My adult son has been placed in adult family homes in the last year (now paid with only Medicaid / DSHS). Both homes he’s been in are owned and run by (legal) immigrants who have poor English speaking or none. So, there have been language barriers, miscommunications with family, medical providers, pharmacies, medical transportation, drivers, etc. The homeowners / providers and caregivers in these homes are all from the same foreign country immigrating to US sponsored to work and even live within these AFHs. Some received their nursing education in their own countries like the Philippines or Kenya for examples. Finding out in my experiences they can have their own cultures of what is cleanliness. So, some believe bathing or washing their hair only once per week is normal, acceptable, or even better for you. Or keeping the home at 80 degrees fully dressed sweating is acceptable for unhealthy and medically compromised residents. They get paid thousands $ per month per resident. Like $7,000 + per month for my son. All his clothing, supplies, formula (tube feeding only) and medical bed, haircuts, nail trimmings, etc. provided & delivered by Medicaid or the services provide by the family. So, I’d think with AFHs it’s expensive for Medicaid / Medicare & taxpayers. Wouldn’t it be cheaper for states to do a better job helping families with less conundrum to help their loved ones in their own homes and allow family to some full-time skilled caregivers when help is critical? AFHs commonly keep residents in their rooms alone isolated, no activities or outings or social events ever. They will do the bare minimum and only do what is itemized written to be done by DSHS. So, for example if a resident should be moved in bed often, rotated reducing pressure points, or have any gentle passive range of motion for risk of joint contractures etc., they won’t do it even if it’s just common sense and humane. And claim they are not educated or qualified enough to do any of this. And it’s Only if they get paid extra. Families I know wouldn’t do this in their home, wouldn’t be compromising the health and welfare of a loved one while Hustling for more $$$. I provided home care until the help wasn’t there from the state for me to keep it up. It’s 24/7 care and some skilled nursing care is required everyday & at night which I could do myself, but I had to work too, to pay the mortgage, utilities, debts, and car payment, etc. And in my state, you are penalized for having a home of your own, “an asset," no matter how little it’s worth or if you have already used up all your equity to help things out. They will help you when they take your home away from you, so homeless. Soon enough they will consider our homes all capital gains here. Rather than it’s just a HOME you pay a bank to live in for years (instead of paying the high constantly unstable rising rent costs out there especially with corporate rental housing investors). But the adult family homes get paid by the state more or accordingly for the rising average cost of their mortgages or property values. They benefit, win/win. We families lose.
The problem is not where the owners are from or what language they speak. The problem is their motivation for being owners in the first place. TRUST me when I tell you, owners do not give a rat's donkey about the residents. Only the income. When the owners are visiting a facility they own 8 hours away from where they reside in the same state, they are still going in to talk to their most destitute of residents draped in gold chains, watches, Armani suits. When the residents complain about the poor care they receive, they make empty promises to fix the problem but nothing ever changes except the Balance in their bank account. Every word of their promises spoken in English, from mouths born and raised in America.
There a few "six packs" as Alva describes the 6 person residential board and care facilities, and they tend to be highly sought out over the venture capital money grabbing traditional facilities.
Many outside the United States value caregiving as an essential part of the community and their participation. I could only wish that it would be this highly valued in the United States.
The costs of care, the regulations, the fact that now you don't just serve a meal but serve the exact calories and things that cannot and can go in it, and on and on and on. It became not worth it for them. Not a business that could survive.
So most of our family care type places are gone. The social workers became more and more devastated trying to seek good care.
A tough subject, this, to be sure. Very.
You write, “And in my state, you are penalized for having a home of your own, “an asset," no matter how little it’s worth or if you have already used up all your equity to help things out. They will help you when they take your home away from you, so homeless.”
The state doesn’t penalize you for having an asset. They expect you to pay your own way rather than have their taxpayers pick up the burden. Only when you can no longer take care of yourself should taxpayers have to provide for you. As a taxpayer, I’m happy to help those in real need. But you aren’t in REAL need if you can pay your own way.
We have so few here who are Daughters of the American Revolution.
As an RN I would tell you that I worked with so very many people from other countries. My last trainees were actually from Russia.
Oddly enough I found so much more of love and respect in these cultures than in my own. They truly CARED for these elders.
I am very sorry you are receiving what you feel is sub-par care. You will find that those jobs that are least treasured (picking our food out of the growing fields comes to mind) are often taken on by the newer immigrants among us. The persons you see "living" in these care homes? They are on 24 hour duty call, and are not well paid. Needless to say.
Then there are the jobs that the CORPORATIONS don't want to do any more.
Think of Human Resources and Pension plans and billing and customer service. They "outsource this" usually to poorly paid immigrants here on H 1 B work visas, who live in a sort of ghetto in towns (usually they hail from East India) such as Maple Shade, NJ and work from home, all day on the phone answering your calls, often poorly trained and unable to help you.
But like I said, Corporations don't care to do that work anymore and save, they save, average 25% by farming it out in this manner.
When you get as BIG as the United States of America (where quite honestly a whole lot of people would kill to die to get to, and DO), and as complex as we are, with as many needs and wants, things fall through the cracks.
I have never found an answer. I think perhaps the answer is to become very, very wealthy? Not sure. Haven't got there yet. But my neigborhood in San Francisco is notorious for being one of the prized, and daily I see the nannys caring for the multitude of children. They are sooooo kind to them. I sit in the park and watch, watch them at the library hours. And yup, guess what, those kids are already, at about age 2, MULTI-lingual.
I wish you the best of luck. You have taken on a huge subject here. One with so many tendrils and branches out into the society as a whole. I wish you luck of it, and I sympathize with your frustration.