e-Patient Dave

Power to the Patient!

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Integracare Assisted Living charged us full price. Severely understaffed, they stiffed us.

Recently I’ve posted about horror stories that have happened as investor-driven chains get into hospice (here) and nursing homes (here). More broadly, nursing homes and assisted living are called long-term care, aka LTC.

For our mother and family, LTC has meant Less Than Caring. Last night, I posted My family’s disastrous experience with a growth-driven long-term care company, starting with this:

As many of you know, my mother died in October. What we haven’t disclosed until now is that it happened in horror story #3: she passed after a single week of “respite care” provided by the local outlet of a growing chain of assisted living facilities.

Many people asked who it is, and we’re ready to say: the chain is Integracare, and the local facility near Mom’s home in Annapolis is Bay Village.

Here’s how they advertise themselves. It does not in any way match our experience.

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Healthcare’s moral crime scene, part 2: private equity takes over a nursing home

Last week I wrote “For-profit hospice is a vast crime scene, and private equity is holding the knife,” about a November article in The New Yorker article. I emphasized: “Good hospice can be immensely valuable. But there are predators.”

It doesn’t stop at hospice: in August the magazine also published When Private Equity Takes Over a Nursing Home, a superbly reported piece by Yasmin Rafiei. It’s a nasty story, with the same lesson: when for-profit investors take over a care industry, and they don’t get punished for poor “care,” the cared-for can wind up in danger. Or dead.

I believe that we as consumers need to be aware that some heartless people have gotten into the care industry. Here’s how Rafiei’s article starts:

When St. Joseph’s Home for the Aged … was put up for sale, in October, 2019, the waiting list for a room was three years long. The owners, the Little Sisters of the Poor, were the reason. For 147 years, the nuns had lived at St. Joseph’s with their residents, embodying a philosophy that defined their service: treat older people as family, in facilities that feel like a home.

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“For-profit hospice is a vast crime scene, and private equity is holding the knife”

Screen capture of New Yorker article headline

Good hospice can be immensely valuable. But there are predators.

A wise friend referred me to this New Yorker article last month about a Pro Publica investigation. I skimmed it then, and today I read it in full. It’s appalling. If anyone you know is considering hospice, or has been “invited” by a company to consider it, beware. Here’s what the friend basically said – and they were right:

For-profit hospice is a vast crime scene,
and private equity is holding the knife

Note, I’m talking (and the article talks) about for-profit hospice companies. For-profit hospice chains bill the government four times more per patient than not-for-profits, and focus on both maximizing admissions and cutting costs (i.e. cutting back on services), all the while gaming the system to barely squeak under the wire before Medicare makes them give back the money.

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What’s up with the US health system?? (What I’m doing in 2019, episode 1)

Click to enlarge this composite of images from previous posts

I haven’t been blogging nearly as much as I did five years ago, largely because my early blogging was all about trying to figure out “what the heck is up with the American healthcare system???” and it’s now been two years since I had any new realizations. Here’s a summary of that, then some quick hits on recent and upcoming events.

No, wait – this part turned out long, so I’ll continue tomorrow with the “quick hits.” For today, here’s the baseline I reached two years ago.

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The effectiveness of the US health system, in one graph

I’ll leave you with this thought for the weekend.

After years of study of healthcare around the world, listening to an immense number of arguments about what’s important and what works and doesn’t, it’s all summed up in this one picture. The Y axis is life expectancy; the X axis is cost. This graph has been tweeted furiously and often lately by health journalist @DanMunro. (More on him below.)

You can easily see that US health costs per capita are way, way, way out of whack with the rest of the world. And, the life expectancy we get for it is years worse than the countries that cost 2-3x less.

Some will argue bitterly that the facts aren’t relevant, or a hundred other arguments.  I’ve lost interest in those arguments, because they’re all about rationale, and no rationale is worth a damn if the outcomes they’re trying to explain don’t match the rationale.

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“The Big Ugly” meets Speaker Academy #19: What’s up with expense checks??

This is the latest in the Speaker Academy series, which started here. The series is addressed to patients and advocates who basically know how to speak on a subject but want to make a business out of it. I’ll try to be clear to all readers, but parts may assume you’ve read earlier entries.

I’m really not happy to be writing this, but push has come to shove. Two thirds of my expense reimbursements are past due, and fully a third of them are more than 90 days out.  I’ve seen some people stretch payments at times, but I’ve never seen anything like this.

The stories I’ve been getting about “gosh, sorry, there’s nothing we can do about it” or “gosh, the only person who can write checks went on vacation” or “we only print checks on Thursdays and she was out when she came back from vacation” are familiar, but this year they’re much more common.  What’s up, healthcare? Is The Big Ugly coming home to roost?

I wrote about The Big Ugly last year:

… something I’m starting to call The Big Ugly – a wave of suffering that will happen as the medical industry contracts, and everyone tries to find ways to maintain their income. Unfortunately when an industry shrinks, everyone can’t maintain the same income. As anyone knows who’s seen an industry die (like mine, typesetting; or steel in America, or what Detroit went through), it’s painful. Good people get hurt, and organizations fight for survival.

It’s interesting, because the people I work with, for the event are good and almost entirely on time with paying my fees. But expense reimbursements? They seem to go through a different approval and payment process. I mean, things get lost in the expense rabbit hole, and even my good-to-work-with friends are unable to extract them.

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