I have had a parent in the long-term care industry for some time. I have seen some good things and many not so good things that will never change without enough voices and force. Activism is not really my thing except when it comes to my mother's care but I am very concerned about what I see. If it is the case that there are 1.4MM residents in 15.7K mostly for profit nursing homes with the demand for care expected to rise in the future, things must change.

I have seen poor response physician care, poorly trained aides, incredibly high turnover, unnecessary testing, overmedication of residents and have encountered deception and lies. If you have not seen the tax waste in this system, you ought to take a look. Patients should be receiving far higher levels of care then they do with the costs paid out by Medicare and Medicaid. They should also have much better equipment such as beds and wheelchairs and never lack broad nutritional options-yes, they often get shamefully cheap food. Perhaps taking the profit out of the system is the answer?

Regulations are important but a small army is needed to drop in and check nursing homes at odd and unexpected times, this has to happen. If not, the insidious practices that are so prevalent and known to be "just the way it is" will continue. It should also be mandatory that each facility has a family council because the relationship between families and many nursing homes is rightly adversarial and lacks trust. This is not always the case but try having a parent or loved on who needs more than a tylenol.

Please offer any input you can like what agencies to write, what politicians to write and ways to make a difference. Even a small step might lead to some change. I cannot in good conscience stand idle and allow what I know and see to not be useful to others who may be in the system or need to be in years to come.

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To understand the plight of eldercare, and many other issues in this country, you cannot ignore the current state of politics in America. F flyer hit on the point about voting and taxes. Working class and middle class Americans have been convinced by the ruling class to consistently vote against our own interests.

We're told that government, any regulations, environmental protections, and taxes are bad and health, education and welfare are all up to the individual. Get Big Government Off Our Backs!

We must take care of the "Job Providers", not tax them or regulate them. Does any of this sound familiar? Unless you've been living under a rock you've heardvall this crap for the last 30 years and Americans have dutifully obeyed, slitting their own throats in every election.

Does anyone think that social security, Medicare, and Medicaid were just gifts bestowed upon us by Wallstreet? No, they are vital programs that were fought for and won by the struggles of working people and the government that used to serve the greater good.

Anyone remember Mother Jones? She said , "Pray for the dead and fight like hell for the living" . And it's going to be a long hard fight until we stop listening to those whose agenda is to seek profit at any cost.

And to be clear, this screed is not aimed at only one political party. The programs for elder care and America at large have been betrayed by politicians of all stripes.
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Here is one organization:
Also I am not sure what you do to become an ombudsman, but the lady we dealt with was very helpful at getting the nursing home to take my aunt's concerns seriously.
Good for you that you want to help, since this is a very worthy cause.
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Rather than re-invent the wheel, research and determine if there are any elder advocacy groups that share your agenda. Contribute time and money to their cause. As you work with them, you may identify omissions in their efforts that you could encourage them to address. As time goes by you may branch out on your but at a much better prepared level.
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Thanks for the responses, so very helpful. GardenArtist, you've given me a lot to think about!
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Reginia, Google "congress improving nursing homes", you will find a variety of articles that might be helpful in your push for change.
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Well, this is quite a question. It will be interesting to see the responses.

Some thoughts first on your questions:

1. Remove profit incentive. Without sounding sarcastic, how would you propose to do this? A government takeover would be reminiscent of some of the authoritarian regimes, and God help us if the federal government gets into this field.

Mandating that all facilities become nonprofits would probably violate some or more laws supporting free enterprise. Corporations, LLCs and other commercial entities would be forced to divest. Stockholders in any public companies might get payouts but probably wouldn't be happy, assuming they invested for returns. A lot of capital could be lost in conversion from a profit to a nonprofit.

But then, what's the incentive? You'd have to have a different perspective, with a different group of people. Have you ever worked in a nonprofit organization? If so, what methods were used to incentivize people to perform?

You might want to study some hospital models; there have been acquisitions of nonprofit hospitals by for profit corporations. I can only speak to a few with which I'm familiar, and in the one case, the for profit corporation made a lot of changes which have drastically improved care and morale. Granted, that's only one situation...

2. Impromptu inspection of facilities requires individuals skilled in medical issues as well as therapy, nutrition, safety, hygiene, etc. Who would fund these inspections, if not John Q Public, through regulatory laws?

3. I do think the concept of a family council is interesting, but frankly and bluntly, I don't want my family subjected to decisions or even involvement from other families unless they're of a similar mind, especially ones which are not educated as to the issues involved. I don't want to be involved in what could turn out to be gripe sessions.

4. If you want to start lobbying, I would suggest contacting your state senator and congresspeople, then their counterparts at the federal level, with the goal of determining which committees have jurisdiction over the medical placement facilities ranging from SNFs to long term care facilities. Then start lobbying them, learning their positions, strengths, weaknesses, voting records, and pork barrel projects.

And remember, you individually (and the rest of us individually) aren't going to have the clout of say Heartland which last time I researched had a number of facilities throughout Michigan, and possibly other states. Money speaks, and it speaks loudly to some less than honest people in Washington, D.C.

5. Researching which agencies to contact is a time consuming process; frankly, it isn't something I would do for someone who can do it himself. Each of us here has our own priorities. Some of the people here are overwhelmed with caregiving and day to day survival tactics. We each have to pick our own priorities.

You could just ask the congresspeople and/or senators when you contact them - they should know offhand and be able to respond quicker than any of us can do a lot of research.

6. I don't question your sincerity, and I think it's admirable, but I think there's a lot of research to be done, goals established and prioritized, people to be recruited, and mobilized. It's an admirable goal; it's also a real challenge for someone whose loved one is in a facility - and you'll have to question whether you could be more effective starting with that one facility and expanding rather than taking on the whole system.

Nevertheless, your goals are laudable, and I wish that such a movement could be generated. Perhaps you might also study past movements, how they began, were mobilized, gained supporters, raised funds, prioritized their goals, were effective or not effective, etc.

7. You might need some "big guns" in your movement; figure out how to find heavyweights who are on the same wave length, how to get their support and leverage that into a larger movement with more momentum. You might want to study grass roots campaign strategy and adapt tactics that are appropriate.
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There are many folks who will tell that "the private sector always does it better" and "there should be fewer regulations". I disagree with those notions and feel that there should be no profit motive in caring for the elderly.
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We have only ourselves to blame when it comes to benefits funded by our tax dollars.

How many times do we go to the voting booth and vote *no* to raising taxes for this or that? If the outcome is *no*, then money needed for that item has to come from somewhere else in the budget.... thus education and State health care get slashed.

Running a nursing home is very expensive.... according to an article in Fores, brand-new facilities will eat $130,000 to $145,000 PER ROOM in start-up costs–or about $11 million for an average-sized location with 80 units. The two highest expenses are caregiving staffers and food. With regard to staffers, there is a very high turnover due to burn out.

Next highest costs liability insurance, property taxes, and utility bills. Then payroll for administrators, accountants, lawyers, security, housekeeping, maintenance, landscapers, transportation drivers [bus expense], etc.
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