Unlike most of the rest of the state, both Lehigh and NorCo both maintain nursing homes to care for the elderly. At least in NorCo's case, most would have a difficult time getting into a privately-run facility. Executive Lamont McClure has consistently maintained, both as a member of County Council and now as top dog, that it is our "moral obligation." Without doubt, it serves a meaningful humanitarian mission. But dark clouds loom on the horizon, and we should start studying alternatives that might actually do a better job of serving our elderly than packing them four to a room.
During COVID, we experienced the Great Resignation in which many employees left their jobs. This became a major problem at Gracedale, which at one point enlisted the national guard to provide nursing service. According to Skilled Nursing News, this problem remains. Turnover among CNAs alone is 44%, despite increases in compensation and other perks. Gracedale, like 60% of all nursing homes, is forced to rely on agency nurses and to decrease census, which in turn makes them unsustainable in the long run. The county could make a pitch for foreign workers, but given the current immigration climate, that seems to be a no-starter.
On top of the staffing crisis, there's reason to be concerned about the intergovernmental transfer, a creative financial mechanism under which counties pool their money to get a larger federal grant each year. Without that, Gracedale would have a far more difficult time breaking even. But it could be on the chopping block. Conservative think-tanks like Paragon Health Institute describe it as "money laundering." Even former President Joe Biden called it a "scam".
It's unclear to me whether the recently enacted Medicaid cuts will impact nursing homes. I refuse to engage in the histrionics of Hakeem Jeffries. But no one can dispute that the federal government is becoming less willing to fund our social safety net.
With all of this in mind, let me introduce you to the "Villages of Baltimore County," which recently provided $50,000 to six nonprofits specifically to help our older population to age in place. There are 285 such villages nationwide.
This is more than a plan for paying for home health care aides. Volunteers can help the elderly make it o doctor visits or grocery shopping. Scouting groups have planted community gardens with real and healthy food.
I believe something like this would be far less costly to the county and would give our older population a little more dignity than packing them into a room.
What do you think?
23 comments:
May you never need to put an elderly parent in a nursing home. It happened to my mother. Early on we found a private facility to take her, very nice and well kept. The first thing they did was assess her assets. I sold her house and car and all things of value. Each year the rates increased by at least 15 percent. The place we selected did not take medicaid....most don't but Gracedale and some private ones do. They are in demand. When my mother began to run out of money (we are talking 1200/month 10 years ago) I had to find a place that would take medicaid to take her. Waiting list city. The homes that did take medicaid were a little depressing because they did not have the money for decorations and activities like the expensive homes do. To those who are out of money Gracedale has a great reputation because it is not run by privateers who try to house patients on the cheap. the staff is paid a little better and they were better staffed and the staff worked a little harder due to the condition of the patients. These are not retirement homes, they are nursing homes for patients who cannot be left alone if mobile or bed ridden. It is not a rosy picture. Gracedale was built by the county to do exactly what is does for county residents who cannot care for themselves. They take the patients other homes boot out when they are out of money and considering how little they get from medicaid they provide good care.
Who keeps the people with dementia from wandering into the woods ?
Older residents on Easton’s College Hill formed The Village On College Hill a few years ago to help people age in place. It is a very worthwhile endeavor.
Falls are a major problem in LTSNFs. They rarely lead to death, but often hospitalization. In a Community Village they will lead to more deaths and even more hospitalizations. The hospitalizations will lead to an increase in health care costs. Excess deaths and a more costly healthcare system doesn’t sound like a solution.
It hasn’t happened yet, but soon the Federal and State government will put county homes out of business.
Certainly, worth a look. Hard to imagine it could be worse than the debacle gracedale
Here’s an example in Philadelphia: https://www.northwestvillagenetwork.org/. At the bottom of the page is a link to the umbrella organization providing infrastructure support, “Helpful Village”. There are at least two in Philadelphia and one in Lancaster.
This would be an easy lift for Lehigh Valley people. I can think of one neighborhood, West Bethlehem, which is ripe with will and a sufficient number of aging and vital persons who are informally doing mutual support.
I’m also pretty confident that places like West Side Moravian Church, the Lehigh Valley Friends (Quakers), or First Presbyterian Church could offer gathering space for a local “village”.
It is extremely difficult to give an intelligent decision on this issue without knowing and fully understanding the financing and reimbursement process. I admit I do not know anything about the process but off the top of my head, if I were an elected official I would seriously consider an in-depth study to determine the need, the cost, and what are the alternatives. You would not buy a pig in the poke and neither should the taxpayer. We don't have enough information.
There are no discussions at any level of gov’t to eliminate the igt.
Nursing homes all across the country find it challenging to find employees and you think that people are going to volunteer to care for these people? Are you delusional?! This type of situation isn't even medically appropriate. You are a terrible person to try and throw our county nursing home under the bus all while trying to boost LVH during her election year! And that's a hard lift!!!
