Mandatory Nurse-to-Patient Staffing Ratios: Is Your State Next?

jaeger19 said:

Nope.. no fail.

Actually the link you provided had a link to the actual report.

In the report.. they randomly (that's good).. sampled 260 nursing homes from 15, 728. That means they sampled about 1.5% percent of nursing homes. That's a pretty small sample size to generalize that "90% of nursing homes have a criminal record. Such a small sample size is rife for having problems with outliers.

AND when looking at the report it did not specify exactly what crimes constituted a criminal conviction.. It did mention that it included things like writing bad checks and shoplifting.

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Keep Googling. You will see it is a widespread problem. Always has been. Sugar coat it if you want, but the problems continue.

Waddy said:

Keep Googling. You will see it is a widespread problem. Always has been. Sugar coat it if you want, but the problems continue.

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I own nursing homes. I ran a major chain. I understand that its not a widespread problem. Heck..the liability alone almost precludes it. At least in a licensed medicare/medicare certified facility.

Now..assisted livings, and care homes were there is less oversight? even though not a widespread problem..it could be more of an issue.

I had a facility shut down over hot coffee being available to residents in one of our independent livings. A person in independent living took their friend from the nursing home section.. and took her to the independent living section. Got a cup of coffee for herself and her friend. They sat and had their coffee.. with no problems.. no burns.. nothing.

We got put on stop admissions for potential to cause harm because the surveyor stated that "well.. what if the coffee had been too hot". But it wasn't. We had regulators on the coffee etc.

The state made us take the coffee out of the independent living section and residents could only get coffee if it was dispensed by a licensed nurse.

We made the change. And they allowed us readmissions. On the return survey.. the surveyers then cited us for "failure to provide a homelike environment".. because the independent living residents complained that they could not get their own coffee.

And you are telling me.. in that climate? We are going to hire hardened killers off the streets to care for residents?...

Do you really think I want a lawsuit that badly... that I am going to risk a multi million dollar lawsuit.. because I just had to hire a convict to take care of someones grandma?

As far as google. I could google a lot of things that aren't true and only based on opinion or isolated incidents.

jaeger19 said:

Ummm why are you telling lies?

I never said that nursing home OWNERS..know better. I said that nursing home owners MAKE THE DECISION.. when it comes to how many nursing personnel are needed.

Staffing ratios are generally based on what the corporation feels is acceptable financially. and not on what the needs of the patient population are..

And I also said that staffing ratios..don;t mean a whole lot because it depends on the patients complexity more so than the number of patients. Like I said.. a nurse can handle 10 easy patients.. ''

Or two complex ones. A staffing ratio of 5 patients per nurse is pretty meaningless.


By the way.. whats needed also tends to differ based on the amount of documentation that's required.. the efficiency of that documentation. The quality and health of the nursing staff. etc.

Some floors will operate just fine with one nurse and two aides... and that same floor with the same patients needs, on the next shift can't get by without one nurse and four aides.

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Forgive me as I probably should have searched for your verbatim quote and did not. My inaccuracy.

jaeger19 said:

I own nursing homes. I ran a major chain. I understand that its not a widespread problem. Heck..the liability alone almost precludes it. At least in a licensed medicare/medicare certified facility.

Now..assisted livings, and care homes were there is less oversight? even though not a widespread problem..it could be more of an issue.

I had a facility shut down over hot coffee being available to residents in one of our independent livings. A person in independent living took their friend from the nursing home section.. and took her to the independent living section. Got a cup of coffee for herself and her friend. They sat and had their coffee.. with no problems.. no burns.. nothing.

We got put on stop admissions for potential to cause harm because the surveyor stated that "well.. what if the coffee had been too hot". But it wasn't. We had regulators on the coffee etc.

The state made us take the coffee out of the independent living section and residents could only get coffee if it was dispensed by a licensed nurse.

We made the change. And they allowed us readmissions. On the return survey.. the surveyers then cited us for "failure to provide a homelike environment".. because the independent living residents complained that they could not get their own coffee.

And you are telling me.. in that climate? We are going to hire hardened killers off the streets to care for residents?...

Do you really think I want a lawsuit that badly... that I am going to risk a multi million dollar lawsuit.. because I just had to hire a convict to take care of someones grandma?

As far as google. I could google a lot of things that aren't true and only based on opinion or isolated incidents.

