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Senior homes and assisted living centers are a national disgrace. They are entirely about profit maximization (what business isn’t?), and as such hire people a

Senior homes and assisted living centers are a national disgrace. They are entirely about profit maximization (what business isn’t?), and as such hire people at the exact minimum and have well over 100% yearly turnover. The staff commonly steal from residents, and the management do not care. They’d rather retain a larcenous pig who barely executes her duties than have to go back and scrape the barrel for a replacement. The residents are often lonely, in awful health, overlooked by their families, and spend all day watching television. Many of them are verbally abusive towards the staff. Elderly people should live with their families. The ones with no families to care for them should be in nonprofit, closely regulated facilities with well-paid staff. And it’s time to stop spending $500K on medical care just so an 88 year old can make it to 89. Whoever spread that “death panels” meme should be forced to write America a check for five hundred billion dollars.

pmorici 5y ago
"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.
- batch12 5y ago
  Damn-- in their 50s. I don't have much time left. I'd rather walk the planet than check myself into a center.
  - deleted 5y ago
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- throwawayboise 5y ago
  There are probably well-run exceptions but in my experience senior communities are mostly about extracting all the wealth and insurance payments they can get from their residents before they die. You think it's hard taking care of your aging parents? They took care of you when you were a helpless, shitting, crying, little ball of flesh.
  - mjevans 5y ago
    Getting old sucks :( https://www.nia.nih.gov/health/end-life-care-people-dementia https://www.nia.nih.gov/health/end-life-care-people-dementia I need to write up some kind of living will or something where, sure expend whatever is (reasonable) to return me to normal health... until I forget why I need to ask for help (that I need) or even myself; and that isn't just a rare occurrence but an always or even mostly always state of my mind having fallen apart before my body. If my mind does fall apart before my body: I want any treatment known or suspected to fix that. Then to be admitted to any study hoping to establish such treatment. Then failing any hope of return to health... I'm already dead as far as our medical tech allows; make it painless, useful to those who might benefit from viable parts, useful to the progress of science (generally) and medicine, quick, and resource efficient; in that order of decreasing importance.
  - gruez 5y ago
    >You think it's hard taking care of your aging parents? They took care of you when you were a helpless, shitting, crying, little ball of flesh. try lifting a baby vs an adult. also, seniors in retirement communities tend to have some sort of chronic condition that make them non-trivial to care for without medical expertise.
  - whatshisface 5y ago
    You're sweeping a lot of people in your use of the term "aging parents," ranging from physically strong yet mentally deranged dementia patients, to little old ladies who simply don't have anyone to talk to. What is obviously true for the second is obviously false for the first.
  - nradov 5y ago
    Babies gain a degree of self sufficiency within a few years, at least to extent of wiping their own asses. But elderly dementia patients can hold on for decades gradually requiring more and more hands-on care. When my time comes I don't expect my children to ruin their lives just to care for me.
- roenxi 5y ago
  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.
  - pmorici 5y ago
    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.
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tomrod 5y ago
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.
- soperj 5y ago
  >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.
  - peteradio 5y ago
    > You're the richest nation on earth* *On paper
    - maxerickson 5y ago
      The material abundance here is obvious, it's not just on paper.
    - jachee 5y ago
      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.
  - abeppu 5y ago
    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.
stult 5y ago
> 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
swman 5y ago
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.
- TrispusAttucks 5y ago
  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.
- ErikVandeWater 5y ago
  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.
bpodgursky 5y ago
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.
- neither_color 5y ago
  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.
  - Swizec 5y ago
    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
    - WalterBright 5y ago
      Every day you can wake up, get out of bed and stand up is a beautiful day.
  - taxicabjesus 5y ago
    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.
disabled 5y ago
> 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 https://en.m.wikipedia.org/wiki/Death_panel It’s quite disgusting as she is a mother with a disabled child.
- gruez 5y ago
  >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".
  - disabled 5y ago
    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.
    - shadilay 5y ago
      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?
      - disabled 5y ago
        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.
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gruez 5y ago
>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.
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batch12 5y ago
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.
rrrrrrrrrrrryan 5y ago
> 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.
- nradov 5y ago
  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.
  - MichaelZuo 5y ago
    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?
    - lmm 5y ago
      They cover some treatments and not others, but those decisions are made through debate and politics, not QALY measures.
      - MichaelZuo 5y ago
        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?
        nradov 5y ago
        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/
Aloha 5y ago
You can take care of my mother then, I didn't sign up for that burden.
- ARandomerDude 5y ago
  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.
  - Aloha 5y ago
    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.
eru 5y ago
> 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.)
ricardobayes 5y ago
Let me get that straight, are you advocating that old people should just die and not be treated/cured because of financial reasons?
antiSingularity 5y ago
And these are precisely the people we just shut down the global economy (and culture, and inter-personal connection) to apparently "protect".
falcolas 5y ago
> 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.
- deleted 5y ago
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- stirlo 5y ago
  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).
- nyokodo 5y ago
  > 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.
  - lazide 5y ago
    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.
marsdepinski 5y ago
They are given psychotropic drugs to make them easier to manage and less likely to be able to complain.
Factorium 5y ago
The necessary innovation is ethical/political. People over age 80 should be able to request to medically cease their life for any reason.
- reb 5y ago
  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.
- vbezhenar 5y ago
  You can buy gun. Why do you have to request anything?
  - kube-system 5y ago
    So that you don't risk harm to other people and property in the process?
    - gruez 5y ago
      a tank of helium + mask/bag satisfies that criteria.
      - kube-system 5y ago
        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.
      - sli 5y ago
        Consumer helium is sold with a good amount of oxygen in it now for exactly that reason.
        nradov 5y ago
        I'm pretty sure that's a myth, at least in most areas. Helium tanks usually contain >99% pure helium. I've never seen one with a significant amount of oxygen.

