October 27, 2020 • 51 mins
In America, we've treated our senior citizens in very different ways over the years. Tune in to hear about how we've tackled compassionate care.
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Episode Transcript
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Speaker 1 (00:01):
Welcome to Stuff you should know, a production of My
Heart Radios How Stuff Works. Hey, and welcome to the podcast.
I'm Josh Clark, and there's Charles w Chuck Bryant and
Jerry's out there wandering around in the ether and that
makes this stuff. You should know. She's been wandering around
(00:23):
the ether for weeks at least, I dare say months
by not Chuck. Yeah, she's uh, actually just chatted with
Jerry from ten feet away. Oh that's nice, man, that
must have felt really special. Did in her hair is long? O? Man?
My hair is really long too. Yeah. I feel like
I saw Jerry a couple of months ago and her
(00:45):
hair was long, So she must have like a full
on like do now? Uh? Yeah, you know she looks
like a proper lady. I'm not touching that one, all right, So, Chuck,
this one was of yours. It was a nursing homes
is the idea? Right? Yeah? So I have a question
for you. What what made you decide that you want
(01:07):
to do on nursing homes? You know, I mean, I'm
almost fifty, My parents are in their mid seventies. Emily's
grandmother is edging towards one so you know, this is
the kind of stuff that just you gotta start thinking
about at some point. And Emily and I are old
parents and have an only child that we don't want
(01:28):
her to have to like have to take care of
us or anything. So like we're just starting to have
all these thoughts. And I was like, yeah, you know what,
I'm not so sure America does it right here. Um,
And after studying this stuff, it's we do it, okay.
But it's also like, hey, work your whole life and
then go broke at the end. Yeah, that's that's a
(01:50):
real bomber about the whole thing is just you're just
kind of like expected to spend whatever money you have
on care at the end of your life. And it
just seems a little wrong to me too. Yeah, and
we need to shout out first of all, our buddy
Dave Ruse helped us put this together, and he actually
did a real deal interview with Dr Muriel Gillick, who
(02:10):
was an author of Old and Sick in America colon
the Journey through the health Care system and was quite
a resource, and that the history of this stuff in
this country I think was pretty fascinating. Yeah, it is.
It's super fascinating. Um, and the whole thing kind of
started out. Um, you know, when we're talking about nursing
homes in particular, but there's just no way we can't
(02:31):
talk about other kinds of homes in particular, because nursing
homes grew out of this kind of system that developed
that seemed to really kind of take shape and take
hold around the Second Industrial Revolution, the one that happened
here in the States, and because of that, because people
were like, you know, I don't feel like swinging the
(02:52):
scythe any longer. I'm gonna go into town and see
what they have in the way of jobs. So long
mom and dad. All of a sudden, Mom and dad
were like gulp, because they were on their own, not
just you know, one set of parents in particular, but
as like a general intergenerational trend where kids were moving
away from the farm, and all of a sudden, there
weren't multi generational homes like there were before. Because when
(03:13):
you have a multigenerational home, you don't have to worry
about what's going to happen to you when you get older.
Where you're gonna live. You're gonna live in the same
house you raised your your Brady, little kid in to
take care of you until you die. And that's just
the way it was for years and years and years
in America. Yeah, there's a stat here. Uh In nineteen hundred,
fifty seven percent of adults over sixty five lived in
(03:37):
a multigenerational household, and by nineteen eighty eight years later,
that went down to seventeen percent. And big reasons for that,
Like you were talking about, you know, moving away from
the farm. But just nowadays people just move away. I mean,
sixty percent of American adults have moved to a completely
new community at least once. And as uh Dr Gillick
(04:01):
points out, she says, not only are people not living
with their adult children, they're not even living near them
many times now, Yeah, because they finally wised up and
we're like, gosh, I can get away from my kids
once and for all now that they're adults. Well, I
think it's more like the kids are like, hey, gee,
I want to go live in wherever the heck I
want to and we'll just think of a plan for
(04:24):
my parents at home. My generation doesn't have any hangups
about guilt or morality, you know. But the thing is,
it's not just the kids moving away. Like my grandmother
moved far away. She moved to Florida, she moved to Arizona.
She moved. She was like, so long, everybody, I got
this UM. But she was very fortunate that she had.
(04:44):
One of the things that UM nursing homes exist for
is to take care of people who don't got it,
who either don't have family, who don't have the money
to hire people to take care of them, who don't
have the money to go live in and you know,
say like assisted living or something. UM. That's what nursing
homes have kind of evolved to take care of. And
in that sense, they're actually directly related to what came
(05:06):
what were originally called alms houses or county houses or
poor houses, which if you were old and you didn't
have anyone to take care of you, in like the
late eighteenth early nineteenth century in America, you could go
to like a farm that the county maintained and there
would be a bed there for you, and um, you
(05:26):
would be housed with a bunch of different people with
a bunch of different conditions, and the one thing that
you all had in common was that society didn't quite
know what to do with you. Yeah. So I mean
it could range from people who had no living family
two and just you know, needed care that had nothing
else wrong with them except just being old and needing
care and having no one around, uh, to people that
(05:49):
were mentally ill, maybe people who were suffering from dementia,
or people who were alcoholics or drug addicts, and like
you said, they you could get a bed, but there
were no doctors, there were no nurses, you couldn't get
medical care. Uh. And that was sort of the the
beginnings of of the shame almost if you want to
(06:10):
look at it that way. Yeah, kind of. But it
does say something that society did say, we have a
responsibility of people. We can't just be like, well, there's
a corn field for you to go lay in until
you die of exposure, good luck, you know, Like there
was a bed that was provided. As meager and horrific
as that whole thing was, it was at at least
an experiment or an attempt to do something. Yeah. And
(06:34):
you know, the next big change happened, um, sort of
midway through the nineteenth century when uh, sort of around
the time in the Civil War, we started getting our
first big hospitals like medical hospitals, public medical hospitals and
the big cities around the country, and they, you know,
they were sort of the the beginnings of modern um
(06:55):
large scale public healthcare. And here's the thing, though, is
they were back then they focused on acute care. So
if you again were a senior and you uh they
called them old chronics, like you had maybe a chronic
condition and no one to take care of you, then
you uh, basically you were too too dependent to go
(07:19):
to one of these places because it was a hospital,
and they're like, you can't stay here, right because even
though you know you're called an old chronic, you might
not have anything wrong with you aside from being really old,
and maybe you can't make it to the bathroom very
easily something like that, but not necessarily anything that a
hospital could treat you for. It was just they had
a bed about hospitals. Very quickly, we're like, we can't,
(07:41):
like this isn't working. You're gonna stay here indefinitely and
there's really nothing wrong with you. We gotta find a
place for you. And so about that time, some charities,
especially either ethnic or religious based charities like the um
Baptists or the German Aid Society was was a big
one in Boston. I think, um, the German Ladies Aid
(08:03):
Society of Boston. I'm sorry. Um, they kind of said,
you know what, we we have members who are uh
they're members of our church or you know, they're German,
they're part of our community and they don't have anybody,
so we we need to make sure that they're taken
care of. And they actually started founding what we're called
old age homes, which is basically they would get like
a large home and um kind of outfit it with
(08:25):
different Each room was like a different room for a
different tenant, and they would take care of like old
widows basically who didn't have the money or the children
to take care of them. Yeah. But specifically, what they
deemed as worthy poor uh, And here's what differentiated them
from the almshouses was, uh, if you were worthy poor
(08:45):
and you know that's in air quotes, that meant that
you were the wife of of a man who who
worked hard all his life but never made a lot
of money, maybe worked at a shipyard or just had
sort of a very low paying, blue collar but respectable job,
but certainly not the kind of dough to pay for
(09:05):
like private nursing homes or anything like that, but not
alcoholic or drug addict or you know, there was no UM.
They didn't like force a shame attachment to it. So
these widows who were you know, in their sixties or seventies,
depending on you know, how their husband lived their lives,
They're like, I've been morphine free since seventy three, so
let me in. Uh. They didn't have these big pensions
(09:28):
or anything because of the jobs their husbands had. So
they were taken into one of these homes like a
Baptist m or something, and they were given to bed
and they were given again, not medical care, but they
were at least given meals in a bed. Right. Um.
A lot of times they were expected to kind of
pay for their their room and board. Um. It was
kind of like a needs based sliding scale. I got
(09:51):
the impression some of them, UM just straight up said hey,
give us five hundred dollars. At the time, I think
around nine or uh, late nineteenth century, I don't remember
exactly when it was, um, the Winchester Home for Aged
Women in Massachusetts, the Winchester Mystery House. I looked it up.
I was like, is that the same one? But it was.
It was bequeathed by a Lucy Winchester, who I couldn't
(10:14):
find anything about. But it's not the same person. A
lot of people in the house, you would, um, although
you gain a lot more ghosts, it's true. But um,
they said, you pay us five hundred dollars. So this
is in nineteen o four. You pay us five hundred
dollars and you can stay here for the rest of
your life. And five hundred dollars back then was worth
about fifteen thousand today, And exactly I was thinking about that.
(10:34):
It's a bit of a gamble on both sides. But
it's a bit like insurance. It's like some sort of
long term care um insurance where you're like, okay, let's
stretch my five dollars as far as I can go,
or you know, you could die two days after they
still kept your five hundred dollars. But then hopefully it
was used to make life better for the other people
who's who had used up their five hundred dollars long ago.
(10:58):
You know. So there was this kind of idea that
if you could pay for it, you should pay for it.
And then as time went on, it was like, oh,
you just you know, you sold your house. We need
that money if you're gonna stay here, And people would
take in more and more money from that person's estate
um as they were alive to take care of them.
(11:18):
And this was starting in like the beginning of the
twentieth century into the nineteenth century. So that's a very
long tradition of extracting everything from old people as they're
dying to to pay for their care. And I'm got you,
I'm bothered by that. Yeah, I mean the question became U,
not how how much is it for your care facility,
and it's more like how much you got how much
(11:41):
you got here? Graham by the ankles and turn them
upside down, or if they you know, if they weren't charging.
