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Raif: Considering a growing crisis in elder care

Dec. 8, 2017 at 11:33 p.m.

In all the hullabaloo about health insurance and who pays for what, one forgotten population is senior adults. We have a crisis in elder care. Specifically, there are those in bad health who require nursing or hospice care, or those who simply cannot live alone and need to go to an assisted living facility.

There is no painless way to pay for extended long-term care. Neither Medicare nor private health plans cover it. The average annual cost for a shared room at a skilled nursing facility is $80,000, out of pocket. According to the Kaiser Family Foundation, a nonpartisan research group, 47 percent of men and 58 percent of women who are retirement age or older will need long-term care in the future. Medicaid is the default payer for 61 percent of all nursing home residents in the United States.

Beyond the question of paying for nursing home care comes questions of how trustworthy the facility is in providing the service it is being paid for. One nurse had her cellphone turned off and missed 12 calls for help. At an assisted living facility, an 87-year old Catholic nun was raped in her bed. Credible evidence showed she could have filed a civil lawsuit, and would have won. She couldn't go to court because a part of the admission process to the facility required her to sign an arbitration agreement.

An arbitration clause means the customers are denied the right to file a class action or civil suit. The customer waives the right to sue companies in court, regardless of how egregious the damages may be. This means assisted living and nursing home facilities are off the hook, no matter how irresponsible they have been. Experts on arbitration say about 2.5 million Americans in these facilities are bound by the agreements, which are required by about 90 percent of large nursing home chains. To make matters worse, the owners of these chains are often unaccountable because they are hard to track down.

The Dec. 4 issue of Time magazine reported the number of people in nursing homes is likely to increase in coming years. In June, the Trump administration proposed a new rule that would allow nursing homes to require residents to sign arbitration agreements as a condition of admission to a facility — either sign it or find somewhere else to live.

Hospices, which used to be the last resort for the dying, are faulted somewhat. In the past, their job was to give comfort and care during the patient's last days, not to prolong life. In a Kaiser Foundation study, 80 percent of 2,128 respondents rated a hospice a 9 or 10 out of 10. However, as small hospices are being absorbed by large companies, the quality of care is declining. Twenty-one percent of hospices, which served more than 84,000 patients, failed to provide crisis care in 2015. This meant that not a single skilled visit from a nurse, doctor, social worker, or therapist was provided to a patient in the last two days of life.

Government entities that oversee these facilities are being stonewalled. Many times they get no answers to their inquires. It would seem many of these facilities — hospices, assisted living centers and nursing homes — are gaming the system to get paid but not providing services.

Of course not all are this bad. There are those that are ethical and care about and for those in their facility. However, scamming is increasing in every area. We as seniors (or their loved ones) need to be aware of what we are signing up for.

For further information, read the Nov.27-Dec. 4 issue of Time magazine. If you are a member of AARP, the November issue of the AARP Bulletin has a pull-out section on nursing homes. I plan to make copies of both articles for each of my sons. More than likely either my husband or I will outlive the other. It's quite possible either or both of us will not be in a mental state to make an informed consent. My sons can decide which is the best choice for me if neither my husband nor I are able to make a wise choice.

I've always been a take-charge person and, frankly, it disturbs me greatly I might make a very wrong decision or, worse, be forced to give away my rights to compassionate care. That is why I am going to investigate all the facilities now, while I'm in my right mind.

We all die; that is a given. But it is not a given that we have to live our last days on this earth at the mercy of someone who does not care about or for us.

— Gayle Raif, a Longview resident, is a regular contributor to the Saturday Forum. Find her blog "Limiting God" at



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