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.
Nothing to do with anything specific. But my husband worked for Adult Protective Services for a few years. There was an elderly couple who someone (adult children? neighbors?) reported them to be living in squalor. They kept refusing Adult Protective Services permission to enter their house, and legally APS couldn't enter.
Because the couple had dogs APS was able to notify animal control, or the SPCA, and they were able to enter the house to check on the dogs. APS went with them and able to intervene with the humans.
A little research shows that it is about half of the population that does not pay Fed Income tax. I think it is fair to question not only that, but also what is the gov. doing with the money it does receive from any/all taxpayers. Anyone who pays taxes should be appalled at the waste/abuse of OUR money. Consider the fact that there was no Income tax until around 1900, now look at how much we pay (local/state/fed etc.) and the waste. If people would come together to fight the waste in gov. we would all be better off. Also, I am not sure that the people who don't make enough to pay taxes could afford LTC Ins, might be better to at least have them pay some taxes (percentage etc) to offset the cost (assuming the gov wont waste it).
LTC insurance policies through most employers are essentially worthless. How many of us will be with the same employer all those years?
And even if you are still in the same physical location, ownership and benefits can change, sometimes dramatically.
Add to this that policies cost (even relatively) much more now because of the higher cost of healthcare, 30 years ago people were not going to nursing homes for the issues/care that now they do, much higher acuity.
55% sounds very low. Some of those deductions are probably not taxes, but things like health and life insurance?
We have health insurance through my husband's bomb because out is better and cheaper than the hospital. I don't have life insurance. I'm 58 and my kids are all grown and I have no debt, so I don't need it. Also, my state doesn't have income tax.
A little research shows that it is about half of the population that does not pay Fed Income tax. I think it is fair to question not only that, but also what is the gov. doing with the money it does receive from any/all taxpayers. Anyone who pays taxes should be appalled at the waste/abuse of OUR money. Consider the fact that there was no Income tax until around 1900, now look at how much we pay (local/state/fed etc.) and the waste. If people would come together to fight the waste in gov. we would all be better off. Also, I am not sure that the people who don't make enough to pay taxes could afford LTC Ins, might be better to at least have them pay some taxes (percentage etc) to offset the cost (assuming the gov wont waste it).
Very interesting article! I guess when you think about it, the numbers make sense. If you are unemployed you don't pay tax. If you don't work, you don't pay tax. Thanks for the article.
As a home health RN I see these situations way too often and it's so sad! Home health is a great option for those elderly patients who live alone and have no one, but unfortunately it's not enough to keep them home. Medicare coverage even for home health services has been getting cut more and more each year and covers less and less. I struggle with this on a daily basis at work. I want to help and get all the services I can for patients in dire situations including getting social worker on case to find caregivers, apply for Medicaid, and community resources. But Medicare doesn't pay for home health to be there indefinitely. Even more so for the ones who are medically stable. I had to discharge poor patients who couldn't shower alone and had frequent falls, but Medicare guidelines stated that I cannot keep these patients on service even bath aid is all they need, even if it's for their safety. LTC insurance is great, but not everyone can afford it and some policies are very tricky. I had a Pt who was paying for her ltc insurance for over 20 years and when she really needed to start using it for caregiver services at home, they told her her policy will start paying after she shells out 3500$ first. Now this poor old lady lived alone on ssi, could already barely afford to pay for her food and eating 1 meal a day to save money for rent and other costs such as insurance and copays. So having this wonderful ltc insurance which she still pays for but gives her nothing. The only ones I see who have a better opportunity to stay at home even when bedridden and confused are patients with wealthy families. Of course, there are also those cases of really stubborn patients. They fight against every solution you give them if it's not exactly what they had in mind. I had a patient who would've greatly benefited from rehab/nursing home stay for a few weeks to regain strength as home PT is nowhere nearly as rigorous as rehab PT. But he refused every single time, until he fell at home and stayed on the floor for 3 days unable to get up or get help. When his manager finally found him and called 911, he got the help to get off the floor, refused to go to the ER because it wasn't the hospital he wanted to go to. I took him to the hospital ER he liked myself, even though it's not my job or responsibility, but I knew if I left him he wouldn't get through. Unfortunately I think it may have been too late as I have never heard back from him, and he was my patient for 3 years on and off. I wish there was more I could've done and I still have hope that maybe he finally agreed to be placed in long term care, but knowing him that's probably not what happened. It makes me sad that there isn't more help for these people, but it also stems from them not wanting the help (not all, but many of them).
Specializes in Psych, Addictions, SOL (Student of Life).
Add to this that policies cost (even relatively) much more now because of the higher cost of healthcare, 30 years ago people were not going to nursing homes for the issues/care that now they do, much higher acuity.
This is true. 30 years ago when people reached a certain state in their health they died. They were not kept alive on feeding tubes and such until they reached 100 years old with absolutely no quality of life. I am not saying that we should just let the older population die. I am not that heartless. But people need to be making plans and talking to their loved ones long before the need for certain decisions arrives. Families also need to be willing to follow the wished put forth by their elders.
In addition to be very thrifty with their money my mother and father were very clear about their end of life provisions, what they wanted and what they didn't want. We honored those wishes as best we could. Even when we wanted to do something different. We did have to forcefully remove my mother from her home because she could not care for herself nor would she let any of us care for her in our homes. By forcefully I mean kicking and screaming with a sheriff's deputy standing by to make sure the neighbors didn't think an actual kidnapping was taking place. It was the hardest thing I ever had to do. Fortunately my dad made plans with all their hard earned and saved money to provide for her care after he died. I might add that at least two of my siblings wanted to strip her of all her money so that she would qualify for Medicaid. They favored sending her to some government funded crap hole to wither away so they could access her money for themselves. Mom passed away about a week ago and they are all lining up with their hands out for their checks. It sickens me.
This is true. 30 years ago when people reached a certain state in their health they died. They were not kept alive on feeding tubes and such until they reached 100 years old with absolutely no quality of life. I am not saying that we should just let the older population die. I am not that heartless. But people need to be making plans and talking to their loved ones long before the need for certain decisions arrives. Families also need to be willing to follow the wished put forth by their elders.
In addition to be very thrifty with their money my mother and father were very clear about their end of life provisions, what they wanted and what they didn't want. We honored those wishes as best we could. Even when we wanted to do something different. We did have to forcefully remove my mother from her home because she could not care for herself nor would she let any of us care for her in our homes. By forcefully I mean kicking and screaming with a sheriff's deputy standing by to make sure the neighbors didn't think an actual kidnapping was taking place. It was the hardest thing I ever had to do. Fortunately my dad made plans with all their hard earned and saved money to provide for her care after he died. I might add that at least two of my siblings wanted to strip her of all her money so that she would qualify for Medicaid. They favored sending her to some government funded crap hole to wither away so they could access her money for themselves. Mom passed away about a week ago and they are all lining up with their hands out for their checks. It sickens me.
I am so sorry for your loss, I think it is especially hard when you have had to change their living conditions when they didn't want to (but I think deep down they know it is for the better)!! Yes it is sad to see family behave that way (greedy) when someone is elderly/has passed, seen it in my own family too, so sad. Hugs/prayers and wishing you well!!
brownbook
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Nothing to do with anything specific. But my husband worked for Adult Protective Services for a few years. There was an elderly couple who someone (adult children? neighbors?) reported them to be living in squalor. They kept refusing Adult Protective Services permission to enter their house, and legally APS couldn't enter.
Because the couple had dogs APS was able to notify animal control, or the SPCA, and they were able to enter the house to check on the dogs. APS went with them and able to intervene with the humans.