There was the expectation that they didn't need so much
care that they couldn't also contribute, like here, we got
a room for you. We'll feed you, but you gotta
make your bed, and you gotta clean your room and
maybe help keep the property up. So I got the
idea that these were people who, like I said, you know,
(12:03):
a senior widow who just didn't have anywhere else to
go and otherwise was doing okay, yeah, but forced to
make knockoff Gucci wallets during craft arts and craft. Should
we take a break? All right, I got a Gucci
wallet to work on myself. Okay, So we've got alms
(12:53):
houses are still around. They have they stayed around until
like the nineteen forties. From what I could see, these
county houses poor houses, um, and then alongside of those
you've got old age homes. But then, um, the government
was kind of like, we can do we can do
better than this. New York itself, I think, became the
first state in the United States to say, um, it's
(13:14):
a ten ninety it's modern era, we need to do
more to take care of like our our elderly and
in particular are mentally infirm. Um. They and they that
state made a commitment to take care for the state,
to take responsibility for its mentally ill and that included
people with dementia of all sorts, which they would have
(13:36):
called senility back then. Um. And so that was kind
of like the first entree of the state into caring
for elderly people. And that actually kind of opened a
bit of a floodgate. I think, um. Other states started
to kind of follow suit, but it was like a
it was a step in a really dark direction, because
(13:57):
by World War One, if you were elderly, especially if
you had some sort of um declined, some sort of
cognitive decline from age, there was a really good chance
that you were in a mental asylum um with everybody else.
And in a lot of cases, I think even if
you were just elderly, you would find yourself in a
(14:17):
mental asylum in that right, Yeah, I mean absolutely. So
you've got a situation where the states start to say, hey,
we need to take care of our mentally ill, but
seniors just started getting kind of lumped in if they
didn't have anywhere else to go. So you might have
you know, someone's someone's grandmother who just didn't have family
and who was really doing okay upstairs and and was
(14:41):
in pretty good health, might find themselves in, like you said,
a mental hospital with people with severe mental illness. Uh.
And I think there's a couple of stats here that
Dave dug up by there were more elderly Americans and
mental hospitals than in those almhouses and the price that
old age homes combined. And he mentioned one in particular,
(15:04):
Chicago State Hospital, which was a mental hospital in the
nineteen thirties, of the patients there were quote aged or
infirm that had no other underlying psychosis or mental health condition. Right.
So that's a really dangerous place for old people to
be because if you act up, they can put you
on medications, they can give you, um, the hydrotherapy treatment,
(15:26):
they can do all sorts of stuff to you because
you're in a mental hospital. And I think it's kind
of like one of those things where, um, if you're
a hammer, everything looks like a nail. Well, if you're
a nineteen thirties old timing psychiatrist, everything looks like a um,
a mental condition, a mental condition, right, you know, um,
and you're gonna treat all of the people the same way.
And so luckily Francis Perkins arrived on the scene around
(15:50):
this time. So World War One is when old people
really started to get shuffled off to mental hospitals by
the government. Swoop James like, whoa, whoa, this is way wrong,
Like we need just because these people are old doesn't
mean that they're um, they're mentally ill. So let's extract
them from that environment and figure out if we can
do something else. And thanks to Social Security that that
(16:13):
really began to change. Fairly quickly. Yeah, so this is
nineteen thirty five. Again, you mentioned the great Francis Perkins.
If you didn't listen to that episode, go listen to it.
It's fantastic out the Social Security Act. Um. Basically like
when we think of Social Security now, we think of
the program where you pay in your whole life from
(16:35):
your paycheck and then when you retired you get a
monthly income and if you work longer than your checks
are gonna be bigger. Um. I started working when I
was thirteen, so imagine I'm gonna be rolling in dough.
You're always boasting about that of hearing about that about
my thirteen year old bus boy job. Yes, it's a
title Max. Now, by the way, yeah dry Max, got
(16:58):
your money, your mind, real money. Oh man, that's some
good free advertising. Yeah. I drove. I drive by there
on the way to my mom's and Emily's parents house sometimes,
and I always pointed out to my daughter and say, hey,
that's the barbecue restaurant I worked at. It's now a
title Max. Is that the one where the guy put
his foot in the Brunswick sto? Yeah? God, I wonder
(17:22):
where that guy is now. Randy, he's in he's in
I don't know. I'm not even going to guess the
feeling Randy's in prison, do you think so? I mean,
he saw him do a lot worse than put his
foot in the Brunswicks, do you know what I mean?
Oh jeez, I don't put My mind is rased at
life behind bars and I'm not laughing at that. It's
it's very sad. But Randy, you know, he made his
(17:44):
own decisions. That reminds remember Randy the hippie from MTV
and like the late eighties, early nineties, No, he ran
for president. He was like just this total weirdo burnout
who was yeah, who looked today like he could have
been in l m f A. Oh okay, Like really
(18:05):
he dressed like that, but this is like decades before.
But anyway, I remember like he he like ran for
president and I think he lost and he's like, I've
made my bed now I must lie in it. I'll
never forget that. For some reason, I thought it was hilarious.
But yeah, that was Randy. Well, I mean maybe it
was d Randy Brunswich, it was the Rands. What I'm saying, um, so, yeah,
(18:25):
that that was old age insurance is what they called
it originally. But then there was also Old Age Assistance
oh a A, which was you're gonna get payments when
you're older, even if you didn't work, which was a
big deal because so many women were not allowed to
work and have jobs, so like what were they going
to do? They're like, say, hey, you didn't pay anything
(18:47):
in sorry, you just raised your kids and grandkids. That's
a great that's a great point. I think we still
do that today though, unfortunately, but at least women can
actually work in the workforce if they want to. But yeah,
if they if they stay home and raise kids, then
they're still treated the same way, which is pretty shameful.
But I get your point. And the point is is
that we needed to be able to UM take care
(19:10):
of people who hadn't necessarily worked in the workforce and
paid into Social Security, and then also we had to
offset that first basically generation that we're like, Okay, we're
the first ones nobody's been paying in, but why do
we Why are we the ones who have to pay
him but we get nothing from it? So the Old
Age Assistance the o a A really helped with that
(19:33):
UM and I guess that's kind of gone the way
of disco because the only thing I know about is
the Old Age insurance that's still around, and I know
they don't call it that any longer, but that Old
Age assistance where it's like, I guess that would be Medicaid, right, yeah,
I think so okay, So so we'll and we'll talk
a lot more about Medicaid and medicare. Just put a
(19:53):
button in that all of you bureaucrat walks. You're gonna
love it. Yeah, but uh, you know, FDR, this is
when things really changed. And the reason we're talking about
social security and stuff like this is because it really
it's sort of laid out the roadmap for what was
going to happen and how we cared for our grandparents
and what kind of places they were going to be.
(20:14):
So because he went in there with a new deal
and he was like these all houses are terrible. He's like,
we need to get rid of these. And he said
in these state mental hospitals, they're overburdened. And that's not
right either. So here's what I'll do. Part of the
o A A the Old Age Assistants. A big provision
here is that you can't um you can't get any
of that money if you're living in a public institution
(20:36):
like an alms house or like a state mental hospital,
No money come in your way. No. So suddenly the
people who were stuck in state mental hospitals or alms
houses not only were like, oh, well I could get
out of here. Now I have the funds to get
out of here and go somewhere better. And this led
to a huge boom in the growth of private um
(20:58):
uh living facilities for the elderly. Yeah. I think that
was the big change. I mean, surely people were like, great,
I can get out of here, but I think people
saw dollar signs said wait a minute, I can get
paid by the government to take in these people and
take care of them, right, sometimes directly get paid by
the government. Yeah. That was kind of like an amendment
(21:18):
that they made later on where it was like, um yeah,
that that incentivized it even more. It's like, well, we'll
pay you directly. There's not even this person as gonna
have to be involved. Just take care of them, you know,
follow these guidelines and we'll send you this check every month.
And the people is there any money left over for me?
You know? And no, no, no, no, this just don't
ask any questions. It's as a matter of fact, now
(21:39):
that you bring it up, do you have any money,
you're gonna give it to them first before we give you.
There's a balance on your account, sir. So. Um, this
is kind of how it went for like the first
you know, fifteen twenty years after so Security Act was
introduced in nineteen thirty five, where um it fueled this
boom of retirement homes. Basically the retirement home into Tree
(22:00):
found its its birth there. And then about fifteen years
after the government was like, you know what, we've been
sinking a lot of money into this, maybe we should
look around and see if any of these places are
any good. And they found that no, in a lot
of cases they weren't really good. There was, um, you know,
if you if you converted an old Victorian mansion into
an old age home with a dozen rooms, you probably
(22:23):
didn't add a fire exit onto every room and fire
stairs on the second and third floor. Um, there's probably
not sprinkler system because they weren't very prevalent by that time,
and so if there was a fire, all of these uh,
the dozen ages and infirm people who lived there were
going to die in a fire. Um that was the
one big one that they turned up that came out
(22:44):
of these early investigations into into what came to be
called nursing homes. Yeah, so this is when Congress steps
in again, like you said, about fifteen to twenty years
later in the nineteen fifties, and said, all right, here's
the deal. If you're getting this dough from us, we
need to regulate, um, what's going on there, and they
need to be safe. And a lot of these mom
(23:05):
and pops that, like you said, converted an old house,
they couldn't make those upgrades. You can't just slap on
a fire escaped to an old Victorian. I guess you could,
but it wouldn't look that great or probably work that well.
And so a lot of these smaller ones floundered and
all of a sudden, and this is things where things
really start to change. There's a big market for just
(23:26):
basically I don't even know if I would call it
the corporatization yet, but maybe to a certain degree, these
bigger facilities for residents that had this money that could
go straight to them. And uh so these sort of
larger places that weren't individual houses started popping up. Yeah, well,
that's like an ongoing and recurring theme in a big
(23:47):
criticism among conservatives of big government or government regulation is
that it homogenizes things because usually the mom and pop operations,
even if they are well meaning and not nefarious, like
they don't have money to add those fire exits on.
But say like a corporation that's going to own several
of these things, they can build new ones with all
(24:07):
the modern fire exits and fire sprinklers. And so those
bigger corporations start owning more and more and more, and
by building more and more and more, they're not gonna
make each one like really unique and and embedded in
the community. They're going to plunk down the same one
in every place they build one. And so there's this
homogenization that occurs as a result of that. And that's
(24:27):
exactly what happened with what came to be called nursing homes,
which really started to find their advent in the nineteen
fifties from these reforms where the government was like, you
guys need to be able to do this, this, and this, um,
we're gonna assign the Public Health Service to to lay
out guidelines. The Public Health Service knows about regulating hospitals,
so they really added onto that homogenization, this this underlying
(24:51):
medicalization of caring for older people, which makes sense. You know,
you think of older people, olderally people, senior adult you think, gosh,
the you know, the body is starting to wear down.
