Long-care system broken

The Post-Star on failures in the long-term care system.

A story last week by Post-Star reporter Kathleen Moore made clear that, when it comes to taking care of our old parents and grandparents, we are depending on the kindness of strangers.

Those strangers are certified nursing assistants, the women and men (but mostly women), who perform the front-line jobs in nursing homes. They are the ones who answer the calls from residents, who feed them and give them their medications, bathe them and help them to the toilet.

They are the ones who can provide comfort with a soft touch and a kind word, who can treat residents with tenderness when they cannot care for themselves and who can make sure that, after they die, their bodies, too, are handled with respect.

We get all this for $12 an hour to start at one of the homes run by Centers Health Care, which owns more than 50 skilled nursing facilities in the Northeast and five in the local area.

It seems an unreasonably low wage, when you consider that, starting Dec. 31, the minimum wage upstate for most workers will be $11.10 and for fast-food workers will be $12.75.

Working in a hot kitchen, troweling french fries into paper bags, isn’t easy, but a lot of people would consider it easier than helping an adult out of bed and to the toilet. What you don’t get while tossing condiments in to-go sacks is the fulfillment of caring for another person — of knowing that your efforts are helping another human being.

Professional caregivers frequently grow attached to the people they care for, and that is what we all rely on, because without those feelings of attachment and satisfaction, few people would choose to do the exhausting job of a CNA — not when easier jobs are available for the same or better pay.

But this is no way to run a long-term care system. We should not tolerate a system so starved for resources that it must pay caregivers poorly in order to make a profit, and we should question whether the for-profit model is a good fit for nursing homes.

The U.S. offers Medicaid coverage for those who need nursing home care but lack the money to pay for it. If you have some money, you have to use it up before becoming eligible for Medicaid, which means people approaching old age will go to great lengths to transfer assets to their children and will take other steps to ensure their life savings don’t get eaten up by nursing home costs.

Also, since private-pay patients are charged a much higher rate than Medicaid pays, nursing homes will first accept patients who have money, so poorer patients may have difficulty finding a place.

Other developed countries take a more comprehensive and compassionate approach, with programs that everyone pays into (as we do with Social Security, for example), which then cover the costs of long-term care for whoever needs it.

The efficiency of market capitalism can be a great thing, except when efficiency is not what you’re looking for. Taking 15 minutes to sit with someone and hold their hand and calm their fears may not be efficient, but it is the kind of care we all want for our loved ones and the kind of thing that overworked CNAs cannot take the time to do.

One problem locally is that, because Centers owns many of the local nursing homes, it can, to some extent, control the competition and keep wages low. Yes, Fort Hudson in Hudson Falls and Wesley Health in Saratoga Springs start CNAs at wages that are appreciably higher, but even they struggle with high turnover.

Our system is an ungainly hybrid of private operation and public oversight, with nursing home companies becoming expert at passing state inspections without providing residents with the personal attention and quality of care they deserve.

It’s easy to say we should care for our elderly and infirm. But when it comes to spending money, other choices — including cuts in the taxes that pay for such programs — are often far more popular.

In the end, if we are dissatisfied we can blame only ourselves. We have not made the commitment, as a country or a state or a community, to providing quality long-term care to everyone who needs it.

As with health care, the quality of the long-term care you receive in our country often depends on how much money you have. Something about that seems wrong. But that’s how it is for now, and how it may still be on the day when each of us discovers how well this system will care for us.

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