By: David Kingsley
Elites sneer at the idea that people in general are intelligent enough to make good decisions in democratic elections. This is a disgusting and ill-informed attitude mostly aimed at the middle- and lower-income classes. But historical evidence indicates that people en masse are not as dumb as the self-anointed educated class and the mainstream media would have us believe.
Hubris and ignorance on the part of political elites and the intelligentsia have led pollster charlatans, journalists, bureaucrats, and politicians to assume that public opinion is little more than clueless folderol, rife with nonsensical conspiracy theories. In so many ways, the “people” are viewed by the affluent and college educated classes and opinion influencers in the media as “lesser thans” and “lower types.”
Machiavelli knew better. As he wrote in Discourses on Livy, “But as for prudence and stability, I say that the people are more prudent, more stable, and better judges than a prince. And not without reason is the voice of the people compared to that of God, for popular opinion has been seen to predict things in such a marvelous way that it is as if some occult power[virtu] enables it to foresee the evil and the good that may befall it.”[1]
Harry Truman knew better. Among other issues, he ran on the principle of universal, single payor health care and won. Elites, pollsters, and journalists predicted that he would lose in a landslide. We didn’t get the health care – thanks to the bigotry of Southern Democrats – but we got the people’s opinion about government’s role in medicine for the masses. There is no evidence that it has changed.[2]
Women fighting for reproductive rights know better and are winning ballot measures to enshrine those rights in state constitutions across the U.S. Extremist conservative legislators are consistently trying to undermine the efforts of citizens for a “right of choice” through anti-democratic legislative maneuvers.
In Missouri, where I live and where the Republican majority in the legislature has gone extremist right-wing bonkers, Medicaid expansion was passed by “the people” through a referendum. Ballot measures on reproductive rights and a minimum wage will be on the ballot in November and will likely pass.
Oracles from left-to-center-to-right elitist political ingroups were shocked when voters from so-called “red states” voted to enshrine reproductive rights of women in state constitutions. The media – all the media from right to left – would have you believe that we are a “divided nation.” We aren’t. But that story is good fodder for television and newspapers. The truth is most Americans share the same values and want the same things from government. The broad middle (the overwhelming majority) of the voting public can best be described as ambivalent with some conservative views and some liberal views – mostly commonsensical views.
I will stipulate that a pathological, narcissistic-sadistic fascist was able to win the electoral college and become president – but like every other Republican since George H.W. Bush he didn’t win the popular vote. He lost by an even wider margin in 2020. Furthermore, many counties in states like Pennsylvania that Barack Obama won in 2012 by an overwhelming margin flipped to Trump by a wide margin in 2016. I believe there is an explanation for that – which is ignored by the media and political intelligentsia.
In this Age of Show Business, the Role of Media is to Entertain You – Not Inform You.
No doubt, in a country with a population of 334 million people (231 million are 18 and older) [3] and 161.42[4] million registered voters, an unstable tyrant can round up tens of millions of ardent, true believer followers. Given the spread of mental illness, fractured egos, instability, financial stress, and other psychologically damaging stresses of toxic capitalism, it should come as no surprise that a demagogue could and would come along and with the help of the MSM drive the electoral process into nonsense and chaos.
This should be even less surprising when the demagogue’s persona is the creation of NBC, which is owned by Comcast, one of the most powerful corporations in the oligopolistic media industry. It was, therefore, the mainstream media that led a significant mass of busy stressed-out people into believing that Trump was a kick ass, savvy businessman who could and would straighten things out and lessen their pain. For years, he was a corporate created caricature foisted onto unwitting and economically hurting television viewers looking for escape.
Since 2015 when Trump descended on the escalator in Trump Tower – and after setting up Mexican immigrants as America’s enemy – the media has feasted on his burlesque politics. Nothing attracts attention like dangerous cartoonish politicians with slapstickish, outrageous performances. For nearly a decade, Trump has been a prop for feeding the much needed noisy, shallow product on cable channels, morning talk-entertainment shows, and nightly news. Although we “have nothing to fear but fear itself,” fear plus titillation keeps people tuned in. The corporate need to enhance and protect shareholder value enhances the value of all Trump all the time on cable political entertainment channels such as CNN, FOX, and MSNBC plus all of the NBC, CBS, ABC, and FOX Sunday talk shows.
