My hot take is that the problem isn't regulation, the problem is that seniors with dementia sometimes become a danger to themselves and others and no one wants to pay for the enormous staffing levels that would be required to care for them without sedation.
We would like to think that the problem is that we're just not cracking down on nursing homes hard enough to keep those greedy bastards from neglecting patients for fun and profit, or that Republicans just hate welfare spending, but actually it's just fantastically expensive.
Obviously there are terrible nursing home operators, because there are terrible people doing any profession you'd care to name, but mostly my sense is that they negotiate a huge gap between the lavish care we want them to provide, and the middling sums we want to spend on it.
And that in turn is actually its own hard tradeoff because society has just never had to deal with so many completely incapacitated old people living so long, with so relatively few young people to care for them.
Conservatives love to complain that this is all selfish women's lib types refusing to provide traditional home care, but very few victorian women cared for such extremely debilitated people for very long, because before modern medicine they tended to die.
Even in the 1960s, my great grandmother got dementia, broke her hip, and died soon afterwards. My grandmother broke her hip, and spent another five years in a nursing home getting a literally impossible level of care for any family to provide in 1960.
Providing that level of care is actually fantastically expensive, because it's mostly labor. Labor is expensive! Skilled labor, more so!
If we want this to stop, we need to talk about being willing to actually pay a lot more for nursing home care, rather than demanding that nursing homes care for aggressive patients without either sedating them, or charging us what it costs to care for them without sedation
Especially now, because huge numbers of workers appear to have noped out of nursing home work, and we might need to drastically up wages to lure them back.

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More from @asymmetricinfo

27 Aug
If you went to a NYC private school--and I went to one of the ones quoted in this article--this quote is amazing. These schools are purpose-built machines for manufacturing and sustaining inequity.
It was a nice school. I'm glad I went. I learned more than even Penn classmates from some of the top-ranked public schools in the country. My teachers were excellent, the grounds were lovely, and I was shielded from people who otherwise might easily have persuaded me to drop out.
But if you want to fight the systems that create inequity, the board of the Brearley School is a peculiarly ineffective vantage from which to do so, unless the board's in the process of shutting school down, transferring the kids to PS 151, & donating the endowment to charity.
Read 6 tweets
21 Aug
I think it's entirely possible that things will settle down in Afghanistan next week, and the anxiety and criticism of Biden will give way to a "Well, not one died, everything's always rough at the start" consensus. Folks going all in on "This is Biden's legacy"are too confident
I also think it's possible that actually this looks like a disaster because it is a disaster. People who are very certain that the critics are overreacting are also much too confident. This could definitely get worse as well as better.
I lean towards "better" rather than "worse" but with a hefty dose of "predictions are hard, especially about the future". Economy's more urbanized than 1996 making transition trickier, especially now banks are out of money. Operational control of troops may not be Priority 1.
Read 5 tweets
18 Aug
I try not to have strong opinions on foreign policy. But I do have strong opinions on the thesis of this column: if you think intractable realities of culture or human nature made Afghanistan unwinnable, you should probably think fighting there was nonetheless inevitable.
The Taliban sheltered a terrorist group that killed thousands of Americans. Human nature, plus the fact that we could, meant that we were going to respond with overwhelming force, not a few airstrikes. Americans are also prone to human emotions, and culture-bound.
Yes, there were people who opposed the war. Well done! But there was no scenario in which we didn't invade Afghanistan. Maybe an ultra-wise dictator would have chosen differently, but we had a democracy that responded to the 90% of the public who wanted an invasion.
Read 10 tweets
12 Aug
IF I'm reading this map right, for the first time since the 1950 census, DC "white alone or in combination" outnumbers "black alone or in combination". Huge change that mirrors both broader urbanization trends, and entrenched economic disadvantage.…
White population up 31% (!!!!) in 10 years.
Also these folks are not having kids: 18 & over population is 83%.

Read 4 tweets
12 Aug
This cannot be emphasized enough: the left spends an inordinate amount of time heaping shame and contempt upon conservatives. Shaming only works on people who conceive themselves to be in the same moral community as you. Otherwise, it's just an ideological pep rally.
Ideological pep rallies are fun! But I see a lot of people confusing this with an actually effective political tactic. Any column I write heaping insufficient opprobrium on conservatives triggers progressive screaming that I am literally endangering lives and supporting fascism.
To be clear, if you are just enjoying telling each other about how awful conservatives are, that's defensible. (Though given that they can see you, do consider the costs, backlash-wise). But understand it's a consumption good with a political effect range from nil to negative.
Read 4 tweets
11 Aug
Visited my Dad this weekend, and we were talking about the Kidz these days, and how connected they are to their parents.

Dad once again asked me why I had not asked for help even when I needed it--like when my roommate stole all my cash & I had to stop eating for 2 weeks.
Gave him the same answer: it just never occurred to me. I had gotten myself into trouble; it wasn't their job to get me out.

Maybe this is idiosyncratic to me; I've always been stubbornly independent. But I think it's a real generational thing.
Millennials and Zoomers find it natural to appeal to authority whenever anything goes wrong. GenX assumed the adults were all in league against us (we were right). This carried into adulthood: we don't assume authority will care, or be on our side.
Read 9 tweets

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