08x08 - Nursing home care in the United States

[bunniefuu]

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John: hi there!

Welcome to the show.

Still coming to you from this
blank void.

Which I actually share with the
pixar lamp.

It says if I try to leave, it'll

Crush me like the letter "i",

And I can't tell how scared

And/or horny I should be.

It's been another busy week.
In the u.s., Covid vaccinations

Are racing against new variants

Of the virus.

And in the u.k., Prince philip

Died, which is a tragedy if you

Don't know a single thing about

Him.

And even if you know a little

About him, you might not know

This.

Take it back to the beginning

For us, alastair, and tell us

How the young prince philip of

Greece and denmark met the

Then-princess elizabeth.

Well, they were related.

John: yeah, that's right,

Prince philip and

Queen elizabeth are cousins who

Later got married... Also known

As a "giuliani meet-cute."

Meanwhile, the matt gaetz saga

Continues to unfold this week,

And not in any ways that look

Good for him.

The new report overnight

Alleges gaetz sent close

Associate and accused

Sex trafficker joel greenberg

$900 In two late-night venmo

Transactions in 2018.

According to the daily beast,

Greenberg used the same app to

Send three young women,

Including one who had recently

Turned 18, varying sums of money

That amounted to $900.

Greenberg made the payments to

The three young women with the

Descriptions "tuition,"

"School," and "school."

John: you f*cking idiots!

I can't believe I have to say

This, but if you're trying to

Suspicious potentially criminal

Transactions,

Venmo is not the app to use.

Venmo is for one thing and one

Thing only: passing judgment on

Friends' spending habits while

Obsessing over wild financial

Mysteries.

Wait, brian paid his girlfriend

For pizza?

Why can't kaitlin just let him

Slide on this?

They live together, and it's

Pizza.

Wait, kaitlin's paying brian

Now?

For cake?

Brian liked it?

The f*ck is going on in

This relationship?

And look, I have to tell you,

Matt gaetz has denied all

Accusations.

And I'm sure there will be more

To say about all this when he

Goes to prison.

But for now, let's talk about

Immigration.

There's been a lot of coverage

Lately about what's happening on

The border, which is troubling

And complicated, but I'd

Actually like to talk about

Something a lot less complicated

That's also getting a lot less

Coverage, and that is the u.s.

Refugee admissions program.

It's for people currently abroad

Fleeing persecution or v*olence

Who've applied for resettlement.

And the u.s. Used to be a world

Leader in how many refugees we

Accepted, but this f*cking guy

Not only slashed the admissions

Cap down to a historic annual

Low of 15,000, he also added

Discriminatory eligibility

Categories that have blocked

Many muslim and african refugees

From coming to the u.s.

And to his credit, biden ran on

A platform that included

Reversing trump's policies.

And since taking office, he's

Been about as eloquent as biden

Can be about the moral

Imperative of doing so.

Come with me into

Sierra leone.

Come with me into parts of

Lebanon.

Come with me around the world

And see people piled up in

Camps, kids dying, no way out,

Refugees fleeing from

Persecution.

We, the united states, used to

Do our part.

We were part of that.

We're... And, you know, that's,

You know... Send me your

Huddled masses.

Come on!

John: right, and underneath

That patriotic word salad is a

Pretty good point.

Even though he's making it while

Managing to sound like a guy in

A statue of liberty costume in

Times square.

"Send me your huddled masses.

Come on.

I'm breathing in green lead

Paint here, so do you want

A picture with me and

Buzz lightyear or not?"

In early february, biden

Announced that he'd raise the

Ceiling on admissions to over



Restrictions, and raise the cap

Even higher next year.

Which sounds great.

Unfortunately, that was two

Months ago, and he still hasn't

Signed the presidential

Determination that would revise

Trump's rules.

And it has been hard to get a

Straight answer from this

Administration about why.

The president has said that

That's something that should be

Done immediately.

Why didn't he do it today?

I think we're gonna have more

Again soon in the coming days

And weeks on more steps and

Actions that the president is

Interested in taking.

So I'm just not gonna get ahead

Of that right now.

