I will never allow myself or any family member to be left in the bottom 99% of nursing homes
Let's talk about how this would change YOUR life to fulfill this promise since so many have this same opinion but probably are too young to even see the realty of such a life changing event.
For taking care of your family member, you need a house or apartment that is easily accessible. The hospital is not going to hold your family member while you get permits and build ramps or knock down a wall to expand a living area. If you choose to take your family member home anyway, you may need the services of an ambulance rather than a WC van for every appointment your family member has. Your family member may then become that dreaded BS call that requires carrying down stairs every week just to go to the doctor.
You may also have to give up your career or ask you spouse to quit their job just so there will be someone to provide 24/7 care to your family member...or to you if that is the situation. Some even have made their children quit college to care for their grandparent. Some may also spend their life's savings after quiting a job and then have little for their own future or that of their children's. Single people may even give up a chance for marriage and children to care for their family member for many years.
Some elderly people are very appreciative of the sacrifices but are also very sensitive to the changes and hardships they have caused. That is when they realize they are now a burden to their family. The family may start to show their own resentment, even if unintentionally, from the stresses of less earning power and giving up opportunities for their own lives.
Now for a short term situation such as hospice or comfort care where it is only a few weeks or just days, that is different as Family Medical Leave may apply.
Next time you do pick up a patient who is being cared for at home, look deeper into the changes within the living situation.
One hand it can make you very cynical (low pay, interactions with crappy SNFs/patients, long hours) but if you are able to see past these things and appreciate the fact that as a low-paid, barely-trained EMT, you can still have a positive effect on peoples lives through your short interactions, then it can still be rewarding and enjoyable (run-on much?)
There are still many good nurses and CNAs at the crappy SNFs with the crappy patients regardless of appearances. First, patients in SNFs are generally there because they need assistance and may not be able to help making a mess with their bowel movements. Second, these CNAs and nurses are going against the odds with maybe 4 health care providers for every 100 patients. Often one CNA will have over 20 patients to care for during 8 or 12 hours attempting to meet the many needs of a long term patient. Be very, very thankful you only have one patient at a time and for only a few minutes. Try to do the very best you can with that patient in such a short time. For some patients your own attitude may be no different than that of those you consider to be crappy in the nursing homes. You could also cut those in the nursing homes some slack because you don't know what type of shift they are having and how many difficult patients they are trying to manage. Some EMTs complain over and over for days about "one" bad patient and expect everyone to be sympathetic or cut them some slack. Nursing homes are now given an big task with little funding coming through. In some states, especially California, the staff at these facilities work without knowing where their next paycheck is coming from since that state is broke and not always paying for MediCal during budget disputes. If you are still getting a paycheck in California, consider yourself very lucky.
Look closer at the jobs of the many health care providers that make up a system or that of any other profession. You may find yourself very lucky to have the ability drive around to pick out a restaurant that gives large discounts to EMS. You may also be very lucky to have a job where the station has a computer, large screen TV, kitchen and a bed for you to earn money sleeping. Appreciate the fact you may only have to get out of bed once, while on the clock, to do a short crappy SNF transport that still gives you a paycheck. Yes, there are many positive things about working in EMS.
Also, when you think you have a BS patient from a nursing home, try to look at what their life had been before becoming old or disabled. We're going to see alot of disabled veterans from the wars this country is involved in. Unfortunately, some will become those BS homeless patients who get the ambulance called for them every time they fall down from losing their balance occasionally due to a head injury or substance abuse problems. Appreciate your own health as it may not take much more than a missed step at a curb or stairs to put your into that same situation.