Firefighters say they’re swamped by calls for routine care from senior homes(oregonlive.com)
oregonlive.com
Firefighters say they’re swamped by calls for routine care from senior homes
https://www.oregonlive.com/business/2021/10/firefighters-say-theyre-swamped-by-calls-for-routine-care-from-senior-homes-setting-off-one-sided-political-battle.html
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> 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
It’s quite disgusting as she is a mother with a disabled child.
Alaska governor and 2008 Republican Vice President candidate Sarah Palin started the “death panels” farse.
See: https://en.m.wikipedia.org/wiki/Death_panel
It’s quite disgusting as she is a mother with a disabled child.
>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".
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".
Dude, seriously just shut up.
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.
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.
If you're not paying for it then someone else is. The question is how many net contributors does it take to pay for you? Hundreds? Thousands?
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.
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.
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.
It 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.
>[...] 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.”
Source: https://scholarship.shu.edu/cgi/viewcontent.cgi?referer=&htt...
“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=&htt...
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.
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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.
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
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.
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.
> You're the richest nation on earth*
*On paper
*On paper
The material abundance here is obvious, it's not just on paper.
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.
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.
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.
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.
Well if you have to pick something, the US has the highest GDP in the world.
By net wealth (assets - liabilities). Here's a Wikipedia list (https://en.wikipedia.org/wiki/List_of_countries_by_total_wea...) based on the Credit Suisse Global Wealth Report (https://www.credit-suisse.com/about-us/en/reports-research/g...). You're right that it's not even close, the US is almost twice as rich as China in the #2 spot.
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.
By the most simple definition of the term: total wealth.
https://en.wikipedia.org/wiki/List_of_countries_by_total_wea...
https://en.wikipedia.org/wiki/List_of_countries_by_total_wea...
There are large countries (India, China). There are rich countries (Germany, Japan, the UK). The US is the only large, rich country.
You discussed everything except the profit motive of the owners to bleed every bit of penny from their "earnings"
> The US can barely afford to school its children
Ironically, I was just listening to this today: "Why Does the Richest Country in the World Have So Many Poor Kids? (Ep. 475) " [1]
There really isn't any excuse - it's all a product of our politics and culture, or vice versa... I'm not sure.
1) https://freakonomics.com/podcast/child-poverty/
Ironically, I was just listening to this today: "Why Does the Richest Country in the World Have So Many Poor Kids? (Ep. 475) " [1]
There really isn't any excuse - it's all a product of our politics and culture, or vice versa... I'm not sure.
1) https://freakonomics.com/podcast/child-poverty/
> US is unwilling to support euthanasia
I don’t know about the rest of the US, but Washington and Oregon have allowed physician-assisted suicide for the terminally ill for years.
I don’t know about the rest of the US, but Washington and Oregon have allowed physician-assisted suicide for the terminally ill for years.
Parent was referring to physician-mandated homicide.
No, and I'm not sure how you arrived at that.
I was referencing policies like those in WA, OR, and Europe where people can choose to end their life.
I was referencing policies like those in WA, OR, and Europe where people can choose to end their life.
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.
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.
Are you less baffled now?
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.
Are you less baffled now?
Try committing suicide while surrounded by family without risking those present to be charged with murder.
Were they?
If I wanted a chip to help me commit suicide once I'm no longer mentally fit then is that legal?
If I wanted a chip to help me commit suicide once I'm no longer mentally fit then is that legal?
> 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.
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.
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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."
My favorite part is "Some say"[who?]
"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."
My favorite part is "Some say"[who?]
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.
https://en.m.wikipedia.org/wiki/The_Limits_to_Growth
https://en.m.wikipedia.org/wiki/The_Limits_to_Growth
They're still on that neo-Malthusian thing hot and heavy, though. They have a Twitter account and it seems clear they consider themselves vindicated.
Not sure i agree with no trouble at all. It is done at great cost to the environment, and to ourselves.
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> The US can barely afford to school its children
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.
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.
Funding and educational attention are bumpy metrics. Putting Mississippi and Massachusetts in the same bucket doesn’t lend itself to fair comparisons.
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.
It could be a lot worse without this support.
It could be a lot worse without this support.
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?
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?
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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.
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.
> 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
Something tells me Sarah Palin doesn't have that much money
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.
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.
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.
Facilities where the family pays aren't going to get away with mistreatment, because the family will choose a different facility.
