My Mother’s Last Month Showed Me How American Nursing Homes Really Work

Until my mother got sick, I never gave nursing homes a thought. I’m 68 this year, I exercise, and I feel fine. But after what I saw in the last month of her life, I can’t walk past one in New York or Chicago without looking twice.

How my parents started over in America

My parents left Minsk with us in 1989. After six months of waiting in Europe we reached the United States. They settled in Milwaukee, and I went to Iowa and then to Chicago. My mother was 54 and my father 58. Back home my father, Mikhail Radunsky, had played ten years for Dinamo Minsk, and anyone who followed soccer knew his name. In Milwaukee he coached a local club without speaking English and washed pots at night in a restaurant owned by the club’s owner. My mother remembered him waking up with aching hands. She went to work as a bookkeeper at 54.

Because she worked, she earned a pension and ended up on Medicare, and that turned out to matter. People who came here and lived on public programs are on Medicaid, and when it comes to long-term care, Medicaid covers more than Medicare does. Someone who arrived at 40 or 45 and worked until retirement can get less help in old age than someone who never worked here at all.

A toast, a fall and three hospitals

We drove to Milwaukee to see my mother’s two sisters. She had vertigo and sometimes lost her balance, so I usually sat next to her. That evening neither my brother nor I did. She was 86. She stood up to make a toast and fell, and nobody caught her. Afterward she could move and said nothing hurt, but she couldn’t get up. I carried her to the car, drove her back to my parents’ condo in Skokie and carried her inside. My father was 90 then. He is 94 now, and at 92 he was still dancing at my brother’s place.

The next morning my father said she wasn’t doing well. We called an ambulance, and she was taken to the emergency room of a hospital in Skokie. She wore a diamond wedding ring and one other ring. A couple of days later both were gone. We hadn’t taken them. Someone there had.

From Skokie she was moved to a hospital in Evanston, a very good one, with a private room. A doctor there, a very capable woman, told us that at my mother’s age we should put her wishes in writing in case she lost consciousness. My mother was fully conscious and said it herself: if she stopped responding, she didn’t want to be kept alive on machines. We signed the papers. Four or five days later she was stable enough to go to rehab.

Friends pointed me to a rehabilitation center on the North Shore, and it looked just like its photos. She had a room to herself, and a Russian-speaking physical therapist started working with her. It was October, and more than once I came in to find the window open and my mother cold. Nobody was keeping an eye on it, so I tipped the staff to do it. Three days later the therapist called to say she had been taken back to the Evanston hospital and was barely conscious. Nobody ever told us she had had a stroke, but from everything I saw and read afterward, I believe she had a small one at that dinner. I’m not a doctor, and I may be wrong.

What “rehab” turned out to be

I had assumed a rehab center was a stand-alone place for physical therapy. It turns out it almost always shares a building with a nursing home. The first one was a three-story complex with a nursing home on the other floors. I only ever went to her floor, and it was clean.

For the second stay I was referred to a woman at another center of the same group, in Skokie, closer to my father. On the phone she promised she would keep an eye on everything, and I didn’t go to see the place first. When my mother was brought in, I was shocked. Finding a doctor or a nurse took real effort, and I handed money to everyone. Sometimes I walked onto the other floors, where the nursing home was, and saw many Russian-speaking old people. I had never seen anything like it. My mother died there a month after the fall. By then it was hospice care.

On one of those floors I saw an American man of about 80. He was perfectly lucid and kept asking why he couldn’t go outside for some air. Security wouldn’t let him out. To me it looked like a prison: a man in his right mind wasn’t allowed to leave.

There’s a 2020 film, I Care a Lot, about a court-appointed guardian who strips old people of their property and locks them away in care homes. It’s billed as a comedy. After what I saw, I didn’t laugh: the way the staff treat the residents in that film is close to the truth.

Who pays, and why that decides the care

Most people in nursing homes aren’t wealthy, and Medicaid pays for most of them. To qualify, you generally have to spend down almost everything you have; in most states your savings have to fall to about $2,000 before it starts paying. Then it pays the minimum, and the care is the minimum.

Medicare, which my mother had, pays only for a short stay after a hospital admission: up to 100 days of skilled nursing or rehab, and in full only for the first 20. It’s built for recovery, not for living there. The usual story goes like this. You land in the hospital, they send you to rehab, and you expect to be home in a couple of weeks. That is exactly what we thought. But you come out weaker, there’s no help at home, and the rehab patient quietly becomes a permanent resident.

On paper, residents have rights, overseen by the Centers for Medicare & Medicaid Services. In practice you’re weak, you depend on the staff, and you can’t leave. You don’t decide when you eat or when you sleep, and the doors are locked “for your safety.” From what I read later, one aide can have around fifteen people to look after. The staff aren’t bad people. They’re underpaid, they burn out, and they keep leaving, while the residents wait their turn for help.

What private equity changed

When we came to America, nursing homes were different, from everything I’ve heard: the care, the food, the staff. Over the last 15 or 20 years that changed, and one reason is private equity, investment funds that buy existing businesses outright or take a majority stake. Once a fund owns a nursing home, it’s an investment, and the question becomes how to raise the return. The quickest way is fewer staff and less money spent on each resident. Funds often sell off the land and the building as well, and the home goes on paying rent. Old age turns into an Excel spreadsheet.

This isn’t just my impression. A study published by the National Bureau of Economic Research in 2021 and revised in 2023 looked at Medicare data on patients in U.S. nursing homes. It found that private equity ownership raised patient mortality by about 11%, while nurse staffing and compliance with care standards fell.

That’s how the system works now: while you pay, you’re a customer. Once you’re weak, you’re an expense.

What I think about now

In the Soviet Union, old people lived with their children and grandchildren, and the family looked after them. In America the answer is often a nursing home or assisted living, and it can happen to anyone. You can be successful, smart and strong your whole life, but if you haven’t prepared for old age, the system has prepared for you.

You can win at life and still lose your old age.

I feel fine, knock on wood. But since that month I notice every new building for seniors that goes up. I wish everyone good health in old age, a clear mind and strong legs. Work on your legs, so you can get up without help and keep moving. And, as I always say: keep fighting and don’t give up.

Originally published as a video on my YouTube channel on 17 April 2026. Watch on YouTube