Why hasn't the president

Signed the paperwork to lift

The, the... Raise the refugee

Cap?

Well, I would refer you to

The state department.

Last month, the president did

Announce that he intended to

Raise the refugee cap.

That hasn't seemed to happen

Yet.

Why haven't those flights

Continued?

He remains committed, but I

Don't have an update on the

Timing of the flights.

Does it have anything to do

With the fact that resources are

Going towards the border at this

Time?

Or...

No, no, it's not related to

That.

No.

John: then what is it related

To?

Although props to jen psaki,

Only a few months into the job

And she's already waving away

Concerns about stranded refugees

With the ease of

A spirit airlines gate

Agent letting you know your

Flight's delayed.

"Rest assured, we're committed

To getting you to orlando

Eventually.

We just can't tell you where

Your plane is, why it's taking

So long, or what year you might

Arrive."

And the thing is, there are

Nearly 115,000 refugees in

Various stages of the

Resettlement process right now,

With more than 35,000 already

Approved for resettlement here.

But until biden signs that

Determination, they're still

Beholden to trump's low

Admissions ceiling and bullshit

r*cist rules.

And much among, more than 700

Refugees had their flights

Canceled.

And remember, these are

Vulnerable people who may have

Surrendered their belongings or

Homes in anticipation of leaving

The country or who are waiting

In camps.

Also, any delay can mean their

Required health or security

Checks expire, and they have to

Start the whole process all over

Again.

One congolese woman was

Scheduled to fly here in early

March but had her ticket

Canceled, and because she's

Pregnant and now in her third

Trimester, she can no longer

Travel at all.

And by the way, when her baby is

Born, that child will have to

Undergo a separate screening

Process that could take months.

Which is pretty weird because

I'm relatively sure you can't

Have foreign allegiances before

You have object f*cking

Permanence.

There are thousands of people

Now stuck in this pointless

Limbo.

It's an infuriating situation,

Perhaps best summed by this

Woman, who can't figure out why

Her friend... A refugee

Currently stuck in a camp in

Malawi, who's been approved for

Resettlement... Can't get on a

Plane.

This president, joe biden.

When he came, he said that he

Would just add more refugees to

Come to usa.

And I hear in the news that

There is a paper.

I don't know which is a paper or

Something that he's supposed to

Sign.

Please, please, if he hear my

Voice, please help our friends

Who are struggling in the

Refugee camp.

John: look, at least some

Of the people who voted for

Biden... Maybe reluctantly...

Did so on the understanding that

Refugees would not have to go on

Camera to beg for their

Already-approved loved ones to

Be allowed to come here, because

That is one of those things that

Good guys are supposed to

Change, right next to not hiring

Their own kids or not letting

Mike lindell swap out the

Pillows in the lincoln bedroom.

And for biden, this is actually

Really simple.

He doesn't need to negotiate

With republicans on this or

Reckon with joe manchin's boner

For the filibuster.

He just needs to sign a piece of

Paper.

And for a guy who clearly wanted

To be the person who "restored

The soul" of america, it's past

Time for him to look deep into

His own, pick up a f*cking pen,

And do the right thing.

And now this.

Announcer: and now, a

Farewell tribute to the greatest

Questions ever asked on

Yahoo! Answers.

Why do my balls smell like

Ham?

What's wrong about being

Sexually attracted to pokemon?

Is it true that sweat in pee are

Like cousins?

What is that one movie where

Lindsay lohan and jamie lee

Curtis switch bodies?

Not "freaky friday?"

Std from doug?

Is it possible?

Okay, weird question, I saw a

Frog carrying another frog on

Its back.

Does of art contain dna?

How is babby formed?

John: moving on.

Our main story tonight concerns

Nursing homes, the absolute last

Thing you want andrew cuomo to

Be handling, tied comfortably

With literally anything else.

Nursing homes, and long-term

Care in general, are something

We tend to avoid thinking about,

But the truth is, whether due to

Old age or disability, many of

Us do or will require help with

Daily living.

The number of americans 65 and

Older is projected to nearly

Double over the next 40 years,

And one study estimated over

Two-thirds of americans who

Reach 65 will need long-term

Care at some point in their

Lives.

