Later On

A blog written for those whose interests more or less match mine.

Archive for the ‘Healthcare’ Category

Per country: Health spending vs. longevity

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Conrad Hackett posts on Mastodon:

Here’s a scatterplot of health spending per capita (x axis) and life expectancy (y axis) in OECD countries. The lines represent averages.

One country sits alone in the bottom right quadrant due to its much higher health spending and below-average life expectancy.

Source: oecd-ilibrary.org/sites/ae3016

Scatterplot showing averages by country of health spending vs. longevity. The trend is strongly that greater spending means greater longevity, with the US as outlier: great spending, low longevity.

Written by Leisureguy

25 November 2022 at 5:06 pm

Get your flu shot

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Chart show very steep and very early rise of flu infections — in mid-November the infection rate matches late December of previous years.

The chart above is from an article in Vox by Karen Landman. The article begins:

Flu season is here — and early red flags suggest it’s on track to be very, very bad. The latest data from the Centers for Disease Control and Prevention’s (CDC’s) Flu View report show extraordinarily high numbers of positive flu tests reported to the agency from labs around the US. As of November 5, nearly 14,000 positive flu tests had been reported, as shown in the orange line on the above chart. That’s more than 12 times the number reported at the same time in 2019 (shown in the black line).

This year’s early and meteoric rise in flu transmission is at least somewhat related to the fact that more people are being tested for the flu than during previous years. Over the past five weeks, nearly twice as many flu tests were done at clinical labs nationwide as during the same period last year (about 460,000 versus 254,000). More testing means more cases will get picked up.

But there are other signs that these numbers represent real and very scary trends.

For starters, . . .

Continue reading. And get your Covid booster, too, if you haven’t already done so.

Written by Leisureguy

14 November 2022 at 12:27 pm

Covid killing more Whites than Blacks

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In the Washington Post, Akilah Johnson and Dan Keating have a stunning article (gift link, no paywall) — I rate this one as a must-read. I recently discovered that gift links expire, so you can also use a no-paywall link to the archived article, but that version lacks photos and some charts. So use the gift link if it’s still active.

From the article:

After it became clear that communities of color were being disproportionately affected, racial equity started to become the parlance of the pandemic, in words and deeds. As it did, vaccine access and acceptance within communities of color grew — and so did the belief among some White conservatives, who form the core of the Republican base, that vaccine requirements and mask mandates infringe on personal liberties.

“Getting to make this decision for themselves has primacy over what the vaccine could do for them,” said Lisa R. Pruitt, a law professor at the University of California at Davis who is an expert in social inequality and the urban-rural divide. “They’re making a different calculus.”

It’s a calculation informed by the lore around self-sufficiency, she said, a fatalistic acceptance that hardships happen in life and a sense of defiance that has come to define the modern conservative movement’s antipathy toward bureaucrats and technocrats.

“I didn’t think that that polarization would transfer over to a pandemic,” Pruitt said.

It did.

A lifesaving vaccine and droplet-blocking masks became ideological Rorschach tests.

The impulse to frame the eradication of an infectious disease as a matter of personal choice cost the lives of some who, despite taking the coronavirus seriously, were surrounded by enough people that the virus found fertile terrain to sow misery. That’s what happened in northern Illinois, where a father watched his 40-year-old son succumb to covid-19.

And later:

Researchers at the University of Georgia found that White people who assumed the pandemic had a disparate effect on communities of color — or were told that it did — had less fear of being infected with the coronavirus, were less likely to express empathy toward vulnerable populations and were less supportive of safety measures, according to an article in Social Science & Medicine.

Perhaps, the report concludes, explaining covid’s unequal burden as part of an enduring legacy of inequality “signaled these disparities were not just transitory epidemiological trends, which could potentially shift and disproportionately impact White people in the future.”

Translation: Racial health disparities are part of the status quo.

And because of that, government efforts to bring a public health threat to heel are seen by some White Americans as infringing on their rights, researchers said.

“This is reflective of politics that go back to the 19th-century anxieties about federal overreach,” said Ayah Nuriddin, a postdoctoral fellow at Princeton University who studies the history of medicine.

And later:

“We put it on Republicans and politics,” she said, “but I think we should dig deeper.”

That’s what Jonathan M. Metzl, director of Vanderbilt University’s Department of Medicine, Health, and Society, did for six years while researching his book “Dying of Whiteness: How the Politics of Racial Resentment is Killing America’s Heartland.”

Published in 2019, it is a book about the politicization of public health and mistrust of medical institutions. It is a story about how communal values take a back seat to individuality. It’s an exploration of disinformation and how the fear of improving the lives of some means worsening the lives of others.

“I didn’t know it at the time, but I was writing a prehistory of the pandemic,” Metzl said in an interview. “You’re seeing a kind of dying-of-Whiteness phenomenon in the covid data that’s very similar to what I saw in my data.”

Metzl and Griffith, a Vanderbilt professor at the time, conducted focus groups on the Affordable Care Act throughout middle Tennessee including White and Black men who were 20 to 60 years old. Some were small-business owners and security guards. Others were factory workers and retirees.

The divergent medical experiences of Black and White patients permeated Metzl’s focus groups, particularly when the conversation veered toward the politics of health and government’s role in promoting well-being.

“Black men described precisely the same medical and economic stressors as did White men and detailed the same struggles to stay healthy,” Metzl wrote. “But Black men consistently differed from White men in how they conceived of government intervention and group identity. Whereas White men jumped unthinkingly to assumptions about ‘them,’ Black men frequently answered questions about health and health systems through the language of ‘us.’ ”

Tennessee has yet to expand Medicaid under the ACA, a decision fueling rural hospital closures at a rate that eclipses nearly every other state because there isn’t enough money to keep the doors open. Not only would expanding Medicaid have saved hospitals, Metzl wrote, it would have saved thousands of lives — White and Black.

There’s much more. Read the whole thing, either through a gift link or through a no-paywall link (though that link is missing photos and some charts, so the gift link is better — but the gift link expires).

Written by Leisureguy

19 October 2022 at 11:37 am

Southern states don’t like for black people to get government benefits like Medicaid

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The map above is from a post by Kevin Drum that’s worth reading.

Written by Leisureguy

14 October 2022 at 3:07 pm

How a Brazilian doctor got nearly every person in her city to take a COVID vaccine

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The US cultural attitude toward healthcare differs a lot from that of Brazil. Nurith Aizenman reports for NPR:

It’s one of the most impressive COVID vaccination campaigns in the world. And it began with a text message out of the blue.

Dr. Gabriela Kucharski had just dropped off her son at his elementary school when her phone pinged. It was a researcher from a nearby university, asking Kucharski — who heads the health department of Brazil’s southwestern city of Toledo — to call back immediately.

