Long-Term Care: Last Week Tonight with John Oliver (HBO)

Moving on to our main story

tonight

, it's about nursing homes, the

last

thing you want Andrew Cuomo to handle comfortably tied to literally anything else. Nursing homes and

long

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term

care

in general are something we tend to try to avoid thinking about, but the truth is that whether due to old age or a disability, many of us need or will need help with daily living. , the number of Americans age 65 and older is expected to nearly double over the next 40 years, and one study estimates that more than two-thirds of Americans who reach age 65 will need

long

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term

care

at some point in their lives. and the good news is that for the wealthy there are many options there are multiple luxury retirement communities where residents can transition, if necessary, to full-time nursing care like this exquisitely delivered by two chains, okay , so the name of this episode is called the most expensive retirement right and this is the most luxurious and exclusive retirement home I have ever seen and I have never heard of the building itself, it costs 100 million dollars to build the marble from which is. uh Italy it's a custom rug yeah I see a lot of art I see Versace plates okay aside from the extravagance of that place let's all agree the $195 plate sucks and I'm not normally a guy On the plate, your boy is a source of phenomena. back, I'm a bowl, plates aren't really my thing, but even I can tell that plate is a two, which is a two in Ohio, if you're going to spend that kind of money on a plate, it better be very big, very funny or really. very hot that plate, look at me, put your phone down and look at me when I'm talking to you, that plate, but the fact is that most of us don't end up in that place, in fact, the vast majority of people receive long-term benefits. care in the home and about 80 percent of that care is provided by unpaid caregivers, often family members who want to keep their loved ones out of institutional care, like this wife and daughter, Cheryl and Kristen, find themselves among the 42 million Americans who care for their loved ones at home and the tasks they do have become increasingly complex when we have to flush their picc line or clean their peg tube or take their blood glucose or blood pressure arterial, you know, none of us went to school for that, I mean, we're not raised that way.

I don't feel like I've had enough training for this, we've learned through trial and error, which seems very difficult, and there are certain things you hope to do through trial and error, solving a puzzle, learning to pronounce the name. of tambourine on Saturday or choosing a haircut and for the record error error error and error but providing essential medical care should not be one of those things caring for someone at home can be an incredibly complicated full-time job that is almost always unpaid In fact, in terms of lost wages, the work of family caregivers amounts to about $67 billion a year;

That is, a workforce that, if paid, would rival the entire GDP of Bulgaria, except for those who cannot afford to eat on unacceptable dishes or whose loved ones cannot help. At home, many end up in long-term care facilities, there are two million people in them in the United States and, as we have seen during the covid crisis, they may be far from ideal residents and the staff who care for them represent less of one percent. of the population, but currently accounts for around a third of Covid deaths, the pandemic pushed an already very strained system to the absolute brink, with conditions getting so bad they were near constants in local news like this one, a resident here says that his calls for help were ignored. because there weren't enough staff to respond I was screaming get me out of here get me out of here this thing was screaming at them I was in terrible pain and they didn't come get me penny shaw was suffering as she lay helpless in her bed at the Braintree Manor nursing home in the middle of the Covet 19 pandemic, he became so desperate that he even called Braintree police for help.

I can't stay in bed for hours and hours, you know, with pain like that, now I have to tell him. you, we reached out to that facility who chose not to address their then-staffing levels in their response to us, insisting that the safety of their residents is of utmost importance, but that's pretty hard to believe when they call the police to ask for help. There are only two cases where you can expect to lie in bed for hours screaming in pain and that is if you are giving birth or you are digesting a supreme crunch, that's it and the truth is covert, it just exposes what we have basically known for years. that the way the elderly and disabled are treated in too many of these facilities is, at best, with indifference and at worst, abuse and neglect, so

tonight

let's talk about long-term care , how the industry is structured, how that structure creates bad incentives, and what we can do.

We can do in the future and we are going to focus on the two main types of long-term care facilities: Nursing homes and assisted living nursing homes are medical facilities supervised by registered nurses and largely staffed by Low-paid and long-standing nursing assistants Problems with nursing home care: A Gao report covering a five-year period before the pandemic found that 82 of the homes had been cited for deficiencies in prevention and infection control and about half had persistent problems that had been cited over several years and a big reason for that. It may be because understaffing is a big problem, as employees are often tasked with caring for too many residents, as these nursing assistants pointed out

last

year they don't bathe people fall out of bed men don't They shave people fall where they fell out of their wheelchairs and if they need change they could get it once a day we have 22 residents a piece most days that's enough for one person to do laundry, get up two meals and They are being neglected because they can I can't reach everyone I told the manager I'm ashamed of my job I process my work process because I can't do what I was trained to do on how to care for these residents.

