By Teresa Palmer, MD

Until our society vastly improves the way it delivers services to elderly and disabled people, about 50% of us will spend time in a nursing home or “Rehab Facility” before we die.

The Covid-19 pandemic, with serial die-offs of nursing home residents unmasked the reality of how so many nursing homes are run. Studies on what happened during these years showed us what we already knew. Good working conditions, adequate training and quantity of staffing, and open access for concerned family members is what leads to good care.

Payroll is the biggest expense for long term care. But “high payroll” interferes with the “generation of revenue” (profit) in “for-profit” facilities. In non-profit, or government run facilities, saving money on staffing means money can be spent elsewhere.

In general, the data shows that non-profit facilities are safer. But our health system is broken. The generous staffing that medically complex and chronically ill people truly need can, in any nursing home setting, fall short. Facilities especially may have overly “lean” staff on big holidays and long weekends, if not on Friday evening through Monday morning in general.

And that is where family (or “chosen family”) comes in: to monitor, advocate for and supplement the care that is not reliably available in nursing homes at this time.

There are times in our lives when only a nursing home (or a rehab facility) will do. This is especially true as we AND our supportive others grow older and frailer, or if progressive memory impairment arises. At that time, we need to be in a facility near our loved ones—that is easy to visit and keep the daily connection.

That is why, as San Francisco City and County Retirees, we must be adamant that, upon hospital discharge, we go to a nursing home or rehab “SNF” (skilled nursing facility) near our home. This means, for San Franciscans, and residents of other larger cities—a facility in our own home city. In less urban areas, it means a facility within the county AND close/ accessible from our home base.

As a first step, S.F. Health Service Board should require that our insurance companies give the board a yearly or semi-annual report on “out of home city” admissions to nursing homes/rehab facilities: and progressively show us improvement on this.

At a large facility like Laguna Honda, San Franciscans are within their rights advocating for admission policies that embrace San Francisco City retirees and other San Francisco residents that worked and paid taxes all their lives here.

Our big insurers, like Kaiser and Blue Shield, need to get in the same room with City Retirees and Laguna Honda administrators on common goals: keeping San Franciscans in their own city during the most vulnerable period of their lives.

This process will clarify how to assure close to home placement for retirees in other counties. This process will educate us, as we age, on our rights in regards to hospital discharge and nursing home placement-rights that are frequently violated. Our knowledge will enable us to help our aging families and friends.

Here’s a link for more detailed information: https://westsideobserver.com/26/1-guide-to-long-term-care-and-end-of-life-decisions.php.

 

 

Teresa Palmer, M.D., is a POB director and a retired geriatrics/family medicine doctor. She is also a long-term SF City and County Retiree.