How much to save for retirement

[sophie]

Thanks @boglerdude!

I found something similar in northern NJ, where my mother lives: Fox Trails. They have similar houses in the community and they specialize in dementia care for small groups. Cost was about $7-8K/month but they had a much better staffing ratio (3 aides to about 20-30 residents) than typical nursing homes. So additional private aides might not be necessary, or at least they wouldn't be needed more than a few hours a day. I toured one of them and it's lovely - BUT, the residents were all much more advanced than my mom. All were nonverbal and they looked very, very sedated. It could be a really good option for my mom once she gets to that stage, although I'm not sure they'd accept her because she has limited mobility from an old back injury.

That brings us to the time course of dementia. After a lot of reading and observing, I think I can safely assert that Alzheimer's is always going to be about a 15-20 year course, regardless of how old you are. The only thing that shortens that time is for the person to die of something else along the way. A fall, a respiratory infection, cardiovascular disease, cancer etc. This is more likely when you're older of course, so that's why Alzheimer's survival time decreases with age. So financially you need to plan for 15 years. My suggestion is to plan on home care with aides for the first 10 years (about $100K/year), and 24/7 aides and/or nursing home in some combination for the last 5 years (about $300K/year). If you're part of a couple, you need for the first person to be fully funded, but the second person can be financed in those last 5 years by proceeds from selling the home and fixed income from SS and other sources. I would also advocate getting the person qualified for hospice as soon as possible, and dispensing with all medical care (especially preventive) that isn't part of comfort care.

Don't count on an Alzheimer's treatment coming down the pike anytime soon. There's nothing worthwhile on the radar, and the research community is too busy chasing after genes, which is totally ridiculous for a condition that 1/3 of us will get. That's like looking for genes responsible for the common cold. There are some hints in the literature supporting what my view of Alzheimer's is: a combination of insulin resistance and systemic inflammation, with damage slowly accruing over many years. If this is true, there will never be a "treatment" to reverse the damage. I would guess that you can delay it with dietary modification, by eliminating sugar and refined grains especially wheat, and limiting carbohydrates in general, and there's some good evidence to support that as well. But, we will all develop this condition eventually. Which means we all need to plan for it. In the post-pension, low retirement savings, and Medicare/Medicaid insolvency era, it's going to be truly disastrous for anyone who isn't financially prepared for it. The one possibly good thing about Alzheimer's is that the affected person has absolutely no insight into their condition, and are firmly convinced that everything's fine, they don't need help etc. Maybe there's something to be said for letting the person starve, or wander outside and die of exposure (that happened to my brother-in-law's uncle during a Minnesota winter). I often wonder if a person with dementia wouldn't be happier that way instead of having to accept an aide or a move to assisted living. None of them will ever accept these things willingly - as seajay has found!

[flyingpylon]

Seems like the answer to “how much to save for retirement” is always the same as how much the rich should pay in taxes: “more”. If you think you have it all figured out, someone will make you aware of some new reason that no, actually you’re doomed.

All any of us can do is to do our best and we’re going to end up with whatever we end up with. People have been retiring that way forever.

It’s interesting that so many of us are dealing with elderly parents. That doesn’t get discussed much here. Unfortunately my parents (separately) have inadvertently followed the “die with zero” plan and it’s stressing me out. My mother lives alone in an old home in a rural area 900 miles away and has stage 4 congestive heart failure among other things. She hired a friend part-time to do general assistance and housekeeping and a home health care nurse stops by once a week. Friends check in on her often but not every day. She is eligible for hospice but “doesn’t think it’s time for that yet”. She is pretty content and manages to get by but she’s declining and I don’t think it will be too long before she needs far more assistance if she doesn’t die first. She wants to stay at home which is good because there are waiting lists at the few facilities in the area. But with a pension and SS she makes too much for Medicaid but not enough to pay for a lot of additional care. Even if she was on at-home hospice care, they require a primary caregiver to be available 24x7. My sister lives more than twice as far away as I do so we will have to hire someone. We’ll have to tap into my mother’s home equity to do that. Given her health status it’s unlikely we’d run out of money but she’s defied the odds in many ways throughout her life so it’s still a consideration. Just a whole lot of uncertainty right now which is difficult to deal with.

My mother-in-law has late-stage Alzheimer’s with my elderly father-in-law being her primary caregiver, and that has its own issues. Fortunately they are just a few hours away, live in a populated area with more options, and have much better financial resources. But that situation is a challenge too.

