“Charles, why are there a dozen bowls of water in the backyard?” she asked. “The dogs are thirsty,” Dad explained. He always was a soft touch—dogs could always hustle the last bite of cookie. Now he was seeing friendly dogs everywhere. As he sank further into Parkinson’s dementia, however, the hallucinations turned to bouts of paranoia. Mom hid both kitchen knives and new door locks to prevent his wandering. As his problems with eating, sleeping, toileting, and medications worsened, her health began to decline. She couldn’t continue.
At a friend’s suggestion, she called someone who connected weary caregivers to willing “live-ins.” Lesya, a Ukrainian who’d left her young daughter in the care of others to make a better life in America, moved in the next day. Mom didn’t ask many questions. She didn’t check for Lesya’s green card. She paid in cash. A year later, pneumonia sent Dad to the hospital and he died soon after. Read more »
Public Union Impact: Past and Future
Recent and ongoing work by CGR in several counties throughout New York has placed a spotlight on public employee unions and their impact on the cost of governmental services. In particular, the future status of county-owned nursing homes is directly affected by high labor costs and especially high benefit levels that have historically been negotiated with public unions, to the benefit of public employees and at the expense of taxpayers. County nursing home benefit levels, including retirement pensions and health insurance costs, are typically at least double the corresponding level in non-public facilities.
In decades past, county nursing homes were providers of last resort for the poor. While county homes continue to accept some residents that other facilities are reluctant to admit, as Medicaid has become a source of support for the long-term-care needs of both the poor and the middle class, nearly all nursing homes, both private and public, depend on Medicaid funding for a substantial share of revenue. Where county-owned homes are no longer the only facilities caring for the poor, they compete more directly with privately-owned homes. In this more competitive context, counties are questioning how much longer they can ask their taxpayers to cover the employee cost differential created by collective bargaining agreements—especially as counties face increasing fiscal stress, and as nursing homes face the prospects of probable declines in reimbursements looming in the near future. Read more »