“And I remember that I stopped the car,” says Kucharski, “And I said, ‘Uh … Hello. How are you? What do you need?’ ”

The researcher explained that the pharmaceutical company Pfizer was looking to pick a city in Brazil for a study: They wanted to see if you could stop COVID by vaccinating every single person there — in one fell swoop.

“I think, ‘Oh my God! I am not hearing this!’ ” recalls Kucharski with a laugh.

This was back in May of 2021 — in the thick of the Delta wave. And while the highly effective mRNA vaccines were already plentiful in wealthy countries such as the U.S., in middle income countries such as Brazil vaccines of any type were limited.

Toledo was also still reeling from a giant COVID wave.

“We didn’t have enough hospital beds of intensive care here in Toledo — or anywhere else,” says Kucharski. “Wherever you went, nobody had them.”

Toledo is a prosperous city: It’s a regional center of agribusiness with a fairly small population of 145,000 people. But COVID had overwhelmed it.

Kucharski had been forced to set up makeshift ICU beds. Even those weren’t always enough. She recalls occasions when her staff called to say there was another person they needed to put in intensive care.

“And we didn’t have a place to put this person,” says Kucharski. “And we’d think, ‘My God, What is going to happen? Because we don’t have anything else to do.’ ”

There was no question, she adds, that people were dying as a result. Now, this Pfizer experiment promised literal salvation.

Working in secret

But there was a catch. Toledo was one of eight cities in contention for the study. Pfizer would only choose one. So Kucharski would have to put together a detailed case for why Toledo should be their pick.

In the meantime, says Kucharski, “They told us, ‘You can’t tell anybody.’ Because it was a secret.” As in, she couldn’t even tell the mayor.

When Kucharski reached her office she called  . . .

Continue reading.

Written by Leisureguy

14 October 2022 at 12:32 pm

Republicans becoming more explicit about their outlook and plans

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Heather Cox Richardson:

Last Thursday, October 6, the Republican members of the House Judiciary Committee tweeted: “Kanye. Elon. Trump.”

On Sunday, October 10, after his Instagram account was restricted for antisemitism, rapper Kanye West, now known as “Ye,” returned to Twitter from a hiatus that had lasted since the 2020 elections to tweet that he was “going death con 3 On JEWISH PEOPLE.” This was an apparent reference to the U.S. military’s “DEFCON 3,” an increase in force readiness.

Today, Ian Bremmer of the political consulting firm the Eurasia Group reported that billionaire Elon Musk spoke directly with Russian president Vladimir Putin before Musk last week proposed ending Russia’s attack on Ukraine by essentially starting from a point that gave Putin everything he wanted, including Crimea and Russian annexation of the four regions of Donetsk, Kherson, Luhansk, and Zaporizhzhia, as well as Ukraine’s permanent neutrality. This afternoon, Musk denied the story; Bremmer stood by it.

On Sunday, at a rally in Arizona, Trump claimed that President George H.W. Bush had taken “millions and millions” of documents from his presidency “to a former bowling alley pieced together with what was then an old and broken Chinese restaurant…. There was no security.” (In fact, the National Archives and Records Administration put documents in secure temporary storage at a facility that had been rebuilt, according to NARA, with “strict archival and security standards, and…managed and staffed exclusively by NARA employees.”)

Then Trump went on to accuse NARA of planting documents—his lawyers have refused to make that accusation in court—and, considering his habit of frontloading confessions, made an interesting accusation: “[The Archives] lose documents, they plant documents. ‘Let’s see, is there a book on nuclear destruction or the building of a nuclear weapon cheaply? Let’s put that book in with Trump.’ No, they plant documents.”

Antisemitism, Putin’s demands in Ukraine, and stolen documents seem like an odd collection of things for the Republican members of the House Judiciary Committee, which oversees the administration of justice in the United States, to endorse before November’s midterm elections.

But in these last few weeks before the midterms, the Republican Party is demonstrating that it has fallen under the sway of its extremist wing, exemplified by those like Representative Marjorie Taylor Greene (R-GA), who tweeted last week that “Biden is Hitler.”

Senator Tommy Tuberville (R-AL) this weekend told an audience that Democrats are in favor of “reparation” because they are “pro-crime.” “They want crime,” Tuberville said. “They want crime because they want to take over what you got. They want to control what you have,” Tuberville told the cheering crowd in an echo of the argument of white supremacists during Reconstruction. “They want reparation because they think the people that do the crime are owed that. Bullsh*t. They are not owed that.”

On October 6, New Hampshire Senate nominee Don Bolduc defended the overturning of Roe v. Wade and the subsequent loss of recognition of the constitutional right to abortion. The issue of abortion “belongs to the state,” he said. “It belongs to these gentlemen right here, who are state legislators representing you. That is the best way I think, as a man, that women get the best voice.” Republican super PACs are pouring money behind Bolduc.

Even those party members still trying to govern rather than play to racism, sexism, and antisemitism are pushing their hard-right agenda.

Senate Republicans have introduced a bill to get rid of  . . .

Continue reading.

Written by Leisureguy

11 October 2022 at 8:22 pm

Psychiatry wars: the lawsuit that put psychoanalysis on trial

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Rachel Aviv writes in the Guardian:

Before entering Chestnut Lodge, one of the most elite psychiatric hospitals in the US, Ray Osheroff was the kind of charismatic, overworked physician we have come to associate with the American dream. He had opened three dialysis centres in northern Virginia and felt within reach of something “very new for me, something that I never had before, and that was the clear and distinct prospects of success,” he wrote in an unpublished memoir. He loved the telephone, which signified new referrals, more business – a sense that he was vital and in demand. “Life was a skyrocket,” he wrote.

But when he was 41, after divorcing and marrying again quickly, he seemed to lose his momentum. When his ex-wife moved to Europe with their two sons, he felt as if he had ruined his chance for a deep relationship with his children. His thinking became circular. In order to have a conversation, his secretary said, “we would walk all the way around the block, over and over”. He couldn’t sit still long enough to eat. He was so repetitive that he started to bore people.

His new wife gave birth to a baby boy less than two years after their wedding, but Ray had become so detached that he behaved as if the child wasn’t his. He seemed to care only about the past. He felt increasingly overwhelmed by the stress caused by professional rivals, and he sold a portion of his business to a larger dialysis corporation. Then he became convinced he had made the wrong choice. After finalising the sale, he wrote: “I went outside and sat in my car and I realised that I had become a piece of wood.” The air felt heavy, like some sort of noxious gas.

Ray felt that he had carefully built a good life – the kind he had never imagined he could achieve but, on another level, felt secretly entitled to – and with a series of impulsive decisions, had thrown it away. “All I seemed to be able to do was to talk, talk, talk about my losses,” he wrote. He found that food tasted rotten, as if it had been soaked in seawater. Sex was no longer pleasurable either. He could only “participate mechanically”, he wrote.