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.
"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
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
Every day you can wake up, get out of bed and stand up is a beautiful day.
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.
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.
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.
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.
> 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.
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.
"Live miserable and alone for 364 days grandma, so we can see you one more day"
Talk about gross.
Talk about gross.
They are given psychotropic drugs to make them easier to manage and less likely to be able to complain.
The necessary innovation is ethical/political. People over age 80 should be able to request to medically cease their life for any reason.
You can buy gun. Why do you have to request anything?
So that you don't risk harm to other people and property in the process?
a tank of helium + mask/bag satisfies that criteria.
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.
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.
Ethical self-driven euthanasia requires a lot more than just "buy a gun"
Right, there are no ethical downsides to putting the elderly in hellish group homes as long as we give them death when they ask for it.
> 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.
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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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).
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.
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?
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.
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.
> because they thought they were 20
That is a hard case, one that I originally explicitly called out as extremely difficult to handle. So your criticism is unfounded.
That is a hard case, one that I originally explicitly called out as extremely difficult to handle. So your criticism is unfounded.
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).
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
"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.
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.
Damn-- 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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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.
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.
>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.
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.
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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.
> 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.
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.
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?
They cover some treatments and not others, but those decisions are made through debate and politics, not QALY measures.
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?
This 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/
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
You can take care of my mother then, I didn't sign up for that burden.
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.
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.
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> 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.)
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.)
Let me get that straight, are you advocating that old people should just die and not be treated/cured because of financial reasons?
And these are precisely the people we just shut down the global economy (and culture, and inter-personal connection) to apparently "protect".
If there is an industry that needs startups, it is long term care and senior care in general.
Expensive, nearly universally badly done, and it seems like a lot of people could stay in their homes with some automated appliances/thoughtful redesigns of everyday items.
Hoping that when my grandparents start needing it in 5-10 years that the options have dramatically improved.
Expensive, nearly universally badly done, and it seems like a lot of people could stay in their homes with some automated appliances/thoughtful redesigns of everyday items.
Hoping that when my grandparents start needing it in 5-10 years that the options have dramatically improved.
> A resident needs a bandage changed? An IV line inserted? A catheter replaced? A prescription refilled?
This is not stuff that robots can do in the near future.
This is not stuff that robots can do in the near future.
First three, no, but why couldn't a robot refill a prescription or at least automatically handle the scheduling for that?
And the goal isn't to automate that stuff, but rather automate everything else to free up expensive human hours for this work. So instead of spreading humans thin between cleaning toilets, cleaning floors, doing laundry, and putting in IVs, get the cleaning and laundry off the plate of the human.
And the goal isn't to automate that stuff, but rather automate everything else to free up expensive human hours for this work. So instead of spreading humans thin between cleaning toilets, cleaning floors, doing laundry, and putting in IVs, get the cleaning and laundry off the plate of the human.
Filling prescriptions needs human supervision and takes very little time relative to other things care facilities do.
> with some automated appliances/thoughtful redesigns
Can you give some examples?
I guess I can start: something that monitors gas cookers, which already exists: iguardfire.com
Can you give some examples?
I guess I can start: something that monitors gas cookers, which already exists: iguardfire.com
Sure. I am not talking about large things like chair lifts for stairs but rather small problems that cumulatively could drive a senior out of their home.
- Gutters. Being on a roof at 78 is not safe and contracting out gutter cleaning can be expensive. Some way to make gutters easier to empty/make them not require emptying. I imagine a robotic snake that wiggles through, but I am sure the real solution is more mundane.
- Small steps. Lots of little steps are casually put into homes. For example, the garage often has a step into the powder room or there is a step between the living room and the kitchen. Yes, you can put a small stool there, but it moves and isn't that stable and is still too high. What I want is a small ramp that they can shuffle up if they need to and is sturdy enough that it won't move and is thin enough at the top to fit under the door.
- Food prep. An automated way to stir a pot. Oven trays with easy to grasp sides. Automated peelers/choppers. The tasks which are hard on old hands or require stability.
- Social connection. Event info has moved online, but it is hard for them to access. I did a hackathon project on this where it was an Alexa skill for getting event info. Ideally there might be some rideshare integration as well.
- Cleaning. I find it crazy that humans still clean virtually every toilet. There has got to be a better way. Toilets are one of the hardest things for them because you have to get down on hands and knees.