I have watched four parents and parents-in-law experience four different late in life residential arrangements before their passing. Within the next decade or so both my wife and I expect to have to make some sort of residential arrangements appropriate for ourselves. From what I have observed there is no one size fits all answer to these questions. I believe that available public funding and community support efforts should be directed to developing several alternatives that fit the needs of the residential consumers as well as maximize cost efficiencies of any needed care. Independent living facilities and different levels of assisted living care should be encouraged as much as possible to reserve nursing home residences for those people needing the highest level of full time care. If these proposed villages provide better flexibility and more choices for potential residents, I fully support the idea.
Bernie, I’m a senior citizen. I see how aging in place is attractive, emotionally and financially, but it really doesn’t solve the problem. “The Neighborhoods” is a good idea, but our approach to aging needs to be overhauled. I deliver for meals on wheels and many of the clients are hoarders. In both good and bad neighborhoods, many seniors are prisoners of a home they have loved, and possessions that they are proud of. Many are “saving” things for their children and grandchildren, but we know that most of these things will be in the dumpsters in the future. In the city and in the upscale cul de sacs, older folks are isolated by their homes. They aren’t getting the social interactions that make them part of a viable community. They aren’t getting social services and health care they need. While we are beginning to explore this problem with some living arrangements that balance independence with continuing care they remain only for the wealthy. Silo-ing people, two in a room was almost always a bad idea, but financially viable. It’s always too little, too late.
I agree completely that Gracedale serves a valuable role for those who are incapable of caring for themselves. But needs and solutions evolve. You say that Gracedale was built for this purpose. Actually, it was not. It was originally the county's poor house, established as such in 1837. It was a farm and the residents were expected to work the fields. Over time, poorhouses became less relevant as social service agencies began to provide services, but the older remaining population was too fragile to work the fields. The nursing home was established in 1951. Like the original poorhouse, it has served a laudable goal. There are many good people who work there and who are strangely altruistic. But I see no reason for using it as a short-term rehab as we do in an attempt to make more $. And fewer people are willing to work in a nursing home environment. So I do think we need to explore options that best serve our aging population. We might want to keep Gracedale, but in a smaller scale.
I think this is something worthwhile to at least explore further.
I deliver too, and the hoarding issues are common. Old magazines, answering machines, old canned food. Yet they can afford to stay at home and prefer to. Many elderly are well off and don't want to leave.
Unfortunately not true. Everyone falls and no study saying falls in nursing homes have any better outcomes. In order to keep dignity and activity we will all risk falling that might contribute to our demise
Once upon a time people in this country had to work for pay and benefits. That is no longer the case. Nobody wants to be a CNA for $15/hr when they can collect SNAP benefits (food stamps), Section 8 housing vouchers, and Medicaid.
The Inter governmental transfer program is ONLY as good as the NUMBER of county owned homes in the program. The numbers of homes in the program are declining, and thus, the shared funding is reduced dramatically. The clock is ticking given the amount of cuts that are being done at the federal level. So, unless a given county that owns its nursing home can raise taxes or a create a funding vehicle of sort to take the pressure off the taxpayer base, then yes, the IGT program will fail to fiscally support the nursing home’s needs. Ask Dave Holland, he knows this.
Nobody is a very definitive term and you misuse it in your MAGA rant. There are a lot of individuals who place humanity above money.
4:13 - you are incorrect. The number of county owned homes is less today than it was five years ago, but the counties make a much greater margin off the IGT program today.
So easy to just say, let’s build a village for elderly and aging residents…..first off, Gracedale is a combined patients, resident, and rehabilitation home, not just for aging…Secondly, the costs of building, repurposing, or managing a controlled village environment would quickly escalate beyond what currently is in the $2million dollar range per year at Gracedale. The last straw would be transitioning the current population of beds, and approx 600 patients/residents/rehabs
Into stream of condo/village type housing.
Sounds like a program destined to fail .
I'm not suggesting in this post that we build a village for elderly and aging residents. I am suggesting that we study the community village concept, which is quite different. This is a concept that enables the elderly to stay where they are and retain their dignity.
I am aware that Gracedale offers a rehab and is in the process of starting or has started dialysis. Although these are both money makers, they detract from the main goal of a nursing home, which should be to care for elderly people who simply are unable to live on their own.
I am suggesting that our long-term needs evolve. I do not think the county should be in the rehab or dialysis business, although I'll agree that many of those who use both are elderly. We need to take a close look at our long-term needs. Just as Gracedale evolved from a poorhouse located on a farm into a nursing home, it might want to consider reducing its size and pursue other avenues that keep our elderly happy and at home as long as possible.
If you have children particularly under 6 and you work for $15/hr you will still qualify for snap, vouchers, and medicaid especially if the employer does not pay health benefits, plus you will have to pay for child care. Many of those programs have a work requirement.
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