The media is responsible for Trump – not public stupidity. The media has a vested interest in keeping him going. The public does not.
Venal Media & Political Forces with Dangerous, Self Interest Designs Have Hijacked Political Narratives through Propaganda, Chutzpah, and Manipulation
As we have learned from history, industrialists, media, and other powerful institutions (think religion) with the intent to install a strong man and a fascist movement in power for their own benefit, have the capability to misinform the public about real conditions and move them to participate in their own destruction. Once falsehoods are instilled in desperate and unwitting citizens, it is very difficult to tear them down.
As the American people are subjected to another round of election time insanity, the MSM is at it again – minimizing the severe pathologies and dangers of Trump and magnifying real and imagined negatives of President Biden. In their stressful, busy attempts at survival, ordinary people naturally and unconsciously process signals – memes and narratives sometimes subtle, sometimes not so subtle. It is to the benefit of media corporations to create and maintain an appearance of normality and a “horse race” so that their customers don’t lose interest. As former President Obama said last week “behavior that used to be disqualifying is now normal.”
Let “We the People” have Honest Information – not Propaganda – and then Let Us Decide
U.S. leadership values have dragged mass culture downhill since the post World War II robust and optimistic middle-class and Golden Age of Capitalism (circa 1945-1975). Since that time, the former Republican Party has degenerated into a full-blown fascist movement – a phenomenon filtered out of MSM narratives. It is dangerous for the media to ignore the resilience of fascism [5] and concentration of wealth and power in mammoth corporations and super-rich individuals/families.
The fascists have clearly laid out their agenda. The MAGA Project 2025 will take the American people to a place where an overwhelming majority does not want to go. It is a blueprint for dismantling the administrative state, stacking the courts, white supremacist rule, repression of dissent, and oppression of the middle and lower classes. The healthcare program is misogynistic, religiously fundamentalist, and identitarian.[6]
None of the theocratically fascist program offered to the American people by the fanatics of a movement that could gain control of government in a few months would pass muster in a referendum on healthcare or any of the other scary elements of Project 2025. The cruelty of the current healthcare system would become cruel in spades. I believe that the media should be less sanguine about rising fascism for the sake of appeasing shareholders and provide truth instead of pablum to consumers of television and print publications.
Furthermore, the Democratic Party should stop its political poll idolatry and naïve idealism about “working across the aisle” and wage a more robust fight. The overwhelming majority of the American people can see through all of this political theatre and are disgusted. Why don’t we just have a national referendum on what the people want?
[1] Niccolo Machiavelli (2003) The Prince and Other Writings. New York: Barnes & Noble Books, 182.
[2] David McCullough (1992) Truman. New York: Simon & Schuster, p. 532. It is widely believed by historians and social scientists that the American Medical Association blocked Truman’s single-payer, universal, healthcare program by convincing the American people that it was a slippery slope into socialism. That’s false. Southern Democrats killed Truman’s proposal for a national health insurance program that would look like the “Medicare for All” proposals devised by progressive Democrats. The Democrats with a majority in Congress could have passed Truman’s plan and the AMA could not have stopped it. However, Senators and Congressmen from the former Confederate States had to power to block any legislation that would threaten the racial hierarchy and plantation capitalism of the South. When it came to healthcare, he American people in general did not share the Jim Crow agenda of the Southern Delegation.
[3] National Population by Characteristics: 2020-2023 (census.gov)
[4] Number of registered voters U.S. 2022 | Statista
[5] The Allies defeated Hitler and Mussolini, but fascism has been quite robust and is now more potent than ever. Consider the strength of Marine LePen’s National Front in France and the results of the recent EU elections. See also: Richard Wolin (2004) The Seduction of Unreason: The Intellectual Romance with Fascism from Nietzsche to Postmodernism. Princeton, N.J.: Princeton University Press.