- Gutters. Being on a roof at 78 is not safe and contracting out gutter cleaning can be expensive. Some way to make gutters easier to empty/make them not require emptying. I imagine a robotic snake that wiggles through, but I am sure the real solution is more mundane.
- Small steps. Lots of little steps are casually put into homes. For example, the garage often has a step into the powder room or there is a step between the living room and the kitchen. Yes, you can put a small stool there, but it moves and isn't that stable and is still too high. What I want is a small ramp that they can shuffle up if they need to and is sturdy enough that it won't move and is thin enough at the top to fit under the door.
- Food prep. An automated way to stir a pot. Oven trays with easy to grasp sides. Automated peelers/choppers. The tasks which are hard on old hands or require stability.
- Social connection. Event info has moved online, but it is hard for them to access. I did a hackathon project on this where it was an Alexa skill for getting event info. Ideally there might be some rideshare integration as well.
- Cleaning. I find it crazy that humans still clean virtually every toilet. There has got to be a better way. Toilets are one of the hardest things for them because you have to get down on hands and knees.
> I guess I can start: something that monitors gas cookers, which already exists: iguardfire.com
Induction stoves are the much better option here. They will only heat up ferromagnetic material (i.e. actual pots and pans) and most can sense when nothing is on them and turn off automatically.
Induction stoves are the much better option here. They will only heat up ferromagnetic material (i.e. actual pots and pans) and most can sense when nothing is on them and turn off automatically.
True, but that's a much bigger purchase I guess, and many ppl would prefer gas if that's what they are used to.
No, it’s not a startup industry. Nursing homes cannot be humane and generate the profits needed to be startups.
Nursing homes are the end of the road for “medical” related services. They are the last stop for people who nobody wants. Everyone associated with these places is exploited other than the guy who owns it and the custodians who clean and plow.
Nursing homes are the end of the road for “medical” related services. They are the last stop for people who nobody wants. Everyone associated with these places is exploited other than the guy who owns it and the custodians who clean and plow.
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Here's a home sharing company for older/younger pairs that I know of (not affiliated, had a friend work there for a while) https://www.silvernest.com/
Interesting take on it, imo.
Interesting take on it, imo.
Silvernest is more of a roommate matching service for old folks. Not so much for pairing young and old.
Hmmm. I just looked through it and, yes, it appears to be a roommate matching service, irrespective of age.
But looks like it is aimed at helping folks age in place: "If you can't swing a forever home and you still want to stay where you are, you may need an alternative source of income. And an increasingly popular one…is home sharing. Silvernest, a home-sharing service for older homeowners that matches them with roommates..."
When I first heard about it, I remember being told the focus was on young/old matches, but maybe they pivoted or I misremember.
But looks like it is aimed at helping folks age in place: "If you can't swing a forever home and you still want to stay where you are, you may need an alternative source of income. And an increasingly popular one…is home sharing. Silvernest, a home-sharing service for older homeowners that matches them with roommates..."
When I first heard about it, I remember being told the focus was on young/old matches, but maybe they pivoted or I misremember.
A lot of people do stay in their homes. There is a significant niche industry of building contractors and suppliers for retrofitting homes. Wheelchair ramps, stair lifts, walk-in bathtubs, etc. The real problems come with seniors who need direct hands-on care due to dementia and other serious medical conditions. Remote patient monitoring and smart healthcare devices can help a little, and there are many startups in that space.
Sounds like an industry that needs regulation and public sector intervention. If you care and have a lot of money, you can pay for home health aids who will do an excellent job caring for your elderly relatives. The issues is that a good number of people just don't care and take an "out of sight out of mind" approach. A startup can't disrupt this, only regulations which protect elder rights can. Those who do care frequently can't afford it, but a startup can eliminate the costs of caring human interaction, which is the primary thing that elderly people today need more of. The government, however, could help pay for these costs by covering more elder care under Medicare.
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This is not the kind of problem that can be solved with a fancy app. What the industry needs is proper oversight.
Capitalism can't save this. This is fundamentally a social decay problem. Modern social behavior sweeps all "unpleasant" grief under the carpet. Out of place out of mind.
There is a sociological argument that this is a core element of what it means to be “civilized”. We displace the responsibility for dirty work on others so that we - the civilized - can maintain the appearance of being clean. For instance, we eat lamb chops, but we don’t carve a lamb at the table.
