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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.  

Originally posted to ARODB on Mon Oct 08, 2007 at 10:40 PM PDT.

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Comment Preferences

  •  Comments welcomed..... (33+ / 0-)

    And to make things even worse, those who buy long term insurance to pay the higher price for better nursing service are having a hard time collecting, as described in this article.

    And if anyone is curious about my interview with the Blackwater VP, it's here.

    •  this is the best argument for universal coverage (3+ / 0-)
      Recommended by:
      Orj ozeppi, trashablanca, marykk

      right now enormous costs are being borne especially by those least able to handle it. The safety nets, when available, are constructed in order to maximize inconvenience/trauma, requiring spending down of assets, shifting people around, and the resources/incentives aren't there for preventive care and forming communities to help people maintain independence and stay out of these expensive, scary institutions.

      I'm in the middle of a career shift towards helping people create their own self-directed independent living communities, senior cohousing, places that supporting aging in community. I've spent a lot of time studying this area and the options available, and how Denmark has dealt with it successfully.

    •  a couple of hints (2+ / 0-)
      Recommended by:
      julifolo, arodb

      If you have to place a family member in a LTC here are a few hints about evaluating a facility that you won't see most places.

      1. Look for a facility that is owned by a local person, not a corp. You will find that the building might be older but the owner is generally more responsive to complaints and the staffing/food service/housekeepng are generally better.
      1. Ignore the advice to visit at a mealtime. Visit at the END of a meal and look at the assisted dining trays that are being sent back. Are the drinks opened? Bread and butter opened? Salt/pepper? Are the trays at least 50% eaten? (this will show you how well the staff is assisting)
      1. Nursing homes smell at certain times of the day but at other times they should not. Visit at 11AM. There should not be a urine smell. (feces smells are tough is someone had an accident).
      1. Talk with the Charge Nurses. Do they seem knowledgeable? Can they answer most of your questions? Very Very bad if they keep refering you to another department (unless you have a money question). The CN is your residents advocate and should be attentive and know her residents.

      Just a few items to look at. I hope your aunt does well.

  •  Sad but true... (11+ / 0-)

    "Letting old people in nursing homes suffer during their last months is now priced into the value of this stock"

    when are we going to pay premium for social responsibility in financial portfolios

  •  Diary Title Change.... (12+ / 0-)

    from "Don't Get Old in America"


    "Conservative Reign of Terror on the Aged"

    First 40 minutes 1 comment, let's see if this more evocative title gets some more readership.

  •  Sad story(ies) indeed (7+ / 0-)

    It never ceases to amaze... the richest country in the world, that wants to control/dictate a woman’s womb, and then, a helpless person’s final ‘exit’ from life (Shaivo) ...but cares only about how to extract every-cent-of-worth (not to mention dignity) from their point of birth, till a decision to ‘pull-the-plug’ on them.  The free-market "care" is so obviously superficial (and hypocritical).  

    My mom (86) is very fortunate to be in a quality nursing-care home (Dad left enough ka-ching, for her to try to retain her dignity, she wouldn’t want to be "a burden" on any of her 6 children (in five different states) ... although, be assured, half of us have offered our homesteads (and encouraged her, it’s absolutely fine :)

    Most families aren’t as fortunate, as with my mom.  Dad had a decent ‘retirement’ account.  Most of us 6 (boomer) kids won’t.  And, unless the ‘values’ in America change (to a more ‘compassionate’ [heh] system) our kids won’t have any safety net either.

    Health care and old age (retirement) are the two things ("social" programs) that the conservatives whine the most about.  "Don’t waste [~20% of my] tax dollars on ["social" programs for] any ‘lazy people’ who didn’t earn-their-own!  ...but, it’s OK to spend [~60% of] my tax dollars on killing/bombing all those horrible ‘non-white’/non-Christian ‘heathens’ I see on TeeVee."  


    ~A govt lobbied, campaigned and selected by corporation... is good for corporation. Bad for people.~ -8.88 -8.36

    by Orj ozeppi on Tue Oct 09, 2007 at 12:35:21 AM PDT

  •  Perhaps There Was a Time (8+ / 0-)

    No there wasn't.

    We are called to speak for the weak, for the voiceless, for victims of our nation and for those it calls enemy.... --ML King "Beyond Vietnam"

    by Gooserock on Tue Oct 09, 2007 at 12:58:39 AM PDT

  •  a few comments... (7+ / 0-)

    ...this is an industry that will not easily be "automated", as much of the work is one-on-one and not well suited to assembly line organization.

    for that reason it is also an industry that, like restaurants, is very much a "cost-cutting" exercise from a labor point of view.

    the majority of clients are insurance or medicaid funded, so there will always be pressure to hold costs down.

    of course, if you want better staff, this costs money.

    some states are more aggressive than others in setting limits on staffing, and you can bet there is plenty of money passed around to "adjust" those limits in favorable ways.

    we presume a "states' rights" argument would be made if national regulation became a popular idea...but i can't see how a nursing assistant or a nurse can give care to more clients in mississippi than in massachusetts, for example. (disclaimer: states in example were chosen at random.)

    we're not the only ones with this problem...but that said, it is shocking to see what some facilities can look like....and how they're staffed.

    an additional point: a "hidden" cost of staffing is the burden of indistrial insurance costs being borne by the nursing facility. these jobs have very high injury rates, and it is likely the facility is carrying several injured staff as a cost added to their annual premiums. (no excuses here: the homes often have miserable histories in regard to worker safety...i'm just pointing out this issue.)

