
Best and Worst Cities for Nursing Homes in the US - vinnyglennon
https://priceonomics.com/the-25-best-and-worst-cities-for-nursing-homes/
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sfRattan
Two terms not mentioned in the article are elder and guardianship abuse. The
prevalence of these factors can and should be _huge_ in determining both where
to retire and, if it comes to it, a nursing home for one's own parents.

Specifically abuses of elder guardianship, in which scummy lawyers work
closely with nursing homes and local magistrates to usurp guardianship of
elders from next-of-kin and then collectively drain the bank accounts of their
elderly wards for 'services' rendered. Which sounds like a dystopian,
Kafkaesque nightmare, but happens in a number of states.[1][2][3]

[1]: [https://kbzk.com/cnn-regional/2018/11/05/four-plead-
guilty-i...](https://kbzk.com/cnn-regional/2018/11/05/four-plead-guilty-in-
guardianship-abuse-case/)

[2]: [https://www.ozarksfirst.com/news/ozarks-lawyer-testifies-
in-...](https://www.ozarksfirst.com/news/ozarks-lawyer-testifies-in-
washington-committee-hearing-on-elder-abuse/614553680)

[3]: [http://www.providencejournal.com/news/20180831/elder-
abuse-i...](http://www.providencejournal.com/news/20180831/elder-abuse-in-ri-
gaming-system-is-easy-for-fiscal-guardians)

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raincom
I knew some nurses who worked in nursing homes. If you want a good nursing
home, try to get the insider info on how many nurses work per shit, how many
patients are there, and how many of these patients need nurses hourly for
taking readings, giving pills, etc.

Nurses are overworked in these places, and the owners of nursing homes make
money only by hiring not enough nurses. I know of a nurse, who used to not
take readings, but filled them out based on yesterday readings. This, because
she had so much work to do on her own.

~~~
lunchables
Staffing levels are used to calculate the star rating of a nursing home.
States have required staffing ratios, for both nurses and CNA.

What I recommend is to look up the facility star rating and the last couple
yearly AHCA survey results for the nursing home. You can also check to see if
they have had any complaint surveys recently and what the outcomes of those
were.

>Nurses are overworked in these places, and the owners of nursing homes make
money only by hiring not enough nurses.

As above, there are staffing level requirements.

>I know of a nurse, who used to not take readings, but filled them out based
on yesterday readings. This, because she had so much work to do on her own.

She could lose her license for this, and blaming someone else won't save it.
Nurses are in incredibly high demand and she should go work somewhere else.
Let me know if she needs a job and what state she's located in (and what
license? RN, LPN?). We hire hundreds of nurses per year.

~~~
raincom
She is a RN in California , she learned it from another RN who worked with
her. This was from 4 years ago. Since she could not find a job at hospitals,
she took this job. Nurses don't like working at nursing homes: pay sucks; work
is hard.

She told me to not tell anyone about this, as she will lose her license--names
and exact locations withheld. Anyway, she found a better job at a prison, with
better pay, benefits, etc.

~~~
pc86
The fact that another RN taught her how to commit a terrible crime against the
people entrusted to her care doesn't change the fact that that's what it is.

Hopefully she takes better care of the prisoners.

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WhompingWindows
This is not great data science. I appreciate their ranked lists and bar graphs
but you see the limitations of their very basic approach when you see ND, SD,
and WY are high up on the best state rankings. It's easy to infer this is
because those are very small states, they have a much smaller sample size than
NY or CA. And yet they present data in ranked lists or bar graphs, neither of
which convey the sample size of these vastly different states and cities to
the audience.

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robertsd247
I will never go to a nursing home. I'd rather die. I have seen the inside of
those places and I can assure everyone, regardless of how nice they look and
whatever amenities it has, it is a horrible place to spend the last years of
your life. My Dad died at home and that's the way you do it.

~~~
pc86
As with most things, the topic is nuanced and making blanket statements
without hard data as support is useless. There are no hard and fast rules and
no "way you do it" when it comes to this.

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ahi
This dataset from CMS is probably better:
[https://www.medicare.gov/nursinghomecompare](https://www.medicare.gov/nursinghomecompare)

I would be skeptical of family reviews as a reliable indicator. Nursing homes
are almost always miserable places.

~~~
arebop
[https://www.medicare.gov/nursinghomecompare/search.html](https://www.medicare.gov/nursinghomecompare/search.html)
or [https://data.medicare.gov/data/nursing-home-
compare](https://data.medicare.gov/data/nursing-home-compare)

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cr4ig_
I think affluence of the local population and job competition also affect the
rankings. The places with the worst-rated homes generally have larger
populations of less affluent (i.e. on Medicaid or will be soon) patients, and
there are also a lot of other job options for people aside from working in
that sort of a facility (not the most pleasant job to be sure). The ones with
the best rankings seem to be in areas where there is a more affluent
population (nursing care ain't cheap) and/or jobs in a nursing care facility
are more attractive compared to other local options (resulting in a higher
quality workforce). A rough correlation, YMMV.

But that last bit about lack of other attractive job options contributing to a
higher quality workforce was something that I was told by someone looking for
nursing/assisted living care options, and in my experience (aging parents and
aging parents of friends) it is actually true. I can also confirm from
personal experience that New Mexico has absolutely horrible nursing/elder
care.

Lastly, re: I think I'd rather kill myself than ever go live in a nursing
home? You and me both. I've seen enough that I'd rather take myself out at a
time/place of my choosing rather than go into nursing care. I don't think most
people give it a thought though, much less have seen it firsthand.

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dr_
Sometimes patients don’t have an option but to go to such a facility, at least
on a short term basis. Hospitals try to discharge patients as quickly as
possible, which often results in patients leaving when they may be medically
stable, but are functionally compromised or are in need of services, such as
iv antibiotics or wound care, that may be difficult to provide at home. If
they live alone, it’s even more challenging. So the nursing facility becomes
the only option. Facilities traditionally have had an easy access to a
constant supply of patients, along with high reimbursement. They’ve have had
little incentive to improve.

Fortunately care bundles (BPCI) are starting to change this, giving hospitals
a vested interest in where their patients go and what the outcome is.
Facilities are going to have to improve the level of care and service they
provide - or risk shutting down.

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asianthrowaway
I think I'd rather kill myself than ever go live in a nursing home. I suppose
the only way I'd accept is if I had late stage dementia and didn't realize
where I was.

~~~
WhompingWindows
Would you feel differently if you fell and broke your hip, unable to walk or
do a dozen other activities of daily living, thus needed nurses to monitor you
24/7? The thinking and math on this changes a lot when complex medical
situations come into play.

~~~
asianthrowaway
If I needed 24/7 monitoring that's when I'd kill myself.

