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.
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.
Without 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.
After 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.
Babies gain a degree of self sufficiency within a few years, at least to extent of wiping their own asses. But elderly dementia patients can hold on for decades gradually requiring more and more hands-on care. When my time comes I don't expect my children to ruin their lives just to care for me.
You're sweeping a lot of people in your use of the term "aging parents," ranging from physically strong yet mentally deranged dementia patients, to little old ladies who simply don't have anyone to talk to. What is obviously true for the second is obviously false for the first.
>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.
try lifting a baby vs an adult. also, seniors in retirement communities tend to have some sort of chronic condition that make them non-trivial to care for without medical expertise.
> They took care of you when you were a helpless, shitting, crying, little ball of flesh.
This guilt tripping is so wide spread. What else they could do? Leave the baby outside after giving birth? Kids are brought to this world by parents in the first place. A baby is not asking please let me born to you.
Just stop breeding and spare the kids from the trauma that life actually is (and going through the same thing when they also get old), plus this will remove the trouble that taking care of the baby needs, saves money.
There might be many reasons to give birth, but none of it is for the benefit of the potential child.
A baby can’t turn the stove on and burn down the house or attempt to drive a car and kill someone. Some forms of mental decline require specialized care facilities for the safety of both the elderly and their family members.
> They took care of you when you were a helpless, shitting, crying, little ball of flesh.
And most people will be paying that forward. That's not an argument for paying it back. Maybe if you said the parents took care of their kids while also taking care of their parents who had progressing dementia there would be an argument.
I need to write up some kind of living will or something where, sure expend whatever is (reasonable) to return me to normal health... until I forget why I need to ask for help (that I need) or even myself; and that isn't just a rare occurrence but an always or even mostly always state of my mind having fallen apart before my body.
If my mind does fall apart before my body: I want any treatment known or suspected to fix that. Then to be admitted to any study hoping to establish such treatment. Then failing any hope of return to health... I'm already dead as far as our medical tech allows; make it painless, useful to those who might benefit from viable parts, useful to the progress of science (generally) and medicine, quick, and resource efficient; in that order of decreasing importance.
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.
I 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).
> 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.
I 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.
> I take it you haven’t actually tried to do this?
What is “this?” I’m talking about cheap and simple early interventions that delay or even avoid needing to put elders in a home by avoiding the negative effects of badly managed healthcare. Incidentally, this level of care is the vast majority elder care that gets no funding or attention; instead, the focus is put on the hard cases or intervention when it’s too late and too difficult. What are you talking about?
The ‘this’ is taking care of someone who is declining or needs assistance for daily living - added on to the responsibilities of one of their children, which is how I read your comment.
The difficult situations I’m talking about were folks who didn’t need emergency intervention and weren’t hard cases. Rather folks who would wander out side the home looking for yard work to do and then hurt themselves because they thought they were 20, or who would try to go to union hall (that they used to go to), and then get lost on the way.
Those situations were much, much harder to handle than they looked from the outside, and caused immense stress on the caregivers relationship with their spouse (and them), required full time attention (which means no job and fewer social events or other outside activities), and while yes placed less strain on ‘the system’, were an immense strain on the people involved.
They still ended up having to go to care homes, as it eventually (after 5ish years) was too crushing a load.
Certainly not in the opinion of the Dr's or insurance companies, who didn't think he should be or needed to be in a dedicated nursing home.
So perhaps you're jumping to conclusions?
Near as I could tell, the only difficult cases they felt should be in nursing homes were those that were violent, non-compliant with direction, prone to escape (not in this sense which is a 'hey, I want to do x', but will listen if you catch him), but the type that will actively try to bypass security measures, or unable to care for themselves in major ways (like lock in syndrome, inability to follow directions, inability to recognize basic environmental factors, etc.).
Are there potentially easier cases where they are 100% fully functional, yet in nursing homes? Maybe I guess, but I didn't run across any when I was visiting them later. All had some significant cognitive issues that made them very difficult to care for in some major way. But then, this is in California where it is extremely expensive for nursing home care ($3-5k/mo last I remember).
The best thing about the pandemic was working from home. It allowed me to move in and care for my father-in-law for the last 6 months of his life. If I had been commuting, the stress of everything would have probably killed my wife
What 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.
>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".
Because 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.
>[...] 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.
I’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.”
I am physically and medically disabled and I am of childbearing age.
I require an orphan drug (a blood product from paid blood donors which contains the pooled antibodies from tens of thousands of people, as required by FDA regulation) which quite literally costs hundreds of thousands of dollars per year, under contract by insurance, just so I can stay alive, as I have an immune mediated rare disease. Last time I checked my insurance statements (before I left the US for good in early 2020), my insurance (Medicare, by the way) was paying $275,000+/year under contract for the medication.