That is obviously unacceptable. Do you have any idea how? Bad things must happen for you to tell your boss that you're embarrassed by your job. I'm not even ashamed of my job and just three minutes ago I joked about a plate. That wasn't really a joke. Call me a wolf dish and nursing assistants are not only overworked, they are actually underpaid, the national average salary for that job is just $30,000 a year and one of the reasons is that almost 70 percent of Nursing homes are now for-profit institutions and there is a lot of profit for them. to do because they don't pay the staff much but they charge you a lot, the average cost per person for a private room is a hundred thousand dollars a year and if you're thinking about it, yes, that's expensive, but the Medicare program isn't. that I have paid for all my life coverage, well no it's not Medicare, it only fully covers the first 20 days of nursing home care after an eligible hospital visit, then partially pays up to 100 days, but after that , you are in trouble.

At any cost, the only other way to access taxpayer help to live in a nursing home is to become almost completely impoverished to basically spend up to the point of qualifying for Medicaid, the government program for the poor that reimburses nursing homes. nursing homes at less than half the average daily rate that Medicare pays, and while you would like to think that nursing homes would treat all patients equally whether they are on Medicare or Medicaid, the truth is that you can have two very different experiences because if you are on Medicare you could end up getting too much care just listen to an assistant manager of a nursing home chain describe how Medicare patients were treated what percentage of the therapy he was told to administer do you think was not necessary I would say probably over time about forty percent, forty percent of the work I was doing was not reasonable or necessary under Medicare guidelines at another facility, the entire rehab staff signed a letter to their boss. which says we have been encouraged to maximize reimbursement even when it is clinically inappropriate.

It is absurd that the Department of Justice actually filed a lawsuit alleging that the chain that woman worked for, Life Care Centers of America, which operates more than 200 nursing homes, was subjecting its patients to therapy even when they were in their homes. deathbeds, alleged that a 92-year-old man who was recorded as dying of metastatic cancer after having received 48 minutes of physical therapy, 47 minutes of occupational therapy and 30 minutes of speech therapy just two days before his death, a day he was spitting up blood, which is ridiculous, the residents should receive proper nursing care, no. tons of expensive therapeutic treatments that are clinically inappropriate, which by the way, I'm pretty sure was goop's original slogan now life care denied any wrongdoing, but agreed to pay $145 million to settle that lawsuit and they're not alone here in last.

Over the decade, many other large nursing home chains have been accused of fraudulent Medicare billing practices and denied wrongdoing while paying tens of millions of dollars to settle their cases. You know the same as when you are totally innocent, so to recap here if Medicare is paying for the risk. that you could be billed for unnecessary treatments, but if Medicaid pays, remember, reimburses nursing homes at less than half the average daily rate, things could get much worse because if the facilities want to open a bed to one more patient lucrative, they can take drastic measures. Ronald, who was 51 years old and homeless, received rehabilitation at the nursing home where he lived for more than a year and then one night around 10 p.m. m., says an administrator came into his room with a big smile on his face saying they were going to kick you out, they smiled, yeah, and they just put me in a van and left me here on the sidewalk, the Avalon call center Villa through his attorneys told NBC News that he firmly denies that he discharged any patients inappropriately.

The homeless shelter where Ronald now lives says he's seen cases like this. before experts even have a term to describe it, dumping residents, oh come on that's just evil, dumping residents is a completely unacceptable practice. I don't even like it when residents are thrown into Grey's Anatomy in the alter berk, you throw that resident at the altar, how? Could you do that to Christina, your monster? And you would expect regulators to punish nursing homes for doing things like that, but oversight here has some huge gaps - for example, the federal government maintains a list of so-called special focus facility homes that have a pattern. of serious problems over a long period of time and therefore receive additional inspections.

There are 88 nursing homes on that list, but interestingly not because there are only 88 homes that deserve to be on it, but because due to limited resources, the government has limited the list to that exact level. number even though they fully recognize that an additional 400 facilities qualify for the program and look I'm not saying every list should last forever if a list of the cutest otters had a limit of 88 that would be a perfectly good list but If there were 400 other cute otters who also abused the elderly. I'd really like to know who all of them are, and if you're thinking, look, it's good to know that's good information if I need to move a loved one into a nursing home.

