Long-Term Care: Last Week Tonight with John Oliver (HBO)

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John Oliver explains the industry behind nursing homes and assisted living facilities, and why long-term care needs fixing. Connect with Last Week Tonight online... Subscribe to the Last Week Tonight YouTube channel for more almost news as it almost happens: www.youtube.com/lastweektonight Find Last Week Tonight on Facebook like your mom would: www.facebook.com/lastweektonight Follow us on Twitter for news about jokes and jokes about news: www.twitter.com/lastweektonight Visit our official site for all that other stuff at once: www.hbo.com/lastweektonight

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Video Transcript:

Moving on our main story tonight concerns nursing homes the absolute last thing you want andrew cuomo to be handling tied comfortably with literally anything else nursing homes and long-term care in general are something that we tend to try to avoid thinking about but the truth is whether due to old age or disability Many of us do or will require help with daily living the number of americans 65 and older is projected to nearly double over the next 40 years and one study estimated over two-thirds of americans who reach 65 will need long-term care at some point in their lives and the good news is for the rich there are plenty of options there are multiple upscale retirement communities Where residents can transition if needed into full-time nursing care like this one taught in exquisite fashion by two chains all right so the name of this episode is called the most expensive retirement right and so this is the most upscale luxurious retirement homes that i've ever seen and never heard about the building itself costs 100 million dollars to build The the marble it's from uh italy it's a custom carpet yeah i see a lot of art i see the versace plates okay extravagance off that place aside let's all just agree that 195 dollar plate sucks and i'm not normally a plate guy your boy's a source of freak from way back i'm a bowl plates aren't really my thing but even i can tell that plate is a two that's a two in ohio if you're gonna spend that kind of money On a plate it better be really big really fun or really really hot that plate look at me put your phone down and look at me when i'm talking to you that plate but the fact is most of us aren't ending up in that place in fact the vast majority of people receive long-term care at home and around 80 percent of that care is provided by unpaid caregivers often Family members who want to keep their loved ones out of institutional care like this wife and daughter cheryl and kristen are among the 42 million americans caring for loved ones at home and the tasks they perform have become increasingly complex when we have to flush his picc line or clean his peg tube or take his blood glucose or his blood Pressure you know none of us went to school for that i mean we're not educated that way i don't feel like i had enough training at all for this we've kind of learned by trial and error that seems really hard and there are certain things you kind of expect to do by trial and error solving a puzzle learning to pronounce the name of tambourine saturday or choosing a haircut and for the record Error error error and error but providing essential medical care should not be one of those things taking care of someone at home can be an incredibly complicated full-time job that is almost always unpaid in fact in terms of lost wages the labor of family caregivers totals about 67 billion dollars annually that's a workforce that if it were paid Would rival the entire gdp of bulgaria but for those who cannot afford to eat off unfuckable plates or whose loved ones are unable to help them at home many wind up in long-term care facilities there are two million people in them in the united states and as we've seen during the covid crisis they can be far from ideal residents and staff in them make up less Than one percent of the population but currently account for around a third of covid deaths the pandemic pushed an already heavily strained system to the absolute brink with conditions getting so bad that were near constant local news stories like this one one resident here says her calls for help were ignored because there wasn't enough staff to respond I was screaming get me out of here get me out of here this thing i was screaming at them i was in terrible pain and they didn't come for me penny shaw was in pain as she lay helpless in her bed at braintree manor nursing home in the midst of the covet 19 pandemic she became so desperate she even called braintree police for help i can't lay in bed for hours and hours You know in pain like that now i have to tell you we contacted that facility which chose not to address its staffing levels back then in its response to us instead insisting that the safety of its residents is of utmost importance but that is pretty hard to believe when they're calling the police for help there are only two instances where lying In bed for hours screaming in pain is to be expected and that's if you're giving birth or you're digesting a crunchwrap supreme that is it and the truth is covert just exposed what we've basically known for years that the way the elderly and disabled are treated in far too many of these facilities is with at best indifference and at worst abuse and neglect so Tonight let's talk about long-term care how the industry is structured how that structure creates bad incentives and what we can do going forward and we're going to focus on the two main types of long-term care facilities nursing homes and assisted living nursing homes are medical facilities overseen by registered nurses and largely staffed by low-paid nursing Assistants and there have long been issues with nursing home care a gao report covering a five-year period before the pandemic found that 82 of