When Ray began to threaten suicide, his new wife told him that if he didn’t check into a hospital, she would file for divorce. Ray reluctantly agreed. He decided on Chestnut Lodge, which he had read about in Joanne Greenberg’s bestselling 1964 autobiographical novelI Never Promised You a Rose Garden, which describes her recovery at the Lodge and serves as a kind of ode to the power of psychoanalytic insight. “These symptoms are built of many needs and serve many purposes,” she wrote, “and that is why getting them away makes so much suffering.”

During Ray’s first few weeks at the Lodge, in 1979, his psychiatrist, Manuel Ross, tried to reassure him that his life was not over, but Ray would only “pull back and become more distant, become more repetitive,” Ross said. Ross concluded that Ray’s obsessive regret was a way of staying close to a loss he was unable to name: the idea of a parallel life in which “he could have been a great man”.

Hoping to improve Ray’s insight, Ross interrupted Ray when he became self-pitying. “Cut the shit!” he told him. When Ray described his life as a tragedy, Ross said, “None of this is tragic. You are not heroic enough to be tragic.”

At a staff conference a few months after he arrived, a psychologist said that after spending time with Ray, she had a pounding headache. “He is like 10 patients in one,” a social worker agreed.

“He treats women as if they are the containers for his anxiety and are there to indulge him and pat his hand whenever he’s in pain,” Ross said. “And he does that with me, too, you know? ‘You don’t know what pain I’m in. How can you do this to me?’”

Ross said that he had already warned Ray: “With your history of destructiveness, sooner or later you are going to try to  . . .

Continue reading.

Written by Leisureguy

11 October 2022 at 12:29 pm

The Spread of Catholic hospitals limits reproductive care across the U.S.

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Americans seem to recognize the dysfunction that theocracy brings when they look at, say, Taliban’s rule in Afghanistan, but try to ignore the same dynamic when it occurs in the US, as in the recent Supreme Court ruling denying bodily autonomy to women and in a report (no paywall) by  Frances Stead Sellers and Meena Venkataramanan published in the Washington Post. The report begins:

The Supreme Court decision overturning the constitutional right to abortion is revealing the growing influence of Catholic health systems and their restrictions on reproductive services including birth control and abortion — even in the diminishing number of states where the procedure remains legal.

Catholic systems now control about 1 in 7 U.S. hospital beds, requiring religious doctrine to guide treatment, often to the surprise of patients. Their ascendancy has broad implications for the evolving national battle over reproductive rights beyond abortionas bans against it take hold in more than a dozen Republican-led states.

The Catholic health-care facilities follow directives from the United States Conference of Catholic Bishops that prohibit treatment it deems “immoral”: sterilization including vasectomies, postpartum tubal ligations and contraception, as well as abortion. Those policies can limit treatment options for obstetric care during miscarriages and ectopic pregnancies, particularly in the presence of a fetal heartbeat.

“The directives are not just a collection of dos and don’ts,” said John F. Brehany, executive vice president of the National Catholic Bioethics Center and a longtime consultant to the conference of bishops. “They are a distillation of the moral teachings of the Catholic church as they apply to modern health care.” As such, he said, any facility that identifies as Catholic must abide by them.

The role of Catholic doctrine in U.S. health care has expanded during a years-long push to acquire smaller institutions — a reflection of consolidation in the hospital industry, as financially challenged community hospitals and independent physicians join bigger systems to gain access to electronic health records and other economies of scale. Acquisition by a Catholic health system has, at times, kept a town’s only hospital from closing.

Confusion post-Roe spurs delays, denials for some lifesaving pregnancy care

Four of the nation’s 10 largest health systems are now Catholic, according to a 2020 report by the liberal health advocacy organization Community Catalyst. The 10 largest Catholic health systems control 394 short-term, acute-care hospitals, a 50 percent increase over the past two decades. In Alaska, Iowa, South Dakota, Washington and Wisconsin, 40 percent or more of hospital beds are in Catholic facilities.

“It’s all about market share,” said Lois Uttley, a senior adviser to the hospital equity and accountability project at Community Catalyst. Uttley, who has been tracking hospital mergers and acquisitions since the 1990s, said that with fewer choices, patients today face more difficulty obtaining reproductive services.

In Schenectady, N.Y., Ellis Medicine is in talks with the multistate Catholic giant Trinity Health. Last month, in Quad Cities, Iowa, Genesis Health System signed a letter of intent to enter a partnership with MercyOne, also part of Trinity Health. And this semester, Oberlin College had to find a new provider to prescribe contraceptives after outsourcing student health services to a Catholic system that would not provide them.

In rural northeast Connecticut, residents are protesting the prospect of their 128-year-old hospital becoming part of a Catholic system and the potential impact on reproductive services.

“It would be very troubling to see . . .

Continue reading. (no paywall)

There’s much more, and it’s clear that Catholic hospitals not only will not tolerate abortions nor will allow contraception or sterilization. Religious rules will shape medical care.

Written by Leisureguy

10 October 2022 at 1:07 pm

The hallmarks of good therapy

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Like many things, therapy can be good or bad, and one wants to avoid bad therapy. (Terminating a relationship with a therapist is — or should be — straightforward: “This isn’t working for me, so I’m going to discontinue the sessions.”) What you should be looking for is described in an excellent post at GoodTherapy.org, which begins:

There are many models and types of therapy to choose from. We believe there are a handful of common denominators present in all forms of healthy, ethical therapy. These elements are described here:

NONPATHOLOGIZING

Viewing a person as greater than his or her problems is the hallmark of nonpathologizing therapy. It does not mean problems do not exist; rather, it means one does not view the problems as the whole person. Working nonpathologically requires a shift in both the understanding and the approach to pathology.

Here is the understanding: Most of the issues people go to therapy for are not organic disorders—they are not hardware problems, they are software problems. These issues are the result of the person’s psyche doing the best it can to deal with life experiences—to adapt, survive, and prevent the person from ever getting hurt again. Certainly, there are some “disorders” that are purely organic in etiology (meaning a hardware problem that is genetic, biochemical, or neurological), such as some forms and instances of psychotic and mood disorders. However, the nonorganic problems people bring to therapy, which are often labeled as disorders, are actually very organized, orderly, and systemic psychological reactions. Thus, the word disorder is simply inadequate and misleading. Adding insult to injury, being labeled with a disorder can provoke shame and inadequacy and make some people feel worse. Read more about the GoodTherapy.org position on the concept of disorder, here.

Here is the approach: Treatment of a software problem requires curiosity and compassion in order to undo the orderly and organized response to suffering. Treatment of a software problem does NOT warrant psychological amputation—this is what the medical model does to pathology. When a therapist joins a client in getting rid of a symptom instead of exploring its depths, the therapist is overlooking the client’s opportunity to heal. We do justice to a person’s true nature when we remember that behind the layers of protection, no matter how self-destructive or hurtful to others an individual has been, there is a loveable and vulnerable person at the very core. What about sociopathy?