[6] Project 2025 – Wikipedia:
“Project 2025 accuses the Biden administration of undermining the traditional nuclear family and wants to reform the Department of Health and Human Services (DHHS) so that this household structure is promoted.[18] According to Project 2025, state governments should have the authority impose stricter work requirements for beneficiaries of Medicaid,[23] the federal government should promote the Medicare Advantage program, which consists of private insurance plans,[56]: 464–65 federal healthcare providers should deny gender-affirming care to transgender people, and eliminate insurance coverage of the morning-after-pill Ella required by the Affordable Care Act of 2010 (Obamacare).[18] Project 2025’s healthcare plan would also remove Medicare‘s ability to negotiate drug prices.[18]
Project 2025 aims at dramatically reforming the National Institutes of Health (NIH) by making it easier to fire employees and to remove DEI programs. Conservatives consider the NIH to be corrupt and politically biased.[15]
Project 2025 accuses social media networks—directly naming Facebook, Instagram, Twitter, and TikTok—of jeopardizing the mental health and social ties of young Americans by creating a form of addiction. “Federal policy cannot allow this to continue,” it states.
Last Updated: May 14, 2016 by CHIP Admin Leave a Comment
Welcome to CHIP!
The Center for Health Information & Policy is a nonprofit entity engaged in health care research, public education, and advocacy. The mission of CHIP is to educate the public about the health care system in the U.S., and advocate for better health care for all Americans. Our purpose is to continuously research the state of public health and medical delivery systems, inform citizens about the status of those systems, and to lobby for policies that will improve them. Learn More
Last Updated: November 29, 2024 by David Kingsley, PhD Leave a Comment
Nursing Home Alert: Reliant Care Management, LLC
By:
Dave Kingsley
The Center for Health Information & Policy (CHIP), our nonprofit research arm, has issued a nursing home alert that we believe will be of utmost interest to our readers. CHIP has developed a nursing home data analytics system by organizing data sets available from the Center for Medicaid & Medicare Services. With that capability, we will inform the public about the good, the bad, and the ugly facets of the U.S. nursing home system on an ongoing basis.
NURSING HOME ALERT! NOVEMBER 4, 2024
RELIANT HEALTH CARE, LLC: AN EXTREMELY LOW PERFORMING MISSOURI NURSING HOME CHAIN
Reliant Care Management, LLC owns 21 Medicare & Medicaid funded skilled nursing facilities in the State of Missouri – four are in the Kansas City Metropolitan area. In our work across the United States in cities, counties, states, and regions, we have not encountered a chain with lower federal ratings on quality of care. In this alert, we will lay out the case for a high level of concern among families, ministers, social workers and others who might have an occasion to find a skilled nursing facility for a loved one or a client.
LOOK FOR THE RED HAND
The Center for Medicare & Medicaid Services as the federal regulatory agency for Medicare and Medicaid funded skilled nursing has a complicated rating system for each facility that ranges from l for low performing facilities to 5 for high performing facilities. Facilities with a rating plus a red hand have incidents that present a danger to patients. It is rare for a chain of even a few facilities to have more than one red hand. Nevertheless, of the 21 Reliant facilities 9 have a red hand (see table below).
Red hands are signs of poor quality of care. In addition to incidents that place patients in immediate jeopardy, ongoing neglect often occurs due to a lack of adequate staffing. Nursing staffing is measured by the number of nursing hours per resident day (HPRD). The current average of the 14,516 skilled nursing facilities in our data file is 3.8 (3 hours & 48 minutes) HPRD for RN, LPN, and CNA staffing – which most experts agree is far too low. Nevertheless, nursing homes with an HPRD of 2 or less are quite rare – only 7 tenths of 1 percent or 103 out of 14,516 facilities.
As the table below illustrates, the hours per resident day column indicates that Reliant facilities are extremely understaffed (“HOURS” was somehow deleted from the column – it should be “HOURS PER RESIDENT DAY”). Indeed, HPRDs in the low 2s and 1s for an entire chain is appalling.
*According to CMS, a Special Focus Facility has, “More problems than other nursing homes (about twice the average number of deficiencies),” More serious problems than other nursing homes,” and “A pattern of serious problems that have persisted over a long period of time.”
**Special Focus Candidates:” Not quite bad enough to be a Special Focus Facility yet but moving in that direction. It is truly phenomenal to see a chain of this size with one SFF and two SFF candidates.