One of the takeaways for me is that I should be willing to be more open about finances with my kids at an earlier point than my parents have been with me. To be fair, part of that is on me because I never wanted to pry or tell them how to spend their money (and the few times I did, they didn’t listen to me anyway). I’m not really sure what the answer is, I guess each family needs to figure that out for themselves.

[Mountaineer]

Seems like the answer to “how much to save for retirement” is always the same as how much the rich should pay in taxes: “more”. If you think you have it all figured out, someone will make you aware of some new reason that no, actually you’re doomed.

All any of us can do is to do our best and we’re going to end up with whatever we end up with. People have been retiring that way forever.

<snip>

This post reminded me of the book "Enough" by John Bogle. Well worth reading in my opinion.

"John Bogle puts our obsession with financial success in perspective
Throughout his legendary career, John C. Bogle-founder of the Vanguard Mutual Fund Group and creator of the first index mutual fund-has helped investors build wealth the right way and led a tireless campaign to restore common sense to the investment world. Along the way, he's seen how destructive an obsession with financial success can be. Now, with Enough., he puts this dilemma in perspective.

Inspired in large measure by the hundreds of lectures Bogle has delivered to professional groups and college students in recent years, Enough. seeks, paraphrasing Kurt Vonnegut, "to poison our minds with a little humanity." Page by page, Bogle thoughtfully considers what "enough" actually means as it relates to money, business, and life.

Reveals Bogle's unparalleled insights on money and what we should consider as the true treasures in our lives
Details the values we should emulate in our business and professional callings
Contains thought-provoking life lessons regarding our individual roles in society
Written in a straightforward and accessible style, this unique book examines what it truly means to have "enough" in world increasingly focused on status and score-keeping."

https://www.amazon.com/Enough-True-Meas ... 0470524235

flyingpylon, the remainder of your post that I snipped was very touching to me. I can certainly identify; I've been down much of that road. Best wishes for dealing with your elderly loved ones.

... Mountaineer

[sophie]

All any of us can do is to do our best and we’re going to end up with whatever we end up with. People have been retiring that way forever.

That they have. But several things are different now. First, people are living longer while getting substantially less healthy. That means far more time spent needing care. Second, families are now scattered and older people move away from the neighborhoods they lived in as adults. There's also been an explosion in the numbers of people with Alzheimer's - the one condition that is truly impossible to live with without inflicting serious harm on the caregiver. And even then, the cost of getting help in caring for an ill elderly family member has skyrocketed, because there are a lot more people needing care than there are people willing to provide it. My father's care, even with my mother taking on as much of the work as she could manage (her devotion was truly a monument to her love for my dad, who was severely disabled for the last 3 years of his life), cost a good $100K/year. That was in 2012-2015. Aide costs, whether private or via and agency, have doubled since then. Guessing it would be more like $200K now.

Also, the only real option for someone with no resources is to go on Medicaid and move immediately to a nursing home before they really need to be there. Medicaid does not fund home care, nor will it cover care in the nicer or dementia-specialized nursing homes/memory care facilities. Tyler's family's magical nursing home notwithstanding, this is a pretty awful scenario but it's what awaits the majority of people on the retire with no savings plan.

[joypog]

All any of us can do is to do our best and we’re going to end up with whatever we end up with. People have been retiring that way forever.

To be pedantic…is that true? My speculation is that voluntary retirement is a modern construct.

[vnatale]

Related to retirement ... though this newsletter is aimed at advisors it has three excellent articles in it which you can either apply to yourself or to assist others to apply.

https://www.retirement-insight.com/2022 ... -accounts/

“5 Critical Social Security Concepts You Need to Know to Elevate Your Credibility” by Heather L. Schreiber, RICP®, HLS Retirement Consulting, LLC.

“Determining Your Client’s Retirement Income Style” by Wade D. Pfau, Ph.D., CFA, Professor of Retirement Income for the American College of Financial Services.

“Advance Planning for Clients with Health Savings Accounts (HSAs) and Medicare” by Kelley Long, CPA/PFS, CFP®.

[flyingpylon]

All any of us can do is to do our best and we’re going to end up with whatever we end up with. People have been retiring that way forever.

To be pedantic…is that true? My speculation is that voluntary retirement is a modern construct.

I meant “for as long as people have been retiring”, not literally “forever”.