There have they have all these conditions or whatever, So
it makes sense that you a couple hospitalization or medicalization
with that. But that's not always the case. And the
(25:12):
problem is, as it became the case, whether you needed
it or not, that was the kind of place you
lived was basically a bland institutional extension of a hospital. Yeah,
I mean it's not like in Uh. I kept thinking
of the movie Say Anything when I was researching this
(25:32):
because that was a prominent storyline in that movie. I
never saw it. You never saw Say Anything. I didn't
do you wonder what happens every time a guy in
a trench coat holds up a boom box over his head. So,
I mean, I know you need the cultural reference. Yeah,
of course, I just wondered up all this time. You're like,
what is the deal with this boom box? Yeah, it's
like a reference to Kevin Smith and Clark. Okay, sure,
(25:55):
exactly now Ione Sky's father, the late great John Mahoney.
Was he ran a mom and pop nursing home. Yes,
and was in spoiler coming if you haven't seen a
thirty something year old movie. Uh, he was found to
be ripping them off and that was a big sort
of subplot in that movie. All I heard was that
(26:17):
was a big subplot in that movie. Very good, but uh,
say anything aside. They um, like you said, became more
hospitalized for lack of a better word, And if you
went to one of them back then, there was very
little to differentiate it from a hospital, from the central
nurses station to the cafeteria food. I remember going to
(26:38):
visit my my grandmother on my my paternal grandmother, who
lived to be a hundred and one before my dad
and his wife took her in. She was in one
of these places and uh, or actually maybe it was
the other way around. She went afterward. But it was
it was terrible, you know, it was awful and very
very sad. And if I was not a young man
(27:00):
with nothing, you know, nothing going on in my life,
I might have done something about it, but you know,
I didn't know what to do back then. You would
have opened all the doors and been like, go free,
go free. I would have ripped her out of there
at least and said come home with me. Yeah, I
mean they were pretty bad, especially by the time I'm
guessing you were there in the eighties or nineties. Maybe
this was in would have been the nineties. Yeah, So
in the fifties, in the mid fifties, even these things
(27:23):
made a little more sense at the very least they
were newer. By the seventies and eighties, they were so
bad that we had a reform Act that kicked in seven,
which is basically like this place is wrong, and like
maybe we don't know what to do or replace him with,
but here are some things that that you have to
(27:43):
treat these people with, like dignity. They have to be
able to have a say in what they wear or
what they um, what they eat, or what they do
during the day. And it really kind of got off
the rails within a couple of decades after their advent.
The thing is is like I was saying, nobody knows
what to do about nursing homes, and we'll talk a
little more about that later, but just just kind of
(28:04):
put a pin in that nursing homes were not not great,
and they're still not great. Yeah, should we take a
break and then come back and talk about medicaid and
medicare and how that figures in. Yeah, all right, Well
we'll be right back with those two tiny little things
right after this. Alright, So we promised talk of Medicare
(28:52):
and medicaid, and I think Dave kind of put it
really on the nose here he said no to government
programs have shaped a nursing home care model over the
last fifty years more than than those two programs. UH.
Created in nineteen Lyndon Johnson amended the Social Security Act.
And UH, if you still get confused, if you're like
(29:14):
a young hip and heppen and millennial and you don't
know what those two words mean and you get them
mixed up. Medicare is health insurance universal, one might dare
say socialized medicine. That's a red herring for Americans over
sixty five. Medicaid is long term care for Americans lower
(29:37):
income status. That's right, Yeah, and it can. You don't
necessarily have to be elderly for um Medicaid. I believe. Yeah, Medicare,
you do Medicaid. You could be lower income and have
a lifelong disability and you'd be eligible for Medicaid too. Yeah,
so Medicare again, this is if you're over sixty five,
it's gonna pay for acute medical care when you're in
(29:59):
a hospital. But if you need something long term UM
kind of like what we're talking about at the beginning,
then uh, it won't pay for that. Like you can't
just say all right, I'm gonna go to a nursing
home now and it's gonna just pay for that in full,
but Medicaid would. And for a while everybody's like, okay, well,
we'll just take Medicaid. This is UM after Lyndon Johnson's
(30:20):
Great Society in UM. So they were like, this is fine.
And then somebody realized that Medicare pays way more than
Medicaid does, and so all of the bottom line people said,
how can we can we do this? What are we
gonna do? So they read the the act um and
they found that, uh, there was language in there that
(30:42):
says Medicare will pay for uh stay up to a
hundred days in a skilled nursing facility UM after three
days or more of treatment in the hospital. And so
all of those nursing homes were like, well, we have
we have nurses, we have doctors. Well, let's just rebrand
ourselves as skilled nursing facilities. And so there was a huge,
(31:05):
massive transition from nursing homes where you would go live
potentially the rest of your life and there were not
nurses and doctors and all of that. Um, and this
was your new home until you died. To you guys
got to go because we're now a skilled nursing facility,
which means the most you could stay as a hundred days,
but we're gonna make way more off of flipping people
(31:27):
every hundred days than we would because Medicare is gonna
pay then we would letting you stay here as a
nursing home because Medicaids paying for that. That, like I said,
just caused a huge change in the industry. Yeah, and Americans,
uh in the eighties and nineties, UM, generally we're like,
you know what, we need better um facilities and more
(31:47):
comfortable facilities that feel more like uh, feel less like
a hospital and more like an apartment, let's say. And
that was sort of the birth of what's known now
as assisted living facilities, where they're different levels of care
that you can pay for um. And the idea is
that if you go to one of those, you have
a little bit more independence. Um, you have a little
(32:10):
bit more uh say, and like how your day goes,
um like and that's just at a just like a
daily schedule level. Um. And you know that it's like
a little more social like it it's it's sort of
like you what you I mean. The best ones are
like what you would hope they would be, which is
a place for your grandparents to go hang out and
hang out with other seniors who and and you know,
(32:33):
have a social life and tell stories and be with
one another and not just sort of be in a
hospital room. Right, So, like if you can't just stay
in your house or something as you're getting older, this
is a real alternative for you. Um. And because there's
different levels of care, you can age in place there,
like you can just keep getting older and older and
(32:54):
then they'll start, you know, adding greater and greater layers
of care. The thing is is assisted living is expensive
and it's outside of the federal purview. Like the Feds
went all in on nursing homes. They regulate nursing homes,
they don't regulate assisted care. Um. They they will pay
for nursing homes, they won't pay for assisted care. Um,
(33:15):
there's a lot of differences, and they're almost they're they're
very much intertwined nursing homes and assisted living, but um,
they're very they're very separate as far as the US
government is considered. There are two different things, and the
government recognizes nursing homes. Um. The thing is, it's like
you were saying, in the eighties and nineties, people were like,
we we don't want to live in nursing homes anymore,
(33:36):
we want to move over here. And all the nursing
homes were like, fine, we're skilled nursing facilities now, and
we can get some of that sweet sweet medicare money.
So if you did you see that stat Yeah, sixty
three there were five hundred and seventy thousand skilled nursing
beds into there were one point two millions. So they
(33:56):
definitely were like, oh, that that money needs to become
in our way exactly so, and that's exactly what they did.
They said, you know, we're we're skilled nursing facilities now,
and you know they probably are owned by the hospitals
where you do three days in there and then get
moved to the skilled nursing facility and then maybe if
it's a large enough group, they might own an assisted
living facility to that you can say move into after
(34:19):
that hundred days or something. Um. The thing is is
the assisted living is great. Um. It can be really
really good, and nursing homes can be good too. There's
not like all nursing homes aren't bad, and they all
of them have like their their upsides. Like you were saying,
assisted living is very social. There's probably you know, a
lot more going on, a lot more activity, just because
(34:41):
a lot of the people who live there these days
are going to be more active still, whereas in nursing homes.
It's now the people who live in nursing homes tend
to be much sicker, more infirm. Um, But there's still
socialization where there's not necessarily if you just you know,
live alone your house and somebody comes by a couple
of times a week. So there are definitely good things
(35:04):
to nursing homes. The problem is is se of them
are for profit. Some of them are owned by um
private equity firms. We shouldn't let private private equity firms
anywhere near the aged population. Ever in any country. That's
just a terrible combination. And apparently, in fact, their studies
(35:24):
that show when private equity firms take over nursing homes
there is a measurable decline in health outcomes for the
residents because their whole thing is there they you know,
they're dedicated to making you know, corporate profits, and so
you've cut costs and you cut services, and you just
approach things differently than you should. And that's kind of
(35:44):
like this evolution that's going on now, is we we've
been providing services to elderly people as they age, as
if their customers where instead we should be providing care.
And those are two different things. Even though from you know,
a few paces back they might look similar, they're not.
They're different. And that's kind of the push that we're
(36:05):
going toward now. Yeah, So where we find ourselves today
statistically is uh. And I was kind of surprised about this.
I had a feeling that more Americans were in these
facilities than I thought. Um, I guess it's a little
bit heartening to hear the numbers. Um, there are about
one point four million Americans in residential nursing homes and
(36:28):
then another one point seven million cycling through those skilled
nursing nursing facilities if they have like a surgery or
an illness or something they're recovering from or rehabbing from,
which is only about four point five percent of all
Americans over sixty five and ten of all Americans over
eighty five. I thought it would be higher than that. Um,
(36:52):
you know, if you want to look at the downside, though,
is one big reason why. Maybe the cost um It
depends on where you are, of course, but if you
um are in a private room at a nursing home,
and I guess was this in Georgia, Yeah, two hundred
and thirty five dollars a night in New York, that's
about four hundred dollars a night and change on average
(37:14):
a night like at that point, just move them into
the w Hotel, right, pretty pretty much. Yeah. The only
thing is that they don't have nurses at the the
W Hunt. But that's a lot of money, man, And
you can just get bled dry at the end of
your life. Well you do. And as a matter of fact,
to pay four a place like that a nursing home,
(37:38):
Medicaid says you have to have paid in which basically says,
you need to have if you if you don't own
your house anymore, you have to um give the proceeds
from your house. Um. Yeah, you have to liquidate your
your your inheritance, you have to you have to pay
down to usually something like I saw like maybe seven
hundred dollars a month income is the cut off. Anything
(38:01):
over that, and you have to be contributing. Um. Anything
under that, the Medicaid will kick in and pay the
place directly for letting you stay there. Um. But the
thing is, it's like, of course, the the better alternative
is assisted living. Some state Medicaid programs will pay or
help pay for assisted living. But for the most part,
(38:22):
if you're if you are paying for if you're living
in an assisted living facility, you might have a reverse
mortgage on your house. You are probably you've liquidated all
of your um, your investments. Um, you're you're you're paying
for it out of pocket. In the United States for
the good kind of retirement home. Yeah, and you know
(38:43):
there are people out there that are trying to further
reform uh what these places look like. Uh. There's a
gentleman named Dr Bill Thomas, who is a geriatrician who
has something called the Eden Alternative. Um. That is he's
trying to basically reframe these nursing home uh residents in
(39:04):
caregivers as care partners. And you know it sounds kind
of hippie dippy, but um, he wants people to be
able to still grow in life and to still flourish
and to still learn. Um, just because you're a senior
doesn't mean you just have to to sit in a
room and watch Judge Judy or push checkers around a checkerboard. Uh.