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You may be an ethical owner, but your industry has a horrible reputation; deservedly so. That's why there are so many stories on the internet. Ans so many lawsuits. One horror story after another. Unfortunately, my father in law was in one such nursing home; his watch, wedding ring and several items of clothing were stolen. It was apparent he wasn't getting cared for, so my wife moved him. He died shortly after going to the next nursing home. And nursing homes do hire ex-cons, sometimes by mistake, sometimes through carelessness. You are trying to defend the indefensible.

Waddy said:

You may be an ethical owner, but your industry has a horrible reputation; deservedly so. That's why there are so many stories on the internet. Ans so many lawsuits. One horror story after another. Unfortunately, my father in law was in one such nursing home; his watch, wedding ring and several items of clothing were stolen. It was apparent he wasn't getting cared for, so my wife moved him. He died shortly after going to the next nursing home. And nursing homes do hire ex-cons, sometimes by mistake, sometimes through carelessness. You are trying to defend the indefensible.

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No.. the industry has a horrible reputation and not deservedly so. The nursing home reputation is the result of in part the tremendous oversight of nursing homes.. compared to virtually little to no oversight of hospitals, assisted livings, group homes and home health/care at home.

I am not saying that nursing homes don;t need oversight. But when they are basically the only entity that gets severe oversight from the state.. it makes the look like the bad actors in healthcare.

But.. I have had facilities were we received patients from the hospital, from home, from assisted livings with beginning pressure sores/Decubitis ulcers. The nursing home gets the blame. Because the nursing home has to report decubitus and has to have a plan and so on.. while the other entities don;t have that level of oversight.

So.. we end up treating say 8 patients with pressure sores. None of them originated from the nursing home. But. because these residents have them.. it affects our statistics... and then there are headlines... "nursing home had 8 patients with pressure sores".

Whats worse.. the only documentation of the ulcers? Comes from the nursing home.. because there is no documentation from the hospital, or assisted living etc.. home health that there even was an ulcer or beginning ulcer. . Only when they come to the nursing home because that comprehensive skin evaluation is required for a certified medicare facility.

No doubt there are bad facilities, I ve been in some. But a lot of the reputation that nursing home gets.. comes from the amount of regulation and oversight that's present.

No one is reporting about hospitals or home care, or group homes or assisted living nearly as much because there is so much less state oversight.

I just had a patient come to me.. in a wheelchair that had no breaks, that had no footrests.. that didn't even fit her. She came from an assisted living.. where the state placed her because her home was "an unsafe environment".

The assisted living had her sleeping in a chair!..not a recliner even.. simply a chair.. upright! For more than a week. She had not slept basically for 5 days and with her legs dependent.. she was beginning to get cellulitis and we had to order ultrasound to make sure their was no DVT.

I had to place a call to the state regarding the level of care. Now.. a nursing home? this would potentially be a stop admissions.. creation of harm violation..

But.. the assisted living is under no regulation to provide a bed for her. Since she could not provide her own bed? Oh well. And the state was not willing to provide her one.. even though it was the state that didn't allow her to return home and sent her to assisted living.

jaeger19 said:

No.. the industry has a horrible reputation and not deservedly so. The nursing home reputation is the result of in part the tremendous oversight of nursing homes.. compared to virtually little to no oversight of hospitals, assisted livings, group homes and home health/care at home.

I am not saying that nursing homes don;t need oversight. But when they are basically the only entity that gets severe oversight from the state.. it makes the look like the bad actors in healthcare.

But.. I have had facilities were we received patients from the hospital, from home, from assisted livings with beginning pressure sores/Decubitis ulcers. The nursing home gets the blame. Because the nursing home has to report decubitus and has to have a plan and so on.. while the other entities don;t have that level of oversight.

So.. we end up treating say 8 patients with pressure sores. None of them originated from the nursing home. But. because these residents have them.. it affects our statistics... and then there are headlines... "nursing home had 8 patients with pressure sores".

Whats worse.. the only documentation of the ulcers? Comes from the nursing home.. because there is no documentation from the hospital, or assisted living etc.. home health that there even was an ulcer or beginning ulcer. . Only when they come to the nursing home because that comprehensive skin evaluation is required for a certified medicare facility.

No doubt there are bad facilities, I ve been in some. But a lot of the reputation that nursing home gets.. comes from the amount of regulation and oversight that's present.

No one is reporting about hospitals or home care, or group homes or assisted living nearly as much because there is so much less state oversight.

I just had a patient come to me.. in a wheelchair that had no breaks, that had no footrests.. that didn't even fit her. She came from an assisted living.. where the state placed her because her home was "an unsafe environment".