THE NURSING HOME CLASS DIVIDE AND THE RELIANT BUSINESS MODEL
If you’ve seen one nursing home, you’ve seen one nursing home. If you’ve seen one nursing home chain, you’ve seen one nursing home chain. If you’ve seen one state nursing home system, you’ve seen one state nursing home system. Nevertheless, similarities in patterns and practices can be seen in the SKN/LTC system. For instance, some chains accept Medicare but not Medicaid, some accept Medicaid and Medicare, some have very little Medicaid while others have mostly Medicaid as a payor. The amount of contract labor used, and the price paid for it varies from chain to chain and so forth.
With 90 percent of its bed days reimbursed by Medicaid, Reliant has an extremely high number of patients who are in long-term care and too poor to pay out of pocket. The company runs mostly large facilities (120-250 beds) and a small proportion of small facilities (approximately 60 beds). Bed size varies between and within chains. However, the pattern we see is this: the larger facilities in number of beds tend to be in poorer neighborhoods and serve a disproportionate number of Medicaid patients. We have also noticed that these “big” facilities with mostly Medicaid bed days tend to be rated lower in CMS Nursing Home Care Compare quality measurement system.
Some Significant Reliant Financial Information:
WHO OWNS RELIANT CARE MANAGEMENT, LLC AND WHAT ARE OFFICIALS AND AUTHORITIES DOING ABOUT THIS CHAIN?
According to CMS ownership records, Reliant is owned by one individual – Mr. Rick DeStefane (see, e.g.: Find Healthcare Providers: Compare Care Near You | Medicare). Information (perhaps PR and propaganda) about Mr. DeStefane can be found on the Reliant website (Rick DeStefane | Reliant Care Management, LLC | St. Louis). We cannot be a judge of Mr. DeStefane’s character. We can only ask why his SKN/LTC facilities are rated lower than even some of the most scurrilous chains we have analyzed.
We would also ask Mr. DeStefane to show the taxpaying public Reliant’s consolidated financial reports, e.g. income statement, balance sheet, and cash flow statement. We have no idea the extent of personal wealth accruing to Mr. DeStefane and his family’s assets but we believe that the public has the right to know. Our federal and state governments have failed the public by allowing nursing home providers to hide their finances.
What are Missouri and federal legislators and regulators planning to do about Reliant? Are they even tuned into the ratings discussed in this bulletin? What are local politicians, health departments, ministerial alliances, and other individuals and organizations with an obligation to protect the vulnerable aging and disabled populations with a need for institutional nursing care doing about Reliant? Certainly, it is not OK to allow nursing homes this bad to operate below the radar.
Posted: July 23, 2024 by David Kingsley, PhD Leave a Comment
The Choice between a Humane Health Care System or an Industrialized Medical System for the Benefit of Shareholders & Executives: What would the People Choose?
By: David Kingsley
Elites sneer at the idea that people in general are intelligent enough to make good decisions in democratic elections. This is a disgusting and ill-informed attitude mostly aimed at the middle- and lower-income classes. But historical evidence indicates that people en masse are not as dumb as the self-anointed educated class and the mainstream media would have us believe.
Hubris and ignorance on the part of political elites and the intelligentsia have led pollster charlatans, journalists, bureaucrats, and politicians to assume that public opinion is little more than clueless folderol, rife with nonsensical conspiracy theories. In so many ways, the “people” are viewed by the affluent and college educated classes and opinion influencers in the media as “lesser thans” and “lower types.”
Machiavelli knew better. As he wrote in Discourses on Livy, “But as for prudence and stability, I say that the people are more prudent, more stable, and better judges than a prince. And not without reason is the voice of the people compared to that of God, for popular opinion has been seen to predict things in such a marvelous way that it is as if some occult power[virtu] enables it to foresee the evil and the good that may befall it.”[1]
Harry Truman knew better. Among other issues, he ran on the principle of universal, single payor health care and won. Elites, pollsters, and journalists predicted that he would lose in a landslide. We didn’t get the health care – thanks to the bigotry of Southern Democrats – but we got the people’s opinion about government’s role in medicine for the masses. There is no evidence that it has changed.[2]
Women fighting for reproductive rights know better and are winning ballot measures to enshrine those rights in state constitutions across the U.S. Extremist conservative legislators are consistently trying to undermine the efforts of citizens for a “right of choice” through anti-democratic legislative maneuvers.
