For those of you who play nursing homes, check out the ratings of the ones you work. Go it to Medicare.gov.

Pretty sobering, in some cases.


Russ

To what end, Russ?

Of the 100 or so places I do on a regular basis, I'm guessing 20% are above average...10-15% are probably below and the rest in the middle.

I don't want to assume what you're meaning, so would you clarify?

Thanks-

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Bill in Dayton

Bill, I'm very active in an organization that lobbies for standards of care in the nursing home industry in Kentucky. Because of what I've seen as a long-time caregiver and activist, I don't and won't play nursing homes or assisted living places, but choose instead to donate the proceeds of one of my weekly jobs to our organization and to produce public education pieces, seminars and other awareness P/R projects...no charge. Sadly, the "for profit" nursing home lobby organizations are strong, influential, very profitable and vigorously fight efforts to set care standards. In Kentucky, there are few, if any staffing requirements (in terms of workers per population) and few requirements for staff training and background checks, resulting in abuses, neglect, suffering and unnecessary deaths.

I check the ratings of nursing homes often, and sometimes the ones with the worst ratings are the ones you wouldn't suspect.

If I were in the business of playing for nursing homes and assisted living places, I would want to know the rating and would not have anything to do with the bad ones. Actually, playing in nursing homes is not ever going to happen. When representatives from local facilities approach me at restaurant gigs, they quickly disappear when I tell them my name.

I thought that people here who play these kinds of places would be interested in the ratings of the places they work, and using the website listed above is an easy way to check things out.

In the 14 years I was a caregiver, I was involved in care giving at 7 nursing homes and assisted living places. One of the very fancy ones (I'm talking uniformed servers and a gent in a tux playing a grand piano for every meal) has an unacceptable-bottom care level rating.

The best I've seen is a VA. The really bad ones (numerous fines, multiple failed inspections, pulling of Medicare and Medicaid funds, illnesses and deaths, abuse I've seen first-hand attributed to incompetence, lack of training, etc....even closings) were large national organizations. Thing is, all the money in the world won't always get good care. In the case of both my in-laws, who could afford the best care available, they reached a point where they didn't meet the requirements of the home (couldn't get to the dining area on his own; a broken hip for her), they were asked to leave. The only places available in the state were the "bottom of the barrel" "for profits" who are always in trouble.

If you checked out the places you play, you'd be pleased at some and really disappointed by others. I just looked at the ratings of the homes in Dayton. It just took a few minutes, and it's pretty easy to separate the good ones from the bad ones.

This is just an FYI from someone who thinks that the nursing home and assisted living industries in this country are national disasters.

And someone who works daily, commits thousands of hours yearly and who donates as much as possible to try to do something about it. The hundreds of thousands of the most vulnerable of our citizens deserve better.


Russ



[This message has been edited by captain Russ (edited 05-14-2010).]

Interesting subject, for sure...

I agree wholeheartedly that "standards" are often unevenly applied to the detriment of the residents.

I also agree that some facilities are better than others and that the appearance of the front lobby or the attire of the food-service staff has nothing to do with the quality of care being provided within.

I have seen the "dog & pony show" that occurs when State Surveyors are in town checking them out.

Why do you refuse to perform at places like these? While I'm paid by the NH's owners, I "work" for the residents. The services I provide are of a very high quality (so I'm told, at least...) and are consumed directly by the residents themselves. Its a one on one relationship, not filtered through an Administrator, a Director of Nursing or even an Activity Director.

If I on principle refused to perform in these facilities, how would that help address the issues that face the Long Term Care industry? How would that...ever...benefit the residents daily experience? If I am enriching the lives of the people I play for...and then take that away...doesn't that make their day worse, not better?

I applaud your efforts to improve the industry from outside, but would ask you to "also" focus on the daily experiences of the residents within. The gift you possess is of a valuable currency in this age group. They KNOW what good music is and it impacts them profoundly.

My impact can't be measured in a long term sense since most of these folks won't be here in five years. However, they are here right now and I believe benefit from my performing for them as I do. Long term, your efforts may result in improvements. Hopefully so. But I say you could still bring pleasure to these audiences AND tactfully work behind the scenes to address long term improvement.

Don't misunderstand me, I'm fully behind high quality standards for LTC locations. In this age of "anti-Gov't this and anti-Gov't that" I'm unsure what kind of more aggressive measures we'll see enacted.


