My parents ended up being forced by circumstances to move into a retirement home about five years ago. Fortunately, the place turned out to be run by people who mostly cared about their clients and so my parents' lives were basically OK, except that the food sucked (which AFAICT is par for the course at retirement homes). But a few months ago the place was acquired by a different company, which is trying to squeeze out higher profits. Staffing and services are being cut, and prices are going up. Even the food got worse, which I didn't think was even possible. The response when someone complains is, "If you don't like it you are free to leave."
Yeah, right. My barely mobile 90-year-old parents, one of whom has Parkinson's, are just going to pack up and go. They know perfectly well that they have a captive audience.
Thankfully, my mother died before the acquisition, and my father died last week, only a few months after the acquisition, so I don't have to deal with this any more. But caveat emptor: if you ever go into a retirement home, think about what will happen if they change ownership. Even if it looks great, or even acceptable, now, there is no guarantee that it will still be great, or even acceptable, tomorrow, unless you somehow manage to negotiate such a guarantee. I have no idea what a contract provision like that would even look like. But I am going to be facing this problem myself some day, so I'd love to hear ideas.
The biggest sign something is broken is when someone writes: "Thankfully, my mother died before the acquisition, and my father died last week, only a few months after the acquisition, so I don't have to deal with this any more."
To be fair, my mother had cancer and my father had Parkinson's, and that was a much bigger factor in their ultimate quality of life than any deficiencies in the retirement home they found themselves in. So I don't mean "thankfully" in the sense that "thankfully they died prematurely so they didn't have to suffer under their home's new management", I mean it, "Thankfully the natural course of their lives delayed their deaths so that they were minimally affected by the new management."
But yeah, it kinda sucks, and not just for the residents who are still there. It sucks for the rank-and-file staff as well, most of whom still really care about their clients, but who now have to answer to people who absolutely do not care about anything other than money.
Where I live Medicare and Medicaid want people to live (and die) in their own homes. They send out nurses and nurse practitioners to you. That is what I want. After some research I realized the provider that I want which is UTSW in Dallas has a geographical radius that they serve. I am planning to eventually move to be within that radius.
That was my parents' original plan. But they were in denial about how much preparation would be needed to make that happen. They lived in a split-level house and my father had severe osteoarthritis in his knees. It's actually a miracle that he didn't fall and break his neck going up and down the stairs. But one day he fell in the shower and could not get back up, and that was the beginning of the end.
I’m sure the new owners are scummy, but the fundamental problem isn’t scummy people. There’s lots of markets that are okay-ish notwithstanding scummy people. Even those with natural lock in effects.
The fundamental problem is it is at the intersection of two out of the three areas of the economy that have had insane cost growth over the last 30 years—-housing and healthcare (the third is education.) For the first one we know roughly what we need to do but won’t. For the second we don’t even have that.
> There’s lots of markets that are okay-ish notwithstanding scummy people.
It is not at all clear to me that there are "lots" of such markets, but that is neither here nor there. A prerequisite for an okay-ish market is that buyers need to be able to choose not to buy, and when you have literal limited mobility it becomes very difficult to walk away from your housing and care provider, either literally or figuratively.
The market is perfectly efficient, value is well attributed, lobbying is a social good, being rich means you’re smart and should have special privileges, optimizing for returns on investment is equivalent to optimizing for a better society
People created limited liability and private equity. Fiction is not something you get rid off. Its something you live with. It is a permanent side effect of how the over rated Humam Brain works. The brain makes predictions over multiple time horizons. When there are contradictions between these predictions how is the 3 inch chimp brain supposed to handle it while not splitting? Make up a story for the sake of coherence. Everyone is doing it everyday. They are all making up fictions to handle unpredictability.
There are a finite number of legislative girders underpinning the judicial capacity to support these fictions. When they're removed, it will not be legally possible to maintain them. They are not a product of nature, they are a product of real humans, and as such are subject to human change and intervention. They are among the least durable constructs we interact with.
Don’t require states to uniformly respect limited liability granted in other states. Allow them to add limits, requirements, etc. let the different states explore the trade off.
Revoke corporate charters. Prevent and break up consolidation.
All corporate entities require a registration to operate in a state if they have a physical presence.
In this instance, you can also pass a law along the lines of "After setup, all care homes are required to spend 90/95/99% of their income on direct care of the residents or your charter gets revoked." This would prevent the incentives to buy them in the first place.
It could happen this year; legislatures just need to pass laws. The hardest part is people posting comments like yours as a diversion from doing real work (though there are other hard parts too).
It isn’t the fault of private equity that banks make excessive loans against assets in a leveraged buyout. Banks (such as per the article, The Royal Bank of Scotland) have a duty to ensure that their loans are of properly assessed risk, and if the PE firm that wants to or has bought an asset does not look qualified to run it, then the banks should not be making the loans. Articles that keep casually dropping triggers like “[t]hey rubbed their hands together and said, 'Sooner or later, as the demand increases, the prices must go up'” are not seeking workable solutions but capitalizing on their ability to raise ire. It’s much more yet another article that does its best to paint a profit motive as an evil, completely ignoring that any endeavor that is not profitable is going to die sooner rather than later, and when it’s a government run endeavor then the taxpayers, who were completely uninvolved in the deicsions of where their money should be spent, are the ones left on the hook - HTF is that better?
My parents ended up being forced by circumstances to move into a retirement home about five years ago. Fortunately, the place turned out to be run by people who mostly cared about their clients and so my parents' lives were basically OK, except that the food sucked (which AFAICT is par for the course at retirement homes). But a few months ago the place was acquired by a different company, which is trying to squeeze out higher profits. Staffing and services are being cut, and prices are going up. Even the food got worse, which I didn't think was even possible. The response when someone complains is, "If you don't like it you are free to leave."