(39:25):
And you know that they're depending on where you are,
they might be adopting these methodologies of the Eden Alternative
or UM the greenhouse movement. Another thing he helps spawn,
which is you're in an in an individualized home. It's
not a big facility. You got a private room, you've
got a bathroom, and there's outdoor space for you to
go and garden and to walk around and to again
(39:47):
try and flourish in your in your last years on
this planet. Right. Um. And that's a that's there's also
a push for um for aging in place at home.
Yeah sure, which can be really been official, but again
it can also be isolating, depending on you know what
kind of friends or family maybe if you live in
a condo it would be a little more. But if
(40:07):
you're living in the house that you spent your entire
life in and all the neighbors have moved away and
you don't know anybody anymore, that can be isolating. So
in that sense, assisted living or even a nursing home
could be a better alternative. But a lot of people say, no,
this is my house, I want to stay here at home.
The problem is is um I've seen I've seen it
put that medicaid has an institutional bias, which means that
(40:29):
like they'll pay for you to go to a institution
like the definition of the word institution, they don't really
pay for you to be able to stay at home.
Some programs do, but a lot of them don't, even
if you do want to stay at home, which is
kind of heartbreaking to me. Yeah, I mean, you know
Emily's grandmother Mary, who was very popular with the stuff.
You should know Army as the eldest general. She you know,
(40:51):
we had to move her out of her house that
she was in, you know, not our whole life, but
for a large portion of of her life. But you know,
it was one of those deals where it's out in
the middle of the country in Ohio. Uh, there was
no family close by, there was no hospital close by,
and it's just it's hard to say it's okay to
stay there, you know. Um. And it was sad when
(41:11):
she left, but she was also like, no, this is great,
I'll move in with you guys. Like she didn't kick
and scream, you know, she was she was willing and
understood it was the best thing. And uh, you know,
it's probably one reason why she's pushing one right now.
I think for sure where she live, she lives with
Emily's parents and here in Georgia. Now that's great. Yeah, um, well,
(41:33):
I'm yeah, I'm I'm very glad that that worked out
for um. But I was also looking at like the
antithesis of that, like what happens in the United States
to people who who don't have any family, who don't
have any children, and who don't have any money, like
what happens to them, And they seemed to be they
(41:55):
seem to be kind of left on their own, Like
if they have a house, they're they're probably just to
be left in their house and maybe meals on wheels
will come by. Um. The County Social Services might be
able to help them. But this is if they reach
out for help, if they need assistance, they might not
get it at home because again, there's a lot of
UM services that aren't paid for. And if you don't
I mean money, you're s o l. You could go
(42:17):
to a UM uh nursing home. But if you don't
have any ability to pay UM, they can kick you out. Uh,
they can kick you out for a bunch of different reasons.
They're The most oppressing thing that I've looked up in
a while was nursing home evictions, and they there are
there's a there was a loophole that was recently closed
(42:37):
in two thousand sixteen that said UM, if you if
the nursing home is not able to UM to offer
care for the person, then they can be discharged. And
they use that as like a huge loophole. They'd be like,
we're sorry, we can't offer you the care you need
any longer. You have to leave. And you know, if
(42:58):
you don't have anybody to advocate for you, you're you're
you know, where are you going to go? And I
couldn't get a really good answer, but I get the
impression that it's there are it's not huge and rampant,
but there are a lot of people who are still
falling through the crack society as they age because we
don't have a robust, nationalized UM plan to care for
(43:24):
the elderly no matter what. And I thought, well, of
course the United States is super behind in that respect,
but apparently we're in line with other countries like Canada.
You think Canada would have like a place for every
senior and they're all happy and taking care of and
everybody gets a pet beaver or something like that. Now
you're on your own, kind of like your state might
help you out a little bit, the local city might,
(43:46):
but that's about it. Same with the UK too, which
I was really surprised because both of them have nationalized medicine. Yeah.
I will say that this is where UM. Social media
has been beneficial UM as far as neighborhood and neighbors
go UM. I mean all the time on our neighborhood pages,
we see people stepping up, and especially in a place
(44:09):
like Atlanta, Atlanta, where gentrification has happened, UM, you do
see a lot of neighbors stepping up to help take
care of UM, the senior African American community that is um,
still living in their houses and they haven't been bought
out for a shamefully low price by a greedy contractor
to to flip it into a little McMansion. But you
(44:31):
see it all the time that we work with a
group called Neighbor in Need that really does great things.
And aside from just the the official organizations. All the
time you'll see someone that lives next door to someone
like that. They'll be like, hey, she's having a hard
time paying her power bill this winter, and you know,
in an hour it is funded for for the rest
(44:52):
of the year. Uh, the neighbors step up and and
pay for her power bill. And it's just it's little
things like that. But um, these are in unities where
the houses are close together and people are you know,
each other's business, like um, Emily's grandmother out there in
the middle of the country, and a lot of rural
America like that might not be the case. You might
not have someone checking up on you, and people you
(45:15):
know bleeding hearts like you, and I feel that they
should be taking care of no matter what. You know. Yeah,
but I mean, isn't that something everybody can get behind?
You would think so, But that's just not true. I'll
remind you of our episode on homelessness many years ago. Yeah,
that one's tough for me to swallow. Those are the
people who believed in the unworthy poor. Huh, and we're
to send him to alms houses back in the day. Yeah. Um.
(45:39):
The good news is if you're looking for a home
for a family member these days, Medicare dot gov has
a lot of resources. Oh, I'll tell you another place
to u S News and World Report is really hot
and heavy on um an assisted living in nursing home ratings. Yeah,
nursing home compares another website. And you know there are
places where you can go to really dig in see
(46:00):
which ones you feel are a good fit. Uh. They're
rated on you know, how the people are really doing.
They're not just like how pretty it is. And if
you go and visit one, they said to be aware
of the chandelier effect. Like in fact, if you walk
in and you see a grand piano and a lobby,
just turn around and leave. Well yeah, that's I mean,
that's one of the ways that they get you. You
want to do a little more digging than just that,
(46:21):
and you want to talk to residents, You want to
read like actual like, uh, inspections and reports on those places.
You want to look at stats like how many patients
had to get were taken to the e er or
were readmitted in the hospital, how many have bed sores?
Um any allegations of abuse. Apparently abuse has doubled between
(46:41):
two thousand thirteen and two thousand seventeen. Still low. I
think it was like eight hundred and forty five, which
is too many, but it's still doubled since two thousand thirteen.
So you want to like really look for that kind
of thing. Are they over prescribing medications like for psychosis
to to people who are um who are problematic when
(47:02):
you don't really think they're problematic. There's a lot of
stuff you want to look for that you can look for.
It's out there. Just do some digging because this is
somebody you care about, don't forget. Yeah, and we really
want to point out that, uh, it's easy to zero
in on things like abuse cases and unnecessary medication. But UM,
we really salute you if you are the lion share
(47:25):
of these people, UM that are in nurses that are
taking care of our seniors and doing a great, great
job and a very very tough job. Yeah, and one
of the things actually I saw I'm glad you said
that was that, um, it's it's a really a thankless
kind of job because traditionally people who work in elder care,
(47:45):
like the actual workers are treated like garbage by management.
It's just like an industry wide problem. And that was
actually one of those things from the the Eden alternative
was that workers are treated with the respect that you
want the workers to treat the patients with like everyone
is treated with respecting dignity, not just ideally the patients,
the workers too, because they deserve it for the work
(48:07):
they're doing. It's amazing. Ah, you got anything else about
nursing homes, I've got nothing else. We can do. Better
start thinking about stuff, you know. I mean, you're never
too young to get a plan in places. That's all
I'm saying. Great point, um, And since I say great point,
it's time for a listener, man. I mean, maybe if
(48:28):
you're like twenty five, you don't need to be thinking
about your nursing home options. Okay, but you know what
I mean, well, not necessarily, I'm your parents. I saw
that of nursing home residents were under sixty five, so
there are some younger residents in there that I think
get overlooked a lot, like by us. You know what
(48:48):
you call those people? What the party crowd? That's right, Oh,
that's gonna be me. Man. What the party crowd at
the at the nursing home. I'm be mixing it up
like scat Man Cruthers in the Twilight Zone movie. I
could see that. Let's go play kick the can. Everyone.
It's midnight. It's time. It's time to take off that
gown and live. Good things happen. You're ready, I'm ready, Well,
(49:13):
bread away. I'm gonna call this one. Uh goots follow up? Okay,
this is a good one about the great, great Steve Guttenberg.
I'm hoping someone throws the stuff his way, by the
way he needs he needs to know. I can feel
him right now listening to all right this from Dave. Hey, guys,
on a recent episode, you discuss the episode of Party
(49:35):
Down which the wonderful Steve Guttenberg allows the caters to
throw a party at his house. You knew this had
come up before and wondered in what episode in what context.
By chance, the next day, I was scrolling randomly through
older episodes and selected Barefoot running uh boy, remember that one.
When in this episode you started talking about Steve Guttenberg,
(49:57):
I had an intensely existential experience. I was listen thing
in the present to you talk about Steve Gutenberg in
the past, having listened in the more recent past to
you also for more from a more recent past talk
about Steve Gutenberg, unable to remember the more distant past,
and which you were talking about Steve Gutenberg, which I
was now listening to in the present, which knowledge of
(50:17):
the future, in which you would again discussed Steve Gutenberg.
Steve Gutenberg the center of our cosmos, the nexus around
which space and time and God swirl until they've become one.
The answer to this question for which our souls cry out,
I can only speculate yes. Anyway, I wanted to let
you guys know in which previous episode he featured Steve Gutenberg.
(50:38):
As to the context, there was none. You you started
talking about Steve Gutenberg for no discernible reason. It sounds
like me, which is as it should be, and that
is from Dave. And Dave was very excited that this
was getting read, and he said, to be honest, I
had a little bit to drink when I wrote that,
and I didn't fully remember the whole experience, so good
(51:00):
job there go. This would be proud. Yeah, I think
Dave's going to be part of the mixing it up
crowd at the nursing home to kicking that can you know, Well,
thanks a lot, Dave. That was pretty great. Um. And
if you have something great to tell us, especially if
it's in reference to something we said about something we
said in the past, we'd love to hear from you.
(51:22):
You can send us an email to Stuff podcast at
iHeart radio dot com. Stuff you Should Know is a
production of iHeart Radios How Stuff Works. For more podcasts.