EMPOWERING

Therapists who empower the people they work with in therapy maintain the belief that people have the capacity for change and are equipped with the inner resources to change, even if they never do. Therapy is based on the belief that people can heal if they want to and if they are able to contribute to their own growth what is sufficient and necessary.

Unfortunately, there is a tendency, especially in medical model treatment environments, to view people as fundamentally flawed. When a therapist views a person as flawed or incapable of change, the person is more likely to feel and become flawed. When the therapist is able to see beyond a person’s wounds and defenses, he or she is more likely to discover his or her true nature. Some people may not be able to overcome their obstacles and heal in this lifetime, but the therapist should not become an additional barrier.

COLLABORATIVE

The spirit of collaborative therapy is summarized in the words of Albert Schweitzer who wrote, . . .

Continue reading.

The site has articles on many types of therapy, including one that I personally found to be both interesting and helpful: psychosynthesis. In the list of books I find myself repeatedly recommending, you’ll find Pierro Ferrucci’s book What We May Be, an introduction to (and workbook in) psychosynthesis.

Written by Leisureguy

9 October 2022 at 8:20 am

Some hospitals rake in high profits while their patients are loaded with medical debt

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The Canadian healthcare system is by no means perfect, but IMO it’s much better than the rapacious hypercapitalistic US system where the drive to grow profits penalizes patients. Noam Levey reports for NPR:

PROSPER, Texas [ironic name, eh? – LG] — Almost everything about the opening of the 2019 Prosper High School Eagles’ football season was big.

The game in this Dallas-Fort Worth suburb began with fireworks and a four-airplane flyover. A trained eagle soared over the field. And some 12,000 fans filled the team’s new stadium, a $53 million colossus with the largest video screen of any high school venue in Texas. Atop the stadium was also a big name: Children’s Health.

Business has been good for the billion-dollar pediatric hospital system, which agreed to pay $2.5 million to put its name on the Prosper stadium. Other Dallas-Fort Worth medical systems have also thrived. Though exempt from taxes as nonprofit institutions, several, including Children’s, notched double-digit margins in recent years, outperforming many of the area’s Fortune 500 companies.

But patients aren’t sharing in the good times. Of the nation’s 20 most populous counties, none has a higher concentration of medical debt than Tarrant County, home to Fort Worth. Second is Dallas County, credit bureau data show.

The mismatched fortunes of hospitals and their patients reach well beyond this corner of Texas. Nationwide, many hospitals have grown wealthy, spending lavishly on advertising, team sponsorships, and even spas, while patients are squeezed by skyrocketing medical prices and rising deductibles.

A KHN review of hospital finances in the country’s 306 hospital markets found that several of the most profitable markets also have some of the highest levels of patient debt.

Overall, about a third of the 100 million adults in the U.S. with health care debt owe money for a hospitalization, according to a poll conducted by KFF for this project. Close to half of those owe at least $5,000. About a quarter owe $10,000 or more.

Many are pursued by collectors when they can’t pay their bills or hospitals sell the debt.

“The fact is, if you walk into a hospital today, chances are you are going to walk out with debt, even if you have insurance,” said Allison Sesso, chief executive of RIP Medical Debt, a nonprofit that buys debt from hospitals and debt collectors so patients won’t have to pay it.

A community shadowed by debt

Across the Dallas-Fort Worth metro area — the nation’s fourth-largest — the impact has been devastating.

“Medical debt is forcing people here to make incredibly agonizing choices,” said Toby Savitz, programs director at Pathfinders, a Fort Worth nonprofit that assists people with credit problems. Savitz estimated that at least half their clients have medical debt. Many are scrimping on food, neglecting rent, even ending up homeless, she said, “and this is not just low-income people.”

David Zipprich, a Fort Worth businessman and grandfather, was forced out of retirement after hospitalizations left him owing more than $200,000.

Zipprich, 64, had spent a career in financial consulting. He owned a small bungalow in a historical neighborhood near the Fort Worth rail yards. His daughters, both teachers, and his four grandchildren lived nearby. He had health insurance and some savings, and he’d paid off his mortgage.

Then in early 2020, Zipprich landed in the hospital. While driving, his blood sugar dropped precipitously, causing him to black out and crash his car.

Three months later, after he was diagnosed with diabetes, another complication led to another hospitalization. In December 2020, covid-19 put him there yet again. “I look back at that year and feel lucky I even survived,” Zipprich said.

But even with insurance, Zipprich was inundated with debt notices and calls from collectors. His credit score plummeted below 600, and he had to refinance his home. “My stress was off the charts,” he said, sitting in his neatly kept living room with his Shih Tzu, Murphy.

Overall in Tarrant County, 27% of residents with credit reports have medical debt on their records, credit bureau data analyzed by KHN and the nonprofit Urban Institute shows. In Dallas County, it’s 22%.

That’s more than five times the . . .

Continue reading.

Written by Leisureguy

28 September 2022 at 12:08 pm

That shortage of home healthcare workers

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Kevin Drum has an excellent post that has two graphs. The first shows that the shortage is real, the second offers a possible reason for the shortage. Here’s the second:

His post is worth reading. In it, he notes:

The only way this gets better is if we pay home health care workers considerably more than we do now. But of course lots of people can’t afford that. And that’s why this is ultimately a Medicare problem: we desperately need to make long-term nursing care part of Medicare, and we need to pay workers more if we want to attract higher quality folks. This would be expensive, but it’s inevitable that it will happen someday. The sooner we accept that the better.

Written by Leisureguy

26 September 2022 at 8:03 am

The unspoken reason women leave the workforce

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Terry Weber, CEO of Biote, has an interesting article in Fast Company (no paywall):

It’s no secret women are leaving the workplace in record numbers. Millions of women are now gone from the workforce compared to pre-COVID-19, and while men are rapidly recouping lost jobs, women are returning to the workforce at a much slower rate.

The most commonly cited reason is sky-high childcare costs, caregiving responsibilities, and pressure or burnout from juggling multiple obligations. Analysts are eager to point to the many reasons that would cause women, specifically, to leave the workforce. And yet they continue to leave one reason off the list. 

The Taboo of Menopause in the Workplace

Currently, up to 20% of the U.S. workforce is affected by menopause symptoms.

And unlike women who leave the workforce because of childcare challenges, women who struggle with menopause symptoms rarely find established company guidelines, support, or a sympathetic ear.

As a female CEO in male-dominated industries for most of my career, I can almost see the eye-rolling. How can this be a severe issue when you’ve never heard anyone say menopause was their reason for ending employment?

