Monday Jun 05

Spring 2023

BACKSTORY 53.1 - Care Crisis is More Than Medicare

President Biden says he has a plan to fix any potential shortfall in Medicare:  tax the rich and corporations.  I’m for it.  Go, Joe!

Here’s a problem though.  The problem of caring for the elderly is not just about Medicare.  In some ways, it’s not even just about money, but money is a big whooping piece of it.  We just don’t know what to really do about the elderly, and in many cases, the elderly are unsure what to do about themselves in this changing economic environment.

In France, millions are hitting the streets to protest their President’s plan to move the retirement age from 62 to 64.  In another world, the United States, more people over 65 years old are going to work than we have ever had.  In fact, the largest growth in the workforce between now and 2030, according to the Department of Labor, is going to be among workers older than 65.  That’s a longer timeline than can be described by current inflation.  It speaks to insecurity and the precarity of age.

Besides, work looks a lot better than ending up in a nursing home, especially in the wake of the pandemic when nursing homes seemed to be ground zero of Covid.  Our union, Local 100 United Labor Unions, represents a mess of nursing homes and assisted living centers all over Louisiana, as well as a ton of care workers in facilities in Arkansas, so we are too close to this problem and see the impacts firsthand.  Where cynically perhaps decades ago we saw some of the home operators basically as real estate speculators temporarily wearing white coats and pretending healthcare was there business, now we literally watch some of our homes bandied about by private equity companies and real estate investment trusts.  I’m not sure Wall Street is where you want to put grandma. 

Don’t get me wrong.  Extensive research done during the pandemic found that if you were a client in a unionized nursing home, you were 11% less likely to die of Covid and 8% less likely to catch Covid in the first place.  Nonetheless, even our most skinflint operators are realizing that few want to do this work for so little money, no matter how much they care about the patients, and in some cases are coming to us in the middle of contracts to give wage increases, because they can’t staff the homes. 

Believe me, all managers complain that reimbursement rates at the state and federal level are too low.  Sometimes it’s an excuse, but they have a point.  Our government, our society, even our families don’t make the kinds of investment and support for these kinds of care institutions that speak to the love and respect we should have for the lives and dignity of the elderly.  All of this hit home for me in my mother’s last years with dementia.  When she was in a nursing home after breaking a hip and with her memory fading, ever day at lunch, when I would go to see her when in town, she would ask if I was there to take her home and beg to go.  She couldn’t take it, and neither could I, so she spent her last years at home with sitters 24/7, even though at best, it was a hardly a real solution.

This isn’t just an American problem, though we should still hide our faces in shame compared to many countries.  I read an essay in the London Review of Books that reviewed three books about the crisis in care and was unsparing in its critique of the system and support in the United Kingdom as well. 

The author of the piece, James Butler, ends it this way: 

It would be a failure if the only answers sought were economic.  The problem of care raises questions that lie outside the typical bounds of policy work….What degree of indignity, pain, degradation or abuse are we prepared to see the people around us suffer?  And what, if we are unable or unwilling to do it ourselves, are we prepared to pay for the work most intimate and essential to human life?  Politicians may not wish to acknowledge these issues, but circumstances will force them on us regardless.

With the demographic bulging of the baby boom now an increasing bulk of our elderly, it will be impossible to avoid these issues now, ready or not, even if the odds of us doing the right thing about our senior citizens, based on our record, seems very long.