5 ms·

Not excusing the Portopiccolo Group at all, but it sounds like half the problem is labor shortage. There was (is?) a severe shortage of nurses last year and a n

Not excusing the Portopiccolo Group at all, but it sounds like half the problem is labor shortage. There was (is?) a severe shortage of nurses last year and a nursing home is an undesirable place to work.

Natsu 4y ago
I think there's some cost cutting going on too, not sure, but during Covid, the home that Grandma was in got much, much worse. They simply never had staff to help any longer, and this was (formerly) a good place to be. We tried to move her around, but Grandma died a few months ago, with us constantly fighting to get proper care for her in places that seemed to get progressively worse over time. Just had constant fights to make sure anyone was checking on her or taking care of her or anything at all and seeing constant signs that everything vaguely medically related is horribly under-staffed.
bombcar 4y ago
This is a very large factor - nurses and CNAs working at nursing homes will often jump at the chance to work at a "real" hospital (or even McDonalds, if the pay gets high enough). Of course, a shortage means they aren't paying enough (at $100/hr they'd have no limit of applicants) but they may not be able to adjust fast enough.
JustSomeNobody 4y ago
> ...but it sounds like half the problem is labor shortage. of their own doing. "Within two weeks, management laid out plans to significantly cut back nurse staffing."
BaseballPhysics 4y ago
> Not excusing the Portopiccolo Group at all, but it sounds like half the problem is labor shortage. The problem is enormously complex. First, there's been a labour shortage in geriatric care for years. Then the pandemic came along and exacerbated things. Meanwhile, elder care in highly supportive settings is very labour intensive, which means it's expensive. But it's also a service people have no choice to buy. i.e., eventually some percentage of elders will require full time care, and right now, in most of the western world, that means an institutional setting. And the consumers of the product are some of the least represented in our political systems. Even with organizations like the AARP, the reality is the needs of an aging population get about as much attention as the needs of the poor. When you combine a product with very high and inelastic demand, combined with high costs, and no consumer advocacy, and then privatize that service, guess what: the quality of the product is going to go down in order to cut costs and maximize profits. Given that the primary cost of elder care is staffing, that creates downward pressure salaries, which drives even more people out of an already very challenging industry. The answer is simple: Elder care should be a publicly delivered service. But, the neoliberal answer is to Privatize All The Things. And so here we are.
- ars 4y ago
  > The answer is simple: Elder care should be a publicly delivered service. It is. Medicare pays for almost all Elder care. Which of course is the problem - private pay nursing homes are way better than the publicly funded ones because Medicare pays far less. Or at you implying that the Government should directly own nursing homes, and hire the staff directly? That has a whole different set of problems - don't advocate for that without understand what you are asking. You end up with centralized decision making for something very local. You are misunderstanding the problem - the issue is not privatization, the issue is that Medicare does not pay enough, and nursing homes try to find private pay clients to make up the shortfall.
  - BaseballPhysics 4y ago
    > You are misunderstanding the problem - the issue is not privatization, the issue is that Medicare does not pay enough, and nursing homes try to find private pay clients to make up the shortfall. It's both. America has chosen the worst of both worlds: public under-funding and private delivery. Private delivery leads to cutting corners to maximize profits. Lack of sufficient public funding exacerbates the issue. The solution is to fix the public funding problem by properly investing in the system, and killing private delivery.
  - mindslight 4y ago
    nit: Medicaid. Medicare will pay for inpatient rehab after hospital stays and the like, but long term care essentially requires becoming destitute so that Medicaid will pay. A large part of middle-upper-middle class "estate planning" consists of passing wealth to kids well before the lookback period. The private pay burn rate is like $150k/yr last time I checked. I don't think there is any easy answer. Spending drastically more on the problem is necessary, but obviously not sufficient. Then again, dying from laying in your own feces ("bed sores") when you're 80+ years old isn't the worst way to go out in the US.
- bedhead 4y ago
  Seriously? Let's see, the two industries where the government has gotten deeply involved, healthcare and education, are so comically expensive one doesn't even know where to begin. How in the world is complete government subsidization, which will basically just turbocharge demand by making it "free", going to solve the problem? The bottleneck (as you correctly note) is labor, if you can't fix that then anything to increase demand is just going to make it wildly more expensive and completely dysfunctional.

