Nursing homes are scared. In America, we choose to house chronically immobile and debilitated elderly people into big buildings filled with understaffed and overworked (and often under qualified) personnel, slap them on underfunded and over managed Medicaid and then expect them to provide all the necessary services to keep people alive for a touch more than $100 a day.
And they are expected to do all this with the constant threat of a lawsuit anytime grandma develops a pressure ulcer or falls and breaks her hip when she trips and falls after a fun day of arts and crafts. They don't even want to think about nursing homes gone wild.
Dr RW Donnell helps explain:
Due to the grandstanding in the 1980's skilled care of the elderly became a political football. There grew out of this an advocacy movement on behalf of the elderly and skilled elder care became the most regulated sector of American health care. Difficult and exceedingly complex regulations, draconian inspections by regulatory agencies and harsh penalties put nursing homes on the defensive. Nowadays, in order to avoid any perception of under treatment of the elderly, nursing homes have a very low threshold for transfer to hospitals of patients with acute symptoms.
How do you know when your nursing homes are scared? You'll know your nursing homes are scared when your hospitalists start admitting bed bound elderly patients with a diagnosis of To Old To Go Home (TOTGH) despite the family really only wanting them to have the honor of dying peacefully.