I’m fairly certain people of all classes, ranks, and social situations in ancient Mesopotamia, China, India, and Egypt sometimes swept ‘unpleasant’ grief under the carpet too… unless you have some credible reason to believe otherwise?
The proportion of multi-generational homes in modern western cultures is far lower, and the emphasis on taking care of your parents as a sacred social duty is gone. I'm sure that there were plenty of individuals in those historic cultures who fell short of what was expected, but widespread care homes are a relatively recent change.
Those historic cultures had shorter lifespans and essentially forced women to work as unpaid home caregivers. Times have changed.
> If there is an industry that needs startups, it is long term care and senior care in general.
Whatever happened to Soylent?
Whatever happened to Soylent?
My office, pre-pandemic, was situated between the local firehouse and a senior citizen's home. It was very convenient I guess, to watch a fire truck drive across the street to handle an emergency call.
Sounds like we should tax senior homes to fund increased staff for fire departments, basically de-privatizing senior homes...
GaryTang(4)
Just charge a call-out fee for the homes that use it. No need to punish well-run homes or pass new tax laws for something very easily addressed and internalized.
In all my time living in Louisiana, the only time I saw a fire truck near a home was when the house was actually on fire or under threat of fire.
In Texas? EVERY SINGLE TIME I see an ambulance, I see a fire truck. It makes ZERO sense most of the time. Texas municipalities are using medical emergencies to fund their fire departments (and jack up insurance rates in the process) by sending fire trucks to people even when they're suffering from chronic conditions.
In Texas? EVERY SINGLE TIME I see an ambulance, I see a fire truck. It makes ZERO sense most of the time. Texas municipalities are using medical emergencies to fund their fire departments (and jack up insurance rates in the process) by sending fire trucks to people even when they're suffering from chronic conditions.
If you have a full time fire department, it makes sense to have them working with EMS rather than just waiting for a fire.
If you have a volunteer fire department or part-time fire department, you will call them out only for fires. I would expect in smaller towns that fire departments would not be regularly doing EMS legwork but would focus on fires. But I have no idea if this hypothesis is relevant to your situation. It could also be that the same station has a fire truck and ambulance, and the fireman jump into the ambulance for an EMS call and only use the firetruck for fires.
If you have a volunteer fire department or part-time fire department, you will call them out only for fires. I would expect in smaller towns that fire departments would not be regularly doing EMS legwork but would focus on fires. But I have no idea if this hypothesis is relevant to your situation. It could also be that the same station has a fire truck and ambulance, and the fireman jump into the ambulance for an EMS call and only use the firetruck for fires.
There is a reason for this.
In most municipalities, there aren’t nearly enough fires to keep a fire department busy.
So fire departments also are often first responders for medical incidents.
In most municipalities, there aren’t nearly enough fires to keep a fire department busy.
So fire departments also are often first responders for medical incidents.
Jesus, can't they just... be on standby?
On that note, it would be hilarious if that applied to IT.
On that note, it would be hilarious if that applied to IT.
This is a great observation and there's an obvious answer you may have not made the connection on: it's cheaper, more efficient, and saves lives.
Many midwestern states, because of their large land area, face a bit different problem than compact cities: you can only get some place so fast by highway. Furthermore, because of the large distances, it could be too late when certain first responders are dispatched and the information that was given over the phone was incorrect. (Think of software engineering, how many times have you been given the correct and complete requirements the first time?)
Instead, most fire departments not only have the training to hand the exact same emergencies as the EMS, but they also carry the same equipment onboard the fire trucks.
Another scenario, lets say fire was dispatched to car accident because smoke was reported 20m from the city, and when they got there, someone was bleeding severely. If it were me, the answer I wouldn't want to hear is "oh sorry, can't bandage that, we'll call for EMS". Worse, imagine the fire department was on a call like that and a high rise caught fire, 5m down the road. If they didn't take the fire truck, they'd have to drive all the way back to the city, grab the truck, then drive all the way back. That's why you see that all the time, it's the safest thing to do.
And fire departments go way beyond putting out fires. There are departments in cities that are trained in swift water rescue, electrical hazards, gas/chemical leaks, and many more. Think of fire as general rescue workers, rather than putting out flames.
Source: Firsthand volunteer firefighter work
Many midwestern states, because of their large land area, face a bit different problem than compact cities: you can only get some place so fast by highway. Furthermore, because of the large distances, it could be too late when certain first responders are dispatched and the information that was given over the phone was incorrect. (Think of software engineering, how many times have you been given the correct and complete requirements the first time?)
