To be fair, my mother had cancer and my father had Parkinson's, and that was a much bigger factor in their ultimate quality of life than any deficiencies in the retirement home they found themselves in. So I don't mean "thankfully" in the sense that "thankfully they died prematurely so they didn't have to suffer under their home's new management", I mean it, "Thankfully the natural course of their lives timed their deaths so that they were minimally affected by the new management."

But yeah, it kinda sucks, and not just for the residents who are still there. It sucks for the rank-and-file staff as well, most of whom still really care about their clients, but who now have to answer to people who absolutely do not care about anything other than money.

That was my parents' original plan. But they were in denial about how much preparation would be needed to make that happen. They lived in a split-level house and my father had severe osteoarthritis in his knees. It's actually a miracle that he didn't fall and break his neck going up and down the stairs. But one day he fell in the shower and could not get back up, and that was the beginning of the end.

That’s totally doable and encouraged, as it’s by far more cost effective.

But you really, really need a support system of willing people who care about you, and are savvy enough to effectively advocate for you when you lose that ability. Independent home care works well when you need help, not constant care.

Our family worked with this for 6 years with my bad post stroke and for about a year with my mom and cancer. My siblings were all on board and my mom was uniquely positioned - she was a regulator at the state level who was adept with the rules (and had in fact wrote many!).

Even so, as things progressed it was hard. My mom was devoted to my dad, and filled every gap. We depended on hired help for mom, and despite the financial resources it was difficult to get staff.

Family and friends are key.

It's a nice idea, though I hope I'm humble enough to vacate my house for a younger family that will make the most use of it. By which time I hope to be in a manageable apartment, or perhaps a group home where I can pass the time with others at a similar stage in life.

For some (like one of my family members), circumstances are such that they need more social attention than the family/medical system can provide. That's one of the reasons we are considering.

>Where I live Medicare and Medicaid want people to live (and die) in their own homes. They send out nurses and nurse practitioners to you.

In NY State at least that's turned into a cashgrab too. One they are having trouble reforming.

[dead]

Also a former medic, the best care homes I ever went to were the Jewish Home for the Aged. They were so much nicer and the patients there never had decubitus ulcers or staph infection in skin folds from not being cleaned.

The worst place I ever saw was Atherton Long Care which supposedly is fancy and expensive but they had neglected an old lady so poorly I actually reported them to CDPH and the ombudsman. She had full on necrotized tissue under both her breasts and a rotted unchanged g-tube that you could smell all the way down the hallway to the nursing station it was so sad. John George Psych hospital and Cordilleras MHRC are both also very sad hellholes. Patients sleeping laying on the floor in the hallways with a blanket because the rooms are full etc. We had a lady who purposely stabbed herself in the eye so she could go to the ER to get out of Cordilleras because it was so awful.

What I found if you ever need to place your loved on in a care home is the sniff test is the best assessment of how well it's run and if the patients are cared for. If patients are cleaned regularly and not left to sit in their own diapers it really shows there is enough staff ratio and attention given to the patients. Go on a random evening or day and at different times. Food quality is also a good indicator - eat lunch with your parents there. Would you eat this yourself voluntarily? If yes, it's probably a good place not run on a shoestring budget.

Also - hn readers - if your mom is in a care home please always check under her breasts to ensure she is clean and dry there every time you visit. Far far too many old ladies get candida and bacterial infections under their breasts that are never cleaned or taken care of because it's embarrassing to check or clean and dry so then it just gets wet and rots and is painful, sad and gross and can lead to even worse things like cellulitis or an abscess.

> There is, however, ALWAYS money for the colorful glossy brochures

OMG, so much this! One of the things that happened after the acquisition is that they changed the phones to play a marketing pitch whenever you were on hold. (They even did this on the resident's phones!) One of the things the pitch said was that the place featured "chef-inspired meals" which was about as disconnected as you could possibly get from what I knew first-hand to be reality. It was one of the most bald-faced lies I have ever heard in my life, and it really steamed my clams because I knew there was nothing I could do about it.

Aren’t these kind of borderline fraudulent business practices the sort of thing state attorney generals are supposed to investigate?

Thank you. But he was two months shy of his 90th birthday and, except for struggles with osteoarthritis and Parkinson's, he had a good run. I'm sad that he's gone, but it's not like it took anyone by surprise. And I'm glad that his suffering, which towards the end was not insignificant (though he was very stoic about it), is over.

The last week has actually been pretty (ahem) interesting in a lot of ways. I should probably write a blog post about it.

> housing and healthcare (the third is education.) For the first one we know roughly what we need to do but won’t. For the second we don’t even have that.

Healthcare costs increasing is of very little concern to nursing facility ownership. Almost none of that is borne by the facility itself. They'll often hire skeletal crews of CNAs and LPNs (I was a paramedic, rare was it to see a facility in our area that even had an RN, and if they were, they were the DON, Director of Nursing, and had no direct hand in patient care). The facilities would contract with a physician service who oftentimes would not even speak to the patient, let alone -see- them.

And every, every single interaction with actual care provision was fully billed to the patient/resident's insurance. Anything that is not a profit making center for facility ownership is ruthlessly subcontracted out. A solid portion of the SNFs in my county will openly call 911 for anything beyond the most absolute basic first aid, even when their employees are ostensibly better educated/trained than the EMTs who might be responding.

Healthcare costs in the US are an abomination, but that's not the issue here, or not directly.

The other fundamental problem is the demographic profile in most developed countries. We have aging populations, and proportionally fewer young people to care for them. I'll bet most HN users wouldn't want to work at a retirement home or assisted living facility even if it paid well. My father spent his final years in such a facility and dealing with him was quite difficult for the staff there. This will inevitably cause higher costs and lower quality.

That's not the fundamental problem.

The fundamental problem is that we have ceased demanding that our government produce reasonable outcomes.

The reasons for that are many, but it's a core sign of how far we've fallen that there's even a discussion or argument about this obvious fact. We are in charge. We can just ban private equity companies from doing this you know.

There didn't used to be ambiguity about the point of having a society and having that society governed by the people and having those people's representatives solve problems like this.

That ambiguity was created on purpose, for money, by specific people. Not coincidentally, they're the same people making the profits in this story.

> There’s lots of markets that are okay-ish notwithstanding scummy people.

It is not at all clear to me that there are "lots" of such markets, but that is neither here nor there. A prerequisite for an okay-ish market is that buyers need to be able to choose not to buy, and when you have literal limited mobility it becomes very difficult to walk away from your housing and care provider, either literally or figuratively.

Scummy people are like flies to shit - they thrive in the chaos.

People buying up nursing homes are using tactics like what you’d see in the movie Goodfellas. They’ll structure the buy so that they are assuming the license to operate while “renting” the facility from an affiliated entity, cut opex, fraudulently bill Medicare and Medicaid for rehab, and exit through bankruptcy of the operating entity.