I was sitting at the nurses station when I looked down to see an admission paper. It said that a person was coming in for rehab and that they were paying $750 a day! A day! Now this person was only coming in for rehabilitation so it was probably the bare minimum. I can imagine how much a person who came in needing to have extensive care would have to pay per day. I figured out that if they just charged the bare minimum for 60 residents that would be 1.3 million dollars a month. They most likely use only 10% of that to run the place. There is no excuse that any place should be short staffed. That is pathetic. CNA’s are breaking their backs and upper management is laughing as they run to the bank.
What’s a nursing home prevention program?
The program I work at is called PACE, you can google PACE for older adults. It’s basically a medical center with day time activities and includes pcp, social work, pt/ot, dietary, podiatry, psychiatry, dental, home care, and others I’m sure I’m forgetting. Medicaid gives us a chuck of money for each participant to keep them out of nursing homes as long as possible. Aging in place. It’s amazing. Once someone becomes too sick to remain independent with even all the services and interventions, we help place them in the nursing home.
There's also waiver programs for different types of disabilities. For my state the only way to get on it is to go in the nursing home. Otherwise you stay on a wait list forever. If they would properly fund the waiver programs, they could eliminate a lot of nursing home admits. Politicians love to point out how much money is blown on healthcare but they always ignore that the expenses are largely due to their policies and mismanagement.
god I kinda want to work there now lol
I work somewhere similar but it’s private out of pocket in Canada. It’s retirement but pretty much one healthcare aide and one nurse. It’s a great job because all of the residents are independent.
I worked for PACE for a while. It’s kind of a mixed bag. A lot of people don’t realize that PACE takes over Medicare for the patient. The PACE team and doctors have total decision making power over the patient’s healthcare while they are in the program. For instance, if a person needs SNF care for rehab after a fall, it has to be approved by the team and the person can only go to a PACE contracted facility. The participants also have to use the PACE physician and accept referrals to whichever doctor PACE will pay for them. Also, there is a requirement that participants, as they are called, sit in the day room and do activities and such a few times a week.Sometimes they get therapy as well. This is fine for some people. But no one better try to make me do all that when I’m very old. I’ll just want to sit in a chair in the privacy of a room and read my books or watch television. From my experience, PACE is more of an alternative to assisted living. It’s not that helpful for people who need nursing home level of care unless the person has excellent social support in their home. The home care hours are limited.
Some states have other home and community based options that allow you to retain control of your health care. Medicaid will pay for up to 35 hours of home care per week in my state. Again, this doesn’t touch the level of need of someone who is truly nursing home level of care, but it sometimes works when people have the right social supports in place.
Center attendance for daytime activities is completely optional at our program, I have many on my caseload that come appointments only. I’m sad to hear your experience but it doesn’t shock me after being in the field for many years.
This is so cool! I want!
They are paying around 20k a month for mine. Could pay the rent on an apartment for an entire year with that and save so much money but noooo
Do you feel that you could live more independently?
Yes. The only thing stopping me is lack of funds and lack of affordable housing. I finally have the waiver to get nursing care in the home. But now I have to find a new home
They don't really take good care of people either, at least not where I live.
Well I’m sorry you require that level of care. It really is a shame, how few resources there are for those unable to care for themselves. Everyone deserves a certain quality of life, especially disabled and/or impoverished people. I’m sorry you are not getting better care. The US needs to invest in infrastructure to help Americans.
In what world??? Last I checked medicaid pays like 100ish per day.
Pennsylvania.
Medicaid? What about Medicare?
Even lower. Then there is the automatic defections by Medicare because they know you are cutting corners but are too lazy to find out where
i'll have to look kore into that... weird and confusing. grandma has medicare and needs help. they think she is cutting corners? amazing medicaid is so helpful to able bodied people yet medicare is pretty crap from what i know
You have no clue corrupt medical care. Obamacare allowed the government to charge the manufacturers 6.5% tax on sales to distributors. Obama care then allowed the distributor to charge another 6.5% tax, they sold to healthcare companies and pharmacies. And Obamacare allow them to charge another 6.5%above and beyond sales tax or items sold to the individual. Compounded over 20% of what you pay is tax back to the government on that one item.