homes had been cited for infection prevention and control deficiencies and about half had persistent problems that have been cited across multiple years and a big reason for that may be because understaffing Is a huge problem with employees often tasked with taking care of way too many residents as these nursing assistants pointed out just last year they're not being showered people falling out of bed the men aren't being shaved people fall into where they fell out of their wheelchairs what if they need change they might get it one time a day a day we have 22 residents a piece most days that's for one person to wash dress get up two meals and they're being neglected because you can't get to everybody i told the administrator i'm embarrassed of my work my work process it because i can't do what i was trained to do on how to take care of these residents that is obviously unacceptable do you Have any idea how bad things need to get for you to tell your boss you're embarrassed by your work i'm not even embarrassed by my work and just three minutes ago i joked about a plate also that wasn't really a joke call me wolf plate and nursing assistants aren't just overworked they are really underpaid the median national salary for that job is barely 30 000 a year and one reason is that nearly 70 percent of nursing homes are now for-profit institutions and there is a lot of profit for them to make because they don't pay staff much but they charge you a lot the average per person cost for a private room is a hundred thousand dollars per year and if you're thinking well yeah that is expensive but doesn't the medicare program that i've paid into all my life cover that Well no it doesn't medicare only fully covers the first 20 days of nursing home care after an eligible hospital visit then partially pays for up to 100 days but after that you are on the hook for all costs the only other way to access taxpayer help to live in a nursing home is to almost completely impoverish yourself to basically spend your way down to the Point you qualify for medicaid the government program for the poor which crucially reimburses nursing homes at less than half the average daily rate paid by medicare and while you would like to think that nursing homes would treat all patients the same whether they're on medicare or medicaid the truth is you might get two very different experiences because if you're on medicare You could wind up getting too much attention just listen to an assistant manager at one nursing home chain describe how medicare patients there were treated what percentage of the therapy that you were being told to administer do you think was not necessary i would say probably as time went on about forty percent forty percent of the work that you were doing Was not reasonable and not necessary under medicare guidelines at another facility the entire rehab staff signed a letter to their boss it reads we've been encouraged to maximize reimbursement even when clinically inappropriate that is absurd the doj actually filed a lawsuit claiming that the chain that that woman worked for life care centers of america which runs over 200 nursing homes was subjecting His patients to therapy even as they were on their death beds it alleged one 92 year old who was dying of metastatic cancer was recorded as having had 48 minutes of physical therapy 47 minutes of occupational therapy and 30 minutes of speech therapy just two days before his death on a day he was spitting up blood which is ridiculous residents should be getting proper Nursing care not tons of expensive therapeutic treatments that are clinically inappropriate which by the way i'm pretty sure was the original slogan of goop now life care denied wrongdoing but agreed to pay 145 million dollars to resolve that lawsuit and they're hardly alone here over the past decade multiple other large nursing home chains Have been charged with fraudulent medicare billing practices and denied wrongdoing while paying tens of millions of dollars to settle their cases you know like you do when you are totally innocent so to recap here if medicare is paying the risk is that you could be billed for unnecessary treatments but if medicaid is paying which remember reimburses nursing homes at less than half the Average daily rate things could get much worse because if facilities want to open up a bed to a more lucrative patient they can take drastic action ronald who was 51 and homeless got rehab at the nursing home where he lived for more than a year then one night around 10 pm he says an administrator came into his room big smile on their face saying they're Kicking you out they smiled yeah and they just bundled me into a a van and just dropped me off here on the sidewalk the avalon villa care center through its lawyers told nbc news it strongly disputes that it has inappropriately discharged any patients the homeless shelter where ronald's living now says it's seen cases like this before Experts even have a term for it resident dumping oh come on that is just evil resident dumping is a completely unacceptable practice i don't even like it when residents are dumped on grey's anatomy at the alter berk you dump that resident at the altar how could you do that to christina you monster and you would hope regulators would punish nursing homes for doing things Like that but the oversight here has some massive gaps for instance the federal government keeps a list of so-called special focus facilities homes that have a pattern of serious problems over a long period of time and therefore receive extra inspections there are 88 nursing homes on that list but interestingly not because there are only 88 homes that deserve to be it's because Due to limited resources the government has capped the list at that exact number despite the fact they fully acknowledge an additional 400 facilities qualify for the program and look i'm not saying every list should go on forever if