We fail our old people and it's heartbreaking

Nurses General Nursing

Published

I recently had a patient who was admitted because a neighbor contacted the police when they realized she was living at home with a few pets in a house with no heat or running water. She's been admitted with a minor medical diagnosis, but it's been passed in report that we're just waiting on long-term care placement for her. She's in her mid 80's, has been living independently for many years, and she's pretty clear that she's going back to her house with her pets, because no one has told her otherwise. I've worked with many dementia patients over the years, even the ones that were pretty sneaky about it, and I honestly didn't see indications of dementia. She had some trouble with phone numbers, and these days no one has a phone book, so she was in the process of tracking some people down to help with the heat and water, according to her, before the neighbor called the police. If we had a system in place where elderly people could live in their home, have someone just check in on them for the basics, and they could retain some independence, that would be so beneficial. Now she'll end up in long-term care, potentially funded by the state depending on her financial situation, and she's one of those people that I'm pretty sure will just will herself to die in an institutional setting. And she's going to be one of the combative aggressive ones, too. That's the report I got from the previous nurse, but it's all about approach with her. If she feels empowered to make decisions, she's fine. As soon as she feels control has been taken away, she digs right in and will get feisty, and I don't really blame her. So what's the worst possible thing we could do for her? Long-term care placement. Breaks my heart to think that she'll never be home with her pets again and all she wanted all night was her dog on her bed. Sometimes I hate getting old.

US needs to expand Program of All-Inclusive Care for the Elderly to ALL states:

Program of All-Inclusive Care for the Elderly | Medicaid.gov

In PA/NJ/DE program is called LIFE (Living Independence for the Elderly)

LIFE is an option that allows older Pennsylvanians to live independently while receiving services and supports that meet the health and personal needs of the individual.

Living Independence for the Elderly (LIFE) is a managed care program that provides a comprehensive, all-inclusive package of medical and supportive services to help keep a person living in own home/apt. PA has 35 programs throughout the state. Our health system is largest provider of LIFE care throughout the US. Through this program, my father was able to live at home for 2 1/2 yrs until no longer safe to be alone at night due dementia.

Services provided in own home or at Adult Daycare Center include:

Medical Services

  • Primary care and physician specialist services
  • Nursing care
  • Prescribed medications
  • Physical, occupational and speech therapies
  • Dental care
  • Vision care
  • Hearing care
  • Foot care
  • Medical equipment
  • Personal emergency response systems
  • Mental health services
  • Hospital services
  • Nursing home care (if it becomes necessary)

Support Services

  • Light housekeeping, laundry, cooking and help with bathing and dressing
  • Meal planning and nutrition
  • Spiritual counseling
  • Personal care assistance
  • Medication management meds provided without copay.

Transportation is provided to daycare centers and to medical appointments.

There are income levels under Medicare/Medicaid programs with private pay option available.

Find a PACE Program in Your Neighborhood | National PACE .

This is terrific, and I couldn't agree more that this program should be expanded to all states. It's great that your father was able to benefit from it.

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xxxxxx

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Specializes in Med/Surge, Psych, LTC, Home Health.
I was thinking the same thing. But a lot of times people just don't have the funds to pay for it and insurance depending on the plan at times only wants to pay the absolute minimum. I actually just recently read an article about the home health system and how broken it is. One person in the article elected to work at a coffee shop because that paid more than home health nursing. Its really sad people end up being warehoused until they die. Don't get me wrong plenty of nursing homes are nice places with caring staff but it simply isn't the same as home. I wish we had a better solution for these poor people. I know when my time comes I want to die in my own bed..sadly its not as simple as that for some people but I wish it was.

I daresay, I worked in HH nursing for a while and while the pay certainly could

have been better for the hours I put in... I daresay that I made more money

than I would in a coffee shop.

But yes, I agree the system is broken. Like I said in my post above, the

woman has the right to go back to her home and live as she pleases...

but certainly it is not ideal. Unless she has Medicaid, the poor woman

is not going to be able to afford home care. These places like

"Visiting Angels"... how much does that cost? It has to be

astronomical.

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Specializes in Emergency / Disaster.

