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Senior homes and assisted living centers are a national disgrace. They are entirely about profit maximization (what business isn’t?), and as such hire people a
by john_yaya 5y ago
Senior homes and assisted living centers are a national disgrace. They are entirely about profit maximization (what business isn’t?), and as such hire people at the exact minimum and have well over 100% yearly turnover. The staff commonly steal from residents, and the management do not care. They’d rather retain a larcenous pig who barely executes her duties than have to go back and scrape the barrel for a replacement.
The residents are often lonely, in awful health, overlooked by their families, and spend all day watching television. Many of them are verbally abusive towards the staff.
Elderly people should live with their families. The ones with no families to care for them should be in nonprofit, closely regulated facilities with well-paid staff. And it’s time to stop spending $500K on medical care just so an 88 year old can make it to 89. Whoever spread that “death panels” meme should be forced to write America a check for five hundred billion dollars.
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- disabled 5y ago> Whoever spread that “death panels” meme should be forced to write America a check for five hundred billion dollars. Alaska governor and 2008 Republican Vice President candidate Sarah Palin started the “death panels” farse. See: https://en.m.wikipedia.org/wiki/Death_panel https://en.m.wikipedia.org/wiki/Death_panel It’s quite disgusting as she is a mother with a disabled child.
- gruez 5y ago>It’s quite disgusting as she is a mother with a disabled child. how is that disgusting? that seems entirely consistent with her beliefs, as disabled child means high costs which potentially could mean getting denied care on the basis of cost. it's not any different than say, "congresswoman with cancer pushes for cancer treatment funding bill".
- germinalphrase 5y agoBecause the core issue was about helping people put their own end of life wishes in writing and establish a will? It was never about a panel choosing care on behalf of someone else.
- gruez 5y agoIt was? From the wikipedia article >[...] proposed legislation would create a "death panel" of bureaucrats who would carry out triage, i.e. decide whether Americans—such as her elderly parents, or children with Down syndrome—were "worthy of medical care" I'm not sure how you got estate planning and/or medical euthanasia from that.
- germinalphrase 5y agoI’m not saying anything about medical euthanasia, but - to your question - the Wikipedia article is inaccurate: “Governor Palin’s Facebook post was about a proposal in the ACA that would allow Medicare to pay for patients to discuss living wills and other end of life issues with their doctor. Her statements helped create a huge political and public outcry that resulted in the language being removed from the final legislation and proves the impact and relevance of her statement. “In 2011, the Obama administration even deleted all references to end-of-life planning in a new Medicare regulation when opponents interpreted the move as a back-door effort to allow such planning.” The IPAB was even specifically limited from making recommendations around healthcare rationing: “ The ACA also places limits on the authority of the IPAB. The ACA states, “[t]he IPAB may not recommend rationing of healthcare, raising Medicare beneficiary premiums, cost sharing, or modifying eligibility criteria.”42 This is totally contrary to the “death panels” claim made by Governor Palin and illustrates the concern and confusion over the IPAB’s statutory and regulatory role. Also, Medicare specifically “withholds the power to regulate the practice of medicine from the federal government.” The IPAB has significant limitations on the scope of its proposals. So, as per ACA law, the IPAB cannot submit any proposals that would “ration care, modify Medicare eligibility criteria, raise costs to beneficiaries, change cost sharing for covered services, or restrict benefits in any way.” Source: https://scholarship.shu.edu/cgi/viewcontent.cgi?referer=&httpsredir=1&article=1189&context=student_scholarship https://scholarship.shu.edu/cgi/viewcontent.cgi?referer=&htt...
- code_duck 5y agoWhat I found odd about that discussion or claim is that we have essentially the same system already, but it's operated by for-profit corporations rather than the government. As you probably know, insurance companies will fight you literally to your death to avoid paying for treatments that doctors say are necessary.
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- tomrod 5y agoSo the solution is to spend less money but pay people more, and shoulder the rest on taxpayers? This probably won't work very long since the population isn't as triangular as it used to be (to my understanding this is what happened to Japan). I get the justified call to fix things for people that require these services. The US can barely afford to school its children, purchase its homes, or enact reasonable public health measures without bankrupting people. As a society the US is unwilling to consider euthanasia, decriminalization of most nonviolent drugs, effective gun control, and funding infrastructure. The plight of the elderly is on par with the plight of the transient. Policy is actively hostile for them.
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- soperj 5y ago>The US can barely afford to school its children You're the richest nation on earth. You can afford it, the people who control the purse strings choose to use it on other shit that benefits themselves.
- abeppu 5y agoWell, we also seem really bad at managing education. There has been a huge increase in the number of non-teaching staff (i.e. administration) in schools. At the same time that we wring our hands over class sizes, a growing proportion on dollars spent ostensibly on education go to stuff that doesn't happen in the classroom. We can "barely afford" stuff when we let a whole industry of nonessential stuff graft itself onto the thing we actually care about.
- peteradio 5y ago> You're the richest nation on earth* *On paper
- maxerickson 5y agoThe material abundance here is obvious, it's not just on paper.
