Firefighters say they’re swamped by calls for routine care from senior homes
oregonlive.com
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The residents are often lonely, in awful health, overlooked by their families, and spend all day watching television. Many of them are verbally abusive towards the staff.
Elderly people should live with their families. The ones with no families to care for them should be in nonprofit, closely regulated facilities with well-paid staff. And it’s time to stop spending $500K on medical care just so an 88 year old can make it to 89. Whoever spread that “death panels” meme should be forced to write America a check for five hundred billion dollars.
Spoken with the confidence of someone who has never had to care for an elderly relative who was in both mental and physical decline. In any case it is a deeply personal decision without a definitive right or wrong answer. After seeing my Aunt try to care for my grandmother for years only for it to negatively effect their relationship because of her dementia I wouldn't blame anyone for choosing a care facility.
I know people who were so effected by their experience of caring for an elderly relative that they checked themselves into a senior living community in their 50's so their kids would never have to feel like they needed to do the same for them.
Fact is that getting old can be a truly horrible process. Which is why the pro-euthanasia people keep standing up.
No. It’s an unreasonable burden to expect families, which are barely holding themselves together in this wonderful world of mandatory-two-income-households we’ve built, to take on not only their adult children who can’t afford to rent or buy their own homes, but also the extensive and expensive care of their elders.
I 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).
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.
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 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.
That is a hard case, one that I originally explicitly called out as extremely difficult to handle. So your criticism is unfounded.
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).
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.
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".
>[...] 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.
“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...
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.
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.
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.
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.
"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?]
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.
*On paper
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.
https://en.wikipedia.org/wiki/List_of_countries_by_total_wea...
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.
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.
It could be a lot worse without this support.
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 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 was referencing policies like those in WA, OR, and Europe where people can choose to end their life.
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.
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?
If I wanted a chip to help me commit suicide once I'm no longer mentally fit then is that legal?
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.
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.
"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.
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
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.
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.
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.
Talk about gross.
What's wrong with dignity for other people, I feel like trying to maximize for monetary profit is going to be our downfall.
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.
Facilities where the family pays aren't going to get away with mistreatment, because the family will choose a different facility.
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.)
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.
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.
Something tells me Sarah Palin doesn't have that much money
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...
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.
"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.
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 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.
Sounds like a typical neoliberal "free market" non-solution.
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/...
Did they find a solution before determining that?
People in their 50s are now considered elderly?
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.
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.
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.
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?
160 hours isn’t much when you are getting paid to sleep, eat and hangout. It’s just 6 days.
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.
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.
Interesting take on it, imo.
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.
This is not stuff that robots can do in the near future.
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.
Can you give some examples?
I guess I can start: something that monitors gas cookers, which already exists: iguardfire.com
- 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.
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.
Whatever happened to Soylent?
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.
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
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 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.
On that note, it would be hilarious if that applied to IT.
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.
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.
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.