This post, part 4, and the posts that follow in parts covers a general subject I have written on often in the past. I will post daily until the entire essay is posted. It is too long to be posted all at once.
I would love some feedback on the part of this Essay that deals with the high cost of Institutional Care. By institutional care I mean Assisted Living and Nursing Home Care. This will be discussed in detail over the segments to be posted.
It is the cost, the fact that it is so high, the fact that the poor can only get it paid for by Medicaid, which with the current state of National Economy even that is at risk. Medicaid is the only available source for payment? What happens when it is no longer available? Where do the poor go; the vulnerable, the frail and the elderly who will have nothing and no one to pay for them.
Add further complication with this: Those of us in the middle class, who have something saved for retirement, that goes in payment by the husband and wife without regard for who it is institutionalized. It is a joint obligation which leaves the surviving spouse with nothing to live on.
Once the middle class members pay out their retirement Medicaid will step in and pay for the one in the institution leaving the spouse ready for the Homeless Shelter.
Mind you! This is real as real as it gets.
Oh yes! There is also the well to do. They can afford it!
My purpose in posting this is to once again SOUND THE ALARM! The purse is being squeezed with little more left to give. When it runs out we face ECONOMIC CATASTROPHE! Think of me as the canary in the coal mine. The toxic gasses are killing me before the miners. As they see this they know to get out of the mine. With Dementia I am canary and the warning is given!!!
Illustration # 2
o Recovering from surgery I recently spent time in a transitional care facility. It was considered the best service provider in the area. It was the best but for the following:
§ The hands on service of the providers was plagued by gaps and omissions caused by cost economy limiting services, such as:
· Baths – Once a week because they can’t afford all of the nursing assistants required to give more baths a week.
I have recently heard this is not necessarily the Home’s choice it is because Medicare will not pay for anymore!
· Medical care provided by a physician’s assistant purportedly operating under the management of a doctor who was never seen. This PA was part-time three days a week.
· Lower level support personnel primarily foreign born, recent émigrés with substandard ability in the English language making it impossible to understand them or them to understand us.
· The lower pay of the lower level support produced service style commensurate to the pay. They are treated minimally and they serve in the same way.
· The nursing staff is overworked, spread far too thin, harried and not able to respond were they willing to do so.
· The administration of medications needs constant self-monitoring to see; are they right kind; are they the right quantity; are they little more than palliating with too many sedatives? (designed to keep us quiet and on ice which did happen to me, I was unaware of it, lost in LaLa land, my wife caught it and put a stop to it?)
· Beds clothing designed to withstand the vagaries of the frail and impaired. As such the bedclothes are laundered in toxic cleaners. The beds have rubber, latex or plastic mattress covers. These produce a variety of sensitive skin reaction.
· The nursing and support staff are not equipped to provide suitable care or medication for skin and bed rash. (In my case with severely sensitive Irish skin I brought my own prescription for itching that took four days to be replace when quickly used up)
· Medical consultation and care did not really exist
o I had a cough and sore throat. They didn’t have cough drops, they could get me lozenges. They had cough syrup. I requested lozenges, they came in, no one from the nursing staff told me they had arrived
o I was terribly sick, suspected it to be more than symptomatic of recovery from substantially severe surgery. It acted and felt like a case of the flu. Although asked for medical review or recommendation was never received by me.
o The reason. They provided their own medical care by the physician on staff advising the PA on the line seeing the patients part time. The facility had the exclusive right to provide this service which was one of their selling points. Cost economy limited utilization. It didn’t seem the staff doctor saw patients. The part time PA could not get to everyone.
o The facility itself, namely the physical plant was fantastic. A wonderful campus, in a scenic river setting consisting of many beautiful brick buildings, architecturally magnificent, maintained exquisitely on grounds that competed with the best of parks. Not a dime was spared to make this an attractive inviting setting for someone in need of it.
§ This was the top of the line in quality service providers in our area. I was appalled by the quality it lacked because of cost economies.
§ What must the quality of other service providers be that are provided at greater economy?
o The size and the homogenization of service in order to survive in the highly regulated competitive marketplace has produced this neutering anomaly.
§ Under the guise of provision for and protection of the people served, the infrastructure has become so top heavy and cost prohibitive it precludes the availability of funds for the care they exist to provide.
§ It is in the provision of care that the cost economies are imposed denying the people the care their existence is intended to provide! The cost of their continuing in existence exceeds their ability to provide adequate care.
Now tell me: What is wrong with this picture?
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