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Bill in Dayton

[This message has been edited by Bill in Dayton (edited 05-14-2010).]

Bill, my time is much more valuable as an advocate. My hourly rate for the "no charge" work I do for this cause is in the area of $250.00, where most of these jobs around here pay $100.00 per hour. I'm simply more effective doing what I'm doing. The one weekly job I donate the funds from usually pays $300-500, so that is also a better use of my time and funds.

Mainly, I'm too close to the problem. I will do anything I can for honest people and nothing at all for the rest. I'm simply too upset about this national disaster to be able to associate with these folks in ANY way. And, it is my opinion and the opinion of advocates across the country that what I'm doing is effective and valuable....a lot more valuable, looking at the over-all picture, than playing for the pay available....even if I donated it to our organization. I couldn't bear to take any pay or better myself in any form working for some of these people I firmly believe are "bottom feeders". And around here, there are plenty of people lined up to take the fee for performing, so the service is there and appreciated by residents, I'm sure.

In the end, we all choose to dedicate our time and efforts to causes we believe in.

I certainly understand your conviction that the patients you play for are benefiting and am glad you feel good about that.

And there are some very good facilities and lots of dedicated people who work in the industry.

It's the others I worry about.


Russ

P.S. My dear father-in-law passed away 4 months ago, and I still make daily visits to the VA he was at, bringing clothing, treats, sanitary supplies and watching out for the dear souls who live there. Sadly, most are simply "parked" there and virtually ignored by family members. That's why so much abuse goes unnoticed. I plan to continue to visit and watch out for my "little buddies" as part of my daily routine in the future. For me, it's just the right thing to do.



[This message has been edited by captain Russ (edited 05-14-2010).]

Dear Russ this is also a problem in our coun try Australia.
I have a son who goes into these institutions so that my wife and I can have respite. We are in our seventies.

I dread having to do it.

Some are better than others of course it depends what you can afford to pay in most cases.

One organisation quoted $16,000 a month.

To ensure my son has one of his requirements
met I attend to his showers twice a week while he is in care.

We have a system of finance with some funds coming from the Federal Goverment with residents making contributions

I know of two homes that have lost $1,000,000. a year.

Of course individual carers can make a big difference.

Cousin Ken

I agree with Bill's statement above. I too perform for the residents, and I've grown to know many of them over the years. These are wonderful people who happened to outlive their bodies.

As for the Federal Rating, it's, IMO, not a valid measure of the quality of care, or the overall quality of the facility itself. Some of the information is self-reported by the facility, which automatically makes it a bit suspect.

I looked at the ratings for several of the locations where I perform regularly. Some that were rated fairly high were locations that I would not have sent my cat to live out her last days. Others, that were not rated as high, were locations where the level of care and staff are absolutely top drawer.

And, I have a great deal of admiration for the many, many, hard-working individuals who daily have to take care of a large number of individuals that can no longer care for themselves. The vast majority of the staffers are compassionate, caring, people that give 110 percent to every patient they come in contact with.

I have personally witnessed dramatic changes in the Assisted Living/Nursing Home industry in the mid-Atlantic region of the United States. It's a huge, and very competitive industry that continues to grow as the nation's population ages. The competition is so keen that facilities in this part of the world now resemble luxury resorts. Many have spas, hair salons, dining rooms with waiters and waitresses adorned in tuxedos and incredible, ornamental gardens, both indoors and outdoors.

I have relatives that work for the state's Department of Health and Mental Hygiene who make surprise visits to facilities throughout the state on a daily basis. The show up unannounced so there is no dog and pony show for the inspectors. They're very strict, take photos, and in the past, have issued reports that led to facilities being shut down--some for good!

I don't know much about the assisted living/nursing home facilities in Kentucky, but I suspect they may be a bit behind those in this part of the world, especially when it comes to competition. The same is true in some southern states where conditions were found to be deplorable at best. The following is a mission statement from a Florida location that scored high. "Hospice Care is dedicated to acknowledging and preserving the dignity of individuals by providing comprehensive spiritual, psychosocial and medical support for those dealing with end of life challenges." It also states "Hospice Care acknowledges that death is a natural part of life and encourages every individual to live each day to its fullest." My sister in law tells me the only thing her mother received here was total neglect.