[flyingpylon]

All any of us can do is to do our best and we’re going to end up with whatever we end up with. People have been retiring that way forever.

That they have. But several things are different now. First, people are living longer while getting substantially less healthy. That means far more time spent needing care. Second, families are now scattered and older people move away from the neighborhoods they lived in as adults. There's also been an explosion in the numbers of people with Alzheimer's - the one condition that is truly impossible to live with without inflicting serious harm on the caregiver. And even then, the cost of getting help in caring for an ill elderly family member has skyrocketed, because there are a lot more people needing care than there are people willing to provide it. My father's care, even with my mother taking on as much of the work as she could manage (her devotion was truly a monument to her love for my dad, who was severely disabled for the last 3 years of his life), cost a good $100K/year. That was in 2012-2015. Aide costs, whether private or via and agency, have doubled since then. Guessing it would be more like $200K now.

Also, the only real option for someone with no resources is to go on Medicaid and move immediately to a nursing home before they really need to be there. Medicaid does not fund home care, nor will it cover care in the nicer or dementia-specialized nursing homes/memory care facilities. Tyler's family's magical nursing home notwithstanding, this is a pretty awful scenario but it's what awaits the majority of people on the retire with no savings plan.

I don’t disagree with what you’ve said about the health and financial challenges. But the reality is that most people are not going to have that kind of money set aside for long-term care. They won’t have it if they work until 80 either. So are they not supposed to retire? There’s a lot of room between “no plan” and a “luxury plan” so if the question is “how much to save for retirement” all anyone can do is save what they can and manage their expenses, adjust on the fly, and let the chips fall where they may.

[vnatale]

All any of us can do is to do our best and we’re going to end up with whatever we end up with. People have been retiring that way forever.

To be pedantic…is that true? My speculation is that voluntary retirement is a modern construct.

I meant “for as long as people have been retiring”, not literally “forever”.

I did understand what you meant! Was not that long ago in human history that most people did not live long enough to retire.

[joypog]

All any of us can do is to do our best and we’re going to end up with whatever we end up with. People have been retiring that way forever.

To be pedantic…is that true? My speculation is that voluntary retirement is a modern construct.

I meant “for as long as people have been retiring”, not literally “forever”.

For sure! Totally fair! I suspect I was subconsciously reacting against some of the pessimism that can pervade this forum. The US is going through a long period of relative decline (it can only go down after being the global hegemon of the 1990's)....but widen the frame a bit and we're still doing pretty dang good compared to our ancestors (even if is less awesome than the generation right before us).

[D1984]

All any of us can do is to do our best and we’re going to end up with whatever we end up with. People have been retiring that way forever.

That they have. But several things are different now. First, people are living longer while getting substantially less healthy. That means far more time spent needing care. Second, families are now scattered and older people move away from the neighborhoods they lived in as adults. There's also been an explosion in the numbers of people with Alzheimer's - the one condition that is truly impossible to live with without inflicting serious harm on the caregiver. And even then, the cost of getting help in caring for an ill elderly family member has skyrocketed, because there are a lot more people needing care than there are people willing to provide it. My father's care, even with my mother taking on as much of the work as she could manage (her devotion was truly a monument to her love for my dad, who was severely disabled for the last 3 years of his life), cost a good $100K/year. That was in 2012-2015. Aide costs, whether private or via and agency, have doubled since then. Guessing it would be more like $200K now.

Also, the only real option for someone with no resources is to go on Medicaid and move immediately to a nursing home before they really need to be there. Medicaid does not fund home care, nor will it cover care in the nicer or dementia-specialized nursing homes/memory care facilities. Tyler's family's magical nursing home notwithstanding, this is a pretty awful scenario but it's what awaits the majority of people on the retire with no savings plan.