For my heart Radio, visit the iHeart Radio app, Apple Podcasts,
or wherever you listen to your favorite shows.
Welcome to Stuff you should know, a production of My
Heart Radios How Stuff Works. Hey, and welcome to the podcast.
I'm Josh Clark, and there's Charles w Chuck Bryant and
Jerry's out there wandering around in the ether and that
makes this stuff. You should know. She's been wandering around
(00:23):
the ether for weeks at least, I dare say months
by not Chuck. Yeah, she's uh, actually just chatted with
Jerry from ten feet away. Oh that's nice, man, that
must have felt really special. Did in her hair is long? O? Man?
My hair is really long too. Yeah. I feel like
I saw Jerry a couple of months ago and her
(00:45):
hair was long, So she must have like a full
on like do now? Uh? Yeah, you know she looks
like a proper lady. I'm not touching that one, all right, So, Chuck,
this one was of yours. It was a nursing homes
is the idea? Right? Yeah? So I have a question
for you. What what made you decide that you want
(01:07):
to do on nursing homes? You know, I mean, I'm
almost fifty, My parents are in their mid seventies. Emily's
grandmother is edging towards one so you know, this is
the kind of stuff that just you gotta start thinking
about at some point. And Emily and I are old
parents and have an only child that we don't want
(01:28):
her to have to like have to take care of
us or anything. So like we're just starting to have
all these thoughts. And I was like, yeah, you know what,
I'm not so sure America does it right here. Um,
And after studying this stuff, it's we do it, okay.
But it's also like, hey, work your whole life and
then go broke at the end. Yeah, that's that's a
(01:50):
real bomber about the whole thing is just you're just
kind of like expected to spend whatever money you have
on care at the end of your life. And it
just seems a little wrong to me too. Yeah, and
we need to shout out first of all, our buddy
Dave Ruse helped us put this together, and he actually
did a real deal interview with Dr Muriel Gillick, who
(02:10):
was an author of Old and Sick in America colon
the Journey through the health Care system and was quite
a resource, and that the history of this stuff in
this country I think was pretty fascinating. Yeah, it is.
It's super fascinating. Um, and the whole thing kind of
started out. Um, you know, when we're talking about nursing
homes in particular, but there's just no way we can't
(02:31):
talk about other kinds of homes in particular, because nursing
homes grew out of this kind of system that developed
that seemed to really kind of take shape and take
hold around the Second Industrial Revolution, the one that happened
here in the States, and because of that, because people
were like, you know, I don't feel like swinging the
(02:52):
scythe any longer. I'm gonna go into town and see
what they have in the way of jobs. So long
mom and dad. All of a sudden, Mom and dad
were like gulp, because they were on their own, not
just you know, one set of parents in particular, but
as like a general intergenerational trend where kids were moving
away from the farm, and all of a sudden, there
weren't multi generational homes like there were before. Because when
(03:13):
you have a multigenerational home, you don't have to worry
about what's going to happen to you when you get older.
Where you're gonna live. You're gonna live in the same
house you raised your your Brady, little kid in to
take care of you until you die. And that's just
the way it was for years and years and years
in America. Yeah, there's a stat here. Uh In nineteen hundred,
fifty seven percent of adults over sixty five lived in
(03:37):
a multigenerational household, and by nineteen eighty eight years later,
that went down to seventeen percent. And big reasons for that,
Like you were talking about, you know, moving away from
the farm. But just nowadays people just move away. I mean,
sixty percent of American adults have moved to a completely
new community at least once. And as uh Dr Gillick
(04:01):
points out, she says, not only are people not living
with their adult children, they're not even living near them
many times now, Yeah, because they finally wised up and
we're like, gosh, I can get away from my kids
once and for all now that they're adults. Well, I
think it's more like the kids are like, hey, gee,
I want to go live in wherever the heck I
want to and we'll just think of a plan for
(04:24):
my parents at home. My generation doesn't have any hangups
about guilt or morality, you know. But the thing is,
it's not just the kids moving away. Like my grandmother
moved far away. She moved to Florida, she moved to Arizona.
She moved. She was like, so long, everybody, I got
this UM. But she was very fortunate that she had.
(04:44):
One of the things that UM nursing homes exist for
is to take care of people who don't got it,
who either don't have family, who don't have the money
to hire people to take care of them, who don't
have the money to go live in and you know,
say like assisted living or something. UM. That's what nursing
homes have kind of evolved to take care of. And
in that sense, they're actually directly related to what came
(05:06):
what were originally called alms houses or county houses or
poor houses, which if you were old and you didn't
have anyone to take care of you, in like the
late eighteenth early nineteenth century in America, you could go
to like a farm that the county maintained and there
would be a bed there for you, and um, you
(05:26):
would be housed with a bunch of different people with
a bunch of different conditions, and the one thing that
you all had in common was that society didn't quite
know what to do with you. Yeah. So I mean
it could range from people who had no living family
two and just you know, needed care that had nothing
else wrong with them except just being old and needing
care and having no one around, uh, to people that
(05:49):
were mentally ill, maybe people who were suffering from dementia,
or people who were alcoholics or drug addicts, and like
you said, they you could get a bed, but there
were no doctors, there were no nurses, you couldn't get
medical care. Uh. And that was sort of the the
beginnings of of the shame almost if you want to
(06:10):
look at it that way. Yeah, kind of. But it
does say something that society did say, we have a
responsibility of people. We can't just be like, well, there's
a corn field for you to go lay in until
you die of exposure, good luck, you know, Like there
was a bed that was provided. As meager and horrific
as that whole thing was, it was at at least
an experiment or an attempt to do something. Yeah. And
(06:34):
you know, the next big change happened, um, sort of
midway through the nineteenth century when uh, sort of around
the time in the Civil War, we started getting our
first big hospitals like medical hospitals, public medical hospitals and
the big cities around the country, and they, you know,
they were sort of the the beginnings of modern um
(06:55):
large scale public healthcare. And here's the thing, though, is
they were back then they focused on acute care. So
if you again were a senior and you uh they
called them old chronics, like you had maybe a chronic
condition and no one to take care of you, then
you uh, basically you were too too dependent to go
(07:19):
to one of these places because it was a hospital,
and they're like, you can't stay here, right because even
though you know you're called an old chronic, you might
not have anything wrong with you aside from being really old,
and maybe you can't make it to the bathroom very
easily something like that, but not necessarily anything that a
hospital could treat you for. It was just they had
a bed about hospitals. Very quickly, we're like, we can't,
(07:41):
like this isn't working. You're gonna stay here indefinitely and
there's really nothing wrong with you. We gotta find a
place for you. And so about that time, some charities,
especially either ethnic or religious based charities like the um
Baptists or the German Aid Society was was a big
one in Boston. I think, um, the German Ladies Aid
(08:03):
Society of Boston. I'm sorry. Um, they kind of said,
you know what, we we have members who are uh
they're members of our church or you know, they're German,
they're part of our community and they don't have anybody,
so we we need to make sure that they're taken
care of. And they actually started founding what we're called
old age homes, which is basically they would get like
a large home and um kind of outfit it with
(08:25):
different Each room was like a different room for a
different tenant, and they would take care of like old
widows basically who didn't have the money or the children
to take care of them. Yeah. But specifically, what they
deemed as worthy poor uh, And here's what differentiated them
from the almshouses was, uh, if you were worthy poor
(08:45):
and you know that's in air quotes, that meant that
you were the wife of of a man who who
worked hard all his life but never made a lot
of money, maybe worked at a shipyard or just had
sort of a very low paying, blue collar but respectable job,
but certainly not the kind of dough to pay for
(09:05):
like private nursing homes or anything like that, but not
alcoholic or drug addict or you know, there was no UM.
They didn't like force a shame attachment to it. So
these widows who were you know, in their sixties or seventies,
depending on you know, how their husband lived their lives,
They're like, I've been morphine free since seventy three, so
let me in. Uh. They didn't have these big pensions
(09:28):
or anything because of the jobs their husbands had. So
they were taken into one of these homes like a
Baptist m or something, and they were given to bed
and they were given again, not medical care, but they
were at least given meals in a bed. Right. Um.
A lot of times they were expected to kind of
pay for their their room and board. Um. It was
kind of like a needs based sliding scale. I got
(09:51):
the impression some of them, UM just straight up said hey,
give us five hundred dollars. At the time, I think
around nine or uh, late nineteenth century, I don't remember
exactly when it was, um, the Winchester Home for Aged
Women in Massachusetts, the Winchester Mystery House. I looked it up.
I was like, is that the same one? But it was.
It was bequeathed by a Lucy Winchester, who I couldn't
(10:14):
find anything about. But it's not the same person. A
lot of people in the house, you would, um, although
you gain a lot more ghosts, it's true. But um,
they said, you pay us five hundred dollars. So this
is in nineteen o four. You pay us five hundred
dollars and you can stay here for the rest of
your life. And five hundred dollars back then was worth
about fifteen thousand today, And exactly I was thinking about that.
(10:34):
It's a bit of a gamble on both sides. But
it's a bit like insurance. It's like some sort of
long term care um insurance where you're like, okay, let's
stretch my five dollars as far as I can go,
or you know, you could die two days after they
still kept your five hundred dollars. But then hopefully it
was used to make life better for the other people
who's who had used up their five hundred dollars long ago.
(10:58):
You know. So there was this kind of idea that
if you could pay for it, you should pay for it.
And then as time went on, it was like, oh,
you just you know, you sold your house. We need
that money if you're gonna stay here, And people would
take in more and more money from that person's estate
um as they were alive to take care of them.
(11:18):
And this was starting in like the beginning of the
twentieth century into the nineteenth century. So that's a very
long tradition of extracting everything from old people as they're
dying to to pay for their care. And I'm got you,
I'm bothered by that. Yeah, I mean the question became U,
not how how much is it for your care facility,
and it's more like how much you got how much
(11:41):
you got here? Graham by the ankles and turn them
upside down, or if they you know, if they weren't charging.