- stult 5y ago> Whoever spread that “death panels” meme should be forced to write America a check for five hundred billion dollars. Something tells me Sarah Palin doesn't have that much money
- swman 5y agoOr we could just you know, invest into this since all of us will be old some day and some of us may, even after a life time of contribution, could face unlucky circumstances that leave us alone in the end? What's wrong with dignity for other people, I feel like trying to maximize for monetary profit is going to be our downfall.
- ErikVandeWater 5y agoThe other end of this is depending on the government to ensure the wellbeing of the most vulnerable; the government is the one giving billions to these facilities that do not provide adequate service. Facilities where the family pays aren't going to get away with mistreatment, because the family will choose a different facility.
- TrispusAttucks 5y agoUnfortunately, the people with the power to "invest in this" will not ever be in the situation that the rest of us will be. Most "real" people are more worried about how their children will live with not enough time left over to deal with how their parents will die. This is just one of many issues. We are coming apart at the seams in our society in so many ways that by solving one issue we must ignore another. There is so much poor investment across the board. It's tragic but I fear we are so far off the rails now that perhaps none of it can't be saved.
- bpodgursky 5y agoThe worst part is the payment structure and how it doesn't allow real choice. If you told the 88 year old: "We can (a) pay $500,000 on treatments that will likely extend your life 1 year, or (b) put $250,000 in a tax-advantaged account to put your great-grandchildren through college", I bet that 99% of those 88 year olds would take option B and take hospice care instead. They would all prioritize their children, grandchildren, etc! But that's not the option... it's them, vs some nebulous national slush fund of cash where they and nobody they know gets no benefit out of being selfless. We should fix that.
- neither_color 5y agoAnd in the rest of the non-nihilistic world those grandchildren would rather have one more year of grandma than any amount of money 15 years later. This whole discussion of letting seniors die to optimize economic potential is gross.
- brandonmenc 5y ago> And in the rest of the non-nihilistic world those grandchildren would rather have one more year of grandma than any amount of money 15 years later. Not in families that have regular, frank discussions about death and quality of life. My worst nightmare is having people in charge of my care who are unwilling to pull the plug. Doubly so if they are also paying for it.
- Swizec 5y agoThat probably depends a lot on the state of the grandma. Spry and lively full of great conversation and wonderful tales of old times? Yes! Barely able to remember her own name from dementia or in constant terrible pain from her life of labor on the farm finally catching up to her? Eh … The latter is especially difficult. I have a grandma in the family (not mine) who really just wants to die. Can’t even get out of bed anymore, can barely eat, constant pain that even painkillers can’t fix anymore … but her family can’t let her go because “1 more year with grandma”. Kinda selfish really
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- Factorium 5y agoThe necessary innovation is ethical/political. People over age 80 should be able to request to medically cease their life for any reason.
- vbezhenar 5y agoYou can buy gun. Why do you have to request anything?
- code_duck 5y agoSomeone has to clean up incidents such as that. I've known people who worked for companies who were contracted to clean up homicides and suicides (ServiceMaster). They were kids barely out of high school and the experience was traumatizing for them.
- kube-system 5y agoSo that you don't risk harm to other people and property in the process?
- gruez 5y agoa tank of helium + mask/bag satisfies that criteria.
- kube-system 5y agoA person in these dire circumstances is likely also someone lacking the resources and ability to accomplish any of these "DIY" schemes. People in care homes are there because they have trouble taking care of their basic needs.
- sli 5y agoConsumer helium is sold with a good amount of oxygen in it now for exactly that reason.
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- marsdepinski 5y agoThey are given psychotropic drugs to make them easier to manage and less likely to be able to complain.
- falcolas 5y ago> Elderly people should live with their families. No. It’s an unreasonable burden to expect families, which are barely holding themselves together in this wonderful world of mandatory-two-income-households we’ve built, to take on not only their adult children who can’t afford to rent or buy their own homes, but also the extensive and expensive care of their elders.
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- stirlo 5y agoI don't support the GPs view that the elderly should live with their families. I do however take issue with you suggesting this would be bad for financial reasons. Realistically assigning some of the wealth older people have built up to their families caring for them rather than for profit corporations would be a financial benefit. The issue is expecting younger family members in the prime of their lives to put their life on hold to care for the elderly when this care can be required for decades (unlike infants).
- nyokodo 5y ago> the extensive and expensive care of their elders. Granted cognitive decline and other conditions are extremely difficult to manage, however it’s remarkable how easy and cheap a disturbingly large chunk of elder care is. Just someone there to make sure elders take their meds on time, monitor their blood pressure, making sure they’re eating or go to the doctor if anything bothers them etc; all these tasks could be done in-home with family, or minimally trained healthcare workers. We could even pay families and healthcare workers handsomely and we’d still save massive amounts on the outrageous expense in elder quality-of-life and healthcare expenditure we pay because those simple interventions aren’t made.
- lazide 5y agoI take it you haven’t actually tried to do this? I’ve been involved in several instances of trying to do this now, and it varies from nearly a full time job to 2 full time jobs for anyone who would be otherwise going to a home - and often scary, stressful, and traumatizing to boot.