The assisted living had her sleeping in a chair!..not a recliner even.. simply a chair.. upright! For more than a week. She had not slept basically for 5 days and with her legs dependent.. she was beginning to get cellulitis and we had to order ultrasound to make sure their was no DVT.

I had to place a call to the state regarding the level of care. Now.. a nursing home? this would potentially be a stop admissions.. creation of harm violation..

But.. the assisted living is under no regulation to provide a bed for her. Since she could not provide her own bed? Oh well. And the state was not willing to provide her one.. even though it was the state that didn't allow her to return home and sent her to assisted living.

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I'm in agreement that all of these institutions need more oversight, but the nursing home industry has brought that additional oversight on themselves. They have no one else to blame. And while some patients arrive with problems, lots of those problem you mention start in the nursing home. Blaming too much oversight for the problems is an amazing deflection of responsibility in itself. Talk about blaming the messenger. It's like saying we have too many speeders because the police give out tickets.

Waddy said:

I'm in agreement that all of these institutions need more oversight, but the nursing home industry has brought that additional oversight on themselves. .

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No.. they have not. In fact, certified nursing homes generally have the most difficult patients.. since they aren't able to live at homes..or in assisted livings, or home health.
The most difficult patients are in the nursing home because the state pushes for the cheapest facilities. And only those patients that cannot be taken care of in any manner are refused by the assisted livings or care homes. usually because they have failed at those facilities multiple times or have become too expensive for the facilities to take care of..so they refuse those patients stating that they cannot meet their needs.
Meanwhile.. while these nursing homes have the most difficult patients..they are being squeezed financially by Medicare and Medicaid. So they have higher complexity.. and their complexity of patient mix continues to grow.. while being squeezed by lower reimbursements. And I am not deflecting responsibility here. I am giving you facts.

Its not like saying "we have speeders because the police give out tickets".
It would be like having the police only watch for speeding Harley Davidson motorcycles. And then when Harley Davidson motorcycles get caught speeding... saying..."why those Harley Davidson riders are terrible".
Meanwhile.. the drivers of all other types of cars and motorcycles are going WAY faster and are doing way more dangerous behavior. You just don't know it.. because the police aren't looking for it.

lots of those problem you mention start in the nursing home.

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Actually no. Think about it. Patients now come to the nursing homes.. AFTER problems develop. Nursing home care doesn't occur before you decline.. not generally.
Now.. back decades ago? Yes. It was not uncommon to see a elderly man that is basically functional..but needs help supervising his medications and making sure he eats three times a day in a nursing home.
That ended with assisted livings and home health. Now that guy stays at home with home care.. which means that he basically sits in his chair, and watches TV.. while an aide comes in to check his meds.. and there is an aide to help fix two meals a day. After a year of that..he now has declined where he needs assistance to get out of his chair. He still is at home with the aides who now get him to his chair.. and then have to come in to change his attends (because he can't get to the bathroom on his own).. or toilet him if he is able to hold it.
When he gets chronic uti's and it throws off his metabolics, and he gets weak,.. and can't go back home.. he ends up in an assisted living. Where he ends up sitting most of the day in his chair. Or in bed. The aides to toilet him or change him more than he was before. He might get some socialization if they take him down to the dining room for meals. But physically.. he is in decline. Mentally he is in decline.
Then..he can't walk anymore.. can't stand.. has a fall with the aides and breaks a hip..and ends up after the hospital into a nursing home.

Now.. the guy has hip and knee contractures.. making it difficult for him to stand. He has had chronic incontinence for years. He has pressure sores from the assisted living
He has malnutrition from lack of dentation and lack of nutritional plans. He has general muscle weakness from debility (not moving around). He has dementia made worse from lack of activity or mental stimulation.

And now he is in the nursing home. Now.. under medicare and Medicaid law... as a certified facility.

1. They have to evaluate and come up with a plan to address his contractures. Usually requiring therapy.. possible expensive splinting... and a continued nursing rehabilitation plan after therapy is done.
2. They have to evaluate and come up with a bladder retraining and toileting plan. and if their plan includes a Foley Catheter? The facility gets dinged for having a catheter instead of a toileting plan.
3. They have to come up with a nutritional plan.. enhanced meals.. etc.. and have him evaluated by the dietician. Usually means weights are done to make sure he doesn't have weight loss etc. It may mean speech therapy for swallow..or occupational therapy for self feeding training..and then continued nursing rehab to have him help feed himself . The nursing home gets dinged if they feed him or worse.. have him on a peg tube.