And the good news is, for the

Rich, there are plenty of

Options.

There are multiple upscale

Retirement communities where

Residents can transition, if

Needed, into full-time nursing

Care, like this one, toured in

Exquisite fashion by 2 chainz:

All right.

So the name of this episode is

Called "the most expensive

Retirement," right?

And so this is the most

Upscale, luxurious retirement

Home that I've ever seen and

Ever heard about.

The building itself cost

$100 Million to build.

Damn.

The... The marble, it's from

Italy.

It's custom carpet.

I see a lot of art.

I see the versace plates.

John: okay.

Extravagance of that place

Aside, let's all just agree:

That $195 plate sucks shit.

And I'm not normally a plate

Guy... Your boy's a saucer freak

From way back.

I'm a bowl bitch.

Plates aren't really my thing.

But even I can tell that plate

Is a 2.

That's a 2 in ohio.

If you're gonna spend that kind

Of money on a plate, it better

Be really big, really fun, or

Really, really hot.

That plate...

Look at me.

Put your phone down and look at

Me when I'm talking to you.

That plate fucks.

But the fact is, most of us

Aren't ending up in that place.

In fact, the vast majority of

People receive long-term care at

Home, and around 80% of that

Care is provided by unpaid

Caregivers, often family members

Who want to keep their loved

Ones out of institutional care,

Like this wife and daughter.

Cheryl and kristin are among

The 42 million americans caring

For loved ones at home, and the

Tasks they perform have become

Increasingly complex.

When we have to flush his

Picc line or clean his peg tube

Or take his blood glucose or his

Blood pressure, you know, none

Of us went to school for that.

I mean, we're not educated that

Way.

I don't feel like I had

Enough training at all for this.

We've kind of learned by trial

And error.

John: that seems really hard.

And there are certain things

You expect to do by trial and

Error... Solving a puzzle,

Learning to pronounce the name

Of tambourine saturday, or

Choosing a haircut... For the

Record, error, error, error, and

Error... But providing essential

Medical care should not be one

Of those things.

Taking care of someone at home

Can be an incredibly

Complicated, full-time job

That is almost always unpaid.

In fact, in terms of lost wages,

The labor of family caregivers

Totals about $67 billion

Annually.

That's a workforce that, if it

Were paid, would rival the

Entire gdp of bulgaria.

But for those who can't afford

To eat off unfuckable plates or

Whose loved ones are unable to

Help them at home, many wind up

In long-term care facilities.

There are two million people in

Them in the u.s., And as we've

Seen during the covid crisis,

They can be far from ideal.

Residents and staff in them make

Up less than 1% of the

Population, but currently

Account for a third of covid

Deaths.

The pandemic pushed an already

Heavily strained system to the

Absolute brink, with conditions

Getting so bad there were

Near-constant local news stories

Like this:

One resident here says her

Calls for help or ignored

Because there wasn't enough

Staff to respond.

I'm screaming, "get me out of

Here, get me out of here, get me

Out of this thi... "

I was screaming at them.

I was in terrible pain, and they

Didn't come for me.

Penny shaw was in pain as she

Lay helpless in her bed at

Braintree manor nursing home in

The midst of the covid-19

Pandemic.

She became so desperate she even

Called braintree police for

Help.

I can't lay in bed for hours

And hours, you know, in pain

Like that.

John: I have to tell you,

We contacted that facility, it

Insisted that the safety of its

Residents is of utmost

Importance, but that is pretty

f*cking hard to believe when

They are calling the police for

Health.

Their only two instances where

That is to be expected, and that

Is

If you're giving birth or

Digesting a crunch wrap supreme.

But it's a lot more upsetting

And the truth is, covid just

Exposed what we've basically

Known for years... That the way

The elderly and disabled are

Treated in far too many of these

Facilities is with, at best,

Indifference, and at worst,

Abuse and neglect.

So tonight, let's talk about

Long-term care... How the

Industry is structured, how that

Structure creates bad

Incentives, and what we can do

Gog forward.

And we're going to focus on the

Two main types of long-term

Care facilities: nursing homes,

And assisted living facilities.

