our Legislators to right this wrong. Again let me say that I do not think Nursing Homes should be done away with. I don't think they are all bad. I do think they provided my Grandmother with some quality care on a temporary basis that a rehab hospital or skilled nursing facility may not have been best for.

But they shouldn't be over 3/4's of the solution for elderly and physically disabled care for our most at-risk populations. There should be an open, even playing field. Right now it seems like the thumb of some folks in power is on the scales of that balance and tipping it towards Nursing Homes.

There is no debate that this public health crisis reveals that staying at home with skilled nursing can provide better protection in a social distancing scenario than can nursing homes. It's inarguable.

We need to do better.
Posted by doubleb
Baton Rouge
Member since Aug 2006
36049 posts
Posted on 4/18/20 at 1:20 pm to
Every time people ask what could we cut from the state budget the nursing home desk is hardly ever mentioned.
The fact is La. rules force granny and grandpa into nursing home when thousands could be better served at home and for millions less.
We just had an election and this never came up. People equate better care with more dollars and that just isn’t so.
The Advocate to their credit had a great series of articles on this very issue, but sadly during the last election they gave it little play.
Posted by tigerbait17
Baton Rouge
Member since Oct 2014
976 posts
Posted on 4/18/20 at 2:21 pm to
I would like to start by saying that the OP made a lot of very valid points. Reform for all healthcare is needed and I think that long term care can always make room for improvements. However as someone who works in a nursing home (licensed administrator) I can tell that none of the people responding to this thread have truly ever walked into or spent any time in a nursing home.

To start, I agree with the fact that at home care is a much more popular choice and in a perfect world would be the only choice. Home health is obviously very popular and if a resident is able choose that over a nursing home then that is great. My grandmother had dementia and my grandfather made my mom and her siblings promise they would never put her in a nursing home. She was lucky enough to have 24 hour care at home. Patients like the OP's grandmother are the perfect scenario. Rehab to home patients are success stories for any nursing home. However, at least 3/4's of the patients that are at the facility I work at are required to be there by need not by choice. It is a sad reality but it is simply the truth. Home care is fantastic but is not feasible for someone who truly requires 24 hour care. Any managed care insurance company that tries to make that a reality (AARP, Humana, etc) is simply lying.

I think that nursing homes are so easy to attack because when things go wrong they can go wrong in a hurry. The stories about the facilities in Washington and now the facility in New Jersey that was hiding dead bodies are extremely sad and shine a very negative light on Long Term Care as a whole. For those of you who are 1000% opposed to LTC I recommend that you take a visit to a facility when all this lockdown stuff is lifted and see it first hand. You can make your opinion after that. I can promise you that right now the people work in LTC are working harder than ever. It truly is a stressful time for all.

TLDR: OP made some very valid points. I respectfully disagree with some of them. I work in Long term care and Im just sharing my opinion because Im bored.

Posted by GFunk
Denham Springs
Member since Feb 2011
14966 posts
Posted on 4/18/20 at 2:26 pm to
I’m interested in specifics and genuine discussion. I appreciate and welcome your perspective. I think Nursing Homes have a place. I think it’s difficult to ignore the lobbying efforts, the unequal distribution of care options and the mushrooming or ballooning of costs that are reimbursable by the state when you look at the situation and not draw the conclusion that the scales are tipped in the favor of Nursing Home Operators.

Our work as a state and efforts legislatively with respect to this issue and this area of public health and the elderly aren’t focused on the best patient outcomes from what I can see.

Please speak to your knowledge and share your insights. No opposition to hearing from the opposite side of the coin.
This post was edited on 4/18/20 at 2:28 pm
Posted by Mr Breeze
The Lunatic Fringe
Member since Dec 2010
5957 posts
Posted on 4/18/20 at 2:37 pm to
quote:

I would like to start by saying that the OP made a lot of very valid points. Reform for all healthcare is needed and I think that long term care can always make room for improvements. However as someone who works in a nursing home (licensed administrator) I can tell that none of the people responding to this thread have truly ever walked into or spent any time in a nursing home.

