When Care Became Optional: My Wake-Up Call from the Floor
You ever walk into a shift and know — this one is the one that changes how you see everything?
Because I have.
For years, I’ve cared for patients who—honestly—didn’t need a full nursing facility. Maybe they needed help with bathing, reminders to take medications, someone to talk to. But not the complex, intervention-level nursing care we’re taught. Yet they were locked behind facility doors, treated as liability lines instead of lives.
I’m not a doctor. But I see the damage. And what I feel every single shift is that, since COVID, corporate greed has grabbed the wheel — and it’s driving care off a cliff.
🔥 From Fire to Freefall: How the System’s Burning
Skilled care recently feels less like medicine and more like triage in a disaster zone.
We — the floor workers (nurses, CNAs, therapists, dietary, activities, housekeeping) — are the ones breathing in the smoke and yelling for help. We cut corners (because there is no choice). We skip breaks (because no one can cover us). We take on extra units. We work 10, 11, 12 days straight before a single day off.
I’ve worked alongside nurses and aides who would wake up, drag themselves to work, clock out, and start over — with no real rest. Burnout doesn’t just sneak in. It bulldozes.
And when the caregivers are crumbling, guess who pays the cost? The residents. The patients. The people we vowed to protect.
📉 The Pull of Star Ratings — and How They Quiet Care
Here’s something few talk about: facilities are obsessed with their CMS / Medicare / Medicaid star ratings. Because yes — those stars aren’t just for show. They directly influence reimbursement, grants, contract eligibility, funding, public perception, and occupancy. Facilities chase them like lifelines.
The CMS Five-Star Rating system ties together health inspections, staffing metrics, and quality measures.
Higher ratings mean more leverage — better contracts, more residents, fewer penalties.
It also means, when state inspectors are coming, a facility can “put on theater” — extra staff, fresh paint, spotless rooms. I promise you, I’ve seen it.
In short: star ratings are a blunt instrument that facilities lean on to stay afloat — even if care gets sacrificed in the glare.
🏡 Why I’m Shouting Out St. John (Because They Did Something Rare)
I’ve seen facilities where care becomes optional. But St. John Lutheran Care Center (Mars, PA) was different — or at least less broken. I’m giving them a spotlight not because they’re perfect, but because when the pressure was on, they didn’t forget who they cared for.
“My Caring Plan” reports that St. John has an average community rating of 6.4 / 10, ranking 3rd highest in the city (out of 3 communities).
According to Medicare / CMS data, St. John’s nursing home gets a 1 star overall, but I’ve seen far worse.
Why do I respect it? Because even when the walls were shaking, the staff fought for their residents. They were short-staffed like everyone else, sure — tensions ran high, arguments with scheduling, overtime burnout — but I never saw them give up on care. They caught falls. They caught infections. They worked as a pack. And if someone wasn’t pulling their weight, trust me, they didn’t last long.
They were clean. They communicated. Maintenance and housekeeping were rock stars. They allowed dogs (and who doesn’t love a facility that lets residents see their pups?).
That’s why I’m shouting them out — because even drowning, they still swam toward their patients.
🔍 How to Use Facility Reviews Wisely (Because Stars Lie & Reviews Mislead)
People see 5 stars or 1 star and think that’s the truth. It’s not.
The loudest voices are usually the angriest.
Reviews often reflect a single staff member, one bad shift, or temporary staffing issues.
Facilities can (and do) clean up for inspections — what you see during a tour might not reflect daily life.
So read reviews for context, not ratings. Look at why people were unhappy and decide if it matters for your loved one.
Pro tip: When you do a facility walk-through, ask questions like:
How often do treatments get delayed or missed?
How do you handle short-staff days?
What’s your average aide-to-resident ratio?
How do you handle family complaints?
Don’t trust stars. Trust answers.
🚀 What’s Coming Next — And Why You Should Stay
This is just the beginning. I’m going to pull back the curtain on staffing ratios, facility funding games, and senior outcomes no one wants to talk about — but everyone should know.
Next post: “Staffing Ratios: The Silent Killer.” You’ll see the math, the lives lost, and the lies told.
Tell me your story. Tell me a facility you want me to dig into (yes, I may go undercover).
If you believe seniors deserve real care — not just enough to scrape by — hit subscribe. Because this is Nurse Abby’s fight. And if you’re still reading? We’re in this together.
— Nurse Abby 🩺🔥
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🩺 Statistics & Sources Mentioned in “When Care Became Optional”
1️⃣ CMS Five-Star Quality Rating System
https://www.cms.gov/medicare/health-safety-standards/certification-compliance/five-star-quality-rating-system
2️⃣ Explanation of How CMS Ratings Affect Funding & Perception (Quality Insights)
https://www.qualityinsights.org/nursing-home-insights/cms-5-star-rating-system
3️⃣ Nursing Home Mortality Rates Remain Elevated Post-COVID (Health Affairs Scholar)
https://academic.oup.com/healthaffairsscholar/article/2/11/qxae126/7900538
4️⃣ OIG Report on Infection Rates in Nursing Homes During COVID
https://oig.hhs.gov/reports/all/2023/more-than-a-thousand-nursing-homes-reached-infection-rates-of-75-percent-or-more-in-the-first-year-of-the-covid-19-pandemic-better-protections-are-needed-for-future-emergencies
5️⃣ Axios Report: Nursing Home Death Rate Rose 32% in 2020
https://www.axios.com/2021/06/22/death-rate-nursing-home-2020
6️⃣ KFF Report: Over 200,000 Nursing Home Residents & Staff Died from COVID
https://www.kff.org/policy-watch/over-200000-residents-and-staff-in-long-term-care-facilities-have-died-from-covid-19
🏡 Facility References: St. John Lutheran Care Center (Mars, PA)
My Caring Plan Listing
https://www.mycaringplan.com/senior-living/st-john-specialty-care-center
SeniorAdvice Listing
https://www.senioradvice.com/providers/view/st-john-specialty-care-center-mars-pa
Medicare Care Compare Page
https://www.medicare.gov/care-compare/details/nursing-home/395164/view-all?state=PA
Caring.com Community Reviews
https://www.caring.com/senior-living/pennsylvania/mars/st-john-community
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