Nursing homes are medical

Facilities overseen by trained

Nurses and largely staffed by

Low-paid nursing assistants.

And there have long been issues

With nursing home care... A gao

Report covering a five-year

Period before the pandemic found

That 82% of homes had been cited

For infection prevention and

Control deficiencies, and about

Half had persistent problems

That had been cited across

Multiple years.

And a big reason for that may be

Because understaffing is a big

Problem, with employees often

Tasked with taking care of way

Too many residents, as these

Nursing assistants pointed out

Just last year.

They're not being showered.

People falling out of bed.

The men aren't being shaved.

People fallen to where they

Fell out of their wheelchairs.

What if they need changed?

They might get it one time.

A day?

A day.

We have 22 residents apiece.

Most days, that's for one person

To wash, dress, get up, two

Meals, and they're being

Neglected because you can't get

To everybody.

I told the administrator, I'm

Embarrassed of my work process

Because I can't do what I was

Trained to do on how to take

Care of these residents.

John: that is obviously

Unacceptable.

Do you have any idea how bad

Things need to get for you to

Tell your boss you're

Embarrassed by your work?

I'm not even embarrassed by my

Work, and just three minutes

Ago, I joked about f*cking a

Plate.

Also, that wasn't really a joke.

Call me, wolf plate.

And nursing assistants aren't

Just overworked... They're

Really underpaid.

The median national salary for

That job is barely $30,000 a

Year.

And one reason is that nearly



For-profit institutions.

And there is a lot of profit for

Them to make, because they don't

Pay staff much, but they charge

You a lot.

The average per-person cost for

A private room is $100,000 per

Year.

And if you're thinking, "yeah,

That is expensive, but doesn't

The medicare program I have paid

Into all my life cover that?"

Well, no, it doesn't.

Medicare only fully covers the

First 20 days of nursing home

Care after an eligible hospital

Visit, then partially pays for

Up to 100 days.

But after that, you are on the

Hook for all costs.

The only other way to access

Taxpayer help to live in a

Nursing home is to almost

Completely impoverish yourself,

To basically spend your way down

To the point you qualify for

Medicaid, the government program

For the poor, which, crucially,

Reimburses nursing homes at less

Than half the average daily rate

Paid by medicare.

And while you would like to

Think that nursing homes would

Treat all patients the same,

Whether they're on medicare or

Medicaid, the truth is, you

Might get two very different

Experiences.

Because if you're on medicare,

You could wind up getting too

Much attention.

Just listen to an assistant

Manager at one nursing home

Chain describe how medicare

Patients there were treated.

What percentage of the

Therapy that you were being told

To administer do you think was

Not necessary?

I would say probably, as time

Went on, about 40%.



Doing...

Was not reasonable and not

Necessary under medicare

Guidelines.

At another facility, the entire

Rehab staff signed a letter to

Their boss.

It reads, "we have been

Encouraged to maximize

Reimbursement even when

Clinically inappropriate."

John: that is absurd.

The doj actually filed a lawsuit

Claiming that the chain that

Woman worked for, life care

Centers of america... Which runs

Over 200 nursing homes... Was

Subjecting its patients to

Therapy even as they were on

Their deathbeds.

It alleged one 92-year-old who

Was dying of metastatic cancer

Was recorded as having had





Therapy, and 30 minutes of

Speech therapy, just two days

Before his death, on a day he

Was spitting up blood.

Which is absurd.

Residents should be getting

Proper nursing care.

Not shit-tons of expensive

Therapeutic treatments that are

Clinically inappropriate.

Which, by the way, I'm pretty

Sure was the original slogan of

Goop.

Now, life care denied

Wrongdoing, but agreed to pay

$145 Million to resolve that

Lawsuit.

And they're hardly alone here.

Over the past decade, multiple

Other large nursing home chains

Have been charged with

Fraudulent medicare billing

Practices and denied wrongdoing

While paying millions of dollars

To settle their cases.

You know, like you do when

You are totally innocent.

So to recap here: if medicare is

Paying, the risk is, you could

Billed for unnecessary

Treatments.

But if medicaid is paying...