LTC facilities automatically get their payments reduced to a preset price. They then get deducted3.2% automatically because the government says that is what Medicare fraud costs them. But it can be higher if they find out they are billing for services not performed.
That is the billing rate. Not the reimbursement rate
I am a MDS nurse. Medicare A likely pays for most of your rehab residents and their reimbursement depends on the patient but it is commonly around $700-1200 per day depending on their needs. When they come off Medicare A, the reimbursement is a lot lower but it’s still a few hundred a day. Trust me, these shitty nursing homes have the fucking money
Yep. Google it. Owners have the money and hide it by related party transactions
Hi, fellow MDS nurse here 👋🏻 but that reimbursement doesn’t only go to nursing wages. It covers a lot more facility costs than just that.
Yeah a lot of administrative bullshit
Same MDS here. Our average skilled (Medicare) patient is around $523 a day. (Arkansas based) The therapy company automatically eats almost 30% of that cost. We are also responsible for covering all their medication cost at retail price. If they’re on vancomyacin there’s no way we can even take them usually because we will lose all our money to that one med. We usually “profit” after just those two expenses, $281 a day. These patients make up 15-20% of our overall population. Our Medicaid, about 80%, of our population make up most of our pay source and they reimburse $189 a day.
Now google the congressional request made this month, May 2024, by Elizabeth Warren to Ensign.
Their owners “corporate” - not internal “administration” people in a building- had SALARIES (not profit) of pushing a billion dollars in the last few years.
I don’t disagree there are some making money hand of fist but they are usually the ones that own portfolios. If it’s a free standing facility, they’re probably really struggling if their Medicaid population is really high.
I work in a private unit while the rest of the building is funded, guess how much our residents are paying? Almost 8 grand a month and the services are so shitty, we don't even have toothpaste on stock I have a resident who has been going on a month with no toothpaste because their family won't get it for them and we don't supply it as well. The recreation there is shitty, the food is terrible and I like cheap food but this? Dog food. We don't have any extra staff on the unit and have several incidents because of not enough staff to watch all of our wanderers and fall risks. Also our equipment often breaks down, it's just terrible
People who run nursing homes are some of the most greedy fucked up pos' I've ever experienced. Literally taking advantage of the vulnerabilities of these people and their families, I've had so many residents confide in me that if they know this was how it actually was (because of course they're lied to and only shown the units for a minute so they don't see all the fucked up stuff) they would have done something else.
I agree with you 💯!! They are the most crooked people I've ever met!! Don't care about any other human life. They only care about how to squeeze more money out of residents, and how to pay their staff the least amounts of money!
Agreed. I pulled my dad out of a private pay Memory Care dump in 2020 and will never put him in another facility. Food was like prison slop. And he went to a SNF for rehab (not that he got much) and I pulled him out long before Medicare would stop paying, like after a week. And I had to keep telling them I want him out! They wanted to keep billing Medicare. If people saw what really went on they'd never put their loved ones there. I had a camera in the first place and the SNF I spent 10+ hours a day in his room with him. It was like a warehouse holding miserable people waiting to die.
Time to make an anonymous call and report them.
We have something in my state called DHEC. It stands for the Department of Health and Environment Control. They investigate these things.
I’m not exactly talking about my facility as far as being short staffed, however our building is in need of some serious upgrades. The heating system is heated by the hot water that flows through the baseboard. There’s no A/C and last summer they rented these giant portable A/C units on each hallway. By the time the air got down to end of the hall it was warm again so those rooms were saunas. One dryer has been broken for several months so we barely have any wash rags in the morning. Just stuff that would make our lives and the residents easier.