Clearly the US can afford it. We just choose to treat our elderly like garbage.
I hope you recognize how hypocritical you actually are.
Dude I paid for it via my FICA taxes. It’s called being on SSDI (which is an ENTITLEMENT program which allows you to have Medicare). In other words, I paid enough into the system to receive such care. It is an entitlement program, not a welfare program.
However, there are 2 disability programs. The other one is called SSI (a means tested program) which is a form of WELFARE (which I am NOT eligible for). You have to be very indignant to be eligible for Medicaid, which is likewise an insurance program. However it can be quite a shitty insurance plan depending on the state you live in, and it can end up being life or death for many disabled. As I said, this situation depends on which state you live in, which is unacceptable and disgusting and it really shows how much one cares for their fellow Americans.
You are basically an idiot for being unaware of the semantics of these two programs as you can become disabled at any time. I suggest you actually spend some time on SSA.gov to learn more.
Also, how dare you talk shit about the cost of my medication. As I said it’s an entitlement program obtained via working (except in very rare cases like End Stage Renal Disease). It is in no way my fault that the government actuaries did not do their jobs properly so that we were properly taxed for such things in the first place. I don’t get it: the American public, assholes like you, think it’s OK to talk shit about the cost of my precious lifesaving medication. Yet, the American public does not do anything to compel congress to negotiate the prices of such lifesaving medications.
By the way, I fight back against this BS about the cost of medications all the time. It’s called reading patents and going through engineering school. Trust me, I know how much these medications actually cost. So yeah, I talk shit about it all the time to people like healthcare lawyers fighting the system.
But seriously, it’s called America and I have a right to this medication whether you agree with it or not.
Also, Americans lack the reasonable expectation that someone will care for them. So, there’s a baseline anxiety and fear that dominates our politics which can end up being quite sadistic.
This situation in its entirety is quite unique in the developed world, and Americans have not gotten their act together. I mean, I even get much better care for my type 1 diabetes (autoimmune and insulin dependent) in Croatia, which I am a citizen of. Because of being Croatian, the world is really my oyster and it confers me Freedom of Movement rights as I am a European Union citizen due to being Croatian. So I can live in 27 EU countries and more, where I am conferred far more rights, including with respect to healthcare.
Most importantly, I don’t have to put up with bullshit drama from Americans like you who think it’s OK not to care for their fellow citizens.
So 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.
> The US can barely afford to school its children, purchase its homes, or enact reasonable public health measures without bankrupting people.
No, it can easily afford all that. It chooses not to because the US (that is, the majority of political power in the country) prefers to impose the pain of the imminent risk and frequent reality of bankruptcy on the working class.
Not only that, but the United States' shift in mindset toward disinvestment came about during the civil rights era. Not hard to read between the lines in e.g. https://files.eric.ed.gov/fulltext/ED050960.pdf :/
"The time has come to ask what level of population growth is good for the United States. There was a period when rapid growth made better sense as we sought to settle a continent and build a modern industrial Nation."
"[A] fundamental question about the Nation's future: Do we wish to continue to invest even more of our resources and those of much of the rest of the world in meeting demands for more services, more classrooms, more hospitals, and more housing as population continues to grow?"
"We have all heard about a population problem in the developing nations of Asia, Africa and Latin America, where death rates have dropped rapidly and populations have exploded. Only recently have we recognized that the United States may have population problems of its own. There are differing views. Some say that it is a problem of crisis proportions that the growth of population is responsible for pollution of our air and water, depletion of our natural resources, and a broad array of social ills."
I think the Club of Rome were the first major international policy group to take resource finitude seriously. Although I read a bit of their final report, and their projections were ridiculous and we've already blown well past them with no trouble at all.
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.
Well, 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.
How else does one track “richest” anything? On paper is what matters when counting wealth.
That said, the gap between capability and actuality of spending that your parent comment is lamenting is the gap for that on-paper wealth not being used for real-world-improving actions, and instead being used to increase the on-paper wealth of a tiny minority of wealth-holders.
Humor me, by what measure is the US the richest nation on earth, or even close? Anything per capita will be dominated by Monaco/other tax havens. Anything on a gross level will be dominated by China.
Add in underfunded liabilities and lets see what it shows us. Of course if a country doesn't require all liabilities to be counted it's going to show up at the top of the list.
FWIW, US has one of the highest spend on education in the world. Among OECD countries, it is only behind Luxembourg, Norway, and Austria, and only barely so. If the educational outcomes in US are below expectations, it’s not because we spend too little, but rather because we’re not getting our money’s worth.
Spending and educational outcomes are very loosely correlated in the US. Vermont is spending roughly as much as Mississippi, but it has vastly better educational outcomes. Baltimore spends more per student than the two combined, but its educational outcomes are abysmal.