To start, I agree with the fact that at home care is a much more popular choice and in a perfect world would be the only choice.

There is no choice at the moment and that is the issue. Your industry has made sure of that and I would argue against the best interests of our elder population.

Level the playing field.
Posted by doubleb
Baton Rouge
Member since Aug 2006
36049 posts
Posted on 4/18/20 at 2:37 pm to
quote:

However, at least 3/4's of the patients that are at the facility I work at are required to be there by need not by choice


The discussion isn’t about the 75%, it’s about the 25%.

No one is saying to close nursing homes or that a lot of old folks don’t need nursing home; they are saying that La. nursing home rules unlike most states make it so that more older folks have no other option but to go into a home. Politics and politicians make that so.

The Advocate said La. could save 200 million dollars a year just by rewriting our nursing home rules to get in line with most states.

LINK
Posted by tigerfoot
Alexandria
Member since Sep 2006
56327 posts
Posted on 4/18/20 at 2:46 pm to
quote:


In the last 10 years, Nursing Home Rates in Louisiana have risen over 50% (54 to be exact as of 2018). While Home Health Care averages between approximately $13,500 and $33,100 annually for the elderly and physically disabled, nursing homes care costs the state $47,300+ per year per resident.

As we look at the grim statistics and rates of fatality for our most at-risk population and hear horror stories from Nursing Home Facilities across the State, including the Tragic Stats from Lambeth House in New Orleans alone,
.The poster home for your argument receives no Medicaid or Medicare money.

quote:

, at what point do we admit that whether we are talking about quality of life, dignity, family and personal choice, good government, fiscal responsibility or reasons of public health...Nursing Homes should only be part of the answer for elderly and physical disability care. Not the only one.
They are not: Medicaid waiver, home health, hospice, Telehealth, meal on wheels, medicaid transport services, all exist to help people stay at home.

quote:

We need to do better.
We are asking nursing homes to care for sicker and sicker patients that require more and more complex cafe than ever before. Nursing homes of today don't resemble the nursing homes of 30 years ago except for the physical structures that most occupy. You understand that, correct?
Posted by tigerbait17
Baton Rouge
Member since Oct 2014
976 posts
Posted on 4/18/20 at 3:01 pm to
It is hard to argue against some of the points made. The LNHA ( Louisiana Nursing Home Association) is a very powerful organization. There is a reason that LTC did not receive any sort or budget cuts for the last few legislative sessions. I can say that to care for patients is not cheap. I can also say that care options unfortunately are limited. However I cant say any other solution is better than what are being offered at the moment. At home care offered by managed care insurances companies will not work in my opinion. A patient requiring around the clock care total care cannot receive that at home without spend a substantial amount of money. By substantial I mean more than you would pay for private pay at a facility.

Posted by tigerbait17
Baton Rouge
Member since Oct 2014
976 posts
Posted on 4/18/20 at 3:10 pm to
I would disagree with the fact that there is no other choice. Some people willingly live in a nursing home and are very happy.
Posted by doubleb
Baton Rouge
Member since Aug 2006
36049 posts
Posted on 4/18/20 at 3:37 pm to
LINK