4. They have to have a plan for his dementia. They have to have an activities plan for him to stimulate his brain.. they have to have a behavioral plan to deal with him trying to get out of bed in the middle of the night and falling. Put up the siderails you say..like the hospital and the assisted living? Au contraire mon frere. In a nursing home, that's considered being "restrained"..and as such is a no no and a potential citation. So.. you have to come up with bed alarms... therapy intervention etc... to try to keep him safe. If you put up the bedrails to prevent him falling out.. its a citation. If he falls out of bed.. its a citation.

5. You have to have a plan for his general debility. He has to have evaluations by the resident PT. And at a minimum a nursing rehabilitation plan in place.

NOW..none of those problems originated in the nursing home. And none of those interventions.. are required under assisted livings or group homes.. or even hospitals by the state.
But now its the responsibility of the nursing home.. and anything that the state doesn't like.. is a citation.

And the headline is "nursing home cited for failure to provide care". Even though the contractures they get dinged for..started in the home with home care.

jaeger19 said:

No.. they have not. In fact, certified nursing homes generally have the most difficult patients.. since they aren't able to live at homes..or in assisted livings, or home health.
The most difficult patients are in the nursing home because the state pushes for the cheapest facilities. And only those patients that cannot be taken care of in any manner are refused by the assisted livings or care homes. usually because they have failed at those facilities multiple times or have become too expensive for the facilities to take care of..so they refuse those patients stating that they cannot meet their needs.
Meanwhile.. while these nursing homes have the most difficult patients..they are being squeezed financially by Medicare and Medicaid. So they have higher complexity.. and their complexity of patient mix continues to grow.. while being squeezed by lower reimbursements. And I am not deflecting responsibility here. I am giving you facts.

Its not like saying "we have speeders because the police give out tickets".
It would be like having the police only watch for speeding Harley Davidson motorcycles. And then when Harley Davidson motorcycles get caught speeding... saying..."why those Harley Davidson riders are terrible".
Meanwhile.. the drivers of all other types of cars and motorcycles are going WAY faster and are doing way more dangerous behavior. You just don't know it.. because the police aren't looking for it.

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You do realize you are acknowledging nursing homes have some severe problems, whether it's their fault or not. You're saying the whole industry has these problems, and that nursing homes are simply being singled out. All that says to me is a large part of our health care system needs to be carefully watched and regulated.

And I've got to say, my own experience with nursing homes has been mixed. I've been in one or two that were very nice, but typically the nursing homes that take Medicare and Medicaid smell like urine, patients obviously sitting around for hours on end drooling on themselves, very few actual nurses, and some of the tatted up help looks pretty shady. Often the food isn't very good and sometimes it's not even hot. And my experience isn't unique. I hear the same stories from friends. Almost all of us have watched the older generation pass on, usually ending in a nursing home. I won't be going to one.

Waddy said:

The BS is all over you. All you had to do to see how seriously wrong you are is Google it. Here's some advice; best not to spout off before you got the facts.



Nursing Home Employee Background Checks

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The screening process goes in stages wherever you have levels of screening. For example your state may allow you to initially hire an employee based on a more superficial screen, but still require a more detailed process continue. This happens in my state. They check the state record, hire and train, but if something comes up and the federal check or something suspect shows up, they will pull the new employee off the schedule until the whatever is questionable or appealed, gets resolved. There are definite levels of interest and professional scope here. If you are dealing with either a certified Nursing aide or a nurse you may have to worry about what the board of nursing AND the regulation of the state have to say because licensure is often impacted by convictions.

There is a sincere effort in most jurisdictions to distinguish a serious threat from a youthful mistake. Your pot conviction from 10 years ago will not be a problem but your arson conviction will never ever fly.

Waddy said:

You do realize you are acknowledging nursing homes have some severe problems, whether it's their fault or not. You're saying the whole industry has these problems, and that nursing homes are simply being singled out. All that says to me is a large part of our health care system needs to be carefully watched and regulated.

And I've got to say, my own experience with nursing homes has been mixed. I've been in one or two that were very nice, but typically the nursing homes that take Medicare and Medicaid smell like urine, patients obviously sitting around for hours on end drooling on themselves, very few actual nurses, and some of the tatted up help looks pretty shady. Often the food isn't very good and sometimes it's not even hot. And my experience isn't unique. I hear the same stories from friends. Almost all of us have watched the older generation pass on, usually ending in a nursing home. I won't be going to one.