a list of cutest otters was capped at 88 that'd be a perfectly fine list but if there were 400 other cute otters that were also abusing The elderly i'd really like to know who all of them are and if you're thinking well look that is good to know that's good information if i need to move a loved one into a nursing home i'm definitely going to look online and make sure it's a good one well be careful because while the government does have a website where nursing homes are rated from one to five stars it has an absolutely Massive loophole of the three factors that determine an overall rating only the health inspections are conducted independently the other statistics staffing and quality measures are self-reported by the nursing home these self-reported statistics can boost a three-star rating into a five-star rating overall the problem is you know it's garbage in garbage out so Whatever they're telling the feds the feds are not the federal government isn't going in and double checking that their numbers are accurate yeah garbage in garbage out and that is pathetic something as important as our nursing home rating system should not follow the same rule as every recipe on velveeta's website because there is just no way any of Those are any good if you're making a recipe the cause for a puddle of lorax jizz then don't be surprised when the finished product is equally repulsive it's garbage in garbage out so given everything that you've seen so far it's hardly surprising that for reasons of cost or conditions many might want to avoid a nursing home altogether which brings us to assisted Living facilities or alfs around a third of people in long-term care facilities are in one of these and they do cost far less than a nursing home typically around 50 000 a year alf started out as an alternative for those who needed help with key activities like dressing toileting taking medicines and eating but only needed limited medical support just as with nursing homes the vast majority Of alfs are for profit but there are also some key differences alfs are largely paid for out of pocket and they are far less regulated making it easy for basically anyone to start one and i do mean anyone take stephanie costa by the age of 30 she owned six small alfs in southern california and made a lot of money from them Enough to qualify her to appear in an episode of the millionaire matchmaker my name is stephanie and i'm 30 years old and i own a chain of elderly care facilities my nep worth is three to four million probably i've always had this thing of taking care of older people like sick people that are dying i've always really felt for them so i couldn't wait to graduate college And start my own business doing assisted living facilities like nursing homes okay uh there are a lot of unfair reasons that i inherently don't trust stephanie costa from her driving a douchey ferrari to the fact that she looks like an uncredited extra from an entourage party scene to that voice which sounds like a mouse who wouldn't dress cinderella because it had better things to do But it turns out that gut feeling is actually entirely valid because costa treated her employees and residents so terribly that after multiple health and safety violations california banned her from the industry for life and ordered her and her company to pay about 1.6 million for unpaid wages and penalties but if you think that that gave her accountability You're gonna want to think again she kept this home after filing for bankruptcy and settled with workers for a fraction of what she owed her six care homes are now owned by a property investment company registered by her father oh yeah not just that as recently as last year she was still listed as that company's ceo so the state of california really taught stephanie costa a lesson There specifically the lesson that you can treat your elder care workers like absolute avoid any real consequences and just keep living your life in the single ugliest home in beverly hills although it's legitimately hard to tell whether that is actually a home or just an abandoned white castle but it's not just individuals involved here there are also Big corporations running alfs who've been working hard to fill up beds and despite the fact that als remember are supposed to be for people who require less medical attention recently some have been aggressively caught in dementia patients for memory care programs as seen in this advertisement for brookdale the largest alf provider in the country This is a compassionate place that helps families through very difficult stages of dementia in a safe and comfortable setting and i have peace of mind knowing their staff fully trained 24 hours a day seven days a week i can't believe how much my mom's quality of life has improved since coming here i'm seeing her smiling and laughing again we help them maintain their abilities and encourage the use of their Current skills in a warm engaging environment this is a special place and every day is a new beginning with lots of smiles and memories okay i get that a senior living commercial might want to have at least one staff or with their arms around a resident's shoulders it's kind of nice trustworthy makes you feel safe but immediately cutting to another one feels like a bit much and then a third Starts to make me feel a little nervous and when that fourth one hits as a british person i've got to say that is just too much physical contact that said even i will admit an alf that offered all that commercial claims to but with significantly less touching would really be great unfortunately a woman who worked at a brookdale facility of south carolina painted a pretty worrying picture Of how staffers are trained to work with dementia patients when you first start they have you set through a series of in-services or orientation it lasts about a week but it's just videos but once they put you out on the floor they don't