Working in the life sciences industry, I’ve heard directly from patients whose lives were being upended by menopause symptoms but didn’t think to seek medical help until their symptoms became too disruptive at work.

But that is only the beginning. Once someone decides to seek help, an alarming number of health care providers are uncomfortable treating menopause or unfamiliar with the variety of symptoms that hormonal imbalances can cause. Even when women do seek medical care, they are often . . .

Continue reading. (no paywall)

Written by Leisureguy

24 September 2022 at 8:05 pm

US hospitals are failing their mission (unless their mission is to gouge as much money as possible)

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I’ve had interactions a couple of times with a hospital here in Canada. Once I thought I might be having a heart attack. I called 911, was advised to chew an aspirin (faster absorption), and was picked up and taken to the hospital by an ambulance. (I learned then that going via ambulance has the advantage that you are taken directly into the emergency ward — no waiting room, no stopping at the desk for an interview.) I got an ECG, blood was tested for presence of proteins that indicate heart stress, and everything was fine. I was not having a heart attack, and I returned home, feeling a little sheepish. Total cost: $85 for ambulance. The question of paying the hospital never came up because we don’t do that up here (or in other advanced countries).

The second time was more serious: I got a pacemaker installed and spent three days in the hospital, two in the intensive care unit. Total cost: $3.50 for parking when The Wife picked me up.

In the US, home of hypercapitalism, the situation is different, as shown by two front-page reports in the NY Times today. Here are the two articles (no paywall):

They Were Entitled to Free Care. Hospitals Hounded Them to Pay.

How a Hospital Chain Used a Poor Neighborhood to Turn Huge Profits

Hypercapitalism is highly profitable for a very few — a wealthy very few — but the overall effect on the public and the exploited workers of those companies is horrible.

Written by Leisureguy

24 September 2022 at 7:35 am

After decades in prison, Jack navigates the strange, beautiful outside world

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More and more, I think the most important facet of character is kindness. If we could some teach people to be kind to each other, our lives would be so much better.

The video below comes via Psyche, which notes:

Jack Powers was incarcerated in 1990 following a conviction for bank robbery. In prison, he witnessed a murder and received death threats for testifying against the perpetrators. The experience left him with post-traumatic stress disorder. The next 33 years of his life would be defined by a long and excruciating series of prison transfers and heinous neglect of his diagnosed mental illness, including 12 years in extreme solitary confinement. Amid his struggle to stay alive in these cruel conditions, Powers also embarked on a regimen of self-improvement and activism, becoming an important voice in the prison reform movement from behind bars. In 2022, Powers was finally released and he set out to start his life anew.

A film commissioned by the organisation Solitary Watch, which fights against the widespread use of solitary confinement in the United States, Tuesday Afternoon (2022) follows Powers in the first hours following his release as he travels from a prison in Pennsylvania to a halfway house in New Hampshire. In the US director Pete Quandt’s sensitive hands, this . . .

Continue reading.

Written by Leisureguy

23 September 2022 at 2:47 pm

A Rural Doctor Gave Her All. Then Her Heart Broke.

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The healthcare situation is getting worse. Oliver Whang has a sobering report (gift link, no paywall) in the NY Times:

CLAY, W.Va. — For most of her life, Dr. Kimberly Becher has moved fast. She was married at 21, started medical school with a 3-month-old and has trained for two marathons. In the halls of her clinic, between a bank and a Baptist church in Clay — the county seat of Clay County with a population of 396 — she walks fast, often looking down at her phone as she speeds around corners. She talks fast, too, organizing her staff and speaking crisply with a mountain accent.

But her aspect changes when she enters an exam room where a patient is waiting. She slows perceptibly, and the otherwise intense beam of her attention softens.

Recently, Dr. Becher, in bright pink scrubs, sat with Zane Wilkinson, 15, who had come in for a monthly checkup in the company of his mother, Julia Wilkinson. He wore a newsboy cap and a blue surgical mask; he has Behcet’s disease, a rare autoimmune disorder that, as Ms. Wilkinson described it, “is like having multiple sclerosis, Crohn’s, lupus, and arthritis in one bundle.” Zane had been on chemotherapy for five years with mixed results and had not attended school in person since before the pandemic. But the recent combination of drugs was working well, his mother told the doctor: “He’s almost back to being a normal boy.”

Dr. Becher made the diagnosis in 2017, after the family had spent years bouncing among doctors in confusion. (“They call her Dr. House, because she can figure out things nobody else can,” Ms. Wilkinson said of Dr. Becher.) The question in July was whether Zane could safely return to the classroom despite the risk of Covid-19.

“So, what do you think about school?” Ms. Wilkinson asked Dr. Becher.

The doctor tilted her head. “Well, I think you might be at a point where you have to consider the social benefits in addition to the health risks,” she said. “Like, I don’t want you to feel like you can’t have quality of life just because you might get Covid. You’ve got to live your life.” Zane and his mother nodded.

“Hoover over Clay?” Dr. Becher asked Zane, referring to two nearby high schools that he could attend, Clay County High School and Herbert Hoover High School. Ms. Wilkinson, who teaches at Hoover, laughed. “Would you like to talk about that?” she asked Zane.

“No, not really,” he said.

It was the first thing he had said during the visit, and all three of them laughed.

Dr. Becher has spent eight years as a family physician in Clay, working for Community Care of West Virginia, a federally qualified health center. West Virginia tops most national lists of poverty and poor health outcomes: the highest prevalence of obesity, coronary disease and diabetes; the fourth-highest poverty rate; the second-highest prevalence of depression; the shortest life expectancy. In Clay County, there is no public transportation, no stoplight, no hospital. Most residents live in a food desert. And as one of only two family doctors in the county, Dr. Becher has an all-encompassing job. She visits children in their living rooms to vaccinate them, organizes food drives and administers Suboxone to treat opioid addiction.

But as the political climate around Covid-19 grew heated, and as some of Dr. Becher’s patients and neighbors began to dismiss the science, she became frustrated, then angry. She began to run more, sometimes twice a day, for hours at a time, “raging down the road.” She was mad about the widespread distrust of vaccines; mad about teachers who went to school even after testing positive for the virus; mad about the endemic food insecurity, the county’s lack of affordable transportation, the high rate of fatty liver disease.

The indignities layered one atop the next, forming a suffocating stack. More than anything, Dr. Becher was mad at how she couldn’t seem to do anything about any of it. Some days she went home from work, chugged a beer and ran for miles. Then, on April 17, 2021, her heart broke.

In 1981, two psychologists at the University of California, Berkeley, published a paper in the Journal of Occupational Behavior on “the burnout syndrome.” The authors, Christina Maslach and Susan E. Jackson, set out to measure the degree of . . .