Woah that sounds almost exactly like my work lol literally dying right now as I type because it's so hot. Our residents rooms are around 26C right now which isn't dangerous but is pretty hot and it ain't even summer yet
So like 79 F. Yeah that’s sweaty. 😓
Our department has been through here multiple times and this is just the state of LTC unfortunately :/ every place I've been to has ran similar to this and I've reported way worse with zero action from the department
They don't do jack when you report them to the state where I live.
They really don't, the state will come in, see everything is fine on paper and then leave.
Yep, it's all about looking at records. I reported the place where my dad used to live when a lady in the room next to him had two broken hips and no pain meds for several days. She was constantly crying and some of the staff even told me they cried too but couldn't give the meds, that hospice had to. I called 911 and they must have canceled the ambulance because it never came. I couldn't do anything to help this lady and it was so upsetting. After I reported in great detail to the state and even included a video of the lady moaning and crying, the state didn't find them in non-compliance.
It sounds like you work where I work. The food is out of cans, so it has so much salt and preservatives. Everybody gets the same diet, even if they are diabetics, renal, carb control or cardiac. It doesn't matter they all get the same thing. The snacks are all carbs. Always short staffed, never any decent working equipment. I could go on and on. It's disgusting. I read the advertising brochure for the place and cracked up laughing. It's a bunch of bs.
I work at a private pay RCAC and base rent starts at 5k, three meals a day is an additional ~1200 and every single med pass is like an extra 20 dollars per pass each day. Housekeeping is an extra 120 a month. The list goes on and on, It’s crazy
How can an RCAC charge for med passes? Those people are supposed to be (more) independent, it's not an SNF or assisted living. Those residents are getting hosed and should be able to self medicate in their private apartments.
They can if they are able to do so, but I’d say about 75% of the residents have staff pass their meds
That's crazy!
I’m still not sure of how everything works/is supposed to work but yeah, we are an RCAC assisted living facility. 30 residents, 5 need help toileting/dressing/etc and everybody has some sort of memory issues. And a handful of residents are on hospice. None of it makes sense to me but state was just here not too long ago so I don’t ask questions 🙃
Yep, absolutely. It's horrific just how much these facilities charge their residents while paying their care staff pennies. I used to work at a memory care facility. It was my 2nd memory care job. I worked NOC shift, and one time during break I snuck into the executive director's office. I peaked at the desk, and saw several opened envelopes with bills that read for almost 10k a month for all the care services.
In my 1st memory care job which was at a very high-end facility, I was told that one of the newer residents was paying almost 20k a month for all her "specialized" care. Let me tell you that there was nothing specialized about it. She had a private caregiver, but she didn't work for the facility. And when the caregiver left after dinner, she'd receive the same level of care like every other resident.
Most of these facilities can afford to pay their staff way more. But it's a crooked business.
Most snfs are close to 3k a month
The ALF I work at is between 8k-10k a month
No they aren't. Most SNF and LTC are between 6k-9k/ month. That 3k is THEIR portion, the rest is covered by insurance or Medicaid
No. Not even close. Mine is 20k a month. They take all my money and Medicaid pays the rest. Mine is one of the cheap Medicaid ones in a low cost state too. So I can't imagine what a high cost state would be
3k is very low
Yep. More than double that here in CA. Private pay is like $7k/month.
After insurance and everything else
Not all accept insurance either, my old snf facility was private pay and many paid anywhere from 8-20k monthly depending.
My current ALF is just over 10k a month for memory care. Alllll private pay. We've had at least 6 residents leave in the last few months because they ran out of money, it's disgusting.
In the nursing home I used to work at, there were always CNAs overworking themselves, working through their lunches, etc. I would work at a reasonable pace, ensure my patients were always taken care of, and always took my lunches. I would constantly get scolded for being "too slow" by my manager, but I was the most requested CNA in the nursing home, and the LVN was always impressed with my work. So fortunately, despite being "slow", I was still considered the best CNA in my department.