Yeah, right. My barely mobile 90-year-old parents, one of whom has Parkinson's, are just going to pack up and go. They know perfectly well that they have a captive audience.
Thankfully, my mother died before the acquisition, and my father died last week, only a few months after the acquisition, so I don't have to deal with this any more. But caveat emptor: if you ever go into a retirement home, think about what will happen if they change ownership. Even if it looks great, or even acceptable, now, there is no guarantee that it will still be great, or even acceptable, tomorrow, unless you somehow manage to negotiate such a guarantee. I have no idea what a contract provision like that would even look like. But I am going to be facing this problem myself some day, so I'd love to hear ideas.
The biggest sign something is broken is when someone writes: "Thankfully, my mother died before the acquisition, and my father died last week, only a few months after the acquisition, so I don't have to deal with this any more."
Depressing to read. I'm not sure on which side.
To be fair, my mother had cancer and my father had Parkinson's, and that was a much bigger factor in their ultimate quality of life than any deficiencies in the retirement home they found themselves in. So I don't mean "thankfully" in the sense that "thankfully they died prematurely so they didn't have to suffer under their home's new management", I mean it, "Thankfully the natural course of their lives delayed their deaths so that they were minimally affected by the new management."
But yeah, it kinda sucks, and not just for the residents who are still there. It sucks for the rank-and-file staff as well, most of whom still really care about their clients, but who now have to answer to people who absolutely do not care about anything other than money.
Where I live Medicare and Medicaid want people to live (and die) in their own homes. They send out nurses and nurse practitioners to you. That is what I want. After some research I realized the provider that I want which is UTSW in Dallas has a geographical radius that they serve. I am planning to eventually move to be within that radius.
https://utswmed.org/medblog/geriatrics-cove-team-makes-house...
That was my parents' original plan. But they were in denial about how much preparation would be needed to make that happen. They lived in a split-level house and my father had severe osteoarthritis in his knees. It's actually a miracle that he didn't fall and break his neck going up and down the stairs. But one day he fell in the shower and could not get back up, and that was the beginning of the end.
I’m sure the new owners are scummy, but the fundamental problem isn’t scummy people. There’s lots of markets that are okay-ish notwithstanding scummy people. Even those with natural lock in effects.
The fundamental problem is it is at the intersection of two out of the three areas of the economy that have had insane cost growth over the last 30 years—-housing and healthcare (the third is education.) For the first one we know roughly what we need to do but won’t. For the second we don’t even have that.
> There’s lots of markets that are okay-ish notwithstanding scummy people.
It is not at all clear to me that there are "lots" of such markets, but that is neither here nor there. A prerequisite for an okay-ish market is that buyers need to be able to choose not to buy, and when you have literal limited mobility it becomes very difficult to walk away from your housing and care provider, either literally or figuratively.
The market is perfectly efficient, value is well attributed, lobbying is a social good, being rich means you’re smart and should have special privileges, optimizing for returns on investment is equivalent to optimizing for a better society
Obviously I’m kidding, and something is rotten
A human ATM is just a teller.
A teller would be paid for doing the job.
Private equity didn't. People did. We really need to get rid of limited liability and corporate fictions.
People created limited liability and private equity. Fiction is not something you get rid off. Its something you live with. It is a permanent side effect of how the over rated Humam Brain works. The brain makes predictions over multiple time horizons. When there are contradictions between these predictions how is the 3 inch chimp brain supposed to handle it while not splitting? Make up a story for the sake of coherence. Everyone is doing it everyday. They are all making up fictions to handle unpredictability.
There are a finite number of legislative girders underpinning the judicial capacity to support these fictions. When they're removed, it will not be legally possible to maintain them. They are not a product of nature, they are a product of real humans, and as such are subject to human change and intervention. They are among the least durable constructs we interact with.
The intentions may be good but that's unlikely to happen in our lifetime.
What might be a more feasible solution?
Don’t require states to uniformly respect limited liability granted in other states. Allow them to add limits, requirements, etc. let the different states explore the trade off.
Oof, talk about making compliance difficult and expensive if a company has 50 different sets of regulations to comply with to do business in the US.
Revoke corporate charters. Prevent and break up consolidation.
All corporate entities require a registration to operate in a state if they have a physical presence.
In this instance, you can also pass a law along the lines of "After setup, all care homes are required to spend 90/95/99% of their income on direct care of the residents or your charter gets revoked." This would prevent the incentives to buy them in the first place.
It could happen this year; legislatures just need to pass laws. The hardest part is people posting comments like yours as a diversion from doing real work (though there are other hard parts too).
multi-generational households
I would rather have access to a suicide pod.
careful dont let private equity hear you say that
Get private equity out of healthcare.
Frankly given the sorry mid/long-term state of the UK economy, yes, this is the absolute essential thing to be moaning about...
And frankly moaning about this used to be right wing conspiracies a few years ago so yey for another pendulum swing...
It isn’t the fault of private equity that banks make excessive loans against assets in a leveraged buyout. Banks (such as per the article, The Royal Bank of Scotland) have a duty to ensure that their loans are of properly assessed risk, and if the PE firm that wants to or has bought an asset does not look qualified to run it, then the banks should not be making the loans. Articles that keep casually dropping triggers like “[t]hey rubbed their hands together and said, 'Sooner or later, as the demand increases, the prices must go up'” are not seeking workable solutions but capitalizing on their ability to raise ire. It’s much more yet another article that does its best to paint a profit motive as an evil, completely ignoring that any endeavor that is not profitable is going to die sooner rather than later, and when it’s a government run endeavor then the taxpayers, who were completely uninvolved in the deicsions of where their money should be spent, are the ones left on the hook - HTF is that better?