- pmorici 5y ago"Elderly people should live with their families." Spoken with the confidence of someone who has never had to care for an elderly relative who was in both mental and physical decline. In any case it is a deeply personal decision without a definitive right or wrong answer. After seeing my Aunt try to care for my grandmother for years only for it to negatively effect their relationship because of her dementia I wouldn't blame anyone for choosing a care facility. I know people who were so effected by their experience of caring for an elderly relative that they checked themselves into a senior living community in their 50's so their kids would never have to feel like they needed to do the same for them.
- roenxi 5y agoWithout disagreeing - if that is what happened to her relationship with someone close to her, what would have happened in a care facility of people who don't have any personal connection at all? These care facilities don't sound like fun either. Fact is that getting old can be a truly horrible process. Which is why the pro-euthanasia people keep standing up.
- pmorici 5y agoAfter she was too much for my aunt even with a part time home healthcare worker she did move to a care facility where she has lived for the past ~7 years. The two she has lived at are decent from what I can tell and close enough to family that someone visits her on a pretty much daily basis. Both ways can work.
- batch12 5y agoDamn-- in their 50s. I don't have much time left. I'd rather walk the planet than check myself into a center.
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- throwawayboise 5y agoThere are probably well-run exceptions but in my experience senior communities are mostly about extracting all the wealth and insurance payments they can get from their residents before they die. You think it's hard taking care of your aging parents? They took care of you when you were a helpless, shitting, crying, little ball of flesh.
- gruez 5y ago>The ones with no families to care for them should be in nonprofit, closely regulated facilities with well-paid staff. how's that working for higher education? state schools aside, AFAIK most private schools are non-profit. rather than money flowing to shareholders, it'll be money flowing to bloated administrations.
- batch12 5y agoSad thing is that this is nothing new. I caught this same thing in the first episode of a show from 1984. If I get in a situation where I have been committed to one of these facilities, I hope, for their sake, I have forgotten all the adversarial pentesting skills I've acquired over the years.
- rrrrrrrrrrrryan 5y ago> And it’s time to stop spending $500K on medical care just so an 88 year old can make it to 89. Does U.S. Medicare not use QALYs? (Quality Adjusted Life-Years) The WHO recommends using 3x GDP/capita for each QALY, which would set America's threshold somewhere around $150k, not the $500k in your example.
- nradov 5y agoMedicare doesn't use QALY thresholds to decide which treatments to cover. From a pure economic efficiency standpoint it probably should, but the politics around care rationing are so toxic that it can't be done.
- MichaelZuo 5y agoMedicare doesn’t cover every orphan drug known to exist so surely they must? Unless they technically do for every drug, with some enormous caveats that effectively bars coverage?
- lmm 5y agoThey cover some treatments and not others, but those decisions are made through debate and politics, not QALY measures.
- MichaelZuo 5y agoThen on what other basis do you believe they decide which orphan drugs to cover and which not? I don’t have insider knowledge but nonetheless I’m fairly certain it’s not based on pure random chance. If the implication is that it’s based on whatever political or lobbying faction is in vogue, that seems to be even worse than an economic measure?
- nradov 5y agoThis page provides a good description of how CMS determines which prescription drugs are covered under Medicare Part D. https://medicareadvocacy.org/medicare-info/medicare-part-d/ https://medicareadvocacy.org/medicare-info/medicare-part-d/
- Aloha 5y agoYou can take care of my mother then, I didn't sign up for that burden.
- ARandomerDude 5y agoThis is a poor criterion for responsibility. If you don't sign up to obey the law should you be immune from prosection for murder or robbery (supposing you were to commit those crimes)? Some responsibilities are innate.
- Aloha 5y agoAs far as I'm concerned my mother forfeited her right to lifetime care for me based on how my childhood went. I had a difficult childhood, while its a long story, I was my mothers emotional support network, and effectively parent/spouse, from about 8 on, however when I was inconvenient for her, she pushed me out of the way. I never got to be a normal kid. The start of the break for me was when I first tried moving out at 22, it didn't go well, I asked to move home, she said no. I spent a week in my car. Eventually she relented, but I learned an important lesson, that I needed to be able to rely on myself - largely alone, that my family wouldn't be there for me if I really needed it. I am more than happy to provide some additional financial support, however my mother has a generous pension and social security, and makes more than enough money to support herself. It's the emotional burdens where I draw the line - as a only child who already shouldered more than my fair share of emotional burdens, I'm not willing to put my life on hold again for an unknown period of time to care for my ailing mother, who by any measure is miserable to be around - or rather, specifically, goes out of her way to make me miserable. It'd probably be different if I was not an only child, and this was a burden that could be shared among siblings, but its not, it's just me.
- eru 5y ago> They are entirely about profit maximization (what business isn’t?), [...] And yet, most businesses are rather pleasant to deal with. Perhaps it's something other than the desire for profit that makes them so awful? (Btw, there are also not-for-profit senior home and assisted living centres around the world. They aren't necessarily better.)
- ricardobayes 5y agoLet me get that straight, are you advocating that old people should just die and not be treated/cured because of financial reasons?
- antiSingularity 5y agoAnd these are precisely the people we just shut down the global economy (and culture, and inter-personal connection) to apparently "protect".