One day, the owner asked me (amicably) when I always stayed later than my coworkers. I was honest, I am always on my feet, making sure everything that needs to be done is done, but I just had too many patients to finish during the normal shift.
My assignments were more reasonably balanced after that conversation. So, my advice, do your best, but don't try and force yourself to do two people's jobs. Companies need to hire more CNAs. "No one wants to work", nope, no one wants to work at the pay they are offering. They can definitely afford to pay more.
I work at a nursing home in Canada. We are unionized, make a bit over 26 an hour and are partially subsidized by the government. Private rooms are a little over 2k a month. All meals, refreshments and snacks provided. Also diapers. We have lots of donated clothing, so those with less can get more. We have have some residents that are on disability checks from the government, some that have money that the POA controls (unless they’re still with it enough to be their own POA) full staff is 7 per unit (we have 4 units, close to 180 in the building.) we just provide care for all ADL’s and help with dressing changes and giving some residents their meds that the nurse has asked us to. (Only the ones that need feeding, and if they’re on isolation for droplet precautions) today we were 6 and I had 8 residents in my section. I wasn’t in my usual unit downstairs because they were short upstairs and I volunteered to go. It went well. The other 2 Psw’s (Canadian version of CNA) in my hall helped me out loads because I hadn’t been up there for a while and there were new people. We also specialize in dementia care, and I took extra training to work one on one with the residents that our local psychiatric hospital is following. We try to find ways to make it easier for the staff to provide care if we can. In some cases, the person will be sent to that hospital when the behaviours are extreme. (One resident was trying to strangle other residents and the nurse once for example).
Canada knows how to deal with healthcare. It’s not about the money and the greed.
Right? I mean wait times in hospitals are horrendous, but we really took Covid seriously and it changed a lot of things. No more than 2 residents per room. And we prioritize residents choice, dignity and respect. I get tons of hugs from them and they always tell me how nice and kind I am. Makes me feel good 😊
what does PSW stand for? just wondering as i’m in canada too and instead of CNA’s we are HCA’s (health care aide)
It stands for personal support worker. It used to be HCA, but changed. We get a pin with a number after we graduate the course, and a certificate. In some assisted living places, psw’s can be delegated to do the med cart, but not at my place. We don’t even take vitals..we report any changes in condition to the nurse and she comes to do it
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Yep. Some homes can delegate that, ours doesn’t. We just provide the ADL’s, report any changes etc. to the nurse. Even just behaviour that is out of the ordinary for that person. Usually, vitals are only taken after a fall, and in the couple of days follow up after a fall, or if they’re sick or complain of not feeling well.
I work at a nursing home in Canada too. It's run like how you say your nursing home is. I don't have much issues with it. The managers seem to be running it well.
Since late fall 2023, we have been getting some reno/improvements to the home. Most recently they have hired painters to paint everywhere. Since units can't be painted all at once, it's going slow.
There are SO many overhead costs that you’re not thinking of though. It’s not just nursing and rehab staff that this money goes to. It housekeeping, kitchen, admin, social services, etc. plus, the cost for supplies and utility bills, and landscaping, and plumbers, insurance, and so much more.
Still only a fraction of
Second this. Let’s be real. The people still owning these places still don’t do jack shit. They’re not practitioners. They were never healthcare staff.
They’re still taking the money and running. They don’t deserve basic human needs at that point.
You're probably off in thinking that rehab pays less than complex, it's usually the opposite but let's assume ...750 x 20 (cause after 20 days they only get a % of that 750 and the person is likely to go home before day 20 in most cases) is 15,000.00 per medicare/rehab stay.
Most NHs only have about 20% of their beds allocated to rehab so let's figure a 100 bed facility has at most 20 people at that 750.00 rate at any given time.
To get a daily rate for those patients figure (if full at all times) 20ptsx750day= 15,000.00 a day x30days = 450,000.00 per month in medicare revenue.