Instead, most fire departments not only have the training to hand the exact same emergencies as the EMS, but they also carry the same equipment onboard the fire trucks.
Another scenario, lets say fire was dispatched to car accident because smoke was reported 20m from the city, and when they got there, someone was bleeding severely. If it were me, the answer I wouldn't want to hear is "oh sorry, can't bandage that, we'll call for EMS". Worse, imagine the fire department was on a call like that and a high rise caught fire, 5m down the road. If they didn't take the fire truck, they'd have to drive all the way back to the city, grab the truck, then drive all the way back. That's why you see that all the time, it's the safest thing to do.
And fire departments go way beyond putting out fires. There are departments in cities that are trained in swift water rescue, electrical hazards, gas/chemical leaks, and many more. Think of fire as general rescue workers, rather than putting out flames.
Source: Firsthand volunteer firefighter work
Except it isn't obvious, because it isn't true. When I was living in an apartment complex, I had a neighbor with a magnesium imbalance, and she had an "emergency" about once every 10 days. Her elderly husband was unable to move her to get her the infusions she needed, so he would call the paramedics, who promptly got her out of the apartment every time. The fire department also brought a truck every time, which blocked the main lane in the apartment complex and kept people from being able to get out of their parking spots... while the ambulance blocked the lane closest to the apartments. The result was that about 40% of the complex couldn't leave as long as the paramedics were there.
At no point did the people from the fire department ever lift a finger to actually do anything to help the paramedics, because the paramedics never needed help.
At no point did the people from the fire department ever lift a finger to actually do anything to help the paramedics, because the paramedics never needed help.
In some cities you call 911 give an address and police, fire and paramedics will arrive while they are figuring out what the emergecy is.
For most, 911 is the number you call when you have any sort of medical issue that requires ambulatory transport. For people with chronic medical conditions, there's no "figuring out."
What you saw in Texas is actually quite common. In most other states I have lived, there are typically many more fire trucks than ambulances available. Because if that, Fire response times are much shorter and as they are are trained parametics, they are used as first-responders when not fighting fires. The situation you described was likely the handoff between fire and ambulance.
I saw a fire truck (and ambulance) get called in Santa Cruz, CA, because an elderly person fell inside their house and couldn't get up.
If the elderly person has locked the door, the firefighters will have entry equipment to help the ambulance workers get inside the house.
No that is not why. Some municipalities require Fire departments to staff paramedics on their trucks and private ambulance companies tend to use EMTs.
I was a firefighter and EMT in Washington State about twenty years ago. On certain EMS calls we routinely dispatched an aid car (ambulance) and an engine to ensure enough crew (two from aid car, usually three on the engine) on scene to handle what might arise, such as the need for CPR, or getting a corpulent patient down a flight of stairs on a stair-chair.
Boomers have (poorly) outsourced the elder care of their parents. This what you get.
Along with the US budget deficits and the national healthcare mess, this is just another thing that generation decided it didn't want to have to deal with (change), so they're kicking the can as far as they can down the road.
Along with the US budget deficits and the national healthcare mess, this is just another thing that generation decided it didn't want to have to deal with (change), so they're kicking the can as far as they can down the road.
I'd love to blame "boomers" for this, but I suspect when my generation's parents grow old we won't be eager to set our professional or personal lives aside to change adult diapers or supervise parents with dementia either. Many elders have serious health problems that we may not be equipped to treat at home. And there have always been people outsourcing care of family members when they could afford it. That's essentially what daycare is for children.
Our medical system is completely screwed up from a capacity standpoint. I was sick a few weeks ago and called my primary care doc. No appointments for a week. Do an online appointment which is useless and they say I need to be seen. Go to urgent care. 4 hour wait. I figured that was my best option so toughed it out. During my time waiting I saw multiple people come in, talk to the receptionist, and leave in tears when they were told it was a 4+ hour wait. A guy came in with a badly cut finger. I have no idea why you would try an urgent care aside from the fact that you know the ER is gonna take 12+ hours.
Wow, where is this? Doesn’t match my experience at all (US west coast).
LA is like this, but maybe worse.
Where? This is not anything close to my experience at all.