In Missouri, where I live and where the Republican majority in the legislature has gone extremist right-wing bonkers, Medicaid expansion was passed by “the people” through a referendum. Ballot measures on reproductive rights and a minimum wage will be on the ballot in November and will likely pass.
Oracles from left-to-center-to-right elitist political ingroups were shocked when voters from so-called “red states” voted to enshrine reproductive rights of women in state constitutions. The media – all the media from right to left – would have you believe that we are a “divided nation.” We aren’t. But that story is good fodder for television and newspapers. The truth is most Americans share the same values and want the same things from government. The broad middle (the overwhelming majority) of the voting public can best be described as ambivalent with some conservative views and some liberal views – mostly commonsensical views.
I will stipulate that a pathological, narcissistic-sadistic fascist was able to win the electoral college and become president – but like every other Republican since George H.W. Bush he didn’t win the popular vote. He lost by an even wider margin in 2020. Furthermore, many counties in states like Pennsylvania that Barack Obama won in 2012 by an overwhelming margin flipped to Trump by a wide margin in 2016. I believe there is an explanation for that – which is ignored by the media and political intelligentsia.
In this Age of Show Business, the Role of Media is to Entertain You – Not Inform You.
No doubt, in a country with a population of 334 million people (231 million are 18 and older) [3] and 161.42[4] million registered voters, an unstable tyrant can round up tens of millions of ardent, true believer followers. Given the spread of mental illness, fractured egos, instability, financial stress, and other psychologically damaging stresses of toxic capitalism, it should come as no surprise that a demagogue could and would come along and with the help of the MSM drive the electoral process into nonsense and chaos.
This should be even less surprising when the demagogue’s persona is the creation of NBC, which is owned by Comcast, one of the most powerful corporations in the oligopolistic media industry. It was, therefore, the mainstream media that led a significant mass of busy stressed-out people into believing that Trump was a kick ass, savvy businessman who could and would straighten things out and lessen their pain. For years, he was a corporate created caricature foisted onto unwitting and economically hurting television viewers looking for escape.
Since 2015 when Trump descended on the escalator in Trump Tower – and after setting up Mexican immigrants as America’s enemy – the media has feasted on his burlesque politics. Nothing attracts attention like dangerous cartoonish politicians with slapstickish, outrageous performances. For nearly a decade, Trump has been a prop for feeding the much needed noisy, shallow product on cable channels, morning talk-entertainment shows, and nightly news. Although we “have nothing to fear but fear itself,” fear plus titillation keeps people tuned in. The corporate need to enhance and protect shareholder value enhances the value of all Trump all the time on cable political entertainment channels such as CNN, FOX, and MSNBC plus all of the NBC, CBS, ABC, and FOX Sunday talk shows.
The media is responsible for Trump – not public stupidity. The media has a vested interest in keeping him going. The public does not.
Venal Media & Political Forces with Dangerous, Self Interest Designs Have Hijacked Political Narratives through Propaganda, Chutzpah, and Manipulation
As we have learned from history, industrialists, media, and other powerful institutions (think religion) with the intent to install a strong man and a fascist movement in power for their own benefit, have the capability to misinform the public about real conditions and move them to participate in their own destruction. Once falsehoods are instilled in desperate and unwitting citizens, it is very difficult to tear them down.
As the American people are subjected to another round of election time insanity, the MSM is at it again – minimizing the severe pathologies and dangers of Trump and magnifying real and imagined negatives of President Biden. In their stressful, busy attempts at survival, ordinary people naturally and unconsciously process signals – memes and narratives sometimes subtle, sometimes not so subtle. It is to the benefit of media corporations to create and maintain an appearance of normality and a “horse race” so that their customers don’t lose interest. As former President Obama said last week “behavior that used to be disqualifying is now normal.”