Oh, for those rehab folks the facility is responsible for ALL of theur medicine and equipment (it ain't cheap).
The other 80 beds in the building (most nursing homes aren't anywhere near full but let's say that they only have 5 open beds and lets go with 75. If we're talking about a really nice new building they may have 30% or 40% rehab and maybe even a few "private pay" folks at 250 or so/day. But let's assume it's just a middle of the road, not terrible but not great facility. The average rate for those 75 other residents is going to vary a lot by state but it will be nowhere near that 750. In most states a 300 avg would be great! in some (mostly red states) that average could be as low as 155/day. So low end 155x75x30 = 348,750. So to take care of the poor folks who "LIVE THERE" and likely will for the rest of their lives they get less for 75 people than for 20. So in the most simple terms (and a ton is being left out here) revenue is about 10 million a year.
Avg number and salary for staff in a building like that depends a lot on where you are. LVN/LPN 22-32hr RN 28-37hr CMA 18-25hr CNA 15-20hr Restorative aides Transportation aide DON - 80k -100k yr ADON - 68-85k yr Therapy staff of at least PT, PTA, OT, Cota, SLP Dietary team 3-4 cooks, 5-6 aides, manager, Reg. Dietician Admin 85-120k yr Business office mgr 60k yr
Groceries to feed those folks be 25-30k a month and thats just the literal groceries. Other equipment for cooking, drinks, supplements, specialty dietary items...
The way this country runs it's nursing homes, cares for it's seniors and those who are disabled is a disgrace and that MOST DEFINITELY includes the way it doesn't care for those that care for them. Especially like CNAs who do the backbreaking work. Work they do most often because they truly care.
There are a great number of nursing home operators who I wouldn't spit on if they were dying of thirst but the problem honestly starts in our legislatures and the way the whole thing is set up and the incredible way we don't value folks. Teachers and firefighters and EMTs all similar.
It's not as easy though as all those nursing homes are getting rich or taking the money and running.
Keep your eyes open. Watch as many NHs will close in the next 24-36 months.
Reimbursement is not going up nearly as fast as wages and expenses especially for the care of "long term care" folks who aren't just rehabbing but live there and until it's a crisis the government won't do a damn thing and when they do it'll be to make the rich richer and not much else.
This is the way I see it too. I think it's kind of like daycare where it doesn't seem like it should cost as much as it does. It's actually worse because you need staff 24/7 and there is a ton of overhead.
But I've never actually run the numbers so it could be that the nursing homes are running away with it. But people comparing it to the cost of an apartment are just silly.
Yep, nursing homes and assisted living are all predatory scams. They charge insane amounts of money and make profits by paying employees as little as possible and understaffing. The scum that own them are evil!
And what's sad is even though some residents pay $20,000 a month - CNA's where I work make about $15 - $18 an hour to perform some of the most grueling and difficult tasks of any job I've ever worked.
That 1 resident pays that one CNAs salary for the year.
But wait! There's more!
In my state, nursing homes aren't required to carry insurance on the facility either. So when dear old Mrs. White codes at the lunch table and nobody can remember if she's a dnr or not and somebody has to run and check the chart, and oops she is a full code, when the family goes to sue...the facility "closes", declares bankruptcy, sells out to their brother for $1.00, and the next day Shady Pines has a new sign saying welcome to Shady Gardens. Since the facility Mrs White was living in closed, the family is SOL. That exact scenario actually happened to my best friends grandma (she didn't make it).
But the owners do make bank, it just doesn't have the trickle down effect to where the staff gets paid more, the food quality gets improved, or the cleaning supplies get upgraded from the 90's either.
i live in a boomertown, avg age is mid 60s according to a census.
there is a nursing home on every other corner, all of them have terrible reviews from customers/patients and employees.
on indeed its like 60% of the jobs listed for min wage CNAs to be caregivers.
reading this post made me go to the websites and holy shit you werent kidding.
some of them are very vague "competitive pricing witht he best care in the county" wording and others just have their prices on the website a few clicks away.
really makes you wonder where all of the money goes
That proves they can afford to pay CNAs at least as much as fast food workers make.