Continue reading. (gift link, no paywall)

I think Covey was right to distinguish one’s circle of concern (things they are concerned about but do not control or influence) and their circle of influence (things they can control or at least influence). One’s own attitudes are well within their circle of influence. More here.

Written by Leisureguy

20 September 2022 at 12:35 pm

Has any government — local, regional, national — figured out how to deal effectively with mental illness?

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If any municipal, county, state/provincial, or national government has a working plan for a humane and reasonably effective program for protecting both society (the public) and the mentally ill, then the program could be replicated. So far as I can tell, no government has worked out a solution.

Michael Wilson, in the NY Times, describes one example (gift link, no paywall) of how there has been no effective way to deal with a single issue:

“New York City 911,” the emergency dispatcher answered. “Do you need police, fire or medical?”

“I need police — 312 Riverside Drive,” the caller said in a hushed voice. “The lady in Room 340 on the third floor is cutting herself. She’s mentally ill. She’s buck naked and she’s mentally ill and she’s cutting herself with a razor.”

The dispatcher asked follow-up questions and assured the man: “Help is on the way.”

That call, just past midnight on Dec. 16, was the first of five that day reporting dire emergencies at that same address. Fights, stabbings, sexual assaults, shots fired — all at 312 Riverside Drive. It was the location of thousands of 911 calls going back more than two years — without question, the most dangerous address in all of New York City by this measure.

Again and again, police officers had raced to the tree-lined block of the Upper West Side, between West 103rd and 104th Streets. Firefighters and paramedics met them there.

But the responses all ended the same way: The emergency vehicles turned and left, their sirens off. The police, over time, stopped responding to the calls at all.

Because there is no 312 Riverside Drive.

The calls had been treated like emergencies; now they were a mystery. Who was making them? Why? Was it a coordinated attempt to disrupt the police, or an epic, yearslong prank?

Detectives eventually traced the calls to a single cellphone in a building on West 43rd Street that had once been the Hotel Times Square, but for years has offered affordable housing and counseling to vulnerable men and women in the city.

The police found the phone on the 14th floor, and with it, the man behind every call.

And so the mystery became a puzzle — one that has confounded an entire team of lawyers, caregivers and social workers. His remarkable case is an extreme example of a familiar dynamic. It is one that plays out all over New York when the city’s law enforcement apparatus is confronted with people whose behavior is erratic or delusional, but who do not seem to pose any real danger to others.

This tension feels immediate in New York City, where people returning to their offices after months at home are facing reminders of some of the most visible ways mental illness manifests itself on subway platforms or street corners. A vein of behavior outside the norms runs through the streets, not easily addressed by handcuffs or medication.

One man with a cellphone has created enough havoc to be hauled over and over into court, but not enough to warrant a prison cell. He knows it’s wrong, and he apologizes to the judge, but he won’t stop.

Help is always on the way, but it never quite reaches him.

Vickie Mwitanti walked into her office building near the criminal courthouse on Lower Manhattan’s Centre Street in June and entered the elevator, pushing the button for the 20th floor. She was a lawyer with the New York County Defender Services, a churning and grinding job that can make idealistic young people cynical and exhausted. But three years in, she felt invigorated by the work. She had just been assigned a new client with an unusual case.

Before the elevator doors shut, a tall, older man, 70 and wearing thick eyeglasses, darted inside. He smiled.

“We bonded over the weather, but it was not small talk,” Ms. Mwitanti said later. “He complimented my dress, and we had this engaging back and forth.”

When the elevator arrived at 20, both of them got out. She heard the man approach the front desk of her office, and she realized that he was her new client.

He was not what she had expected. “He was just so warm and kind and sweet,” she recalled later.

His name was Walter Reed.

Mr. Reed had arrived in New York City in the late 1990s, well into his 40s, and trouble followed.

He was arrested and charged with

Continue reading. (gift link, no paywall)

Written by Leisureguy

17 September 2022 at 8:30 am

FutureMe and future walks

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Photo taken today by The Wife, across the street from her apartment.

Today I received my first-of-the-month FutureMe email from one year ago — 9/1/2021 — in which I commented on a FutureMe email from 9/1/2020 that I had just received back then. I am always interested to read these letters from the past, since often I’ve forgotten various aspects, but I was especially interested in this one because of three goals it mentioned.

A year ago, I set goals in three areas:

  1. Diet and weight — in 2020, I learned from the 9/1/2021 letter, I had drifted somewhat from my whole-food plant-based diet, but by 9/1/2021 I had found my footing again, and my goal was to maintain my WFPB diet and also lose some weight. 
  2. Finance — I was still working out how to handle money in retirement. I wasn’t doing bad, but it was clear there was room for improvement. My goal was to improve.
  3. Exercise — a year ago I was getting regular exercise through Nordic walking, and I was optimistic about maintaining that and set a goal to keep going.

Diet and weight

I would say that I have pretty much gotten diet completely sorted. As I have noted, I now build balanced whole-food plant-based meals without really having to think about it. I now know, as one knows a language, my diet and its foods. That is, as when I speak or write, I can focus on the thought I want to express without having to think at all about how to express it, because words, sentences, and structure are immediately available without conscious effort (very unlike when first learning a new language, when much conscious effort is required to express a thought). 

For example, I recently put together a good meal without really thinking about it, and only later added notes to show how the ingredients fit the Daily Dozen template.

Weight, on the other hand, has remained largely unchanged. I haven’t gained over the year, but also haven’t lost. On 1 September 2021, I weighed 191.3 (lbs, not kg). Today, 192.8. My goal is 180.0 — oh, hell: 179.0. And I have made some progress in things that will help — for example, I now rarely eat anything after 5:00pm. But obviously I am still eating too much. (I’m thinking about the big salad I had last night.) 

So the goal for the coming year is to continue the whole-food plant-based approach, cut back somewhat on quantity, and reach 179.0 lbs. 

Finance

I’m a man of modest means, but I finally did — at long last — figure out how to handle money. I’m not talking investments, I’m talking just ordinary daily finance, based on a paycheck (or in my case a Social Security check plus a tiny monthly pension check) — the kind of money management typical of regular employees.

In looking at my 1 September letters from 2020 and 2021, I can see that I was making progress, and that I had the good sense to view setbacks as practice — experiences from which I could learn and thus improve my performance — and not as failures.

And it worked: I did learn and improve. I feel financially confident now, and I have the pleasant sensation that I know what I’m doing, that I now understand how it works. I can see in the worksheet records I use as I plan and track my spending that I’ve steadily improved over the past two years. That’s a good feeling.

I should note that being a Canadian resident has helped. When I abruptly had to get to the hospital and have a pacemaker installed (see this post), it was disruptive (and broke my exercise habit — see next section), but it had zero effect on my finances. Moreover, I did not have to participate in a lengthy and frustrating financial struggle with the insurance company, the hospital, and the surgeon. Indeed, there was no financial struggle at all because no money was involved.