Back when I worked at $HEALTHCARE_INUSRANCE_CO we were trying to solve this (more general problem) from the other side. We regularly saw routine calls for what could only be described as "loneliness". Our research lead us to find that a high percentage of elderly folks (50+) identified as lonely regardless of their living situation. [1]
Looking deeper into claims data, we found a high percentage of these calls were in rural communities. These inessential emergency calls often lead to resources being expended without need. For example: the singular community ambulance being dispatched to the caller's home only because they wanted to chat. Even when considering the dispatcher filtering out these callers, and the emergency personnel doing their best to leave as quickly as possible, it still places a strain on the system. Tying up emergency personnel with mundane tasks creates a far greater risk for the community if & when they're needed.
We unfortunately found no solution to this problem. It ran deeper than just alleviating non-emergency emergency-response claims: it was due to the loneliness epidemic, and the company was uncomfortable shouldering the financial and legal cost of trying to create a solution.
1. https://www.aarp.org/personal-growth/transitions/info-09-201...
Looking deeper into claims data, we found a high percentage of these calls were in rural communities. These inessential emergency calls often lead to resources being expended without need. For example: the singular community ambulance being dispatched to the caller's home only because they wanted to chat. Even when considering the dispatcher filtering out these callers, and the emergency personnel doing their best to leave as quickly as possible, it still places a strain on the system. Tying up emergency personnel with mundane tasks creates a far greater risk for the community if & when they're needed.
We unfortunately found no solution to this problem. It ran deeper than just alleviating non-emergency emergency-response claims: it was due to the loneliness epidemic, and the company was uncomfortable shouldering the financial and legal cost of trying to create a solution.
1. https://www.aarp.org/personal-growth/transitions/info-09-201...
> and the company was uncomfortable shouldering the financial and legal cost of trying to create a solution.
Did they find a solution before determining that?
Did they find a solution before determining that?
> Our research lead us to find that a high percentage of elderly folks (50+)...
People in their 50s are now considered elderly?
People in their 50s are now considered elderly?
50%+, assuming.
I used to volunteer with an organization that pairs people with lonely “elders”... kind of like a Big Brother/Big Sister program. The woman I was paired with was in her early 60s and went to the doctor constantly but there really wasn’t anything wrong with her. It took me a long time to realize she would go to all these appointments to give her something to do, some people to talk to, and sometimes as an excuse to get her (out of state) kids to talk to her on the phone a bit.
I’ll never forget when I was visiting her and realized she was looking forward to an entire day of medical testing appointments. At fist I thought maybe she had Munchausen’s (and maybe, in a way she did) but mostly I think she was just lonely.
I’ll never forget when I was visiting her and realized she was looking forward to an entire day of medical testing appointments. At fist I thought maybe she had Munchausen’s (and maybe, in a way she did) but mostly I think she was just lonely.
One's early 60s aren't even that old.
An individual living in an isolated rural community wanting a chat is almost entirely unlike a for-profit corporation running a group home calling a paramedic to change someone's bandages because they are cutting costs by not hiring sufficient staff.
"because they are cutting costs by not hiring sufficient staff."
If this is an ongoing problem and such a simple fix hasn't been implemented yet, the blame is solely with the incompetence of the fire authority for not having corrected the incentives with a call-out fee.
> call-out fee for frivolous calls
Sounds like a typical neoliberal "free market" non-solution.
Sounds like a typical neoliberal "free market" non-solution.
This snarky reply isn't a rebuttal of any substance. A frivolous call-out fee is a clear and simple solution. If you fix the price then the problem goes away because the incentive for the frivolous call-out no longer exists. It's cheaper for them to hire another staff member than rely on the fire department.
A fee to commercial facilities making frivolous calls could be more reasonable, as they should have competent folks managing things. See my sibling comment regarding fees in general.
No really. Turning a public service into a fee-based means-tested public/private program is the basic neoliberal program. The polices are always put forward with the rubric that the so-called free market is the best way to solve problems of distribution and fairness. To used a tired example, https://www.villagevoice.com/2010/10/11/libertarian-fire-dep...
I'm not disputing that it's a neoliberal solution, I'm disputing the claim that it's a non-solution. If you charge a sufficient amount for frivolous calls from private homes then private homes will stop making frivolous calls.
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It's not a solution. The problem is that emergency services aren't always available to those who need them; if you attach the possibility of a fee to the service then you have ensured that problem exists forever.