Which, remember, reimburses

Nursing homes at less than half

The average daily rate... Things

Could get much worse.

Because if facilities want to

Open up a bed to a more

Lucrative patient, they can take

Drastic action.

Ronald, who was 51 and

Homeless, got rehab at the

Nursing home where he lived for

More than a year.

Then one night, around



Administrator came into his

Room.

Big smile on their face,

Saying, "we're kicking you out."

Yeah.

And they just bundled me into a

Van and just dropped me off here

On the sidewalk.

The avalon villa care center,

Through its lawyers, told nbc

News it strongly disputes that

It has inappropriately

Discharged any patients.

The homeless shelter where

Ronald is living now says it's

Seen cases like this before.

Experts even have a term for it:

Resident dumping.

John: oh, come on, that's

Just f*cking evil.

"Resident dumping" is a

Completely unacceptable

Practice.

I don't even like it when

Residents are dumped on

"Grey's anatomy."

At the altar, burke?

You dumped that resident at the

f*cking altar?

How could you do that to

Cristina?

You f*cking monster!

And you'd hope regulators would

Punish nursing homes for doing

Things like that.

But the oversight here has some

Massive gaps.

For instance, the federal

Government keeps a list of

So-called "special focus

Facilities"... Homes that have a

Pattern of serious problems over

A long period of time, and

Therefore receive extra

Inspections.

There are 88 nursing homes on

That list... But interestingly,

Not because there are only



Because, due to limited

Resources, the government has

Capped the list at that exact

Number, despite the fact they

Fully acknowledge an additional



Program.

And look, I'm not saying every

List should go on forever.

If a list of cutest otters was

Capped at 88, that'd be a

Perfectly fine list.

But if there were 400 other cute

Otters that were also abusing

The elderly, I'd really like to

Know who all of them are.

And if you're thinking, "well,

That's good to know.

If I need to move a loved one

Into a nursing home, I'm

Definitely going to look online

And make sure it's a good one,"

Well, be careful.

Because while the government

Does have a website where

Nursing homes are rated from one

To five stars, it has an

Absolutely massive loophole.

Of the three factors that

Determine an overall rating,

Only the health inspections are

Conducted independently.

The other statistics, staffing

And quality measures, are

Self-reported by the nursing

Home.

These self-reported statistics

Can boost a three-star rating

Into a five-star rating overall.

The problem is, you know,

It's garbage in, garbage out.

So whatever they're telling the

Feds, the feds are not... That

Federal government isn't going

In and double-checking that

Their numbers are accurate.

John: yeah.

"Garbage in, garbage out."

And that is pathetic.

Something important as our

Nursing home rating system

Shouldn't follow the same rule

As every recipe on velveeta's

Website.

Because there's just no way any

Of those are good.

If you're making a recipe

That calls for a puddle of

Lorax jizz, then don't be

Surprised when the finished

Product is equally repulsive.

It's garbage in, garbage out.

So given everything you've seen,

It's hardly surprising that...

For reasons of cost or

Conditions... Many might want to

Avoid a nursing home altogether.

Which brings us to assisted

Living facilities, or alfs.

Around a third of people in

Long-term care are in one of

These, and they do cost far less

Than a nursing home... Typically

Around $50,000 a year.

Alfs started out as an

Alternative for those who needed

Help with key activities... Like

Dressing, toileting, taking

Medicines and eating... But only

Needed limited medical support.

Just as with nursing homes, the

Vast majority of alfs are

For-profit.

But there are also some key

Differences.

Alfs are largely paid for

Out-of-pocket.

And they are far less regulated,

Making easy for basically anyone

To start one.

And I do mean anyone.

Take stephanie costa.

By 30, she owned six small alfs

In southern california and had

Made a lot of money from them,

Enough to qualify her to

Appear in an episode of

"The millionaire matchmaker."

My name is stephanie and I'm



Of elderly care facilities.

My net worth is $3-4 million,

Probably.

I've always had this thing of

Taking care of older people.

Like sick, people that are

Dying.

I've always really felt for

Them.

So I couldn't wait to graduate

College and start my own

Business doing assisted living

Facilities like nursing homes.