There was the expectation that they didn't need so much
care that they couldn't also contribute, like here, we got
a room for you. We'll feed you, but you gotta
make your bed, and you gotta clean your room and
maybe help keep the property up. So I got the
idea that these were people who, like I said, you know,
(12:03):
a senior widow who just didn't have anywhere else to
go and otherwise was doing okay, yeah, but forced to
make knockoff Gucci wallets during craft arts and craft. Should
we take a break? All right, I got a Gucci
wallet to work on myself. Okay, So we've got alms
(12:53):
houses are still around. They have they stayed around until
like the nineteen forties. From what I could see, these
county houses poor houses, um, and then alongside of those
you've got old age homes. But then, um, the government
was kind of like, we can do we can do
better than this. New York itself, I think, became the
first state in the United States to say, um, it's
(13:14):
a ten ninety it's modern era, we need to do
more to take care of like our our elderly and
in particular are mentally infirm. Um. They and they that
state made a commitment to take care for the state,
to take responsibility for its mentally ill and that included
people with dementia of all sorts, which they would have
(13:36):
called senility back then. Um. And so that was kind
of like the first entree of the state into caring
for elderly people. And that actually kind of opened a
bit of a floodgate. I think, um. Other states started
to kind of follow suit, but it was like a
it was a step in a really dark direction, because
(13:57):
by World War One, if you were elderly, especially if
you had some sort of um declined, some sort of
cognitive decline from age, there was a really good chance
that you were in a mental asylum um with everybody else.
And in a lot of cases, I think even if
you were just elderly, you would find yourself in a
(14:17):
mental asylum in that right, Yeah, I mean absolutely. So
you've got a situation where the states start to say, hey,
we need to take care of our mentally ill, but
seniors just started getting kind of lumped in if they
didn't have anywhere else to go. So you might have
you know, someone's someone's grandmother who just didn't have family
and who was really doing okay upstairs and and was
(14:41):
in pretty good health, might find themselves in, like you said,
a mental hospital with people with severe mental illness. Uh.
And I think there's a couple of stats here that
Dave dug up by there were more elderly Americans and
mental hospitals than in those almhouses and the price that
old age homes combined. And he mentioned one in particular,
(15:04):
Chicago State Hospital, which was a mental hospital in the
nineteen thirties, of the patients there were quote aged or
infirm that had no other underlying psychosis or mental health condition. Right.
So that's a really dangerous place for old people to
be because if you act up, they can put you
on medications, they can give you, um, the hydrotherapy treatment,
(15:26):
they can do all sorts of stuff to you because
you're in a mental hospital. And I think it's kind
of like one of those things where, um, if you're
a hammer, everything looks like a nail. Well, if you're
a nineteen thirties old timing psychiatrist, everything looks like a um,
a mental condition, a mental condition, right, you know, um,
and you're gonna treat all of the people the same way.
And so luckily Francis Perkins arrived on the scene around
(15:50):
this time. So World War One is when old people
really started to get shuffled off to mental hospitals by
the government. Swoop James like, whoa, whoa, this is way wrong,
Like we need just because these people are old doesn't
mean that they're um, they're mentally ill. So let's extract
them from that environment and figure out if we can
do something else. And thanks to Social Security that that
(16:13):
really began to change. Fairly quickly. Yeah, so this is
nineteen thirty five. Again, you mentioned the great Francis Perkins.
If you didn't listen to that episode, go listen to it.
It's fantastic out the Social Security Act. Um. Basically like
when we think of Social Security now, we think of
the program where you pay in your whole life from
(16:35):
your paycheck and then when you retired you get a
monthly income and if you work longer than your checks
are gonna be bigger. Um. I started working when I
was thirteen, so imagine I'm gonna be rolling in dough.
You're always boasting about that of hearing about that about
my thirteen year old bus boy job. Yes, it's a
title Max. Now, by the way, yeah dry Max, got
(16:58):
your money, your mind, real money. Oh man, that's some
good free advertising. Yeah. I drove. I drive by there
on the way to my mom's and Emily's parents house sometimes,
and I always pointed out to my daughter and say, hey,
that's the barbecue restaurant I worked at. It's now a
title Max. Is that the one where the guy put
his foot in the Brunswick sto? Yeah? God, I wonder
(17:22):
where that guy is now. Randy, he's in he's in
I don't know. I'm not even going to guess the
feeling Randy's in prison, do you think so? I mean,
he saw him do a lot worse than put his
foot in the Brunswicks, do you know what I mean?
Oh jeez, I don't put My mind is rased at
life behind bars and I'm not laughing at that. It's
it's very sad. But Randy, you know, he made his
(17:44):
own decisions. That reminds remember Randy the hippie from MTV
and like the late eighties, early nineties, No, he ran
for president. He was like just this total weirdo burnout
who was yeah, who looked today like he could have
been in l m f A. Oh okay, Like really
(18:05):
he dressed like that, but this is like decades before.
But anyway, I remember like he he like ran for
president and I think he lost and he's like, I've
made my bed now I must lie in it. I'll
never forget that. For some reason, I thought it was hilarious.
But yeah, that was Randy. Well, I mean maybe it
was d Randy Brunswich, it was the Rands. What I'm saying, um, so, yeah,
(18:25):
that that was old age insurance is what they called
it originally. But then there was also Old Age Assistance
oh a A, which was you're gonna get payments when
you're older, even if you didn't work, which was a
big deal because so many women were not allowed to
work and have jobs, so like what were they going
to do? They're like, say, hey, you didn't pay anything
(18:47):
in sorry, you just raised your kids and grandkids. That's
a great that's a great point. I think we still
do that today though, unfortunately, but at least women can
actually work in the workforce if they want to. But yeah,
if they if they stay home and raise kids, then
they're still treated the same way, which is pretty shameful.
But I get your point. And the point is is
that we needed to be able to UM take care
(19:10):
of people who hadn't necessarily worked in the workforce and
paid into Social Security, and then also we had to
offset that first basically generation that we're like, Okay, we're
the first ones nobody's been paying in, but why do
we Why are we the ones who have to pay
him but we get nothing from it? So the Old
Age Assistance the o a A really helped with that
(19:33):
UM and I guess that's kind of gone the way
of disco because the only thing I know about is
the Old Age insurance that's still around, and I know
they don't call it that any longer, but that Old
Age assistance where it's like, I guess that would be Medicaid, right, yeah,
I think so okay, So so we'll and we'll talk
a lot more about Medicaid and medicare. Just put a
(19:53):
button in that all of you bureaucrat walks. You're gonna
love it. Yeah, but uh, you know, FDR, this is
when things really changed. And the reason we're talking about
social security and stuff like this is because it really
it's sort of laid out the roadmap for what was
going to happen and how we cared for our grandparents
and what kind of places they were going to be.
(20:14):
So because he went in there with a new deal
and he was like these all houses are terrible. He's like,
we need to get rid of these. And he said
in these state mental hospitals, they're overburdened. And that's not
right either. So here's what I'll do. Part of the
o A A the Old Age Assistants. A big provision
here is that you can't um you can't get any
of that money if you're living in a public institution
(20:36):
like an alms house or like a state mental hospital,
No money come in your way. No. So suddenly the
people who were stuck in state mental hospitals or alms
houses not only were like, oh, well I could get
out of here. Now I have the funds to get
out of here and go somewhere better. And this led
to a huge boom in the growth of private um
(20:58):
uh living facilities for the elderly. Yeah. I think that
was the big change. I mean, surely people were like, great,
I can get out of here, but I think people
saw dollar signs said wait a minute, I can get
paid by the government to take in these people and
take care of them, right, sometimes directly get paid by
the government. Yeah. That was kind of like an amendment
(21:18):
that they made later on where it was like, um yeah,
that that incentivized it even more. It's like, well, we'll
pay you directly. There's not even this person as gonna
have to be involved. Just take care of them, you know,
follow these guidelines and we'll send you this check every month.
And the people is there any money left over for me?
You know? And no, no, no, no, this just don't
ask any questions. It's as a matter of fact, now
(21:39):
that you bring it up, do you have any money,
you're gonna give it to them first before we give you.
There's a balance on your account, sir. So. Um, this
is kind of how it went for like the first
you know, fifteen twenty years after so Security Act was
introduced in nineteen thirty five, where um it fueled this
boom of retirement homes. Basically the retirement home into Tree
(22:00):
found its its birth there. And then about fifteen years
after the government was like, you know what, we've been
sinking a lot of money into this, maybe we should
look around and see if any of these places are
any good. And they found that no, in a lot
of cases they weren't really good. There was, um, you know,
if you if you converted an old Victorian mansion into
an old age home with a dozen rooms, you probably
(22:23):
didn't add a fire exit onto every room and fire
stairs on the second and third floor. Um, there's probably
not sprinkler system because they weren't very prevalent by that time,
and so if there was a fire, all of these uh,
the dozen ages and infirm people who lived there were
going to die in a fire. Um that was the
one big one that they turned up that came out
(22:44):
of these early investigations into into what came to be
called nursing homes. Yeah, so this is when Congress steps
in again, like you said, about fifteen to twenty years
later in the nineteen fifties, and said, all right, here's
the deal. If you're getting this dough from us, we
need to regulate, um, what's going on there, and they
need to be safe. And a lot of these mom
(23:05):
and pops that, like you said, converted an old house,
they couldn't make those upgrades. You can't just slap on
a fire escaped to an old Victorian. I guess you could,
but it wouldn't look that great or probably work that well.
And so a lot of these smaller ones floundered and
all of a sudden, and this is things where things
really start to change. There's a big market for just
(23:26):
basically I don't even know if I would call it
the corporatization yet, but maybe to a certain degree, these
bigger facilities for residents that had this money that could
go straight to them. And uh so these sort of
larger places that weren't individual houses started popping up. Yeah, well,
that's like an ongoing and recurring theme in a big
(23:47):
criticism among conservatives of big government or government regulation is
that it homogenizes things because usually the mom and pop operations,
even if they are well meaning and not nefarious, like
they don't have money to add those fire exits on.
But say like a corporation that's going to own several
of these things, they can build new ones with all
(24:07):
the modern fire exits and fire sprinklers. And so those
bigger corporations start owning more and more and more, and
by building more and more and more, they're not gonna
make each one like really unique and and embedded in
the community. They're going to plunk down the same one
in every place they build one. And so there's this
homogenization that occurs as a result of that. And that's
(24:27):
exactly what happened with what came to be called nursing homes,
which really started to find their advent in the nineteen
fifties from these reforms where the government was like, you
guys need to be able to do this, this, and this, um,
we're gonna assign the Public Health Service to to lay
out guidelines. The Public Health Service knows about regulating hospitals,
so they really added onto that homogenization, this this underlying
(24:51):
medicalization of caring for older people, which makes sense. You know,
you think of older people, olderally people, senior adult you think, gosh,
the you know, the body is starting to wear down.
There have they have all these conditions or whatever, So
it makes sense that you a couple hospitalization or medicalization
with that. But that's not always the case. And the
(25:12):
problem is, as it became the case, whether you needed
it or not, that was the kind of place you
lived was basically a bland institutional extension of a hospital. Yeah,
I mean it's not like in Uh. I kept thinking
of the movie Say Anything when I was researching this
(25:32):
because that was a prominent storyline in that movie. I
never saw it. You never saw Say Anything. I didn't
do you wonder what happens every time a guy in
a trench coat holds up a boom box over his head. So,
I mean, I know you need the cultural reference. Yeah,
of course, I just wondered up all this time. You're like,
what is the deal with this boom box? Yeah, it's
like a reference to Kevin Smith and Clark. Okay, sure,
(25:55):
exactly now Ione Sky's father, the late great John Mahoney.