Two obvious questions:

One, how is the average person supposed to save up an additional $4 million or so (this is presuming they had to plan for the worst-case scenario of, say, $200K annually of full-time around the clock care for roughly twenty years i.e. assuming they will be stricken with Alzheimer's and several other conditions at, oh, age 71 or 72 and unable to do virtually any ADLs and will only die in their early or mid 90s) and save for retirement (i.e. put enough back in their 40Ks/IRAs/Roths in order to secure a decent retirement standard of living) and have enough to actually live on (i.e. to pay for such frivolous little luxuries like food in their stomach, keeping the lights on, having a roof over their head, and being able to actually have children and afford to raise them so that, ya know, there actually will be a next generation)? If we had a situation where someone who (for example) made, say, $250K a year every year and thus technically could've saved and invested enough but chose to instead blow it on luxury cars, vacations, dining out every night, etc I would agree that yeah, maybe they "deserve" to not have enough money for LTC...but the average American doesn't make anywhere near $250K (or anything close to that)! In short, if something is a problem for a few percent of the population then maybe you can say it was their individual fault for not preparing better.....but if something is going to be a problem (or at least a potential problem) for the vast majority of the population then perhaps it calls for a society-wide solution.

Two, related to the above, why do you assume that Medicare/Medicaid will continue to be underfunded and thus that poor quality LTC care--or no care at all--will be available to those who aren't wealthy/privileged/lucky enough to have a few extra million $ set aside on top of their regular retirement accounts? These programs not having enough revenue to provide needed LTC benefits is not some unfixable and immutable act of nature/act of God like hurricanes or earthquakes...it is a political choice. Why do you simply assume by fiat that taxes cannot and will not be raised at all, the wealthy cannot be asked to pay more (and for that matter that even the upper middle class cannot be asked to pay a bit more too), and that a social insurance solution of any type or form is simply off the cards? I wish I could recall where but I remember reading several years ago (late 2016-early 2017ish) that even in a "worst-case" scenario (i.e. continuing below-replacement TFRs, virtually zero immigration, resultant rapid population aging comparable to Japan/China/Korea, and hypothetical future slow productivity growth/output growth that was actually slightly worse for the US than Japan's "lost decades" from 1991 to present were for it in terms of economy-wide GDP per capita growth) LTC costs by 2050 wouldn't be more than around 4.6 to 4.8% of total GDP. That's a sizeable number (I believe currently they are at just a hair over 1% of GDP once you include all the cash equivalent costs of uncompensated care provided by family).....but it's not an insurmountable one. Just because a worst-case scenario cost is unpayable by any given individual doesn't mean it is unpayable at all....that's why we have insurance of various kinds. Granted, both current private market solutions (LTC insurance) and social insurance solutions (Medicare/Medicaid) have issues but with actual proper funding (and some needed tweaks/redesigns....don't even get me started on how most LTC insurance is actually designed upside-down.....it is only meant to cover a few years of LTC care when the reality is it should be designed just the opposite; to cover open-ended catastrophic costs BEYOND the first year/few years) most of those issues would disappear. Perhaps it is at least somewhat reasonable to expect people to set aside enough to cover maybe a few months or a year or two of LTC but again, expecting everyone to be able to set aside enough to cover the worst-case imaginable is just nuts.

[vnatale]

Left out of this discussion has been the cost of health insurance / Medicare during retirement?

https://www.fa-mag.com/news/are-healthc ... ?issue=359

Are Healthcare Costs In Retirement Overwhelming?


Fidelity Investments noted this year that an average retired 65-year-old couple in 2022 may need a mind-boggling savings of $315,000 (after tax) to cover their retirement healthcare expenses. Earlier this year, the Employee Benefit Research Institute noted that a 65-year-old couple with median prescription drug expenses needed $296,000 in savings for a 90% chance of having enough to cover their healthcare expenses in retirement.

[vnatale]

Also related ....

https://www.fa-mag.com/news/a-rila-roth ... ?issue=362

A RILA-Roth Combo Can Solve Longevity Risk

In this approach, the client purchases the RILA with an increasing income stream for $300,000, and then does the Roth conversion from within the RILA. From the time they are age 58 to 62, the client converts $60,000 a year to the Roth inside the annuity to even out the tax bill and avoid the two-year Medicare look-back period.

The process involved in this approach, Adams said, is to:
• Create a qualified RILA;
• Transfer $300,000 from the clients’ 401(k) to the RILA;
• Create a Roth IRA portion of the RILA (where the distributions are changed from ordinary income to tax-free income);
• Set up the installment schedule to fund that over the next five years; and
• Take the distributions from the Roth portion of the RILA.

“Now we’re becoming tax efficient with that annuity by making all of the distributions from that annuity during our clients’ retirement completely tax-free,” Adams said. “Our probability of success has now jumped from 59% up to 87% by being smart with our distributions, and by tying our tax-diversified income into our inflation hedge.”