Much of what Baltimore spends on "education" is really social services by another name. That's not necessarily a bad thing because children in bad situations really do need food, healthcare, counseling, etc in order to be able to learn effectively. But bundling all of those ancillary services into the education budget makes it hard to tell whether taxpayers are getting their money's worth.
Apparently, the food, healthcare, and counseling, as administered by Baltimore schools, are not very helpful in education, given the abysmal outcomes they produce.
Those outcomes are not reasonable goals, given the profound challenges these students face. The programs are probably inefficient (many of these services are), but your statement forgets that the bar is too high for kids suffering from abuse, starvation, homelessness, etc.
This is an argument without a limiting principle. Surely, if we spent $1M/year/student in Baltimore, and got the same results as we do now, everyone would agree that we’re not getting our money’s worth. Most likely, everyone would agree to the same effect if we spent $100k/student, and probably, $50k/student. We now spend $16k/student. How do we actually know that this is not enough, “given the profound challenges students face”? Why would we think that spending more would bring outcomes to parity with Utah, which spends $9k per student?
I would very much willing to spend more on schools in Baltimore if people proposing the bump in spend showed 1) a clear goal needing this extra money, and 2) clear proof that this goal actually has significant positive impact on educational outcomes. The reality is, however, that this extra spend is typically swallowed by cost of infrastructure improvements, hiring extra administrators and bumping teacher pay. Irrespective of whether these goals are worthy (obviously, schools needs to be heated, and teachers need to be paid), these things have basically no incremental impact on educational outcomes, so why do some places spend so much more on these, exactly? And are we pushed to spend even more than that?
Choosing to end one’s own life doesn’t require government policy. Human life is plenty fragile. Anyone that actually wants to die has plenty of reliable options and they will be beyond the reach of secular law afterwards.
From that it follows that euthanasia laws are actually about allowing next of kin or whoever has medical power of attorney to lawfully order the principal’s killing. In the best case this is executing the principal’s express wishes, but in most cases it’s not.
Edit: I’m curious, does anyone actually believe they need the government’s permission to commit suicide? It’s so preposterous a proposition that I’m literally baffled.
Some people are not physically capable of suicide. Some people are technically physical capable but under constant medical care that means they would effectively need collusion from others. Some people believe they shouldn't have to die alone and want the choice to have their family or others around them without leaving their family exposed to criminal charges. Some people simply believe they should have access to reliable, comfortable and painless deaths with the assistance of a professional.
Most people who attempt suicide fail. Some of this is due to sheer chance (surviving a jump from the Golden Gate Bridge), some of it is failure to understand the means they choose, some of it is due to sheer psychological inability, like people who faint at the sight of blood.
We print money for bombs & bailouts because there is a valuable enough carrot for our policy makers.
Maybe we can think of a carrot (or better yet a stick) that would stop those things and start printing money for things like education, healthcare, end of life care.
>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.
The 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.
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. This whole discussion of letting seniors die to optimize economic potential is gross.
That 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
That's a ridiculous claim. I don't think you have any concept of how much people suffer under student loan debt.
It's not "just money"... it's living your entire young-adult life under a yoke. It's delaying (or being unable to) buy a house, get married, and have kids of your own. I loved my grandma, but I would absolutely have traded years of her life w/ me in order to afford raising the son I have now (I have a good job, and I didn't have to make this choice).
(on a related note, my grandma spent most of the last year of her life in an assisted care home after a stroke... she gained nothing from that year, and me and my sister, her grandchildren, gained no closure from those last non-verbal visits. I don't think this is even something she wanted for herself.)
Sorry if it sounds calculated, but these are real decisions people make, and money is the lever by which people accomplish their life goals.
My nearly-101 year old grandfather needed his pacemaker replaced. The doctor gave him the choice. He must have thought, "THIS IS MY CHANCE" and elected to have his pacemaker replaced, somewhere around his 101st birthday.
He died of complications of the replacement surgery - his IV lines got infected. I don't think Medicare got a refund on whatever they spent on the replacement pacemaker.
Sometimes US medicine is great. Sometimes US medicine is a wealth transfer program.
Or 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.
Unfortunately, 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.
The 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.
Someone 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.
A 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.
I'm pretty sure that's a myth, at least in most areas. Helium tanks usually contain >99% pure helium. I've never seen one with a significant amount of oxygen.
This 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.
As 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.
Medicare 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.
Medicare 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?
Then 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?
My mother-in-law had kidney failure. The statements showed the cost as 70k per month. Obviously Medicare paid a lower amount, but she had 4 years of dialysis before death. And that’s not counting her hospitalizations for falls and UTIs. I can easily believe 500k
Sad 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.
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.