I work in AL/MC and for MC, residents pay between $6k-$11k a month depending on the care they need, and AL pay between $4k-$6k a month.
I'm in California, ours charge's $350 a day. 10,500.00 a month.
I shadowed at a place 17k a month and only 2 employees on the floor for 22 residents in a dementia ward. It’s a crime. I still can’t shake what I saw and the lack of care. I’ll never ever work in one.
The VA nursing home takes their disability checks too
Rehab patients (Medicare A or insurance) are typically the highest paid as far as reimbursement. It's based on the PDPM classification of the individual, which is basically an alphanumeric score of how complex the resident is, based on the MDS. For rehab patients, the nursing home also has to pay for anything that falls under consolidated billing (supplies, medications, medical devices, some tests, therapy).
In most states, you can look up exactly how much the nursing home receives per day for each Medicaid resident. Search "[state] long term care Medicaid rate list". These are typically the lowest paid. Private pay is somewhere in the middle of the two.
In most states, you can actually look up historical Financials on each facility. Search "[state] long term care cost report".
Many nursing homes would hire NO staff at all, if they could legally get away with it. That's how cheap and unethical they are.
Anyone in Arizona know a SNF or LTC facility that offers training to be a CNA and pays for the state test?
Just start calling them and see.
laughs in IHSS
I want to work.
At least I’m smart enough to understand that if a business doesn’t maker money they close!!
Not sure???
The largest private hospital chain in the country filed bankruptcy yesterday.
How many people lost their job because they could not be profitable???
Who side are you on??? Why not ask those who are getting laid off!
At the facility I work at, in PA, it’s $14,000 a month and the residents share rooms and the unit I work is run-down to say the least. However after private payers go on Medicare the facilities stop making money off them. They keep trying to “rehab” elderly people who are glorified veggies to get their insurance money. If that’s not taking advantage idk what is!
Not me making a comment because my reddit is being watched.....
Forrest Preston, CEO of a company that owns a bunch of NHs and ALS, has a net worth of 1.2B.
So open a facility then, take on all the legal risk, put down the investment capital.
This because even the “owners” down own them. They are a management company that in turn have to pay a REIT. (Real estate investment trust) the REIT hires them to make money off their REAL ESTATE investment. It should be ILLEGAL for REIT’s to be the true owners of a nursing home. 90% of the time the people who tell you they are the “owners” are just the owners of the management company for the REIT. They don’t own shit.
I know multiple family’s that own small care homes(5-11residents) that make bank. They all have no education, poor business sense, and barely speak English. The business model honestly looks fool proof.
Nursing homes are a rip off.
Yeah. When the president stated that they were hurting on money and had to close one facility, which means we will be getting more at ours, and then said that they can't give raises, part of me wanted to blurt out that he would just have to get rid of his elevator and many planes but I probably would've been fired so quick.
I don't even know why we have a president of the company. They get all the money and we as well as the residents suffer for it.
You are incredibly ignorant of business. Off you use point v click care, monthly billing for That alone is $10,000 for That size facility. What about power? What about equipment? Purchases and repairs? Food? The massive government regulations and their effects? Everything cost something even the air
Whose side are you on?
Former nursing home admin here, and this person is right. I ran the most expensive nursing home in my state, and you'd be shocked how often we were in the red. Covid made everything so much worse from a financial/ marketing perspective. Respectfully, front line staff know next to nothing about the finances of a facility. The owner very likely owned that plane before he bought the nursing home. The costs associated with staying open are truly staggering. I left the industry because it's not sustainable.
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Medicaid pays between 8k-10k a month per person for nursing home LTC care. I work in a nursing home prevention program.