Thought and opinion by RRS members and contributors.
Sarah Miller on
Aging Poorly – The Class Divide and Nursing Home Care
Another missed call, another voice mail. I look at my phone and recognize the number. The call was from the daughter of an elderly hospitalized patient. The social workers have been pushing to get her mother out of the hospital and to a nursing home but the daughter wanted to visit potential facilities before agreeing to placement. I press play. “My mother is not going to that place. I wouldn’t even put my dog there! Please call me back.”
In hospitals, elderly patients wait in their rooms for days, weeks and sometimes months. Cleared for discharge by the physicians, they have no place to go. Too sick or debilitated to return home and no family willing or able to care for them, their only option is nursing home care. Hospital social workers provide a list of local facilities to the families. Invariably, they choose the highest rated with the best reputations. After all, they want their loved ones to get the most quality care possible. But that is out of reach for most. The social worker will call the posh nursing homes to inquire about admission but the behind-the-scenes conversation is always the same. “There’s no way the family can afford that facility.”
It isn’t until the daughters and sons visit the few homes that will accept patients with low incomes that they fully realize the disparity that exists between the care provided for the rich and the treatment of the poor. The first thing that hits you as you walk in the door is the smell. It is a distinct odor of human urine, processed institutional meals, and old construction. Every nurse knows about the “nursing home funk.” Then you see the surroundings – fluorescent lighting, old linoleum, a magnet board declaring the current weather “Cool, cloudy,” the date, and the next holiday. The bustling nurse’s station is a flurry of activity – bells ringing, charts stacked on the counter. Residents yell from various reaches of the hallways, sometimes words or names but often just screams. The sensory overload is enough to make you want to turn around and run out the door.
First impressions are not always accurate but State inspections of these nursing homes often tell harrowing tales. Violations in various for-profit facilities in 2016 included physician-ordered testing not being completed, increases in bed sores, residents kept in restraints beyond the legal maximum time limit, over-medication with anti-anxiety and sedating medications, and unsafe food storage. Staffing and turnover is also an issue. In one facility, each resident received 30 minutes of direct care from an RN daily compared to the state average of 58 minutes.
But what about the other retirement communities? The ones with sprawling campuses, activities coordinators and no violations. Families see the billboards encouraging older people to “Live Life Here” and “Be A Part of Our Community!” The advertisements don’t lie. There is gorgeous landscaping, activity buses taking residents to shops and local attractions, multiple restaurants and spas. For those in need of skilled care, they have private, well-furnished rooms and private baths, low nurse to patient ratios and minimal medication errors. There is no “funk” in the air, just the smell of freshly disinfected hallways.
The most expensive retirement community in Lancaster County charges an entrance fee between $99,000 and $419,000 depending on the amenities and type of residence chosen. Monthly fees range from $1,814 a month for a studio apartment to $5,004 per month for a two-story town home. If a spouse or significant other is also residing there, an additional $26,000 to $45,000 entrance fee and another $1,226 per month applies. Community members can be moved to skilled care if the need arises without any additional costs. Another private, church-affiliated facility charges $439 per day for skilled care or $13,170 per month.
Daily nursing home care in Pennsylvania averages at $228 a day for the least expensive facilities. Most of the residents choose these facilities because they have no other choice. The entire cost paid for by Medicaid. Reimbursement rates are determined by the state and are often less than what the facilities normally charge and sometimes much less than what it costs to provide care. So one would think that it would be advantageous and more cost effective to provide in-home assistance. The average rate for a home health aide is $20/hour. These aides are non-nurses and are trained to help with tasks like bathing, dressing and light housekeeping. Having an aide 8 hours a day averages to be $160/day or $4,800/month. Compared to $6,840/month for nursing home care, it seems like the obvious choice.
But private insurance, Medicare and Medicaid pay nothing for in-home care. Nothing. Financial assistance exists only for those in poverty. To qualify for home care waivers in Pennsylvania in 2016, the recipient must earn less than the least $2,205 a month and own less than $8,000 in assets. There are waiting lists in areas where demand outnumbers availability, causing many in higher populated cities to be without help.
Jericho Jones on the shrinking membership of mainstream parties:
As the 2016 election season ground on, it became obvious that the bourgeois media were not going to depart from the mode of the last two decades, deporting themselves like a teen magazine for ugly rich people.
