Private Retirement/Palliative Care Homes

[SharperDingaan]

There has been a lot of recent news on the long-standing issues in these establishments. It would seem that industry operating practices, that were long a dirty little secret, are about to experience permanent, and massive, change. Long overdue, and likely to be ruthlessly applied.

https://www.cbc.ca/news/canada/montreal/covid-19-private-seniors-home-dorval-chsld-herron-1.5530327

 

We would like to hear about the operating/staffing practices in the US/Canada, and ideally find some employment data on the size and composition of the various market segments in different areas. Our objective is a rough picture of where (type of establishment, geography) the problems are worst, and the typical regional industry hiring practices. We're looking for the grey rhino's.

 

We think that we may have a potential blockchain solution, applicable to the HR/certification portion of the industry. But we want to test the value proposition against typical industry practice, before we make a decision on it. One of our coders has a grandparent, who almost went to one of this company's facilities.

 

SD

 

 

[Jurgis]

Some time ago there was a completely horrible article about the scam in the US retirement homes. People were scammed to move into the retirement facilities, lost their property, got drugged in the retirement home so they wouldn't raise issues. If you don't have relatives who care and fight for you, you are screwed. Even if you have relatives, the retirement home mafia got court orders from friendly judges to remove/restrict relative access to the seniors they were mistreating.

 

Overall, I am not sure if this can be solved. Especially for people with no relatives. Doubly especially if a person has any cognitive slowdown. Even if there is a well intentioned government agency, how easy is it to figure out if someone with dementia is being abused/overmedicated/under-cared/etc?

 

Oh yes, blockchain! Just what the doctor ordered.

[Cigarbutt]

This is interesting.

This is an area where there are various levels of public-private partnerships and many inefficiencies.

A few years ago (in my area at least), there was a shortage of registered nurses and demand exceeded supply. It was an ideal situation for private parties to close the gap. Set up an entity that recruits (using filters, certification, competence etc), act as a middleman and charge the public or private customers for the service. Recruited RNs obtain a better salary, better conditions and you get to keep a slice of the pie. Private and public (typically with a significant time lag) eventually close the loop and adjust but first movers do benefit.

 

There appears to be a huge opportunity here. The dynamics will be specific to your state or provincial jurisdiction.

Long term care is a growth business. Most of the work (about 75%) is done by personal support workers (level of training and regulation varies) and the rest is done by nurses with various levels of certification. To have an idea of the number hands that will be required, look a projections of older folks in the population and multiply by 2 to 5 hours of active presence per day for each.

 

The virus has caused a certain intensity in focus but that will settle down to a slow but long term grind. Outside of a minority, most people happily delegate the adult diaper changing to others and will only show up when there is a problem.

 

Here's a link for Ontario (i won't compete with you there):

https://www.oltca.com/OLTCA/Documents/Reports/TILTC2019web.pdf

[LC]

I agree this is still a growth opportunity due to so much dislocation in the industry.

 

It also may be useful to look from a supply side: this is an area where immigrant women have historically thrived. You can start working with an Associate's degree which is a cost and time friendly option (as it is more difficult to invest in 4 year programs for this demographic) and there are growth paths in the field.

[SharperDingaan]

Broad strokes - we're looking at live-time block certs, applicable to those working in the homes. Portable, transparent, ability to add geography based pay subsidies, and worker incentive to the go the legal route vs under the table. Very likely a basic version of what already exists in Latvia.

 

Obviously, we aren't going to disclose the value proposition.

 

SD 

[Cigarbutt]

The case you mention in the initial post seems to be a particularly poor example of what is perhaps more typical across the board. The private home in question was charging between 3-10k per month (depending on level of care) but they obviously had great difficulty with employee recruitment and retention. The direction mentioned that employees had "deserted" the place but the evidence seems to show that they were actually becoming positively sick..It's becoming clear that this will trigger a higher level of oversight by public institutions and may give rise to a need for registries (this can take many forms) for homes and for licensed (and not so licensed) direct-care providers. In some of these instances, it appears that the case load was so elevated that transmission precautions were simply disregarded and some have mentioned that those in charge possibly focused too much on the bottom line. This will happen to various degrees across many jurisdictions and there will be opportunities. Good luck.

The government entities will be ready to outsource some of that but they are looking for reliable and reasonable partners.

Potentially relevant:

https://cnpea.ca/images/futureoflong-termcare_v7_final-09-09-2019.pdf

[SharperDingaan]

Just to throw some things out.

 

Most retirement homes are actually extensions of the medical 'system'. Residents are there because they need varying degrees of daily help, and will ultimately leave in either an ambulance or a hearse. Yet most support staff are expected to share the burden, receive zero benefits, and get paid the same as a burger flipper. Toxic culture.

 

In rural areas, professional and support staff are harder to both find, and retain. There's a pay cut (versus the city), and suppression of reporting anything bad - for fear of staff jumping ship, and making the work-load on the remainder much harder. Complainers tend to have shorter lives, as the dead cant talk. Toxic culture.

 

Prior to Canada's change in the law, overdoses to end a patients suffering were common practice. The culture continues, and is often used to justify ignoring 'temporary' abuses in resident care. Not a lot different to the Catholic church hiding priest abuse of choir boys. Toxic culture.

 

The sheer quantity of NA boomer numbers changes everything they touch, and they are starting to enter retirement homes. Change is coming, it will be overwhelming, and 'same old' is the kiss of death. Long overdue.

 

SD

 

 

[Jurgis]

Barron's on nursing homes: https://www.barrons.com/articles/coronavirus-is-tearing-through-americas-nursing-homes-peoples-rights-are-being-temporarily-suspended-51587722401