I saw my doctor, he sent me to the hospital, I stayed in the hospital for a day before and a day after the surgical team did their work, and I came home with a new pacemaker. I did not have to stop by the billing office or talk to anyone about money, nor did I have to pay a penny. (Well, strictly speaking, that’s not true: my wife had to pay $3.50 for parking the day she picked me up.)

I also don’t have to pay for the every-six-weeks checkup at the pacemaker clinic (nor for the remote monitor they gave me so the the clinic can keep an eye on my heart activity day to day). 

As I recall, it’s not like that in the US. To be fair, the US does not want it to be like that — at least not the powerful part of the US that makes a great deal of money from the way things are done in the US now.

Exercise

The 9/1/2021 letter shows that I was doing very well with my exercise. And in fact I continued a good exercise regimen until a couple of days before I learned I needed a pacemaker. I had taken a walk just around the block and had had to stop twice to rest. Obviously, something was wrong, and the doctor visit two days later determined what it was, and the problem was fixed.

However, for six weeks following the surgery, I had to be very careful in using my arms, and that layoff broke my exercise habit. 

Today, however, that FutureMe letter written a year ago, when I was doing so well on exercise, made me realize (a) I had to resume the habit of regular exercise, and (b) I could do that because, as that letter showed, I had been there before.

Reading how well I had been doing was highly motivating, and so today I set out on a walk that I intend to be the first of a lengthy sequence of daily walks. Because I see this as a long-term effort, I did not push myself — no trying for 3.5mph, quite satisfied with 3.1mph. (A “brisk” pace starts at 3.0mph, and a brisk pace, with sufficient duration, provides cardio benefits. So 3.1mph is fine.)

Since my surgery, I’ve taken a couple of walks with my Nordic walking poles, but during those my heart rate stubbornly stayed within the Aerobic range, which doesn’t garner much in the way of PAI points — around 4 or 6 points for each walk. To get a good number of points, the heart rate must reach the range of VO2 Max (or at least Anaerobic).

I didn’t know whether my heart was just more efficient post-surgery, or whether the pacemaker capped my heart rate. So I decided not to worry about it and just resume walking, which in any case would be good.

But — lo! Also, behold! — the low heart rate may have been an artefact of my Amazfit Band 5. Here are screen shots for today’s walk (2906 steps):

That abrupt jump in heart rate at 9 min 36 seconds seems clearly to be something in the watch, not something in me. I just walked steadily for the entire walk and didn’t notice any particular change in breathing (though I was breathing more deeply) or heart rate. It seemed like an easy walk to me, with no real stress. But today I got 45 PAI (!). When one’s heart rate is in the VO2 Max range, PAI points accumulate rapidly.

I plan to continue this 1.5-mile route for a week or two before I try my 2-mile route. I may remain at 2 miles for a while. My prime objective is consistency. Speed and duration will emerge as a by-product pf consistency.


.
So overall, things are looking up. And those FutureMe letters do have an effect. Give it a try sometime.

Written by Leisureguy

1 September 2022 at 6:59 pm

When Private Equity Takes Over a Nursing Home

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The world “evil” is often casually tossed around, but in the situation described in Yasmin Rafiei’s article in the New Yorker (no paywall), I think it clearly applies. The article begins:

When St. Joseph’s Home for the Aged, a brown-brick nursing home in Richmond, Virginia, was put up for sale, in October, 2019, the waiting list for a room was three years long. “People were literally dying to get in there,” Debbie Davidson, the nursing home’s administrator, said. The owners, the Little Sisters of the Poor, were the reason. For a hundred and forty-seven years, the nuns had lived at St. Joseph’s with their residents, embodying a philosophy that defined their service: treat older people as family, in facilities that feel like a home.

St. Joseph’s itself was pristine. The grounds were concealed behind a thicket of tall oaks and flowering magnolias; residents strolled in manicured gardens, past wooden archways and leafy vines. Inside the bright, two-story building, the common areas were graceful and warm—a china cabinet here, an upright piano there. An aviary held chirping brown finches; an aquarium housed shimmering fish. The gift shop, created in 2005, to fund-raise for tsunami relief in the aftermath of the Indian Ocean earthquake, sold residents’ handmade aprons and dish towels. People gathered everywhere: in line for the home’s hair salon, over soup in the dining rooms, against handrails in the hallway, where the floors were polished to a shine. “Take a deep breath,” a resident, Ross Girardi, told me, during a visit in May of 2021. He reclined in a plush armchair. “Deeper! What don’t you smell? A nursing home.”

The home fostered unexpected relationships. Girardi, a former U.S. Army combat medic, first discovered St. Joseph’s as a volunteer, in the early nineteen-eighties; thirty years later, he and his wife, Rae, decided to grow old there. Jennifer Schoening, a floor technician, was unhoused before she started at St. Joseph’s. A social worker from the nursing home had approached her on a street corner in Richmond, where Schoening was panhandling, and told her that the Little Sisters had an opening. She began working in the pantry, serving meals and brewing fresh coffee, and found an apartment nearby. Ramon Davila, the home’s maintenance technician at the time, worked in a shop next door to Schoening’s supply room. The two got married on the terrace in front of St. Joseph’s last year. “It got to be that the building wasn’t just my safe spot,” Schoening said. “He was my safe spot.”

The Little Sisters of the Poor was founded by Jeanne Jugan, who, in the winter of 1839, took in an elderly widow off the streets of Brittany. Jugan is said to have carried the woman, who was blind and partially paralyzed, up her home’s narrow spiral staircase—and given up her own bed. (Jugan herself slept in the attic.) From this first act of care, the Little Sisters grew. Jugan took in two more women, then rented a room to house a dozen. A year later, she acquired a former convent to support forty elderly people. Charles Dickens, after visiting one of Jugan’s homes in Paris, described the experience in the English magazine Household Words. “The whole sentiment,” Dickens wrote, “is that of a very large and very amiable family.”

At the organization’s peak, in the nineteen-fifties, the Little Sisters of the Poor owned fifty-two nursing homes in the United States. Today it runs twenty-two. “In general, we like to have ten Little Sisters in each home,” Sister Mary John, a former assistant administrator at St. Joseph’s, said. But, since 1965, the number of Catholic sisters in the U.S. has dropped from roughly a hundred and eighty thousand to some thirty-nine thousand, according to the Center for Applied Research in the Apostolate. As a result, the Little Sisters have withdrawn from many of their nursing homes. Typically, the facilities have been sold to nonprofits. A large Catholic health-care system had expressed interest in buying St. Joseph’s, as had the Catholic Diocese of Richmond. “But the pandemic and the lockdowns of nursing homes made it difficult,” Sister Mary John said, of securing a buyer. In the spring of 2021, an offer materialized from the Portopiccolo Group, a private-equity firm based in Englewood Cliffs, New Jersey, which then had a portfolio of more than a hundred facilities across the East Coast. “They said they like to keep things the way they are,” Sister Mary John told me.