One of the reasons I am getting my RN is to be more available for my mom and gram. After speaking with a PhD for my IT program, we determined that an RN was a better course of direction for where I ultimately want to end up (I'm currently a programmer and want to deal with clinical trial data), but that I would have a better work schedule than what I have now in the coming years when time with them will matter the most. I expect that I will be working 3 nights per week - probably weekends and holidays. Since my child is in college and my goal is to take care of these ladies that raised me - this works out perfect for me. I'm not necessarily looking forward to learning how to stay awake at night, but my mom and gram are my responsibility now and I'll do whatever I need to in order to care for them. I'm also hoping that being an RN will afford me the opportunity to save and put a plan in place for myself as well.

I'm in a unique position in that I have both my mom and gramma to care for (yup 4 generations of us girls). I'm hoping that when the time comes my daughter will feel the same need to ensure that I'm cared for properly if I don't get everything into place.

We do need a better option for those at home that just need a little bit of help - little ladies that aren't tall enough to get their clothes out of the bottom of the washer or strong enough to carry their trash to the curb. The little fellas that can't climb the ladder to change a lightbulb or see that they need to tread on their car tires. I do wish we could do so much more for them. I'm all for advocating for better assistance for them.

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Oh God, these stories of people dying in nursing homes, losing their homes, missing their pets are so heartbreaking. I see this on a regular basis. The police and adult protective get involved when things get bad and it's downhill.

One patient sticks out in my memory. An elderly female, she had worked as a secretary for a local business. Of course no pension. She never married and lived with her parents. First her father died, then her mother. She inherited the house, which was paid for, but any savings were eaten up with repairs and taxes. Then the furnace stopped working. The police came when the pipes burst.

She died in a nursing home 2 years later.

Ugghh. I just hate to think of it, it gives me the creeps.

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Specializes in Geriatrics, Dialysis.
In an ideal world we'd pay for long term care insurance or even better we'd live in a country that provides long term care. But hell our country doesn't even provide national healthcare. Funny Trump bashed poor countries and the richest country in the world won't take care of it's own people, something the rest of the world has figured out. We are more like a third world country with respect to the lack of benefits and the miserly minimum wage!

As for long term care I think only people making 6 figure salaries could reasonably afford LTC insurance. The rest of us would be throwing money away only to find out in the end we could no longer afford the premiums or the company would go out of business. This has already happened.

So sure one can plan but there is no guarantee things will work out!

I'm with you on the LTC insurance thing. Cripes, is that expensive! I'm pretty sure that most people that can easily afford LTC insurance until they actually need to use it could also afford to just save that money for their own LTC needs and pay for care when the time comes. Then when the money runs out, which unless that person is extremely well off it will run out state funding for care comes into play.

I see this frequently at work. An elderly person that is admitted for LTC, which in this case means the rest of your life placement in a nursing home has money and is private pay. Then the money starts to run out and they have to "spend down" what little they have left to qualify for Medicaid. Then comes the shopping spree, a new TV for their room, a new computer to keep in touch with friends and family, one lady prepaid for flower deliveries for 3 years just to spend down the money enough to qualify for assistance.

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Not only is LTC insurance not affordable, you usually can't even get it, unless you are in perfect health.

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Specializes in Travel, Home Health, Med-Surg.

I have seen and heard many stories just like this. So sad to see this happen in our great country. But as others have said if she is capable of making decisions she can go back home. There are, or at least used to be, services from Medicare that would help the home bound (cleaning, shopping etc). This country does need to do better to take care of our elderly and this should start with the gov. not wasting so much money (our current admin is working on this!) so more would be available for these services. Some people who work min/low paying jobs do not make enough to save for retirement even if they were able to find a decent job. The elderly just do not get the same attention (by some gov. officials/lobbyist) as other groups so little/no money for them, sad!

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My mother and dad had a good amount of. Money. They lived rather frugally. My mother has dementia and became unable to stand or walk. I told my dad he needed to take her to a hospital and offered to help. He could not do it, despite offers of help. I told him I'd do it. No, not ready yet. He wouldn't do it. My sister told him he should get care for her, but she was less persistent. Finally, I had to call the Dept of Aging and report him.

Luckily they were very understanding. They took her to the hospital. She went to rehab for six weeks, paid for by him. That fabulous psafety net ( weaker than a hairnet) Medicare paid NOTHING!!!!