John: okay.

There are a lot of unfair

Reasons that I inherently don't

Trust stephanie costa, from her

Driving a douchey ferrari to the

Fact she looks like an

Uncredited extra from an

"Entourage" party scene to that

Voice, which sounds like a mouse

Who wouldn't dress cinderella

Because it had better things to

Do.

But it turns out that

Gut feeling is entirely valid,

Because costa treated her

Employees and residents so

Terribly that, after multiple

Health and safety violations,

California banned costa from the

Industry for life and ordered

Her and her company to pay about

$1.6 million for unpaid

Wages and penalties.

But if you think that gave her

Accountability, you're going to

Want to think again.

She kept this home after

Filing for bankruptcy and

Settled with workers for a

Fraction of what she owed.

Her six care homes are now owned

By a property investment company

Registered by her father.

John: oh, yeah.

Not just that, as recently as

Last year, she was still listed

As that company's ceo.

So the state of california

Really taught stephanie costa a

Lesson there.

Specifically, the lesson that

You can treat your elder care

Workers like absolute shit,

Avoid any real consequences, and

Just keep living your life in

The single ugliest home in

Beverly hills... Although it's

Legitimately hard to tell

Whether that's actually a home

Or just an abandoned

White castle.

But it's not just individuals

Involved here.

There are also big corporations

Running alfs, who've been

Working hard to fill beds.

And despite the fact alfs are

Supposed to be for people who

Require less medical attention,

Recently, some have been

Aggressively courting dementia

Patients for memory care

Programs, as seen in this

Advertisement for brookdale, the

Largest alf provider in the

Country.

This is a compassionate place

That helps families through very

Difficult stages of dementia in

A safe and comfortable setting,

And I have peace of mind knowing

There is a staff, fully trained,



Week.

I can't believe how much my

Mom's quality of life has

Improved since coming here.

I'm seeing her smiling and

Laughing again.

We help them maintain their

Abilities and encourage the use

Of their current skills in a

Warm, engaging environment.

This is a special place, and

Every day is a new beginning

With lots of smiles and

Memories.

John: okay.

I get that a senior living

Commercial might want to have at

Least one staffer with their

Arms around a resident's

Shoulders.

That's kind of nice.

Trustworthy.

Makes you feel safe.

But immediately cutting to

Another one feels like a bit

Much.

And then a third starts to make

Me feel a little nervous.

And when that fourth hits, as a

British person, I've got to say,

That is just too much physical

Contact.

That said, even I'll admit, an

Alf that offered all that

Commercial claims to but with

Significantly less touching

Would be great.

Unfortunately, a woman who

Worked at a brookdale facility

In south carolina painted a very

Different picture of how

Staffers are trained to work

With dementia patients.

When you first start, they

Have you sit through a series

Of in-services or orientation

And it lasts about a week, but

It's just video, but once

They put you out on the floor,

They don't... They don't give

You any training.

They just stick you out there.

John: well, that's not really

Ideal, is it?

It's hard to retain important

Information just by watching a

Video.

Case in point: this video.

Think about it.

What have you really learned

From this?

Sure, a few random facts about

The long-term care industry that

You'll probably immediately

Forget.

But mainly, you've learned that

It's possible to want to f*ck a

Plate.

And that's a lesson you will

Never forget.

And brookdale insists that it

Offers ongoing training for its

Workers and that its training

Program for dementia care

Workers meets or exceeds state

Guidelines.

But that is not really saying

Much, as some states only

Require two to 30 hours, and

South carolina... Where that

Facility is located... Has no

State minimum at all.

And by the way, if you're

Wondering about why there were a

Bunch of sh*ts of a pond in that

Story, the answer is horrifying.

Because a 90-year-old resident

There, who was supposed to be

Under constant supervision

Before being transferred to a

Memory care unit, died after

Leaving the facility unnoticed

In the middle of the night.

There are signs out here

Warning people about alligators.

Take a look at this one, it

Says, "alligators may live here,

Be gator safe."

In this case, the signs probably

Would not have made a

Difference, according to

Authorities.

We're told the victim likely

Slipped or fell down a steep

Embankment and landed in the

Water, attracting the gator's

Attention.

