I got home from Potrero late yesterday, after spending the day documenting the protest against the Blackwater training camp that I was going to diary last night. I have some good stuff, including an exclusive interview with the head of Blackwater West, where he refuted the testimony of his boss to Congress. I figured I might even impress this tough Dailykos audience with my efforts.
As I was working on uploading the videos and pictures, I got a call from my sister Arlene that stopped me cold. Aunt Lena was in the hospital after an episode of alimentary distress that need not be graphically described here. She's doing well, but I can't reach her to ask permission, but I'm pretty sure she would give me the O.K. for this diary if I explained the reason for it, that telling her story might possibly help others. She would say that I could use her as an example, even giving away her secret.
It may be time for her to be in a different residential setting, where she would have more care, and more importantly, a chance for companionship that is not available in her apartment. Aunt Lena is lucky, as she has access to nursing homes in her city that are supported by Jewish Philanthropic Organizations, and may get a subsidized price that is affordable. Others, who are dependent on private nursing homes, and haven't visited one in a while are in for a surprise.
The new conservatism, the core ideology of the Republican party, has now infected this area of activity. Nursing homes have never been anyone's idea of a delightful setting. It's for people who can no longer take care of themselves, or have lost their sense of identity and are often close to their end days. It is the very vulnerability of these people that makes the provision of care special. These people generally do not have the ability to complain, to defend themselves or to insist on a decent level of treatment. Somehow the model of free market competition doesn't quite apply here.
This is the problem with ideologues of any stripe. They learn their various truisms, what is bad-Government, and what is good-Free Enterprise; and that is where their thinking ends. People can err on the other side too. But now, in this country, we have a new example of free enterprise that doesn't even deserve the name, as it has a character that was never anticipated by theorists such as Adam Smith. He, and others of his era could not have conceived of this economic principle being distorted to obviate the morality, the norms of decency that they expected would always temper excesses.
The New York Times had a major articlea few weeks ago that begins:
Habana Health Care Center, a 150-bed nursing home in Tampa, Fla., was struggling when a group of large private investment firms purchased it and 48 other nursing homes in 2002.
The facility's managers quickly cut costs. Within months, the number of clinical registered nurses at the home was half what it had been a year earlier, records collected by the Centers for Medicare and Medicaid Services indicate. Budgets for nursing supplies, resident activities and other services also fell, according to Florida's Agency for Health Care Administration.
The investors and operators were soon earning millions of dollars a year from their 49 homes.
Residents fared less well. Over three years, 15 at Habana died from what their families contend was negligent care in lawsuits filed in state court. Regulators repeatedly warned the home that staff levels were below mandatory minimums. When regulators visited, they found malfunctioning fire doors, unhygienic kitchens and a resident using a leg brace that was broken.
No effective government oversight, and the CEO of the Habana Health Care never has to visit the facility. He just reads the P&L statement and gives the order, "cut expenses." And his stockholders are happy with the result, as profits, that is income minus the reduced expenses, soar.
I see it like this:
In a country that is transitioning to an economic libertarian conservative ideology, there are vast sums to be made by those who identify the unwritten moral obligations that infuse a society's economic relationships, and simply eliminate them from their enterprises. The savings to be realized are astronomical.
Privatized hospitals that had been providing educational service to new professionals, simply eliminate this, which increases short term profit. The owners ignore that this deprives new professionals of sufficient hands on training. The indigent, a certain amount who were previously cared for, are simply turned away. The key to all of these depredations is to keep your eye on the bottom line, and on nothing else. All the harm that is not prohibited by law becomes acceptable; as any cultural expectation that is not mandated, is eliminated.
But what about my Aunt Lena. And your aunts, uncles, mothers and fathers, not to mention, many years from now, ourselves. Now that the asset level of Habana Health Care is based on the reduced cost of inadequate care, who will deprive them of their enhanced cash flow. Will all of the owners of this stock, or of mutual funds that have similar equities, now become defenders of this way of doing business. Will those investors, whether Warren Buffet or a guy with a five figure 401K, who depend on the value and cash flow of their assets, accept the Democrats mandating a level of care that the "free enterprise" party is willing to ignore.
Once the standards of decency have been lowered, once the word "unconscionable" has left our national vocabulary, just how do we bring it back? Letting old people in nursing homes suffer during their last months is now priced into the value of this stock, and who knows how many others with a similar business model.
Aunt Lena's secret is her age, 104. She doesn't like to make a big deal about it, and simply goes on. All of her friends are long gone, and having no children, it is her nieces and nephews who look out for her. Somehow as a little girl she learned that she was a Democrat, just like she learned that she was Jewish. I don't think she could ever have articulated her reasons, any more profoundly than when my Dad explained to me a long time ago that, "Republicans are for the Rich, so we are Democrats."
What is missing from that simple explanation, is that the problem is not that the Republicans support the rich, but what they foster to allow them to get rich. Perhaps there were was a time when virtue and wealth were intrinsically connected, but as we see here, this no longer is the case in this country.
I wouldn't even tell Aunt Lena about this diary, since she doesn't have to know quite how bad things have gotten out there. But, next election, if she is in the nursing home, and still with us, I hope that someone takes her to the polling booth.
And you can be sure which lever she will pull.