Natsu 4y ago

I think there's some cost cutting going on too, not sure, but during Covid, the home that Grandma was in got much, much worse. They simply never had staff to help any longer, and this was (formerly) a good place to be. We tried to move her around, but Grandma died a few months ago, with us constantly fighting to get proper care for her in places that seemed to get progressively worse over time. Just had constant fights to make sure anyone was checking on her or taking care of her or anything at all and seeing constant signs that everything vaguely medically related is horribly under-staffed.

bombcar 4y ago

This is a very large factor - nurses and CNAs working at nursing homes will often jump at the chance to work at a "real" hospital (or even McDonalds, if the pay gets high enough). Of course, a shortage means they aren't paying enough (at $100/hr they'd have no limit of applicants) but they may not be able to adjust fast enough.

JustSomeNobody 4y ago

> ...but it sounds like half the problem is labor shortage. of their own doing. "Within two weeks, management laid out plans to significantly cut back nurse staffing."

BaseballPhysics 4y ago

> Not excusing the Portopiccolo Group at all, but it sounds like half the problem is labor shortage. The problem is enormously complex. First, there's been a labour shortage in geriatric care for years. Then the pandemic came along and exacerbated things. Meanwhile, elder care in highly supportive settings is very labour intensive, which means it's expensive. But it's also a service people have no choice to buy. i.e., eventually some percentage of elders will require full time care, and right now, in most of the western world, that means an institutional setting. And the consumers of the product are some of the least represented in our political systems. Even with organizations like the AARP, the reality is the needs of an aging population get about as much attention as the needs of the poor. When you combine a product with very high and inelastic demand, combined with high costs, and no consumer advocacy, and then privatize that service, guess what: the quality of the product is going to go down in order to cut costs and maximize profits. Given that the primary cost of elder care is staffing, that creates downward pressure salaries, which drives even more people out of an already very challenging industry. The answer is simple: Elder care should be a publicly delivered service. But, the neoliberal answer is to Privatize All The Things. And so here we are.

ars 4y ago
> The answer is simple: Elder care should be a publicly delivered service. It is. Medicare pays for almost all Elder care. Which of course is the problem - private pay nursing homes are way better than the publicly funded ones because Medicare pays far less. Or at you implying that the Government should directly own nursing homes, and hire the staff directly? That has a whole different set of problems - don't advocate for that without understand what you are asking. You end up with centralized decision making for something very local. You are misunderstanding the problem - the issue is not privatization, the issue is that Medicare does not pay enough, and nursing homes try to find private pay clients to make up the shortfall.
- BaseballPhysics 4y ago
  > You are misunderstanding the problem - the issue is not privatization, the issue is that Medicare does not pay enough, and nursing homes try to find private pay clients to make up the shortfall. It's both. America has chosen the worst of both worlds: public under-funding and private delivery. Private delivery leads to cutting corners to maximize profits. Lack of sufficient public funding exacerbates the issue. The solution is to fix the public funding problem by properly investing in the system, and killing private delivery.
- mindslight 4y ago
  nit: Medicaid. Medicare will pay for inpatient rehab after hospital stays and the like, but long term care essentially requires becoming destitute so that Medicaid will pay. A large part of middle-upper-middle class "estate planning" consists of passing wealth to kids well before the lookback period. The private pay burn rate is like $150k/yr last time I checked. I don't think there is any easy answer. Spending drastically more on the problem is necessary, but obviously not sufficient. Then again, dying from laying in your own feces ("bed sores") when you're 80+ years old isn't the worst way to go out in the US.
bedhead 4y ago
Seriously? Let's see, the two industries where the government has gotten deeply involved, healthcare and education, are so comically expensive one doesn't even know where to begin. How in the world is complete government subsidization, which will basically just turbocharge demand by making it "free", going to solve the problem? The bottleneck (as you correctly note) is labor, if you can't fix that then anything to increase demand is just going to make it wildly more expensive and completely dysfunctional.