Many places outside the US have a fee associated with call outs (Australia), not even just frivolous call outs, and there's no issue.
Ah yes Australia, that noted bastion of equality where there is definitely no social underclass.
The problem of availability already exists because emergency services are abused on non-emergencies this stops those abuses freeing it up for real emergencies, no person no-matter how poor is going to balk at using an emergency service on an actual emergency cuz maybe they get charged 5 bucks if its not "emergency enough"
If it's 5 bucks then it's not going to stop care homes calling them either. If you look at the numbers being thrown around in these discussions we're talking about maybe 5k or more, which can definitely be a life-changing amount for a poor person.
Then don't fine poor people. Fine private care homes only as was suggested elsewhere in this thread. In the article it explains that they're only considering a fee for facilities, not for individuals.
> Then don't fine poor people
Means-testing for public services? Please no. Means testing introduces bureaucratic hurdles, and the cost of determining and enforcing means limits can be up to 10x the actual amounts paid out. https://www.theguardian.com/social-care-network/2013/jan/14/...
Means-testing for public services? Please no. Means testing introduces bureaucratic hurdles, and the cost of determining and enforcing means limits can be up to 10x the actual amounts paid out. https://www.theguardian.com/social-care-network/2013/jan/14/...
I dislike means testing as much as anyone, but a simple test of "are you a private business/facility with more than 1 employee" is one that I could get behind due to its inherently low bureaucratic overhead.
I think there are a lot of potential problems charging a fee for emergency service calls. Who decided what is frivolous?
The person making the call can't be assumed to be an expert. And in many cases, it might seem serious/freaky in the moment, but be less so to an outside observer.
This sounds like a good way to penalize poor folks and have them avoid using the system altogether, resulting in worse outcomes and higher cost burden on the system when preventable issues aren't dealt with proactively.
I get where you're coming from and agree that preventing frivolous calls is a good aim, I don't know that a fee is the right solution.
The person making the call can't be assumed to be an expert. And in many cases, it might seem serious/freaky in the moment, but be less so to an outside observer.
This sounds like a good way to penalize poor folks and have them avoid using the system altogether, resulting in worse outcomes and higher cost burden on the system when preventable issues aren't dealt with proactively.
I get where you're coming from and agree that preventing frivolous calls is a good aim, I don't know that a fee is the right solution.
It looks like they're considering what I proposed, it's just taking them a while to implement it.
"The new ordinance also allowed the city to levy fines against facilities deemed to be making frivolous or excessive emergency calls."
You have a point about the possible downsides. It would have to be done well, such as doing what you suggested by limiting the fee to commercial facilities.
"The new ordinance also allowed the city to levy fines against facilities deemed to be making frivolous or excessive emergency calls."
You have a point about the possible downsides. It would have to be done well, such as doing what you suggested by limiting the fee to commercial facilities.
For an insurance company, who'll burden the cost, they're the same problem. Different cause, but same problem.
Playing devils advocate here but maybe we have too many fire fighters?
I have four good friends that work in metropolitan fire houses all making well into the six figures. They constantly joke about how they get paid to do nothing and haven’t been on a fire in years, mainly they respond to calls at old folks homes. Oh and the only work a four or five days a month.
I have four good friends that work in metropolitan fire houses all making well into the six figures. They constantly joke about how they get paid to do nothing and haven’t been on a fire in years, mainly they respond to calls at old folks homes. Oh and the only work a four or five days a month.
I was with you until that last line. I know two fire fighters; they work a standard 160 a month (though the schedule itself is kind of bonkers).
These guys have to work 40 hours per pay period, which is two 24 hours shifts every two weeks. This is just slightly more than 4 days a month. They will sometimes work four days in a row, the last two days of a period and then the first two of the next and can go 20+days between shifts.
160 hours isn’t much when you are getting paid to sleep, eat and hangout. It’s just 6 days.
160 hours isn’t much when you are getting paid to sleep, eat and hangout. It’s just 6 days.
> Playing devils advocate here but maybe we have too many fire fighters?
It sounds like the type of service that you want to over-provision for. What if a major fire broke out and you needed all of them?
It sounds like the type of service that you want to over-provision for. What if a major fire broke out and you needed all of them?
Have a reserve, like the military?
The only time this really happens is wildland fires, which are historically understaffed and underfunded anyways.
