By: David A. Smith
He started to rise, then sank, back in the chair again. It was no dice. Just talking to someone or looking in on the place wasn’t being there.
– Clifford D. Simak, Huddling Place, 1952
Ever since I was a little boy, I’ve had a fear of nursing homes.
Calling it a ‘convalescent hospital’ doesn’t really change what it is
Evolution has wired us to delight in and protect the young and to fear and shun the extremely old:
Sacramento Bee (June 13, 2015), pickle font
Sources used in this post
Marblehead Messenger, January 10, 2013 (brown font)
Boston Globe, May 19, 2014 (Forest green font)
Sacramento Bee, June 13, 2015, (midnight font)
While hospitals were certainly a place to avoid, a boy goes to the hospital to get fixed, either from illness or injury, and he expects to emerge from it good as new. In Marblehead, that was the Mary Alley Hospital, which on nostalgic impulse I have just looked up, discovering that like our previously profiled General Sternberg, Mary Alley was a Reconstruction/ Gilded Age progressive:
During the Civil War, Mary Alley formed a Soldiers Aid Society with Mary Graves. Their object was to perform work for the comfort of the soldiers, and to collect clothing, medicine and ‘delicacies’ for use in Union hospitals. They raised $500 in the first week, a large sum of money in 1862. Additional money came from Marblehead teachers, who pledged 6% of their annual salaries.
Town benefactress. Mary A. Alley
[When Mary Alley died in 1904], in her will she donated her land and house at 6 Franklin Street to the Town, along with a $30,000 endowment, to be converted int4o a hospital when her family members no longer needed it. That happened in 1920, the same year the 19th Amendment gave women the vote, and in 1922 the hospital opened. This was the first and only hospital in Marblehead. The building was remodeled in 1953 [The year I was born – Ed.] and finally closed in the mid-1960s.
Whereas one left a hospital healthy again, and that was always a happy day, a nursing home was a place that one’s elderly relative entered and never left – and we who were younger would go to visit, be at loose ends, and leave saddened. These complicated and in many ways unworthy feelings arise even in good nursing homes – what about bad ones?
We need redress – but can we get it?
A valuable right back when postage was ten cents
Even before the updated regulations, regulators always have a nuclear option – they can shut down a facility entirely, or cut off all its Medicare/ Medicaid funding:
Between October and January, three of Shlomo Rechnitz’s facilities, including South Pasadena, were decertified by the federal government, an economic kiss of death that is extremely rare. The punishment strips a nursing home of its crucial Medicare funding until it can demonstrate improvement, or is closed or sold.
Since 2010, the federal Centers for Medicare and Medicaid Services has decertified only six out of more than 1,200 nursing homes in California.
Short of the nuclear option, the Federal government does little except have each facility rated and publish the ratings:
Overall, those aren’t good scores
Yet ratings, helpful though they are, merely guide the choice before one moves in. After the loved one is admitted, what can you do about neglect or abuse? This being America, you can sue … or can you?
One major change, a ban on the binding arbitration agreements that nursing homes frequently require at admission — before any dispute arises — has already stalled.
Giving residents and families the right to take nursing homes to court could bring far-reaching results, Ms. Grant said. Arbitration proceedings typically remain confidential, and monetary awards can be modest.
True enough, but if litigation can be filed, that can lead to class-action litigation, which creates its own potential for abuse:
The American Health Care Association, which represents most for-profit nursing homes — 70% of nursing homes in the United States are for-profit — filed suit to stop the change. In November, a federal court in Mississippi granted a preliminary injunction.
Even without the nuclear option, fines and charges can easily drive a nursing home operator out of business, whether that operator is private or a public agency, and when a nursing home closes entirely, that’s a loss of inventory:
Mr. Rechnitz, looking pensive and sad at the thought of being unfairly driven out of business
Shlomo Rechnitz explained that his business model is to rescue failing facilities and turn them around. Of his 81 nursing homes, he said, 59 were considered “distressed” when he acquired them, meaning that they were insolvent or on the verge of decertification or closure for poor performance.
Is Mr. Rechnitz a double-bottom-line social entrepreneur?
Officials in San Mateo County, for instance, credit Rechnitz with preserving nearly 300 needed beds and dozens of jobs when he took over management of the Burlingame Long Term Care facility in 2012. Formerly operated by the county, the facility had been headed for closure because of financial problems and concerns about the building’s age and safety.
Likewise, Mr. Rechnitz has improved another private nursing home:
A Rechnitz success story: Fullerton
When Rechnitz took over the Fullerton facility, it was in deep trouble – only one of California’s roughly 1,200 nursing homes had more serious violations in 2013. Under EmpRes’ control, a survey in October 2013 resulted in 52 health-related deficiencies, eight of them so serious that residents were harmed or deemed in immediate jeopardy.
When inspectors visited the facility for a survey again in December 2014, after Rechnitz had taken over, they found 17 health violations, none of them serious.
“It was a horrible facility,” said Rechnitz. “That thing was going to be shut down. We met with the health department and (they) said, ‘Shlomo, go in and do what you can do. Try to fix it.’ And we went in and, in fact, we did fix it.”
Social entrepreneur, or a smooth-talking mediagenic serial acquisition-predator? Though the Sacramento Bee (June 13, 2015, midnight font) published a long and well-researched article on the subject, the writers could come to no conclusion, and nor could I.
Sacramento Bee series on nursing homes in California
The end game: what supplants the nursing home?
AHI multi-part posts on unusual emerging housing tenures
May 18, 2009: Outlaw in-laws (accessory dwelling units, 2 parts)
July 22, 2011: Campus of the university of independence (veterans housing’, 2 parts)
January 6, 2016: Sprouting innovation (co-living; 3 parts)
Wars stimulate housing innovation because they displace vast numbers of people: soldiers fighting far from home, and civilians whose homes are disrupted or destroyed by the war’s passage.
Surgical kit, Civil War
When the war ends, as thankfully they eventually do, those displaced by the call to arms or the effect of arms return to what they remembered as home, only to find that both it and they have changed:
Union hospital, Civil War
2. World War I’s end saw the rise of urban social-reformer public housing.
3. After World War II came the mobile home and the convalescent home that became the nursing home.
4. The wars in Kuwait and Iraq are bringing us new supportive housing and veterans’ housing.
Each type of housing is specialized, and most of the innovations are most sophisticated, more technological, and more able to extend our lifespan and expand our mental frontiers even as they cater to our extended frailty.
He shut his eyes and fought down the chill that crept across his body. He couldn’t let it get him now, he told himself. He had to stick it out.
– Clifford D. Simak, Huddling Place, 1952
Today’s nursing homes are a business model designed in the 1950s and obsolete by the 1980s, yet kept on financial life support by $155 billion annually in Medicare/ Medicaid payments.
Who’s going to be in charge of my future?
Though the new regulations are a major improvement, the industry needs not better regulation but a comprehensive reinvention.
The younger you feel, the longer you live