Russ, if you wish to donate your time and services for something you believe will improve the NH industry in your area I sincerely applaud your efforts. You are providing a needed service where your only monetary benefit could be a write-off on your tax return as a charitable donation. Those of us who entertain the residents for a living do so for two reasons--we provide a service that benefits the residents, patients and staff of the facility, which in turn improves their quality of life. And we make our living at providing high-quality entertainment for those individuals.

Good Luck,

Gary

Gary, the Federal rating system isn't perfect, but it's better than nothing. The national "for profit" nursing home lobby is powerful and vigorously fights ANY legislation aimed at accountability and safety.

To the extent that Kentucky has few nursing home regulations, there are more problems here (and in all states that have few mandated standards). 39% of Kentucky homes are in the bottom of the rankings (one or two stars). Nationally, the number at the bottom is about 27%.

Inspectors are generally dedicated (except for the ones taking payoffs, and nearly 100 were caught last year, nationally), but are limited by the applicable standards laws in their states.

Many nursing home workers are caring and competent, but at least an equal number are not trained, underpaid, not certified, have criminal records, abusive, etc...again a by-product of a lack of established legal standards and resistance from the industry.

My involvement is much more than just in Kentucky. Over the last 5 years, I have made 27 trips out of state to participate in legal legislative hearings and have visited over 200 legislators around the country to try to influence their efforts on behalf of nursing home regulation. The Kentucky organization I work with got their 501(c) certification about a year ago, so for 4 plus years, I paid my own travel expenses, funded communications projects, etc. without being able to deduct the funds as donations.

I am a researcher/statistician (I teach statistics and research methodology at the graduate level, and supply research services to some of the country's largest organizations), and the numbers available nationally don't lie. We all know of a good or bad home and good or bad workers, but only when you do a statistically significant analysis of the national issues, frequencies, etc. do you really get a clear understanding of what I believe is a national shame.

The originators of the Federal rating system had no dark ulterior intent, unlike the "for profit" lobby groups who oppose and criticize the ratings system to avoid regulation and save money. And believe me, these organizations are extremely profitable. A quick check of the funds spent on lobbying efforts is shocking (those figures are readily available)...enough to significantly improve the service provided if spent on training, staff, oversight, etc.

Your criticisms of the rating systems are the same ones offered by the "for profits", who, again fight ANY AND ALL efforts to impose measurable, enforceable standards.

As far as the suggestion that playing for nursing homes, assisted living places, etc. is a worthwhile effort appreciated by the population/audience, I believe that's true. My only observation is that, around here, at least, the only ones working the NH/Assisted Living jobs are the ones on the bottom end of the talent pool...not able to get any other kind of work.

I do appreciate your input on this issue and admire your dedication to the work you do to entertain the country's "forgotten" citizens.


Sorry for the rant...

Russ



[This message has been edited by captain Russ (edited 05-19-2010).]

"My only observation is that, around here, at least, the only ones working the NH/Assisted Living jobs are the ones on the bottom end of the talent pool...not able to get any other kind of work."

You've got two fans of your reform efforts here Russ, but I'm scratching my head as to why you felt it necessary to include that comment in your remarks.

I won't speak for Gary, although I think I could. For myself, I've done almost every kind of gig that exists in the Dayton area. I perform mostly at NH's because I prefer to work there.

I've been offered gigs with house bands, industrial work, touring bands, etc. been there and done that, you know? Each had its good points and not so good points. Gary's been around alot, too. You live as long as he has (He's 107, I think...) and if you have skills, you cover some bases. There's plenty of other examples of musicians on the SZ who focus on NH's who are very fine musicians.

While perhaps we're not jazz hipsters, don't write off NH performers as low end, low talent types. Some suck, yes...Some don't...

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Bill in Dayton

[This message has been edited by Bill in Dayton (edited 05-19-2010).]

Bill, no slight of anyone intended. It's just that, around here, this is the culture. That was in NO WAY meant to imply that I believe that this is the way it is everywhere.

I AM NOT slamming those who entertain at nursing homes and realize that many (You and Gary, included) do it because of the benefits to the patients. I in no way intended to imply that all NH and Assisted Living entertainers are incompetent.

I'm aware that this is a condition here and not necessarily elsewhere.


Sorry for any unintended perceived insult.


Russ