The folks at rehab did little for my mother. If she didn't want to get up they didn't push it. So home she went, confused, incontinent, and bed bound. My dad has died. Her home care givers of almost 3 years stole from her. Two homes have been sold and a smaller one bought. She has senior care part time and me part time.

My nursing career is in the crapper. Thirty years. Great salary. So depressing for all. If she lives more than a year or two, she will run out of money. Sad. I thought I could piece it together with some prn Jobs. Where is my sister??? Good question. I chose to help. I wanted the best for her. I fear she will end up in LTC anyway. This is so depressing on so many levels. I am trying to get back into regular work, but will have to share part of my income for care when I can do less time.

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I daresay, I worked in HH nursing for a while and while the pay certainly could

have been better for the hours I put in... I daresay that I made more money

than I would in a coffee shop.

But yes, I agree the system is broken. Like I said in my post above, the

woman has the right to go back to her home and live as she pleases...

but certainly it is not ideal. Unless she has Medicaid, the poor woman

is not going to be able to afford home care. These places like

"Visiting Angels"... how much does that cost? It has to be

astronomical.

HH all depends on efficiency, and computer glitches. You can do well, or you can work for free, depending on your day.

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No home health available? That and neighbor could call police but could not be bothered to 1st determine if there was anything productive she could do to help? I have a friend with whom I grew up whose mother lives nearby, I can look out the window and see her mothers' house. I stop in from time to time and I have had her daughter ask me to check in. Her mom is eccentric and a hoarder but able to care for herself and pets (hoarding limited to a lot of boxes with every document that she ever received.) Not a hazard to getting around.

I swear if I make it to that age I will find a home with no neighbors for a mile in any direction. We absolutely warehouse the elderly, take them away from everything they love. I have a very bad 'pack year' history of cigarettes and doubt I will live to be 80, given the way we treat elderly in this society it is ok with me I cut several years off my life.

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Specializes in Psych, Addictions, SOL (Student of Life).
I daresay, I worked in HH nursing for a while and while the pay certainly could

have been better for the hours I put in... I daresay that I made more money

than I would in a coffee shop.

But yes, I agree the system is broken. Like I said in my post above, the

woman has the right to go back to her home and live as she pleases...

but certainly it is not ideal. Unless she has Medicaid, the poor woman

is not going to be able to afford home care. These places like

"Visiting Angels"... how much does that cost? It has to be

astronomical.

My mother required in home 24 hour care. Initially her competence was not a question. She refused to come a live with any of her children so after she broke her hip. She arranged for her own 24 hour care and went home. Her bill for her 1st month was $22,000.00.Certainly her care givers did not receive that much but that was the cost. She refused to pay it saying that she had never been told it would cost so much. She called the police and said the care-givers were uninvited intruders in her home. After several run ins with police and neighbors we were notified by elder services that we could be charged with neglect as she was clearly no longer competent to live on her own and was not even safe to be left alone for a few hours in a family member's home due to her behavior. We were faced with having to forcefully remove her from her home. 1st to an assisted living, then to a memory care and finally an Alzheimer's /hospice facility. As a family we shouldered the financial cost of this care. I don't under stand why it is the burden of the government to care for people young or old who can't or won't take care of themselves. I know it's an unpopular idea but the largest segment of the population consists of people who pay no taxes whatsoever and live their entire lives far beyond their means. Those of us who work hard, save our money and plan for our future carry the highest tax burden and still manage to plan for our futures. In my mom's case most her care came from funds in trust for her as well as income from her home which was paid for and we rented it out to a tenant. Other relatives in my family have reverse mortgaged their homes allowing them to continue living there while using the accrued equity to cover their expenses. If the LOL (little old lady) in question was competent to care for her needs nobody would have had to step in and intervene.

I will also add that Medicare does not pay for what they term custodial care. It does not matter how hard someone has worked or how much they have paid into the system. Care for the cognitively impaired adult is considered to be custodial. So yes we now put a portion of our savings into long term care insurance. The average cost is $2,007.00 per year or $5.49 a day. this would cover a benefit of $164,000.00 to be paid out over 3 years at a rate of $150.00 a day. The longer one pays in the higher the benefit they can receive.

Hppy

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