Dominated by personalities, mainly Donald Trump’s with an occasional riff on Hillary Clinton’s likability, they exerted themselves only as hard as needed to produce content (and consent) without asking questions. Capital being capital, the rate of return on the nostalgic fiction of “real journalism” is lower than ever. A circus of marketable vulgarity is what we deserve and what we get.
Occasionally I’ll hear an NPR type ask what happened to real journalism, the kind that focused on serious issues presented with a decent regard for the facts. I try to keep a straight face since I’m a polite revolutionary socialist, but among us chickens we know it was all a myth, the product of privately owned outlets where presenters with sober expressions reported on the battles of different factions of capital, carefully avoiding any explicit revelation of their nature. The journalistic front of eminence and professionalism is both the shield and the sword that keeps the national discussion within acceptable bounds.
So it is with our major parties, both of them relying on the stupidity and vulgarity of our culture to narrow a discussion that’s not intended as anything but a program to channel votes and obfuscate facts. Where they concern the ruling class, the purpose of both journalism and politics is not to tell the truth, but to manage it.
On the surface it seems odd that the major parties’ declining membership and internal crises have done nothing to weaken the two party lock on the levers of power. Don’t fewer members mean fewer votes? As with journalism, the real story lies beneath not just the top layer of brightly colored sewage, but under the next layer down, the fondly curated memory of a political culture that never existed. Breathless reports of civil war in the Republican party and “Bernie or Bust” in the Democratic party did nothing to mask a fundamental truth about our TV show democracy and the latest episode known as the 2016 election: the struggle in both parties is, as ever, all about who represents Capital.
It doesn’t matter that Republican establishment politicians are being stalked by the monster they created. Politically, they acclimate or die, slain by Trump’s militant white dupes, with or without Trump himself. The Republican party will live on, the only change being who operates its capital-serving machinery.
For Democrats, the terms of the struggle seemed similar: an outsider with populist tendencies stood at the gate, ready to take power from the morally bankrupt establishment. In theory, he would also have placed it in the hands of the people. But here, the challenger could not rely on the disdain of the party rank and file for normal politicians; still worse, he came late to a party that was planned and paid for by the DNC.
Unlike the Republican elite, which has reason to believe Republican malcontents will follow through on their anger with actual votes, the Clintonite establishment felt confident that, once allowed their fantasy in the primaries, Democrats hungering for a return to the New Deal would either fall into line or find themselves replaced by voters on the leftward Republican margin.
This is why the Democratic establishment consistently holds the party’s “left” in contempt. The left of the party nearly always punks. As to any leftist who bolted the party, crass Clintonite triangulation believed the candidate would gain at least one vote from a nervous Republican. This was once the essence of Clintonism; it has become the essence of the Democratic party.
As all this unfolded, we could observe the trend since 1988, where the mainstream parties together faded as a percentage of the electorate and Independent identification soared. If the trend continues, it won’t be long until a majority of the electorate rejects both parties. Yet despite surface crises that inspire talk their morbidity, the mainstream parties are as free of competition as ever. How can they survive as their numbers dwindle?
Because shrinking parties are good for capital.
The key is to see the parties’ future through the lens of capital: popularity doesn’t matter, power matters. Unless there is a massive and militant shift in American political culture, the two parties and their elites will continue to control the nominating process, numbers be damned. Shrinking party membership is not a negative. It simply means less interference as capital chooses who will represent the only acceptable factions.
As Chomsky famously noted: “The smart way to keep people passive and obedient is to strictly limit the spectrum of acceptable opinion, but allow very lively debate within that spectrum…”. Of course that includes limiting the electoral choices available to us. For capital to keep power, it must. Unless challenged boldly, those choices will shrink until even the current sham democracy is gone.
To the majority, the election appeared to be one of great turmoil and uncertainty. One contestant promised to protect the status quo by redrawing political boundaries to include the middle 51%, blowing off the ineffectual left and smiling rightward to welcome refugees from the ranks of establishment Republicans. The other operated by upending the conventional political discourse, valorizing the anxieties of aging white cranks, and re-positioning the goals of the commercial republic allegedly to favor the white working class. The months following have been no different.
For our real rulers, it’s always been a very different story, one where either outcome protects the influence of capital while at worst relying on the deep state to keep the winner within bounds. There will still be competition among factions of the ruling class, there will still be winners and losers among them, but the commanding heights of power will remain in capital’s hands.
Capital may change political partners, and it may find new ways to distract the public’s attention from its thievery and mass murder, but whatever the outcome, capital remains.