9/11 took every firefighter
This is exactly the problem, I guess. Demand for fire fighters is so incredibly spikey that there is no such thing as “the right amount.” We’re trying to adapt an economic system that’s designed for factories and farms, and fire fighting just doesn’t work like that.
9/11 is an extreme edge case, I would say.
Many places they get paid per call. So maybe thats a factor.
We need enough reserve firefighting capacity to respond to infrequent major fires. But when they're not fighting fires or training then they might as well respond to other emergencies.
Firefighters are a profession that is almost purely a good for society. I wouldn't support a reduction in firefighters until every single other member of the government was gone. In the post apocalypse I hope it is firefighters who are running the provisional government.
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I think the root cause is that you lump fire and EMS into the same basket. You don’t need six qualified firefighters on a half million dollar pumper to attend a nanna down call.
Here in Australia the ambulance service is totally separate to the fire services. The public calls the same number (000) but after that it’s separate dispatch centres, different staff, different depots.
From the fire side we occasionally get called to assist the ambulance service with carrying out people who are injured somewhere way off down a bushwalking or mountain biking track. We’ll very rarely get called to a lift assist for someone that’s fallen in an aged care facility.
The ambulance service in NSW has a whole set of problems around capacity and poor working conditions for staff, of course, but that’s another story.
Here in Australia the ambulance service is totally separate to the fire services. The public calls the same number (000) but after that it’s separate dispatch centres, different staff, different depots.
From the fire side we occasionally get called to assist the ambulance service with carrying out people who are injured somewhere way off down a bushwalking or mountain biking track. We’ll very rarely get called to a lift assist for someone that’s fallen in an aged care facility.
The ambulance service in NSW has a whole set of problems around capacity and poor working conditions for staff, of course, but that’s another story.
>>> You don’t need six qualified firefighters on a half million dollar pumper to attend a nanna down call.
A friend of mine is a former EMT. He told me that they would usually send out 4 people if possible, because in fact you do need that many if someone has had a heart attack while sitting on the toilet in an upstairs apartment, and weighs 350 pounds. Getting people out of their homes can actually be dangerous for the EMT's.
In my locale, all of the firefighters are also EMTs. Same service. When I had my medical "event," a fire truck showed up first because the ambulance was on another call. They started working on me right away, then the ambo showed up and hauled me out.
A friend of mine is a former EMT. He told me that they would usually send out 4 people if possible, because in fact you do need that many if someone has had a heart attack while sitting on the toilet in an upstairs apartment, and weighs 350 pounds. Getting people out of their homes can actually be dangerous for the EMT's.
In my locale, all of the firefighters are also EMTs. Same service. When I had my medical "event," a fire truck showed up first because the ambulance was on another call. They started working on me right away, then the ambo showed up and hauled me out.
And yet, the majority of the country doesn't have full-time professional firefighters. The majority of firefighters are volunteers who are often working for poorly funded departments.
Emergency services in the US have gone from 80:20 fire:medical to 80:20 medical:fire over the last 70 years or so. We retain the framework of firefighting, but devote those
valuable and important resources to using custom built fire trucks much of the time as taxis staffed by paramedics.
It seems like you still need fire trucks though even if only 20% of your incidents are fires.
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Privatizing profits, socializing losses. It's the American Way™.
Your comment could seem like a meaningless sound-bite, but the fact that I can't think of many counter examples makes it hit a bit more.
Should note that publicly managed institutions may not necessarily be better. We have the most generous support policy here in Quebec, Canada and as a result we have the highest share of elderly living in homes, i.e. because it's easier to put them in there, they end up in there, and they're not necessarily very well managed.
I think we might need some basic regulatory policy on this with respect to wages, conditions, protections for residents as well as frankly maybe a different cultural look. We are bad at the later in North America and getting worse - lacking any cultural context as an established basis for these things, and moving ever more away from that, our discussions end up being about legalities and rights as opposed to issues about what is culturally normal.
Denmark apparently has a pretty good system for this, homes are small, local i.e. highly communitarian orientation.
I think we might need some basic regulatory policy on this with respect to wages, conditions, protections for residents as well as frankly maybe a different cultural look. We are bad at the later in North America and getting worse - lacking any cultural context as an established basis for these things, and moving ever more away from that, our discussions end up being about legalities and rights as opposed to issues about what is culturally normal.
Denmark apparently has a pretty good system for this, homes are small, local i.e. highly communitarian orientation.
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.