The total expenses are now $7 million and the guaranteed income is $5.2 million, leaving just $1.8 million to be funded by the portfolio—far less than the $3.6 million the clients started at.

And even with the worst-case, below-average market assumption, the clients would be able to leave almost $500,000 at the end of their lives to a beneficiary. They could leave almost $1.6 million behind for heirs if the market performed at its average.

“That’s off of a $300,000 transfer to the registered index-linked annuity where it provides an inflation hedge with tax diversification within our drawdown strategy,” he said. “It’s definitely something from an advisor’s standpoint where you can show the value that you’re providing to the client’s financial plan.”

[ochotona]

Vinny,

Your article is from a commercial webpage from advisors - the people who would benefit from the sale of annuities. That's not a resource written for the betterment of consumers.

Hasn't it been shown that indexed annuities are a rip-off... they give you some of the index upside, keep all of the dividend stream, and there are huge fees and commissions, and you can't back your money out without surrender charges? Can't they do something like a capital call? No thank you.

If the stock market is up 25%... you don't get that. They might give you 10%. But those "haymakers" are exactly how people become wealthy. Three of those in your investing lifetime is doubling your money (1.25 raised to the 3rd power).

If I were to annuitize, it would be according to a well-defined and simple distribution contract. I'm leaning towards using a QLAC, a qualified longevity annuity contract, basically paying for it using IRA money without incurring taxes when the annuity is purchased, and "smearing" my RMD tax problem into the future after age 85. It would also help fund long-term care or whatever I need to do at 85+. It would be very low risk money, like a bond.

QLACs are consumer advocate Clark Howard's exception #2. Exception #1 are fixed immediate payout annuities. Otherwise he thinks annuities stink.

https://clark.com/personal-finance-cred ... nuity/#why

[Maddy]

The tenor of this discussion is revealing that it is not saving for retirement that is the problem; it's saving for medical care.

Some questions to ponder:

- Do folks over 65 really need to be on 12 different prescription drugs?
- How much of what passes for medical care in the "over 65" crowd could be handled appropriately (or even better) through self-doctoring?
- How much hospital care is the result of poor lifestyle choices, both past and ongoing?
- Do you really want a year of chemotherapy and radiation at the age of 85?
- Bodies don't last forever. Is it so wrong to accept that there is a point when you should just let nature run its course?

In another thread from long ago, we discussed the fact that the medical system is good for one thing: acute care. With respect to the chronic, degenerative stuff, it really doesn't have too much to offer. So why do we continually look to the medical system, with all its layers of expensive bureaucracy, to solve these problems?

[vnatale]

Vinny,

Your article is from a commercial webpage from advisors - the people who would benefit from the sale of annuities. That's not a resource written for the betterment of consumers.

Hasn't it been shown that indexed annuities are a rip-off... they give you some of the index upside, keep all of the dividend stream, and there are huge fees and commissions, and you can't back your money out without surrender charges? Can't they do something like a capital call? No thank you.

If the stock market is up 25%... you don't get that. They might give you 10%. But those "haymakers" are exactly how people become wealthy. Three of those in your investing lifetime is doubling your money (1.25 raised to the 3rd power).

If I were to annuitize, it would be according to a well-defined and simple distribution contract. I'm leaning towards using a QLAC, a qualified longevity annuity contract, basically paying for it using IRA money without incurring taxes when the annuity is purchased, and "smearing" my RMD tax problem into the future after age 85. It would also help fund long-term care or whatever I need to do at 85+. It would be very low risk money, like a bond.

QLACs are consumer advocate Clark Howard's exception #2. Exception #1 are fixed immediate payout annuities. Otherwise he thinks annuities stink.

https://clark.com/personal-finance-cred ... nuity/#why

The article is NOT from a commercial webpage from advisors. The magazine is aimed at articles to Financial Advisors for them to better assist their clients.

Many are against annuities. Some of for. Those for are Professor Wade Pfau of American College and the other well known professor at a college in Toronto. I believe Bernstein has stated that buying an annuity is similar to buying a bond from a company (he is anti).

What you describe may be superior to what is described in that article. Or, not.

[vnatale]

The tenor of this discussion is revealing that it is not saving for retirement that is the problem; it's saving for medical care.