Was he ran a mom and pop nursing home. Yes,
and was in spoiler coming if you haven't seen a
thirty something year old movie. Uh, he was found to
be ripping them off and that was a big sort
of subplot in that movie. All I heard was that
(26:17):
was a big subplot in that movie. Very good, but uh,
say anything aside. They um, like you said, became more
hospitalized for lack of a better word, And if you
went to one of them back then, there was very
little to differentiate it from a hospital, from the central
nurses station to the cafeteria food. I remember going to
(26:38):
visit my my grandmother on my my paternal grandmother, who
lived to be a hundred and one before my dad
and his wife took her in. She was in one
of these places and uh, or actually maybe it was
the other way around. She went afterward. But it was
it was terrible, you know, it was awful and very
very sad. And if I was not a young man
(27:00):
with nothing, you know, nothing going on in my life,
I might have done something about it, but you know,
I didn't know what to do back then. You would
have opened all the doors and been like, go free,
go free. I would have ripped her out of there
at least and said come home with me. Yeah, I
mean they were pretty bad, especially by the time I'm
guessing you were there in the eighties or nineties. Maybe
this was in would have been the nineties. Yeah, So
in the fifties, in the mid fifties, even these things
(27:23):
made a little more sense at the very least they
were newer. By the seventies and eighties, they were so
bad that we had a reform Act that kicked in seven,
which is basically like this place is wrong, and like
maybe we don't know what to do or replace him with,
but here are some things that that you have to
(27:43):
treat these people with, like dignity. They have to be
able to have a say in what they wear or
what they um, what they eat, or what they do
during the day. And it really kind of got off
the rails within a couple of decades after their advent.
The thing is is like I was saying, nobody knows
what to do about nursing homes, and we'll talk a
little more about that later, but just just kind of
(28:04):
put a pin in that nursing homes were not not great,
and they're still not great. Yeah, should we take a
break and then come back and talk about medicaid and
medicare and how that figures in. Yeah, all right, Well
we'll be right back with those two tiny little things
right after this. Alright, So we promised talk of Medicare
(28:52):
and medicaid, and I think Dave kind of put it
really on the nose here he said no to government
programs have shaped a nursing home care model over the
last fifty years more than than those two programs. UH.
Created in nineteen Lyndon Johnson amended the Social Security Act.
And UH, if you still get confused, if you're like
(29:14):
a young hip and heppen and millennial and you don't
know what those two words mean and you get them
mixed up. Medicare is health insurance universal, one might dare
say socialized medicine. That's a red herring for Americans over
sixty five. Medicaid is long term care for Americans lower
(29:37):
income status. That's right, Yeah, and it can. You don't
necessarily have to be elderly for um Medicaid. I believe. Yeah, Medicare,
you do Medicaid. You could be lower income and have
a lifelong disability and you'd be eligible for Medicaid too. Yeah,
so Medicare again, this is if you're over sixty five,
it's gonna pay for acute medical care when you're in
(29:59):
a hospital. But if you need something long term UM
kind of like what we're talking about at the beginning,
then uh, it won't pay for that. Like you can't
just say all right, I'm gonna go to a nursing
home now and it's gonna just pay for that in full,
but Medicaid would. And for a while everybody's like, okay, well,
we'll just take Medicaid. This is UM after Lyndon Johnson's
(30:20):
Great Society in UM. So they were like, this is fine.
And then somebody realized that Medicare pays way more than
Medicaid does, and so all of the bottom line people said,
how can we can we do this? What are we
gonna do? So they read the the act um and
they found that, uh, there was language in there that
(30:42):
says Medicare will pay for uh stay up to a
hundred days in a skilled nursing facility UM after three
days or more of treatment in the hospital. And so
all of those nursing homes were like, well, we have
we have nurses, we have doctors. Well, let's just rebrand
ourselves as skilled nursing facilities. And so there was a huge,
(31:05):
massive transition from nursing homes where you would go live
potentially the rest of your life and there were not
nurses and doctors and all of that. Um, and this
was your new home until you died. To you guys
got to go because we're now a skilled nursing facility,
which means the most you could stay as a hundred days,
but we're gonna make way more off of flipping people
(31:27):
every hundred days than we would because Medicare is gonna
pay then we would letting you stay here as a
nursing home because Medicaids paying for that. That, like I said,
just caused a huge change in the industry. Yeah, and Americans,
uh in the eighties and nineties, UM, generally we're like,
you know what, we need better um facilities and more
(31:47):
comfortable facilities that feel more like uh, feel less like
a hospital and more like an apartment, let's say. And
that was sort of the birth of what's known now
as assisted living facilities, where they're different levels of care
that you can pay for um. And the idea is
that if you go to one of those, you have
a little bit more independence. Um, you have a little
(32:10):
bit more uh say, and like how your day goes,
um like and that's just at a just like a
daily schedule level. Um. And you know that it's like
a little more social like it it's it's sort of
like you what you I mean. The best ones are
like what you would hope they would be, which is
a place for your grandparents to go hang out and
hang out with other seniors who and and you know,
(32:33):
have a social life and tell stories and be with
one another and not just sort of be in a
hospital room. Right, So, like if you can't just stay
in your house or something as you're getting older, this
is a real alternative for you. Um. And because there's
different levels of care, you can age in place there,
like you can just keep getting older and older and
(32:54):
then they'll start, you know, adding greater and greater layers
of care. The thing is is assisted living is expensive
and it's outside of the federal purview. Like the Feds
went all in on nursing homes. They regulate nursing homes,
they don't regulate assisted care. Um. They they will pay
for nursing homes, they won't pay for assisted care. Um,
(33:15):
there's a lot of differences, and they're almost they're they're
very much intertwined nursing homes and assisted living, but um,
they're very they're very separate as far as the US
government is considered. There are two different things, and the
government recognizes nursing homes. Um. The thing is, it's like
you were saying, in the eighties and nineties, people were like,
we we don't want to live in nursing homes anymore,
(33:36):
we want to move over here. And all the nursing
homes were like, fine, we're skilled nursing facilities now, and
we can get some of that sweet sweet medicare money.
So if you did you see that stat Yeah, sixty
three there were five hundred and seventy thousand skilled nursing
beds into there were one point two millions. So they
(33:56):
definitely were like, oh, that that money needs to become
in our way exactly so, and that's exactly what they did.
They said, you know, we're we're skilled nursing facilities now,
and you know they probably are owned by the hospitals
where you do three days in there and then get
moved to the skilled nursing facility and then maybe if
it's a large enough group, they might own an assisted
living facility to that you can say move into after
(34:19):
that hundred days or something. Um. The thing is is
the assisted living is great. Um. It can be really
really good, and nursing homes can be good too. There's
not like all nursing homes aren't bad, and they all
of them have like their their upsides. Like you were saying,
assisted living is very social. There's probably you know, a
lot more going on, a lot more activity, just because
(34:41):
a lot of the people who live there these days
are going to be more active still, whereas in nursing homes.
It's now the people who live in nursing homes tend
to be much sicker, more infirm. Um, But there's still
socialization where there's not necessarily if you just you know,
live alone your house and somebody comes by a couple
of times a week. So there are definitely good things
(35:04):
to nursing homes. The problem is is se of them
are for profit. Some of them are owned by um
private equity firms. We shouldn't let private private equity firms
anywhere near the aged population. Ever in any country. That's
just a terrible combination. And apparently, in fact, their studies
(35:24):
that show when private equity firms take over nursing homes
there is a measurable decline in health outcomes for the
residents because their whole thing is there they you know,
they're dedicated to making you know, corporate profits, and so
you've cut costs and you cut services, and you just
approach things differently than you should. And that's kind of
(35:44):
like this evolution that's going on now, is we we've
been providing services to elderly people as they age, as
if their customers where instead we should be providing care.
And those are two different things. Even though from you know,
a few paces back they might look similar, they're not.
They're different. And that's kind of the push that we're
(36:05):
going toward now. Yeah, So where we find ourselves today
statistically is uh. And I was kind of surprised about this.
I had a feeling that more Americans were in these
facilities than I thought. Um, I guess it's a little
bit heartening to hear the numbers. Um, there are about
one point four million Americans in residential nursing homes and
(36:28):
then another one point seven million cycling through those skilled
nursing nursing facilities if they have like a surgery or
an illness or something they're recovering from or rehabbing from,
which is only about four point five percent of all
Americans over sixty five and ten of all Americans over
eighty five. I thought it would be higher than that. Um,
(36:52):
you know, if you want to look at the downside, though,
is one big reason why. Maybe the cost um It
depends on where you are, of course, but if you
um are in a private room at a nursing home,
and I guess was this in Georgia, Yeah, two hundred
and thirty five dollars a night in New York, that's
about four hundred dollars a night and change on average
(37:14):
a night like at that point, just move them into
the w Hotel, right, pretty pretty much. Yeah. The only
thing is that they don't have nurses at the the
W Hunt. But that's a lot of money, man, And
you can just get bled dry at the end of
your life. Well you do. And as a matter of fact,
to pay four a place like that a nursing home,
(37:38):
Medicaid says you have to have paid in which basically says,
you need to have if you if you don't own
your house anymore, you have to um give the proceeds
from your house. Um. Yeah, you have to liquidate your
your your inheritance, you have to you have to pay
down to usually something like I saw like maybe seven
hundred dollars a month income is the cut off. Anything
(38:01):
over that, and you have to be contributing. Um. Anything
under that, the Medicaid will kick in and pay the
place directly for letting you stay there. Um. But the
thing is, it's like, of course, the the better alternative
is assisted living. Some state Medicaid programs will pay or
help pay for assisted living. But for the most part,
(38:22):
if you're if you are paying for if you're living
in an assisted living facility, you might have a reverse
mortgage on your house. You are probably you've liquidated all
of your um, your investments. Um, you're you're you're paying
for it out of pocket. In the United States for
the good kind of retirement home. Yeah, and you know
(38:43):
there are people out there that are trying to further
reform uh what these places look like. Uh. There's a
gentleman named Dr Bill Thomas, who is a geriatrician who
has something called the Eden Alternative. Um. That is he's
trying to basically reframe these nursing home uh residents in
(39:04):
caregivers as care partners. And you know it sounds kind
of hippie dippy, but um, he wants people to be
able to still grow in life and to still flourish
and to still learn. Um, just because you're a senior
doesn't mean you just have to to sit in a
room and watch Judge Judy or push checkers around a checkerboard. Uh.
