Another billing opportunity

Nursing homes, and other encounters with the "health" care system

My mentor, Hazel Henderson, once said of nursing homes…. “another billing opportunity.” It evokes a mindless whirring machine turning minutes of care or pills dispensed into profit for investors, and thus “maximizing shareholder value” by minimizing the number of LPN’s per 100 beds (not even the people in the beds).

One night in a hospital after going to the ER

As I’ve shared my story about my friend in a Medicaid bed in a NYC nursing home, dozens of other stories have come my way. Here’s one…

I recently moved back to the island from a very expensive independent living facility on the California coast. We are 77 and 82. We moved to be closer to our son as we age, but these “facilities”, even the expensive ones, are inadequate. We had a very nice 2 bedroom cottage with a full kitchen, which we should not have needed because 3 meals per day per person were included in the monthly fee.

The food was inedible. So we cooked a lot, with no decrease in our monthly fees.

And we moved there because if one needed additional assistance, it was available for additional fees, depending on the nature of the assistance.

One day as I was walking near the main building, I bumped into a somewhat younger woman in her 50’s shaking with anger. Her mother who was living in the assisted living area, as she was recovering from a broken hip surgery, had called her around noon, as the mother had been calling for bathroom assistance since early morning, but no one had ever shown up. She rushed over to find her mother in a bed wet with urine and fecal matter and absolutely mortified. In addition to the regular monthly fees of over $5,000 for s studio apartment, her mother was paying over $2500 per month for bathroom assistance.

And another friend told a story about our local continuing care facility where her mom lives. It was bought by Bonaventure.

Bonaventure’s tag line is: We Create Assets!

Further they say:

We are an integrated alternative asset management firm, specializing in multifamily design, property development, construction, and investment management. Proudly headquartered in Alexandria, Virginia, we work throughout the Mid-Atlantic and Southeastern United States. Since 1999, Bonaventure has offered best-in-class capabilities that connect capital to assets.

Chilling, right? Your mom or grandma is part of an asset class. The customer isn’t mom. It’s the investor. This is nothing new. This is capitalism’s natural habitat. It’s just shocking to hear the anguish of my friend on the phone and draw a line to the efficiencies of asset management.

Presence to the predicament

Can-do Americans think there’s something that can be done about any problem. My mind wants to dilute the pain of seeing my friend in pain by finding a solution. I’m working every angle I know, but I also know that living in the gap of what cannot change will be ever more necessary. Fixing can be a way to not feel. So I need to learn to feel other’s anguish in a way that increases my capacity for compassion when there’s really not much to be done, and to do it with less residue of exhaustion. Palliative care for the soul.

Our country is in this gap with the LA fires. We are witness to suffering that we can’t really alleviate, though people are rescuing animals and volunteering and the fire fighters aren’t giving up, can’t give up.

Whatever this capacity to bear witness to pain while bandaging wounds is called, I am called to cultivate it.

At the same time, I have some ideas!

Even if we can’t control the transmogrification of Florence Nightingale into an Insurance company executive, we can ask… what can we do for ourselves, as a community, to facilitate the care that the unwinding systems may no longer provide?

Where I live, we have some homegrown organizations that meet some needs for us as we age, but there are gaps not just in service but in our awareness that we need one another. I wrote to my local friends and acquaintances after that last post to simply name this local fact of aging, sickness and death which none of us will escape.

Hello Whidbey friends,

This week's story on my blog, "How Fast We Can Fall", on the heels of the one 2 weeks ago, "After the Fall" opens a conversation about the perils of slipping into disability and need for care - ourselves or loved ones. There's been a lot of response.

I'm writing to open the conversation among the people I am growing old - and older - among. These aren't polite topics, yet important to surface.

I've gone from "that's other people's or older people's problems" to it's our predicament - whether we are a caregiver or need care.

My last two visits to practitioners at Whidbey Health revealed a wicked problem. We are short staffed - nurses, PA's, NP's, and perhaps doctors. On social media, I see long strings of pile-on complaints about insufficient number of practitioners on Whidbey, or our favorite docs leaving and no replacements, or... (note: medicare apparently doesn’t reimburse enough to keep practitioners in business)

I know people who are moving off island to be near robust medical systems.

How can we possibly age in place, and in grace (and not in poverty), if we need care, here on Whidbey and this trend continues?

Thanks to Lynn Willeford, we have Hearts and Hammers, Friends of Friends and South Whidbey at Home. What else, in that community solution way, can we create? How can we develop light relational systems to ease the fear, pain and isolation?

No accident this arises on the eve of the new administration that may remove ever more protections and support from our lives in the name of "this is a free country". As time goes on, if gaps widen, I trust we'll find a community way forward.

I see that "In-Home Suites" - mother-in-laws with an exterior door, a 3/4 bath and kitchenette - may be even more important to stay in our homes. The homeowner gets income, the safety of another person under the roof, maybe some help with chores as work-trade... and working people in our community get a place to rent. Do you have a suite? Want to consider converting part of your home into one?

Relational aging is the opposite of institutional aging. But how?

Even if you have family it’s not easy. I just read cartoonist Roz Chast’s book, Can’t We Talk about Something More Pleasant about her maddening last two years caring for her parent. I did nothing for my own mother as she aged. We were in a frigid stand off about who would run my life. She died when I was 30. I imagine a later time, had she’d lived, when we would have outgrown the hostility, apologized, forgiven and shared stories without any burrs in them, but that fantasy will never be tested. Instead, I am left with unkind words in both directions and then she was gone. I am not proud of my behavior, but that’s in the past. I am childless by choice. When people made the case that children would take care of me in old age, I just looked at them in disbelief.

Still, I can imagine something like kindness among the children of other mothers as we hit, together, deep old age and those things that were never supposed to happen … happen to us.

Coming of Aging is an inquiry among equals, not a well crafted teaching about how to age gracefully. Clearly, I’m aging truthfully, and humorously, and hopefully in a way that lets you surface your own thoughts.
If I have a lesson learned today, it’s the same as yesterday and tomorrow. Humility before the immensity and mystery of existence, and, at the same time, endless curiosity as if each encounter has a clue in it.