John: holy f*cking shit.

I honestly don't even know where

To begin there.

But I guess I'd start with: why

Would anyone put an assisted

Living facility next to a

f*cking alligator pond?

That seems like the sort of

Detail that really has to be

Included at the end of one of

Brookdale's heartwarming ads.

This is a special place and

Every day is a new beginning

With lots of smiles and

Memories.

Also, one of our residents

Was eaten by an alligator, so...

Y'know...

There's that.

John: yeah.

There is that.

And that's important information

For people to know, brookdale.

And look, obviously, that's an

Appalling story.

But to be fair, it is hard to

Talk about long-term care

Without showing you at least one

Of those.

Just be grateful I didn't show

You the story where a resident

Jumped from a fourth-story

Window of an alf, or the one

About a nursing home resident

Who set herself on fire, or the

One about a 91-year-old

Suffering from alzheimer's who

Froze to death on christmas day.

Which, by the way sounds like a

Holiday album written by

f*cking bjork.

So what can we do?

Well, obviously, increased

Oversight and enforcement are

Badly needed.

That facility with the

Alligators was eventually fined

By the state for 11 violations,

Including not properly

Performing night checks and

Letting staffing drop below

Required levels, but the penalty

Issued was just $6,400.

And it feels like if you lost a

Loved one in such a horrific

Way, you'd want more

Accountability than "don't

Worry, someone decided their

Life was worth the price of a



And the fact is, there are lots

Of ideas on how to force

Facilities to improve...

Mandating a certain amount of

Money has to go to patient care,

For instance, or that residents

Have access to a minimum amount

Of care per day.

But the bigger fix here might be

To try and make it easier for as

Many people as possible not to

End up in these institutions in

The first place and instead

Receive whatever support they

Need at home.

Nearly 90% of people over 65

Apparently want to stay in their

Home for as long as possible,

Which does make sense.

The problem is, right now, many

Of them can't, because under

Medicaid, nursing home care is

An entitlement... But home-based

Care is not.

To access long-term services and

Supports through medicaid in

Your home, you need a waiver

From your state.

And to be fair, some, like

Washington, do that pretty well.

More than 70% of the medicaid

Money they spend on long-term

Care for older people and adults

With disabilities is spent on

Home and community based

Services... Things like skilled

Nursing visits, home care aides

Who can help with daily tasks,

And even the ability to pay

Family caregivers.

You know, people like those two

Women you saw earlier.

The problem is, other states

Have waiting lists that can be

Many years long, by which point,

Seniors trying to access that

Care can be dead, because,

Sadly, that is how time works.

Nationwide, more than 800,000

People are on these kinds of

Waiting lists.

What we need is reform at a

National level... And there are

Actually some promising

Developments here.

A discussion draft of a bill was

Recently introduced that would

Make home and community-based

Care an entitlement under

Medicaid.

And biden's proposed

Infrastructure plan actually

Calls for $400 billion to be

Spent on those exact services.

And that would be a big deal.

And look, aggressive transition

To home-based care is going to

Need rigorous guardrails and

Oversight to make sure that

Money is not misspent, just in a

Different way.

The last thing I want is, five

Years from now, to be having to

Do a show on the evils of

New for-profit home care

Agencies who've been destroying

People's lives in their own

Homes.

And if you're thinking, "wait,

Five years from now you'll still

Be doing shows in the void?"

Oh, no.

We'll be back in the void.

I don't want to get into

Specifics, but...

Spoiler alert...

It's not a pandemic next time!

It's spiders.

But we do need to do something.

And it all starts with showing

That we give a shit about what

Happens to the elderly and

People with disabilities in this

Country, 'cause right now,

Evidence points to the fact that

We absolutely don't, and all the

Other problems are stemming from

That.

And the longer we continue to

Ignore this, the worse it's

Going to get.

Because the fact is, right now,

This is an industry where the

People in its care are being

Figuratively... And sometimes

Literally... Eaten alive.

And now this.

Announcer: and now, a few

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John: that's our show,

Thanks so much for watching,

We'll see you next week.

Good night.