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Oh we have bigger problems than these. If we don't do something about those Medicaid and Medicare re-imbursement rates, you won't be worrying about the smells in those homes much longer. There is a BIG push in the industry to simply not take medicaid patients AT ALL in memory care settings, assisted living or long term care. These industries have been losing money on them for the last 5 years or more and the higher the acuity level, and the more therapy required, the faster they are losing money. At the same time, more and more of our elderly will need Medicaid funding for more and more of their last years. Selling that family home only covers so much for so long, and a lot of them never owned a home in the first place. Pensions are dinosaurs from a past age. Savings are long gone after the first major medical bills strike, and whatever was sitting in the stock market got lost in the Great Recession. We will literally have no place to put 'Mom' unless Mom comes with a nice flush bank account and a lot of these places with go belly up as our population keeps aging and dementia diagnosis keep soaring.

I am currently working in one that just decided no longer to accept any Medicaid patients no matter how low our occupancy level goes, and I just left another company was very close to doing the same thing. Everyone has always fought for the private pay client or the medicare billing because that was where the dollar signs were, but you could eek out some solvency with the steady volume that long term Medicaid patients provided. No longer! These patients bring all the headaches and high acuity that require major staffing and liability costs, but none of the cash to pay for them!/

btthegreat said:

Oh we have bigger problems than these. If we don't do something about those Medicaid and Medicare re-imbursement rates, you won't be worrying about the smells in those homes much longer. There is a BIG push in the industry to simply not take medicaid patients AT ALL in memory care settings, assisted living or long term care. These industries have been losing money on them for the last 5 years or more and the higher the acuity level, and the more therapy required, the faster they are losing money. At the same time, more and more of our elderly will need Medicaid funding for more and more of their last years. Selling that family home only covers so much for so long, and a lot of them never owned a home in the first place. Pensions are dinosaurs from a past age. Savings are long gone after the first major medical bills strike, and whatever was sitting in the stock market got lost in the Great Recession. We will literally have no place to put 'Mom' unless Mom comes with a nice flush bank account and a lot of these places with go belly up as our population keeps aging and dementia diagnosis keep soaring.

I am currently working in one that just decided no longer to accept any Medicaid patients no matter how low our occupancy level goes, and I just left another company was very close to doing the same thing. Everyone has always fought for the private pay client or the medicare billing because that was where the dollar signs were, but you could eek out some solvency with the steady volume that long term Medicaid patients provided. No longer! These patients bring all the headaches and high acuity that require major staffing and liability costs, but none of the cash to pay for them!/

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OK, I got that you all need more money. Who doesn't? And you're right, the baby boomers haven't planned very well. But your response is also an acknowledgement that the nursing home industry has serious problems, including all the things I've mentioned. All in all, then, for a variety of reasons, many nursing homes are urine soaked **** holes. Maybe that's the way it's gotta be. Maybe society just wants those old, dementia ridden people out of sight and out of mind, and isn't willing to pay any more than the minimum; or less. So, yeah, your industry is in a tough spot. But that doesn't make me wrong about what goes on there.

Retirement home staff patient ratio and acute care setting ratio differ greatly. Retirement home resident care only slightly varies from day to day, compared to i.e. ED and ICU.

Waddy said:

You do realize you are acknowledging nursing homes have some severe problems, whether it's their fault or not. You're saying the whole industry has these problems, and that nursing homes are simply being singled out. All that says to me is a large part of our health care system needs to be carefully watched and regulated.

.

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Yes.. health systems need to be watched and regulated. BUT it needs to be in a consistent and intelligent manner. And there will always be problems. Nursing homes are dealing with the most complex and difficult patients. And in the face of declining reimbursement, its more of a challenge. The same is said of hospitals, assisted livings, home health etc.
The question is.. what is most important? Care? Or Cost? There generally is no free lunch here.

I've been in one or two that were very nice, but typically the nursing homes that take Medicare and Medicaid smell like urine, patients obviously sitting around for hours on end drooling on themselves, very few actual nurses, and some of the tatted up help looks pretty shady

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Well.. its hard not to have a urine smell when you have patients that are incontinent of urine or bowel. If you go into an old persons home.. and their are chronically incontinent.. largely the smell is much worse.

Often the food isn't very good and sometimes it's not even hot.