Let “We the People” have Honest Information – not Propaganda – and then Let Us Decide
U.S. leadership values have dragged mass culture downhill since the post World War II robust and optimistic middle-class and Golden Age of Capitalism (circa 1945-1975). Since that time, the former Republican Party has degenerated into a full-blown fascist movement – a phenomenon filtered out of MSM narratives. It is dangerous for the media to ignore the resilience of fascism [5] and concentration of wealth and power in mammoth corporations and super-rich individuals/families.
The fascists have clearly laid out their agenda. The MAGA Project 2025 will take the American people to a place where an overwhelming majority does not want to go. It is a blueprint for dismantling the administrative state, stacking the courts, white supremacist rule, repression of dissent, and oppression of the middle and lower classes. The healthcare program is misogynistic, religiously fundamentalist, and identitarian.[6]
None of the theocratically fascist program offered to the American people by the fanatics of a movement that could gain control of government in a few months would pass muster in a referendum on healthcare or any of the other scary elements of Project 2025. The cruelty of the current healthcare system would become cruel in spades. I believe that the media should be less sanguine about rising fascism for the sake of appeasing shareholders and provide truth instead of pablum to consumers of television and print publications.
Furthermore, the Democratic Party should stop its political poll idolatry and naïve idealism about “working across the aisle” and wage a more robust fight. The overwhelming majority of the American people can see through all of this political theatre and are disgusted. Why don’t we just have a national referendum on what the people want?
[1] Niccolo Machiavelli (2003) The Prince and Other Writings. New York: Barnes & Noble Books, 182.
[2] David McCullough (1992) Truman. New York: Simon & Schuster, p. 532. It is widely believed by historians and social scientists that the American Medical Association blocked Truman’s single-payer, universal, healthcare program by convincing the American people that it was a slippery slope into socialism. That’s false. Southern Democrats killed Truman’s proposal for a national health insurance program that would look like the “Medicare for All” proposals devised by progressive Democrats. The Democrats with a majority in Congress could have passed Truman’s plan and the AMA could not have stopped it. However, Senators and Congressmen from the former Confederate States had to power to block any legislation that would threaten the racial hierarchy and plantation capitalism of the South. When it came to healthcare, he American people in general did not share the Jim Crow agenda of the Southern Delegation.
[3] National Population by Characteristics: 2020-2023 (census.gov)
[4] Number of registered voters U.S. 2022 | Statista
[5] The Allies defeated Hitler and Mussolini, but fascism has been quite robust and is now more potent than ever. Consider the strength of Marine LePen’s National Front in France and the results of the recent EU elections. See also: Richard Wolin (2004) The Seduction of Unreason: The Intellectual Romance with Fascism from Nietzsche to Postmodernism. Princeton, N.J.: Princeton University Press.
[6] Project 2025 – Wikipedia:
“Project 2025 accuses the Biden administration of undermining the traditional nuclear family and wants to reform the Department of Health and Human Services (DHHS) so that this household structure is promoted.[18] According to Project 2025, state governments should have the authority impose stricter work requirements for beneficiaries of Medicaid,[23] the federal government should promote the Medicare Advantage program, which consists of private insurance plans,[56]: 464–65 federal healthcare providers should deny gender-affirming care to transgender people, and eliminate insurance coverage of the morning-after-pill Ella required by the Affordable Care Act of 2010 (Obamacare).[18] Project 2025’s healthcare plan would also remove Medicare‘s ability to negotiate drug prices.[18]
Project 2025 aims at dramatically reforming the National Institutes of Health (NIH) by making it easier to fire employees and to remove DEI programs. Conservatives consider the NIH to be corrupt and politically biased.[15]
Project 2025 accuses social media networks—directly naming Facebook, Instagram, Twitter, and TikTok—of jeopardizing the mental health and social ties of young Americans by creating a form of addiction. “Federal policy cannot allow this to continue,” it states.
Will our government public health officials warn us about the next pandemic?
Last Updated: July 30, 2024 by David Kingsley, PhD Leave a Comment
Let’s take a walk down memory lane….
The U.S. health care system is complex and dynamic. It been declining into catastrophic failure mode for at least the past decade. We struggled to manage and survive a systemic collapse of the economy along with medical systems due to an inept response to a deadly pandemic during 2020 and 2021.