    --we are making enemies faster than we can kill them

    by fake consultant on Tue Oct 09, 2007 at 01:04:33 AM PDT

  •  The repubs. say they are the party of values, all (7+ / 0-)

    the while adjusting their stock portfilo, and the little people loose.

    "Though the Mills of the Gods grind slowly,Yet they grind exceeding small."

    by Owllwoman on Tue Oct 09, 2007 at 03:29:29 AM PDT

  •  It does not (9+ / 0-)

    have to be like this.
       As my husband's mother, in Germany, became progressively demented, she got wonderful, devoted care at a fine assisted-living facility. There was no out-of-pocket expense for her or her heirs.
      I have heard similar stories for end-of-life care in other European countries. It all sounds so pro-family to me, with financial worries out of the question and clean, decent conditions for the patients.

    I could have been a soldier... I had got part of it learned; I knew more about retreating than the man that invented retreating. --Mark Twain

    by NogodsnomastersMary on Tue Oct 09, 2007 at 03:32:56 AM PDT

  •  thank you (5+ / 0-)
    Recommended by:
    raines, mcfly, trashablanca, marykk, arodb

    as an elderly person, i am terrified of an accident or chronic  debilitating illness. around here nursing homes have been replaced by assisted living for the wealthy

  •  Well to make a sad story worse (5+ / 0-)

    there's quite a piece in today's NYT about gay seniors and the even greater barriers they face with end-of-life care.

    If you think you're too small to be effective, you've never been in the dark with a mosquito.

    by marykk on Tue Oct 09, 2007 at 07:06:48 AM PDT

  •  Great diary, arodb (4+ / 0-)

    Thank you.

    "Reign of terror" is no exaggeration.  

    IMPEACH Dick Cheney. "Nearly all men can stand adversity, but if you want to test a man's character, give him power." -- Abraham Lincoln

    by chumley on Tue Oct 09, 2007 at 08:22:19 PM PDT

  •  As a nurse, I have always known to have a bottle (3+ / 0-)
    Recommended by:
    Orj ozeppi, julifolo, arodb

    of something to give me the choice of how and when I leave this planet.

    My first year of nursing school I worked as a CNA at night.  The third night I saw my first death.  An 80 something woman died from exposure for being forgotten on the toilet all night.

    By the end of the first year, I had made my plan and followed thru.  30 years later I still plan on implimenting the plan.

    •  It takes courage... (3+ / 0-)

      most people say that if given a diagnosis of terminal cancer, at some point they would take their own lives.   But only a small fraction of those actually do.

      I don't know what I would do when faced with pain and degradation.

      A few months ago Aunt Lena was depressed, and finally she went to a doctor for another issue, (she never goes to doctors)  Her blood pressure was high, and when corrected, her mood lightened.

      Don't know whether this was just coincidental or not. But now she is sort of OK.  We have good conversations, and she is somewhat upbeat.

      As we get close to ending our lives, we may think about those good days and want to have just one more.

      The survival instinct is strong, and overwhelms rationality for most of us.  

  •  Absentee Ballot. Make sure she has one if (2+ / 0-)
    Recommended by:
    kurt, arodb

    she is not able to get to the polls.  Her right to vote is guaranteed in OBRA, even (or especially)if she is in a nursing home or assisted living facility.

    Health care for people, not for profit.

    by bloomer 101 on Tue Oct 09, 2007 at 08:43:31 PM PDT

  •  Mazel tov to Aunt Lena! Mother is 100; I'm (3+ / 0-)
    Recommended by:
    Orj ozeppi, julifolo, arodb

    70 y.o.
    Apparently I descend from a long-lived stock--esp. the women!!
    Mother has buried 2 husbands, and lived on her own for a few years following her most recent widowhood.
    But she was 93, not seeing well, not hearing either!
    My daughter and I had frequent nightmares of the Shore house burning down!
    Long story short: Mother ended up in an excellent facility-- mostly b/c my daughter ran the gauntlet, vetting several! Since I live 6000 miles awy, and Lisa holds Power of Attorney, that task fell to her.
    We feel confident that Mother's receiving good care, and proper attention - for now. As she grows more frail, the need for increased care will occur.
    About 2.5 years ago, a new entity acquired the "Home", which had us a little nervous! But Lisa monitors closely, and there is not any appreciable change!!

    Aloha .. .. ..

  •  Nursing Home Hell (1+ / 0-)
    Recommended by:

    It is one of my biggest fears - to have a stroke or become otherwise incapacitated - and have well-meaning family or friends put me in a nursing home.

    I imagine the first day after eating some crappy gummable breakfast, being rolled into the day room and plunked down in my wheelchair in front of a TV blaring (we oldsters are hard of hearing) CBN or FOX.  Exposed all day every day to Pat Robertson and Bill O'Really -   helpless in my wheelchair to do anything but turn down my  hearing aid.

    To me this would be Hell on Earth and, judging by the TV bill of fare that greets me when I visit nursing homes, a common fate for our aged.

    If such a horrid fate befalls me, please call my doctor immediately - his name is Kevorkian.

    -Greg Forest

    •  That sounds like hell... (0+ / 0-)

      but so is being in your own apartment, isolated.  Aunt Lena has her own room with her own TV, so she can stay in when she wants to.

      And the home run by the Jewish Philanthopic group, at least will not be showing Pat Robertson.

      We are keeping her apartment in case it turns out the nursing home is wrong.

      And Kevorkian has always been my hero.

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