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Food not being good is pretty normal. The federal and state regulations regarding food basically hamstrings dietary from producing high quality food except at a high expense. Imagine making food for all the individual needs for patients with low sodium diets.. allergies, etc. The food usually has to be quite bland to basically pass muster.

Temperature on the other hand.. is federally and state mandated..and if the food arrives cold.. or cold food is allowed to get to room temperature (like milk).. its a violation.

But proper temps are very difficult. Because the food has to leave the kitchen at a certain temp... but in being served.. it has to wait to be served. IF you raise the temp of the food when it leaves the kitchen.. to a level that will retain the heat by the time its served. You risk a safety violation. (what if a patient was served this.. it would burn them). If you keep the temperature at the normal level.. and the patient say has to be toileted before eating lunch...or the patient wants to be served in their room (which means trays have to wait rather than being served en mass in a dining room).. or a myriad of other things..then the food is loses temp.

No justifying.. just explaining the reality of the challenges.

Almost all of us have watched the older generation pass on, usually ending in a nursing home. I won't be going to one.

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Well. I have watched the older generation pass on.. at home.. at assisted livings.. at group homes... and there is certainly no guarantee that ANY of those are better than a nursing home. In fact.. the reality is that the most comfortable passing of those choices.. is at a nursing home. (for a given level of dysfunction.).

Waddy said:

OK, I got that you all need more money. Who doesn't? And you're right, the baby boomers haven't planned very well. But your response is also an acknowledgement that the nursing home industry has serious problems, including all the things I've mentioned. All in all, then, for a variety of reasons, many nursing homes are urine soaked **** holes. Maybe that's the way it's gotta be. Maybe society just wants those old, dementia ridden people out of sight and out of mind, and isn't willing to pay any more than the minimum; or less. So, yeah, your industry is in a tough spot. But that doesn't make me wrong about what goes on there.

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yeah the problem is that you don't realize that those problems are actually GREATER in hospitals, assisted livings, elderly care homes, and with home health services.

jaeger19 said:

Yes.. health systems need to be watched and regulated. BUT it needs to be in a consistent and intelligent manner. And there will always be problems. Nursing homes are dealing with the most complex and difficult patients. And in the face of declining reimbursement, its more of a challenge. The same is said of hospitals, assisted livings, home health etc.
The question is.. what is most important? Care? Or Cost? There generally is no free lunch here.



Well.. its hard not to have a urine smell when you have patients that are incontinent of urine or bowel. If you go into an old persons home.. and their are chronically incontinent.. largely the smell is much worse.

Food not being good is pretty normal. The federal and state regulations regarding food basically hamstrings dietary from producing high quality food except at a high expense. Imagine making food for all the individual needs for patients with low sodium diets.. allergies, etc. The food usually has to be quite bland to basically pass muster.

Temperature on the other hand.. is federally and state mandated..and if the food arrives cold.. or cold food is allowed to get to room temperature (like milk).. its a violation.

But proper temps are very difficult. Because the food has to leave the kitchen at a certain temp... but in being served.. it has to wait to be served. IF you raise the temp of the food when it leaves the kitchen.. to a level that will retain the heat by the time its served. You risk a safety violation. (what if a patient was served this.. it would burn them). If you keep the temperature at the normal level.. and the patient say has to be toileted before eating lunch...or the patient wants to be served in their room (which means trays have to wait rather than being served en mass in a dining room).. or a myriad of other things..then the food is loses temp.

No justifying.. just explaining the reality of the challenges.



Well. I have watched the older generation pass on.. at home.. at assisted livings.. at group homes... and there is certainly no guarantee that ANY of those are better than a nursing home. In fact.. the reality is that the most comfortable passing of those choices.. is at a nursing home. (for a given level of dysfunction.).

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Well, well, well, it's ALL somebody's else's fault. Take some responsibility; clean up the industry, it smells like piss.

jaeger19 said:

yeah the problem is that you don't realize that those problems are actually GREATER in hospitals, assisted livings, elderly care homes, and with home health services.

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That ain't what the lawsuits are telling us. The lawyers can't all be wrong.

Waddy said:

Well, well, well, it's ALL somebody's else's fault. Take some responsibility; clean up the industry, it smells like piss.

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Nope..not what I said.

You have no desire to learn anything. Have a good day.

Waddy said:

That ain't what the lawsuits are telling us. The lawyers can't all be wrong.

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Sure.. and that's because there is
1. More money in suing a nursing home chain. Than an independent elderly group home, or a persons spouse.
2. Juries are more likely to go after a big bad nursing home.. than their local hospital that they get care at.