Brett Arends’s ROI: The real reason Grandma can’t get into a nursing home


Do you want to know why America’s nursing homes are in crisis?

Do you want to know why grandma or grandpa probably can’t even get a bed in a home right now, while large numbers of rooms sit empty for a lack of staff?

And why for those who do get into a home, horror stories happen all the time—like this 97-year-old woman who froze to death, and this elderly stroke victim, in a “persistent vegetative state,” who was found by a doctor to have suddenly developed a sexually transmitted disease.

Or why 210,000 workers quit over the past three years, why staffing numbers are back to levels last seen in 1994, and why at current rates they aren’t expected to recover till 2027?

It’s really not complicated.

Right now, in America, you can earn more money per hour looking after someone’s dog than you can looking after their elderly or dying parent.

And no, I’m not kidding.

Dog walkers are making on average $16 an hour according to, or maybe just under that according to

Meanwhile a nurse’s aide in a skilled nursing facility is making on average $14.50, according to Uncle Sam.

OK, so these are averages and estimates. Reality may be more complex (for example dogwalkers may be more likely to work in higher cost elitist cities).

But even if we call it a financial tie, it’s no competition.

One of these is a tough, demanding job involving significant training, long hours, frequent medical emergencies, deaths, and heroic levels of commitment. You have to take incapacitated elderly people to the toilet and clean them afterward. You have to move them, bathe them, monitor their vital signs constantly, feed them, and try to provide some level of care comparable to what they might get from family or friends. You may have to work overnight shifts, answer to bureaucratic overhead, and frequently do the work of two people because your employer cannot or will not spend enough money.

The other involves playing with Poochie the pandemic sheepadoodle in a park.

And Poochie’s owner pays better. By about $1 an hour, apparently.

Oh, and to get the job as a nurse’s aide you also have to go through all the time, effort and cost of getting formal training and becoming certified.

Based on the Gen Z dog walkers I see strolling around with AirPods in their ears, dragging six unhappy dogs behind them, dog walking doesn’t need a whole lot of training, certification, or even commitment.

Looking after dogs, 2: Looking after senior citizens in their final years, 0.

All of which goes a long way to explain the current situation.

The nursing home industry’s trade association, naturally, is already pleading crisis. In their most recent member survey more than half of nursing home operators said they were currently operating at a loss. Meanwhile a new report by analysts at McKinsey & Co. say it’s going to get even worse before it gets…even worse than that. The skilled nursing facility industry is going to see shrinking earnings over the next five years, McKinsey estimates.

Well, maybe. I notice that the private equity boys seem to be clamoring to buy up homes, which makes me wonder how bad the economics really are. Or, maybe, what angles they see that others don’t.

Incidentally, a study by the National Bureau of Economic Research found that, on average, private equity ownership of a nursing home “increases the short-term mortality of Medicare patients by 10%” — implying, it said, 20,150 premature deaths over the previous 12 years. “This is accompanied by declines in other measures of patient well-being, such as lower mobility, while taxpayer spending per patient episode increases by 11%,” the economists added. Good times.

Medical studies have shown that the number of skilled staff per patient is a key factor in the quality of care. The more staff, the better Grandma is likely to be. The Biden administration, understandably, wants to mandate minimum staffing levels on the operators. Alas, a mandate for more workers without more actual workers is like offering someone a vacation brochure instead of a vacation.

Right now there are way too few staff. Which is why, even with corners cut and staff overworked, about one fifth of beds are sitting empty. That is twice the number of a decade ago.

Naturally industry honchos say the solution to this crisis involves more immigration. Of course they do. And no, we’re not talking about high-skilled, high-wage immigrants from rich countries. We’re talking about bringing in poor and desperate people, willing to do our most demanding jobs for very little.

The alternative, of course, would be to raise wages. Will this happen? Let’s not hold our breaths.

The good news? This disaster won’t affect you. After all growing old, and ending up in a nursing home, will only ever happen to other people. Right?

This article was originally published by Read the original article here.

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