pmorici 5y ago

"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.

batch12 5y ago
Damn-- in their 50s. I don't have much time left. I'd rather walk the planet than check myself into a center.
- deleted 5y ago
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throwawayboise 5y ago
There are probably well-run exceptions but in my experience senior communities are mostly about extracting all the wealth and insurance payments they can get from their residents before they die. You think it's hard taking care of your aging parents? They took care of you when you were a helpless, shitting, crying, little ball of flesh.
- mjevans 5y ago
  Getting old sucks :( https://www.nia.nih.gov/health/end-life-care-people-dementia https://www.nia.nih.gov/health/end-life-care-people-dementia I need to write up some kind of living will or something where, sure expend whatever is (reasonable) to return me to normal health... until I forget why I need to ask for help (that I need) or even myself; and that isn't just a rare occurrence but an always or even mostly always state of my mind having fallen apart before my body. If my mind does fall apart before my body: I want any treatment known or suspected to fix that. Then to be admitted to any study hoping to establish such treatment. Then failing any hope of return to health... I'm already dead as far as our medical tech allows; make it painless, useful to those who might benefit from viable parts, useful to the progress of science (generally) and medicine, quick, and resource efficient; in that order of decreasing importance.
- gruez 5y ago
  >You think it's hard taking care of your aging parents? They took care of you when you were a helpless, shitting, crying, little ball of flesh. try lifting a baby vs an adult. also, seniors in retirement communities tend to have some sort of chronic condition that make them non-trivial to care for without medical expertise.
- whatshisface 5y ago
  You're sweeping a lot of people in your use of the term "aging parents," ranging from physically strong yet mentally deranged dementia patients, to little old ladies who simply don't have anyone to talk to. What is obviously true for the second is obviously false for the first.
- nradov 5y ago
  Babies gain a degree of self sufficiency within a few years, at least to extent of wiping their own asses. But elderly dementia patients can hold on for decades gradually requiring more and more hands-on care. When my time comes I don't expect my children to ruin their lives just to care for me.
roenxi 5y ago
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.
- pmorici 5y ago
  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.

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tomrod 5y ago

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.

soperj 5y ago
>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.
- peteradio 5y ago
  > You're the richest nation on earth* *On paper
  - maxerickson 5y ago
    The material abundance here is obvious, it's not just on paper.
  - jachee 5y ago
    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.
- abeppu 5y ago
  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.

stult 5y ago

> 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

swman 5y ago

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.

TrispusAttucks 5y ago
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.
ErikVandeWater 5y ago
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.

bpodgursky 5y ago

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.

neither_color 5y ago
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.
- Swizec 5y ago
  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
  - WalterBright 5y ago
    Every day you can wake up, get out of bed and stand up is a beautiful day.
- taxicabjesus 5y ago
  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.

disabled 5y ago

> 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 https://en.m.wikipedia.org/wiki/Death_panel It’s quite disgusting as she is a mother with a disabled child.

gruez 5y ago
>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".
- disabled 5y ago
  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.
  - shadilay 5y ago
    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?
    - disabled 5y ago
      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.

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gruez 5y ago

>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.

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batch12 5y ago

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.

rrrrrrrrrrrryan 5y ago

> 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.

nradov 5y ago
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.
- MichaelZuo 5y ago
  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?
  - lmm 5y ago
    They cover some treatments and not others, but those decisions are made through debate and politics, not QALY measures.
    - MichaelZuo 5y ago
      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?
      - nradov 5y ago
        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/

Aloha 5y ago

You can take care of my mother then, I didn't sign up for that burden.

ARandomerDude 5y ago
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.
- Aloha 5y ago
  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.

eru 5y ago

> 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.)

ricardobayes 5y ago

Let me get that straight, are you advocating that old people should just die and not be treated/cured because of financial reasons?

antiSingularity 5y ago

And these are precisely the people we just shut down the global economy (and culture, and inter-personal connection) to apparently "protect".

falcolas 5y ago

> 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.

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stirlo 5y ago
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).
nyokodo 5y ago
> 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.
- lazide 5y ago
  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.

marsdepinski 5y ago

They are given psychotropic drugs to make them easier to manage and less likely to be able to complain.

Factorium 5y ago

The necessary innovation is ethical/political. People over age 80 should be able to request to medically cease their life for any reason.

reb 5y ago
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.
vbezhenar 5y ago
You can buy gun. Why do you have to request anything?
- kube-system 5y ago
  So that you don't risk harm to other people and property in the process?
  - gruez 5y ago
    a tank of helium + mask/bag satisfies that criteria.
    - kube-system 5y ago
      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.
    - sli 5y ago
      Consumer helium is sold with a good amount of oxygen in it now for exactly that reason.
      - nradov 5y ago
        I'm pretty sure that's a myth, at least in most areas. Helium tanks usually contain >99% pure helium. I've never seen one with a significant amount of oxygen.