I'm definitely going to look online and make sure it's good; Be careful, because while the government has a website where nursing homes have ratings from one to five stars, it has an absolutely gaping loophole of the three factors that determine an overall rating. only ratings health inspections are conducted independently all other statistics quality and staffing measures are self-reported by the nursing home these self-reported statistics can increase a three-star rating to a five-star overall rating the problem is that you know it's garbage in Trash Out, so whatever they tell the feds, the feds ain't, the federal government isn't going to come in and verify that your numbers are accurate, yeah, garbage in, garbage outside and that's pathetic, something as important as our nursing home rating system shouldn't do it.

Follow the same rule as allrecipes on the velveeta website because there is simply no way any of them are any good. If you're making a recipe that causes a puddle of lórax sperm, don't be surprised when the final product is equally repulsive. It's garbage in, garbage out, so given everything we've seen so far, it's no surprise that for reasons of cost or conditions, many want to avoid a nursing home altogether, which brings us to assisted living facilities. or about a third of people in a long time. -Term care facilities are located in one of these and cost much less than a nursing home, usually around 50,000 a year.

Alf started as an alternative for those who needed help with key activities such as dressing, going to the bathroom, taking medication and eating, but only needed a limited amount. Medical Support Like nursing homes, the vast majority of ALFs are for-profit, but there are some key differences as well. Alfs are largely paid out of pocket and are much less regulated, making it easy for virtually anyone to start one and I mean anyone. Take Stephanie Costa at the age of 30, she owned six little alfs in Southern California and made a lot of money from them enough to qualify her to appear on an episode of Millionaire Matchmaker.

My name is Stephanie and I am 30 years old. I own a chain of senior care centers. My net worth is three to four million. I've probably always had this thing about taking care of older people, like sick people who are dying. I have always felt very strongly about them so I couldn't wait to graduate college and start my own business doing assisted living facilities like nursing homes, okay there are a lot of unfair reasons why I inherently don't trust Stephanie Costa, since who drives an idiotic Ferrari to the fact that he looks like an uncredited extra from an entourage party scene to that voice that sounds like a mouse who wouldn't dress Cinderella because he had better things to do, but it turns out that feeling is actually completely valid because Costa treated her employees and residents so terribly that after multiple health and safety violations, California banned her from the industry for life. and ordered her and her company to pay around 1.6 million in unpaid wages and fines, but if you think that gave him liability, you'll want to think again.

She kept this house after declaring bankruptcy and settled with the workers for a fraction of what she owed her six nursing homes are now owned by a real estate investment company registered by her father oh yes, not only that, as recently as last year she was still listed as CEO of that company, so the state of california really taught stephanie costa a lesson there, specifically about lesson that you can treat your senior care workers like absolutely, avoid any real consequences and just continue living your life in the ugliest house in Beverly Hills, although it's legitimately hard to tell if it's actually a house or just an abandoned white castle, but it's not. there are only individuals involved here, there are also large corporations running alfs that have been working hard to fill the beds and even though alfs are supposed to be for people who require less medical care, recently some have been aggressively trapped in patients with dementia due to memory reasons. care programs as seen in this advertisement from brookdale, the largest alf provider in the country, this is a compassionate place that helps families through very difficult stages of dementia in a safe and comfortable environment and I have peace of mind knowing that its staff is fully trained 24 hours a day.

Day seven days a

week

I can't believe how much my mother's quality of life has improved since I got here. I see her smile and laugh again. We help them maintain her skills and encourage the use of her current skills in a warm and engaging environment. This is a special place and every day is a new beginning with many smiles and memories. Well, I understand that a senior housing salesperson might want to have at least one staff member or hug a resident by the shoulders. It's something nice, trustworthy, it makes you feel. It's safe, but immediately moving on to another feels like too much and then a third starts to make me a little nervous and when the fourth hits me as a British person, I have to say it's too much physical contact, even with that said.