Louisiana spends more money on nursing homes every year while alternative spending is relatively less and less. That is contrary to what is going on in most states.
Again we are poor, we are ranked last, buy by god we are going to do it our way.
Posted by oldtimefootball
Winnfield La
Member since Feb 2013
434 posts
Posted on 4/18/20 at 3:45 pm to
Stay-at-home care sounds good but would be more expensive than most nursing homes. If you could get qualified, dependable people to work for $10 per hour, that's $240 dollars per day x 30 days per month = $7200 per month. That is more than most nursing homes cost. And good luck trying to get good people to work for $10 per hour. This is hiring people yourself. I imagine MANAGED CARE providers would cost even more. Nursing home long term care has its drawbacks and improvements need to be made but remember this is a very labor intensive business and better personnel means higher labor costs. I've had 3 close relatives spend several years each in a nursing home. Believe me, providing quality care for elderly patients is a challenge with the public constantly complaining about high costs. I don't think home care would be better. You would still have the problem of high costs and quality of care plus the added burden of managing every facet of care. Nope for me.
Posted by doubleb
Baton Rouge
Member since Aug 2006
36049 posts
Posted on 4/18/20 at 3:47 pm to
Explain why Louisiana is so different than other states then.
Posted by Jake88
Member since Apr 2005
68277 posts
Posted on 4/18/20 at 3:49 pm to
The Nursing Homes care for people who have family that don't. You want to reduce NH population, motivate children and grandchildren to care for their elders. Many residents never hear from their families. That said, good points made about the lobby.
This post was edited on 4/18/20 at 3:57 pm
Posted by Glock17
Member since Oct 2007
22389 posts
Posted on 4/18/20 at 4:17 pm to
quote:

The Nursing Homes care for people who have family that don't. You want to reduce NH population, motivate children and grandchildren to care for their elders


That’s not entirely true. My grandmother had pretty severe dementia in her last year or so of life and basically required 24 hour care. My parents are late 60’s early 70’s and there’s no way they could provide legitimate care for her.
Posted by GFunk
Denham Springs
Member since Feb 2011
14966 posts
Posted on 4/18/20 at 5:45 pm to
quote:

tigerfoot

quote:

The poster home for your argument receives no Medicaid or Medicare money.



The poster home for my argument incubated a novel coronavirus and led to huge amounts of loss of life in a facility that-if we focused less on those types of facilities and more decentralized methods for carrying for at-risk populations-may have led to a reduction in loss of life.

You've mistaken my argument as one that is strictly dollars and sense. It's easy to read and find where it's about much more than that. But you saw what you wanted to see and attacked the one angle you could to try to invalidate the entirety of the rest of my issues, which are myriad and legitimate. Even as per folk who work within the industry. Which I can only assume you do.

quote:

They are not: Medicaid waiver, home health, hospice, Telehealth, meal on wheels, medicaid transport services, all exist to help people stay at home.


They receive preferential treatment by our government and its leaders to dominate the market and choices families and their loved ones have. The undue influence the industry wields thanks to its efforts is a negative for the elderly, the physically disabled and their families and loved ones in this state.

You know it. We all know it.

quote:

We are asking nursing homes to care for sicker and sicker patients that require more and more complex cafe than ever before. Nursing homes of today don't resemble the nursing homes of 30 years ago except for the physical structures that most occupy. You understand that, correct?


I enjoy this response. It's unique and on the surface compelling. Only when one stops to think that the cost of that care has increased by more than double in the last decade, and now outstrips the cost of care for the elderly and physically disabled at home on the top end by at least 20-30%, if not far far more that you realize you're just issuing out a talking point.

If a nursing home whose payments had increased by more than double over a 10 year span still resembled a facility from a time more than three times over compared to the cost increases, we'd probably have already done something about it.

You understand the cost of care and the skyrocketing, unsustainable cost increases, along with the folk that are simply advocating to have a greater choice in the matter are not wrong painting a picture that a special interest group and lobbying efforts are retarding a market from operating efficiently...correct?

You're using influence-read: Money and greed-to fuel an inequality within a marketplace in a capitalist society. I'm not here saying we need pure free markets everywhere all the time.

But in a market where your product or option's costs are increasing over the last decade at more than double the current rate of annual inflation as of 2019 (5.4x vs 2.3 for 2019 rate of inflation) you can't deny that the only method for maintaining your place within the market as a leader has been to influence the methods and the masters of those methods (politicians) to alter the rules to allow you to remain where you are.

You do know that...correct?
This post was edited on 4/18/20 at 5:52 pm
first pageprev pagePage 1 of 3Next pagelast page

Back to top
logoFollow TigerDroppings for LSU Football News
Follow us on Twitter, Facebook and Instagram to get the latest updates on LSU Football and Recruiting.

FacebookTwitterInstagram