Some questions to ponder:

- Do folks over 65 really need to be on 12 different prescription drugs?
- How much of what passes for medical care in the "over 65" crowd could be handled appropriately (or even better) through self-doctoring?
- How much hospital care is the result of poor lifestyle choices, both past and ongoing?
- Do you really want a year of chemotherapy and radiation at the age of 85?
- Bodies don't last forever. Is it so wrong to accept that there is a point when you should just let nature run its course?

In another thread from long ago, we discussed the fact that the medical system is good for one thing: acute care. With respect to the chronic, degenerative stuff, it really doesn't have too much to offer. So why do we continually look to the medical system, with all its layers of expensive bureaucracy, to solve these problems?

This statistic is telling in regards to your third point: "The United States has the 12th highest obesity rate in the world at 36.2%."

Liberal politicians seem to thrive on calling for more paid health care but no politicians seem to be willing to call out Americans who are their own worst enemies health-wise.

[glennds]

This statistic is telling in regards to your third point: "The United States has the 12th highest obesity rate in the world at 36.2%."

Vinny,
If you ignore the Polynesian and South Pacific island nations, the United States is number one reigning champion in obesity.

https://data.worldobesity.org/rankings/

[glennds]

One, how is the average person supposed to save up an additional $4 million or so (this is presuming they had to plan for the worst-case scenario of, say, $200K annually of full-time around the clock care for roughly twenty years i.e. assuming they will be stricken with Alzheimer's and several other conditions at, oh, age 71 or 72 and unable to do virtually any ADLs and will only die in their early or mid 90s) and save for retirement (i.e. put enough back in their 40Ks/IRAs/Roths in order to secure a decent retirement standard of living) and have enough to actually live on (i.e. to pay for such frivolous little luxuries like food in their stomach, keeping the lights on, having a roof over their head, and being able to actually have children and afford to raise them so that, ya know, there actually will be a next generation)?

D1984,
I think this is one of those times you can apply a simple reasonableness test.
Does it seem reasonable to you that the average American would need $3-5 million for their retirement and elder care needs?
If that were the case, where would it leave 98.5% of people?

Take it as inside information from a former hospital administrator, hospital CFO and nursing home administrator, licensed in two states. If I told you the average person is spending closer to $20-$30K/year out of pocket for elder care, even with dementia, would that seem reasonable to you?
(Out of pocket means over and above the average annual SSI benefit.)

And that would be a person who does not qualify for Title XIX Medicaid, which most do after some spend-down period, if not immediately.
I can illustrate how I arrive at these rough numbers if you or anyone else would like.

Of course it is always a choice for people to spend considerably more on private duty care versus conventional choices. Just like it is a choice to charter a private jet versus buying a coach ticket on Southwest Airlines. Or putting your kid in private school versus the public school system.

Would the average scenario of elder care I describe be 'desirable' to those of us who are young?
No, probably not any more than the whole prospect of aging itself is desirable to those of us who are young.
But in my professional opinion the subject becomes as much a societal and cultural issue as a financial one.
There's also a question of what's feasible and what's realistic. Elder care, like most aspects of life, involves compromises.

[flyingpylon]

Take it as inside information from a former hospital administrator, hospital CFO and nursing home administrator, licensed in two states. If I told you the average person is spending closer to $20-$30K/year out of pocket for elder care, even with dementia, would that seem reasonable to you?
(Out of pocket means over and above the average annual SSI benefit.)

And that would be a person who does not qualify for Title XIX Medicaid, which most do after some spend-down period, if not immediately.
I can illustrate how I arrive at these rough numbers if you or anyone else would like.

I would be interested in this. Probably deserves its own thread.

[Maddy]

Another case of abuse by nursing home staff. . . https://www.thegatewaypundit.com/2023/0 ... ouncing-t/

Very similar to my friend's case, but this time it was the health care workers who videotaped their taunting of an elderly person with Alzheimers. Really, really disgusting.

[Xan]

glennds, am I correct that it's your position that the bad publicity of this kind of thing and the threat of lawsuits keeps it from being a big deal?

[glennds]

glennds, am I correct that it's your position that the bad publicity of this kind of thing and the threat of lawsuits keeps it from being a big deal?