(39:25):
And you know that they're depending on where you are,
they might be adopting these methodologies of the Eden Alternative
or UM the greenhouse movement. Another thing he helps spawn,
which is you're in an in an individualized home. It's
not a big facility. You got a private room, you've
got a bathroom, and there's outdoor space for you to
go and garden and to walk around and to again
(39:47):
try and flourish in your in your last years on
this planet. Right. Um. And that's a that's there's also
a push for um for aging in place at home.
Yeah sure, which can be really been official, but again
it can also be isolating, depending on you know what
kind of friends or family maybe if you live in
a condo it would be a little more. But if
(40:07):
you're living in the house that you spent your entire
life in and all the neighbors have moved away and
you don't know anybody anymore, that can be isolating. So
in that sense, assisted living or even a nursing home
could be a better alternative. But a lot of people say, no,
this is my house, I want to stay here at home.
The problem is is um I've seen I've seen it
put that medicaid has an institutional bias, which means that
(40:29):
like they'll pay for you to go to a institution
like the definition of the word institution, they don't really
pay for you to be able to stay at home.
Some programs do, but a lot of them don't, even
if you do want to stay at home, which is
kind of heartbreaking to me. Yeah, I mean, you know
Emily's grandmother Mary, who was very popular with the stuff.
You should know Army as the eldest general. She you know,
(40:51):
we had to move her out of her house that
she was in, you know, not our whole life, but
for a large portion of of her life. But you know,
it was one of those deals where it's out in
the middle of the country in Ohio. Uh, there was
no family close by, there was no hospital close by,
and it's just it's hard to say it's okay to
stay there, you know. Um. And it was sad when
(41:11):
she left, but she was also like, no, this is great,
I'll move in with you guys. Like she didn't kick
and scream, you know, she was she was willing and
understood it was the best thing. And uh, you know,
it's probably one reason why she's pushing one right now.
I think for sure where she live, she lives with
Emily's parents and here in Georgia. Now that's great. Yeah, um, well,
(41:33):
I'm yeah, I'm I'm very glad that that worked out
for um. But I was also looking at like the
antithesis of that, like what happens in the United States
to people who who don't have any family, who don't
have any children, and who don't have any money, like
what happens to them, And they seemed to be they
(41:55):
seem to be kind of left on their own, Like
if they have a house, they're they're probably just to
be left in their house and maybe meals on wheels
will come by. Um. The County Social Services might be
able to help them. But this is if they reach
out for help, if they need assistance, they might not
get it at home because again, there's a lot of
UM services that aren't paid for. And if you don't
I mean money, you're s o l. You could go
(42:17):
to a UM uh nursing home. But if you don't
have any ability to pay UM, they can kick you out. Uh,
they can kick you out for a bunch of different reasons.
They're The most oppressing thing that I've looked up in
a while was nursing home evictions, and they there are
there's a there was a loophole that was recently closed
(42:37):
in two thousand sixteen that said UM, if you if
the nursing home is not able to UM to offer
care for the person, then they can be discharged. And
they use that as like a huge loophole. They'd be like,
we're sorry, we can't offer you the care you need
any longer. You have to leave. And you know, if
(42:58):
you don't have anybody to advocate for you, you're you're
you know, where are you going to go? And I
couldn't get a really good answer, but I get the
impression that it's there are it's not huge and rampant,
but there are a lot of people who are still
falling through the crack society as they age because we
don't have a robust, nationalized UM plan to care for
(43:24):
the elderly no matter what. And I thought, well, of
course the United States is super behind in that respect,
but apparently we're in line with other countries like Canada.
You think Canada would have like a place for every
senior and they're all happy and taking care of and
everybody gets a pet beaver or something like that. Now
you're on your own, kind of like your state might
help you out a little bit, the local city might,
(43:46):
but that's about it. Same with the UK too, which
I was really surprised because both of them have nationalized medicine. Yeah.
I will say that this is where UM. Social media
has been beneficial UM as far as neighborhood and neighbors
go UM. I mean all the time on our neighborhood pages,
we see people stepping up, and especially in a place
(44:09):
like Atlanta, Atlanta, where gentrification has happened, UM, you do
see a lot of neighbors stepping up to help take
care of UM, the senior African American community that is um,
still living in their houses and they haven't been bought
out for a shamefully low price by a greedy contractor
to to flip it into a little McMansion. But you
(44:31):
see it all the time that we work with a
group called Neighbor in Need that really does great things.
And aside from just the the official organizations. All the
time you'll see someone that lives next door to someone
like that. They'll be like, hey, she's having a hard
time paying her power bill this winter, and you know,
in an hour it is funded for for the rest
(44:52):
of the year. Uh, the neighbors step up and and
pay for her power bill. And it's just it's little
things like that. But um, these are in unities where
the houses are close together and people are you know,
each other's business, like um, Emily's grandmother out there in
the middle of the country, and a lot of rural
America like that might not be the case. You might
not have someone checking up on you, and people you
(45:15):
know bleeding hearts like you, and I feel that they
should be taking care of no matter what. You know. Yeah,
but I mean, isn't that something everybody can get behind?
You would think so, But that's just not true. I'll
remind you of our episode on homelessness many years ago. Yeah,
that one's tough for me to swallow. Those are the
people who believed in the unworthy poor. Huh, and we're
to send him to alms houses back in the day. Yeah. Um.
(45:39):
The good news is if you're looking for a home
for a family member these days, Medicare dot gov has
a lot of resources. Oh, I'll tell you another place
to u S News and World Report is really hot
and heavy on um an assisted living in nursing home ratings. Yeah,
nursing home compares another website. And you know there are
places where you can go to really dig in see
(46:00):
which ones you feel are a good fit. Uh. They're
rated on you know, how the people are really doing.
They're not just like how pretty it is. And if
you go and visit one, they said to be aware
of the chandelier effect. Like in fact, if you walk
in and you see a grand piano and a lobby,
just turn around and leave. Well yeah, that's I mean,
that's one of the ways that they get you. You
want to do a little more digging than just that,
(46:21):
and you want to talk to residents, You want to
read like actual like, uh, inspections and reports on those places.
You want to look at stats like how many patients
had to get were taken to the e er or
were readmitted in the hospital, how many have bed sores?
Um any allegations of abuse. Apparently abuse has doubled between
(46:41):
two thousand thirteen and two thousand seventeen. Still low. I
think it was like eight hundred and forty five, which
is too many, but it's still doubled since two thousand thirteen.
So you want to like really look for that kind
of thing. Are they over prescribing medications like for psychosis
to to people who are um who are problematic when
(47:02):
you don't really think they're problematic. There's a lot of
stuff you want to look for that you can look for.
It's out there. Just do some digging because this is
somebody you care about, don't forget. Yeah, and we really
want to point out that, uh, it's easy to zero
in on things like abuse cases and unnecessary medication. But UM,
we really salute you if you are the lion share
(47:25):
of these people, UM that are in nurses that are
taking care of our seniors and doing a great, great
job and a very very tough job. Yeah, and one
of the things actually I saw I'm glad you said
that was that, um, it's it's a really a thankless
kind of job because traditionally people who work in elder care,
(47:45):
like the actual workers are treated like garbage by management.
It's just like an industry wide problem. And that was
actually one of those things from the the Eden alternative
was that workers are treated with the respect that you
want the workers to treat the patients with like everyone
is treated with respecting dignity, not just ideally the patients,
the workers too, because they deserve it for the work
(48:07):
they're doing. It's amazing. Ah, you got anything else about
nursing homes, I've got nothing else. We can do. Better
start thinking about stuff, you know. I mean, you're never
too young to get a plan in places. That's all
I'm saying. Great point, um, And since I say great point,
it's time for a listener, man. I mean, maybe if
(48:28):
you're like twenty five, you don't need to be thinking
about your nursing home options. Okay, but you know what
I mean, well, not necessarily, I'm your parents. I saw
that of nursing home residents were under sixty five, so
there are some younger residents in there that I think
get overlooked a lot, like by us. You know what
(48:48):
you call those people? What the party crowd? That's right, Oh,
that's gonna be me. Man. What the party crowd at
the at the nursing home. I'm be mixing it up
like scat Man Cruthers in the Twilight Zone movie. I
could see that. Let's go play kick the can. Everyone.
It's midnight. It's time. It's time to take off that
gown and live. Good things happen. You're ready, I'm ready, Well,
(49:13):
bread away. I'm gonna call this one. Uh goots follow up? Okay,
this is a good one about the great, great Steve Guttenberg.
I'm hoping someone throws the stuff his way, by the
way he needs he needs to know. I can feel
him right now listening to all right this from Dave. Hey, guys,
on a recent episode, you discuss the episode of Party
(49:35):
Down which the wonderful Steve Guttenberg allows the caters to
throw a party at his house. You knew this had
come up before and wondered in what episode in what context.
By chance, the next day, I was scrolling randomly through
older episodes and selected Barefoot running uh boy, remember that one.
When in this episode you started talking about Steve Guttenberg,
(49:57):
I had an intensely existential experience. I was listen thing
in the present to you talk about Steve Gutenberg in
the past, having listened in the more recent past to
you also for more from a more recent past talk
about Steve Gutenberg, unable to remember the more distant past,
and which you were talking about Steve Gutenberg, which I
was now listening to in the present, which knowledge of
(50:17):
the future, in which you would again discussed Steve Gutenberg.
Steve Gutenberg the center of our cosmos, the nexus around
which space and time and God swirl until they've become one.
The answer to this question for which our souls cry out,
I can only speculate yes. Anyway, I wanted to let
you guys know in which previous episode he featured Steve Gutenberg.
(50:38):
As to the context, there was none. You you started
talking about Steve Gutenberg for no discernible reason. It sounds
like me, which is as it should be, and that
is from Dave. And Dave was very excited that this
was getting read, and he said, to be honest, I
had a little bit to drink when I wrote that,
and I didn't fully remember the whole experience, so good
(51:00):
job there go. This would be proud. Yeah, I think
Dave's going to be part of the mixing it up
crowd at the nursing home to kicking that can you know, Well,
thanks a lot, Dave. That was pretty great. Um. And
if you have something great to tell us, especially if
it's in reference to something we said about something we
said in the past, we'd love to hear from you.
(51:22):
You can send us an email to Stuff podcast at
iHeart radio dot com. Stuff you Should Know is a
production of iHeart Radios How Stuff Works. For more podcasts.
For my heart Radio, visit the iHeart Radio app, Apple Podcasts,
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