they don't give you any training they just stick you out there well that's not really ideal is it because it's hard to retain important information just by watching a Video case in point this video think about it what have you really learned from this sure a few random facts about the long-term care industry that you'll probably immediately forget but if you're honest you've mainly learned that it's possible to want to a plate and that's a lesson you will never forget and look brookdale insists that it offers ongoing training for its workers and that its Training program for dementia care workers meets or exceeds state guidelines but that is not really saying much as some states require only two to thirty hours of specialized training and south carolina where that facility is located requires training but doesn't set a minimum number of hours and by the way If you're wondering about why there were a bunch of shots of a pond in that story the answer is completely horrifying because a 90 year old resident there who was supposed to be under constant supervision before being transferred to a memory care unit died after leaving the facility unnoticed in the middle of the night there are signs that are warning people about alligators take a look at this one It says alligators may live here be gator safe in this case the signs probably would not have made a difference according to authorities we are told the victim likely slipped or fell down a steep embankment and landed in the water attracting the gator's attention holy i honestly don't even know where to begin there but i guess i'd start with why would anyone put an assisted living Facility next to a alligator pond that seems like the sort of detail that really has to be included at the end of one of brookdale's heartwarming ads this is a special place and every day is a new beginning with lots of smiles and memories also one of our residents was eaten by an alligator so you know there's that yeah There is that and that's important information for people to know brookdale and look obviously that is an appalling story but to be fair it's hard to talk about long-term care without showing you at least one of those just be grateful i didn't show you the story where a resident jumped from a fourth story window of an alf or the one about a nursing home resident who set herself on fire or the one about A 91 year old suffering from alzheimer's who froze to death on christmas day which by the way sounds like a holiday album written by bjork so what can we do here well obviously increased oversight and enforcement are badly needed that facility with the alligators was eventually fined by the state for 11 violations including not properly performing night checks and Letting staffing drop below required levels but the penalty issued was just 6 400 and it feels like if you lost a loved one in such a horrific way you would want more accountability than just don't worry someone decided their life was worth the price of a 2013 chrysler motown and the fact is there are lots of ideas on how to force facilities to improve mandating a certain level of money has To go to patient care for instance or that residents have access to a minimum amount of care per day but the bigger fix here might be to try and make it easier for as many people as possible not to end up in these institutions in the first place and instead receive whatever support they need at home nearly 90 percent of people over 65 apparently want to stay In their home for as long as possible which does make sense the problem is right now many of them can't because under medicaid nursing home care is an entitlement but home-based care is not to access long-term services and supports through medicaid in your home you need a waiver from your state and to be fair some like washington do that pretty well more than 70 percent Of the medicaid money they spend on long-term care for older people and adults with disabilities is spent on home and community-based services that's things like skilled nursing visits home care aides who can help with daily tasks and even the ability to pay family caregivers you know people like those two women that you saw earlier the problem is other states have waiting lists that can Be many years long by which point seniors trying to access that care can be dead because sadly that is how time works nationwide more than 800 000 people are on these kinds of waiting lists what we need is reform at a national level and there are actually some promising developments here a discussion draft of a bill was recently introduced that would make Home and community-based care an entitlement under medicaid and biden's proposed infrastructure plan actually calls for 400 billion dollars to be spent on those exact services and that would be a really big deal and look any aggressive transition to home-based care is going to need rigorous guardrails and oversight to make sure that money is not misspent just in a different way The last thing i want is five years from now to be having to do a show on the evils of new for-profit home care agencies who've somehow been destroying people's lives in their own homes and if you're thinking wait hold on five years from now you'll still be doing shows in the void oh no we'll be back in the void i don't want to get into specifics but spoiler alert it's not a pandemic next time it's Spiders but we do need to do something and it all starts with showing that we give a about what happens to the elderly and people with disabilities in this country because right now evidence points to the fact that we absolutely don't and all the other problems are stemming from that and the longer that we continue to ignore this the worse it's going to get because the fact is Right now this is an industry where the people in its care are being figuratively and sometimes literally eaten alive you

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