Xan,
No. If that was your impression, let me correct it.
First off, nursing home abuse whenever or wherever it occurs is always a big deal. What I am saying is bad publicity, lawsuits and regulatory penalty are all bad enough consequences, which should make it in the provider's interest to do their best to prevent them and certainly prevent recurrences.
This said, there are over 26,000 facilities in the country, and there are always going to be bad apples and even bad outlier incidents that will occur in good apples, on a given day on a given shift. When they do happen, like this incident, they are understandably jarring. But I don't think you can extrapolate an incident like this into a widespread allegation that all these places are bad. There are a lot of good facilities with good employees that are sincere about doing what is a difficult job. You just don't hear about them. Especially not in the pages of Gateway Pundit.

My earlier comments were aimed at the legal malpractice industry. What I was trying to say is that the enhanced tort remedies have created an opportunistic plaintiff trade. Many of the cases may be justifiable claims, but an unfortunate by-product of the tort landscape is that the facility is in a disadvantaged position, with a near presumption of guilt, and the plaintiff lawyers have exploited that. A shorter way of saying it is a lot of undeserving facilities get sued along with the ones that deserve it because it's lucrative. I wrote the comment because you interpreted the mere existence of plaintiff lawyer TV ads as an indication that nursing homes are bad and I wanted you to know there is another dimension to it that might not be obvious.

I will also say there is a test used by the regulatory agencies called scope and severity. Severity depends on whether actual harm occurred. In this case, the severity is moderate because there allegedly was abuse and exploitation, but the harm would be deemed less than say, if a patient was physically hurt or died. Not that the harm wasn't meaningful, but just that there is a scale.
Scope refers to whether the incident was isolated or a widespread pattern. The worst situation would be high severity and broad scope.
The regulatory agency will respond by evaluating whether there was a pattern here. If not, then the facility will need to show what steps it is taking to prevent a recurrence. The bad publicity will probably hurt it, for a while.
But if the scope is broad, and there is a pattern, besides lawsuits, the regulatory agency will take punitive measures which could include de-certification, or even putting in temporary management to run the place. Zero defect isn't realistic. What you should be seeking is a facility that is taking reasonable proactive measures to prevent incidents, and prompt measures when there is an incident. Unfortunately the sheer size of the industry and the number of variables make it unrealistic to never have an incident. This particular facility might have been a bad one. Even if only 1% are bad facilities, that's 260.

If you look hard enough, you'll always find reports of nursing home abuses. This article is a little (a lot?) sensational because of where it appears. Have a look at some of their other headlines to see what I mean.
Just remember that there are 26,000 facilities so probably somewhere on order of 1.5MM-2MM residents in them. So just put what you're reading in statistical context.

BTW, I had to do some digging to find the name of the facility from Maddy's article. I eventually found it and their Google reviews are actually pretty good. Many of them mention the Executive Director by name which is a good sign to me. This suggests that at least some people there are getting good care. I just hope these employees were bad apples and the facility is taking steps to make sure it doesn't happen again.

[Maddy]

It's hard to say how pervasive the problem is. Many nursing home residents have no one to speak for them, so when an instance of abuse or neglect comes to light, you can bet that there are many more that will never become known. And while I'm sure that the worst nursing homes are easy to identify, many of the "good" ones are troubled with the very same problems. All three of the instances I cited above involved facilities that were regarded by the families as among the best.

I could write volumes on the issue of tort litigation, but cutting to the chase, the idea of huge jury verdicts in nursing home cases is a myth. The one plaintiff's case in which I was involved led me to do a comprehensive review of past jury verdicts in care facilities, and the awards in even the most egregious cases are so low as to make a case hardly worth pursuing. This clearly represents a bias against the elderly and infirm, whose lives are regarded as having little economic value and whose pain and suffering is not worthy of compensation.

[flyingpylon]

I could write volumes on the issue of tort litigation, but cutting to the chase, the idea of huge jury verdicts in nursing home cases is a myth. The one plaintiff's case in which I was involved led me to do a comprehensive review of past jury verdicts in care facilities, and the awards in even the most egregious cases are so low as to make a case hardly worth pursuing. This clearly represents a bias against the elderly and infirm, whose lives are regarded as having little economic value and whose pain and suffering is not worthy of compensation.

I tried to contact several lawyers to inquire about a possible medical malpractice case on behalf of my elderly mother. All I got were vague immediate rejections before even explaining the details along with referrals to her state’s bar association. I finally figured it out on my own. I understand why they don’t want the case and that they can’t be upfront about it, but I wish they could have helped me avoid wasting my time. It’s just a crappy situation… there’s no justice in the world.

Now if she had been a 40 year old man with a professional career, high income, and a family they would have been all over it. $$$$