The deal was finalized by June. Portopiccolo’s management company, Accordius Health, was brought in to run the home’s day-to-day operations. Staffers recall that, at an early town hall, Kim Morrow, Accordius Health’s chief operating officer, repeatedly said the company wouldn’t institute significant changes. But many staff members felt a disconnect. Someone asked if the number of residents in each room would change. A staffer remembered Morrow saying, “That might change. We might double it.” (Morrow doesn’t recall saying so.) At another town hall, Celia Soper, Accordius Health’s regional operations director, told St. Joseph’s staff, “We see that you all work hard. But it’s time we start working smart.”

Nearly a quarter of the hundred-person staff had been with the home for more than fifteen years; the activities director was in her forty-fifth year. But the ownership change precipitated a mass exodus. Within two weeks, management laid out plans to significantly cut back nurse staffing. Some mornings, there were only two nursing aides working at the seventy-two-bed facility. A nurse at the home, who spoke on condition of anonymity for fear of retribution, told me, “It takes two people just to take some residents to the bathroom.” (When reached by e-mail, a Portopiccolo spokesperson said, “We never made any staffing cuts during the transition.”)

The home was renamed Karolwood Gardens, and the new management filed for a license to admit higher-needs residents, who can be billed at higher rates through Medicare. The aquarium on the second floor disappeared. So, too, did the aviary. Residents’ crafts were removed from the gift shop. No longer did the kitchen serve an eclectic variety of main dishes: turkey tetrazzini, salmon with lobster sauce, or Reuben sandwiches. Now residents were commonly given an option of ground beef. Some days, the kitchen was so short-staffed that the dining hall wasn’t set up, and residents took meals alone in their rooms.

The attentiveness of the nursing staff plummeted. Mary Cummings, a ninety-seven-year-old resident who had lived at St. Joseph’s for six years, went seven days without a bath. Betty Zane Wingo, a ninety-four-year-old resident, went several months without having her hair washed. A resident who suffered from a severe lung disease told me that, one evening, her oxygen tube slipped out, and it took an hour and a half and a call to 911 to get it plugged back in. Several family members told me they called the nursing station to express concerns but that no one picked up. On morning shifts, the home’s nurse aides now changed briefs so saturated with urine they’d turned brown.

Bob Cumber cherished the care that his mother, Bertha, had received under the Little Sisters. One Christmas Eve, a nun had stayed late to file a hangnail on Bertha’s foot. After Portopiccolo acquired the home, Bertha appeared increasingly unkempt. Her hair was dirtier, her teeth coated in plaque. Whenever Cumber visited, she asked him for water. Bertha was a hundred and four years old, but the decline in her care was conspicuous. She had lost weight and developed open bedsores on her hip and buttocks and near her anus. Cumber tried to share his concerns with her nurses. “When I called there, I was put on eternal hold,” he said. Bertha told her son she was ready to pass away. “Mama,” Cumber said, “I don’t want you to leave.” . . .

Continue reading. (no paywall)

Treating people as private equity does for the sole purpose of making money is evil. A good government would protect its citizens from this mistreatment.

Written by Leisureguy

25 August 2022 at 12:25 pm

The Best Diet for Treating Atrial Fibrillation

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I don’t suffer from A-fib, and if I did, my pacemaker would be a big help, but I know some who do. This video is striking.

Written by Leisureguy

24 August 2022 at 6:19 am

The Netherlands makes aging and long-term care a priority. In the US, it’s a different story.

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The headline, taken directly from a Boston Globe report by Robert Weisman, is tactful about the US approach. (If the paywall is a problem, read the report here.)

THE HAGUE — A demographic tidal wave looms. By 2040, one in four Dutch residents will be over 65. The same “silver tsunami” is building in much of the developed world, including the United States. And it will strain the budgets and test the ingenuity of nations.

Here in the Netherlands, a social welfare state roughly twice the size of Massachusetts, leaders have been planning for this graying of society for a half century. Drawing on public funds, a sense of shared responsibility, and compulsory insurance premiums paid throughout their working lives, those born in the post-World War II baby boom take for granted that they’ll have the home and nursing care they need as they age.

“It’s pretty much undebated,” said Bram Wouterse, assistant professor in health economics at Erasmus University in Rotterdam. “People know that when you get old, the government will provide good care.”

In the United States, it’s a far different story. The question of who will take care of older Americans, and who will foot the bill, keep many awake at night. A scathing report in April from the National Academies of Sciences described the US long-term care system as “ineffective, inefficient, [and] fragmented.” The wealthiest can afford quality care; those with less money must navigate a Byzantine system that forces them to spend down their savings to get a nursing home bed.

And despite that increasingly glaring gap, there is little chance this picture will change any time soon. The cost would be vast. Older Americans are projected to account for more than 20 percent of the US population within two decades, but addressing their needs in a sweeping fashion would require a political will that is not yet visible.

Still, the example set by the Netherlands is intriguing — and chastening.

A visit to this nation of 17 million, jutting into the North Sea, offers a look at a society grappling seriously with the struggles and costs of aging. Like their American counterparts, the Dutch face not only a rapidly growing older population but also a worsening shortage of elder care workers. Those trends are fueling anxieties on both sides of the Atlantic. But in the Netherlands, there’s an age-friendly game plan, bolstered by a broad consensus that older people deserve to get the care they need, and that they shouldn’t feel isolated or warehoused.

The Dutch use the word solidariteit, or solidarity, to describe their commitment to older residents. The Netherlands was the first country in Europe to introduce a mandatory long-term care system in 1968. It has updated and refined its plan several times since, holding to its vision of universal care even as it relies more on managed competition between nonprofit providers and insurers to control costs. The most recent overhaul, in 2015, aims to help residents age in place.

People want to stay at home, said Theo van Uum, director of long-term care at the Dutch Ministry of Health, Welfare, and Sport in The Hague. That new emphasis also anticipates and seeks to ease the growing weight of nursing home care on the national coffers.

A tour of senior sites in the Netherlands, from diverse cities dating back to the 12th century to rural hamlets surrounded by tulip fields, reveals some surprises. The Dutch approach looks nothing like a rigid nationalized system; it’s varied, experimental, and humane.

Its much-imitated De Hogeweyk in Weesp, a town on the outskirts of Amsterdam, seeks to “de-medicalize” dementia care in a miniature Dutch village, complete with grocery store, tavern, and barbershop, where residents roam with minimal supervision. Nursing homes have been reimagined in the last decade; instead of hospital-style facilities, many now look more like . . .

Continue reading.

Written by Leisureguy

21 August 2022 at 10:58 am

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