I admit that an alf that offered everything she claims commercially, but with much less contact, would be really great. Unfortunately, a woman who worked at a Brookdale facility in South Carolina painted a rather disturbing picture of how staff are trained to work with dementia patients when you At first, you are put through a series of in-house services or counseling, lasting about a

week

, but they are just videos, but once they put you on the court, they don't give you any training, they just highlight you. well that's not really ideal because it's hard to retain important information just by watching a video, this video proves it, think about it, what have you really learned from this?

Some Random Facts About the Long Term Care Industry You'll Probably Forget Right Away, But If You're Honest, Mostly You'll Have Learned That It's Possible to Want a Plate and That's a Lesson You'll Never Forget and Look, Brookdale Insists They Offer Continuing Training care workers and that their dementia training program meets or exceeds state guidelines, but that doesn't say much, as some states require only two to thirty hours of specialized training and South Carolina, where find that facility, it requires training but doesn't set a minimum number of hours and by the way, If you're wondering why there were a ton of shots of a pond in that story, the answer is completely terrifying because a 90 year old resident who was supposed to He was under constant supervision before being transferred to a memory care unit and died after leaving. the facility goes unnoticed in the middle of the night there are signs warning people about alligators look this one says alligators can live here is it safe for alligators in this case the signs probably wouldn't have made a difference according to authorities I told the victim likely slipped or fell down a steep embankment and landed in the water, attracting the alligator's attention.

I honestly don't even know where to start, but I guess I'd start with the question: why would anyone put an assisted living facility next door? an alligator pond that seems like the kind of detail that really needs to be included at the end of one of Brookdale's heartwarming ads. This is a special place and every day is a new beginning with many smiles and memories. Additionally, one of our residents was eaten. by an alligator so you know yes there is that and that's important information for people to know about Brookdale and look obviously it's a horrific story but to be fair it's hard to talk about long term care without showing you at least one from those.

Just be thankful I didn't show you the story about a resident jumping out of an alf's fourth-floor window or a nursing home resident who set herself on fire or a 91-year-old woman with Alzheimer's and she froze. Death on Christmas Day, which by the way sounds like a Christmas album written by Bjork, so what can we do here? Well, obviously, greater oversight and enforcement is urgently needed. That facility with the alligators was ultimately fined by the state for 11 violations, including failing to act appropriately at night. controls and allow staffing to fall below required levels, but the fine issued was only 6400 and it seems that if you lose a loved one in such a horrible way, you would want more responsibility than just not caring, someone He decided that his life was worth the price. of a 2013 chrysler motown and the fact is that there are many ideas about how to force facilities to improve, requiring that a certain level of money go towards patient care, for example, or that residents have access to a certain amount minimum of care per day, but the most important solution here might be to try to make it easier for as many people as possible not to end up in these institutions in the first place and instead receive the support they need at home.

Nearly 90 percent of people over 65 apparently want to stay in their homes. at home for as long as possible which makes sense the problem is right now many of them can't because under Medicaid nursing home care is a right but home care is not access to long-term services and supports through Medicaid in your home. You need a waiver from your state and to be fair, some like Washington do quite a bit, more than 70 percent of the Medicaid money they spend on long-term care for seniors and adults with disabilities is spent on home and community-based services, That's things like skilled nursing visits, home care aides who can help with daily tasks, and even the ability to pay family caregivers.

You know people like those two women you saw earlier. The problem is that other states have waiting lists that can last many years, by which time seniors trying to access that care may be dead because, unfortunately, that's how time works across the country. More than 800,000 people are on this type of waiting list. What we need is reform at the national level, and indeed there is some promising progress. There was a bill recently introduced that would make home and community care an entitlement under Medicaid and Biden's proposed infrastructure plan actually calls for $400 billion to be spent on those exact services and that would be a big deal and would seek Any aggressive transition to home care is going to need rigorous guardrails and oversight to ensure money isn't just wasted in a different way.

The last thing I want is five years from now to have to do a show about the evils of new for-profit organizations. home care agencies that have somehow been destroying people's lives in their own homes and if you're thinking, wait, wait, in five years you'll still be doing shows in a vacuum, oh no, we'll be back in a vacuum. I don't want to get into the details, but spoiler alert: it's not a pandemic next time, it will be spiders, but we need to do something and it all starts with showing that we care about what happens to the elderly and people with disabilities in this country, because it's true. now the evidence points to the fact that we don't do it at all and all the other problems stem from that and the more we continue to ignore this, the worse it will get, because the fact is that right now this is an industry where people in their care are being eaten alive figuratively and sometimes literally.