The previous president, bureaucrats, and legislators knew this danger was coming but did not have the capacity to respond. A successful response to a rapidly moving scourge requires: (1) a plan, (2) a strategy, (3) adequate equipment/supplies, (4) technology (5) trained personnel, and (6) and competent, honest leadership willing to implement the plan. The turn of the century administration in office called for the implementation of each of these item but was ignored and neglected.
The consequence of that neglect was devastating. There was no plan, no strategy, adequate personal protective gear, enough ventilators, bed capacity and other equipment and supplies needed in a pandemic. The question is why? Public health and infectious disease experts have been warning for decades that pandemics would grow more severe and more frequent (Laurie Garrett warned us with an article titled The Coming Plague going all the way back to 1993). Indeed, since the 1980s, we have seen the HIV, H1N1, SARS, and Ebola outbreaks spread across the planet. It is not as if there have not been dire health scares in our past that could have informed us of the critical need for preparedness in the future.
We should not forget that something serious was going on in China in December of 2019. The Chinese economy was practically brought to a halt and serious isolation practices were implemented as only an authoritarian government can implement population control. The disease quickly spread to other Asian countries. Singapore, South Korea, Taiwan, and Japan implemented extensive organized and effective prevention efforts. Singapore, South Korea, and Taiwan had prior experience with the SARS epidemic and undertook impressive campaigns to keep the outbreak from overwhelming their medical systems. They succeeded.
Why was the United States so blasé and even sanguine about a novel virus that prompted massive public health efforts in China and other Asian nations? Even after known infestations the U.S. government remained seemingly unconcerned. Or did it?
Who Knew What & When Did They Know It? Let’s not forget…
Republican chair of the Senate Intelligence Committee, telling some donors in a private meeting that the coming pandemic could be as serious as the global flu pandemic of 1918. He was not at all as laid back and buoyant as he was in public at that time. The donor meeting occurred on February 27th. The audio of the Senator warning his wealthy supporters about the coming plague can be heard at: https://media.crooksandliars.com/2020/03/44593.mp3_standard.mp3.
Senator Burr is known as a leading legislative figure in the development of a national plan to thwart pandemics. He is not a neophyte in public health policy. Furthermore, he was present at a “closed door” COVID19 briefing presented by the Trump Administration National Security Council on January 24th – over a month before his dire warning to his donors. The contents of the briefing have never been disclosed to the public. In a search of the Senate Intelligence Committee website, no evidence could be found that a meeting regarding COVID 19 was held (https://www.intelligence.senate.gov/, “HEARINGS” tab).
Immediately following the hearing Senator Burr sold $1.6 million worth of stock in his personal portfolio – in companies that he claimed in his talk to donors would be most likely adversely affected by a virus pandemic overwhelming the U.S. (https://www.propublica.org/article/senator-dumped-up-to-1-7-million-of-stock-after-reassuring-public-about-coronavirus-preparedness).
Senator Diane Feinstein, also a member of the Senate Intelligence Committee, cashed out of $6 million worth of stock from her personal investment portfolio. Senators James Inhofe, Ron Johnson, and Loeffler also unloaded a considerable amount of stock at the same time (https://www.propublica.org/article/senator-dumped-up-to-1-7-million-of-stock-after-reassuring-public-about-coronavirus-preparedness).
“Nothing to see here…..”
Senator Burr was not expressing the same alarm in public he imparted to his close political allies. Furthermore, the President of the United States declared at a South Carolina rally on February 28th – one day after Burr’s ominous statements caught on audio – that the corona virus was a Democratic Party hoax.
Throughout February and most of the month of March, Trump and his powerful ancillary propaganda machine consisting of Fox News, an assortment of well-funded and well-organized Christian nationalist organizations, and most of the Republican Party repeated the corona virus hoax lie. A phalanx of right-wing virus deniers, conspiracy theorists, and Fox bloviators were egged on by the president who at best was recognizing the disease did exist, but it was primarily China’s problem and wouldn’t amount to much in the U.S.
Minimizing by The CDC, NIH, HHS, and the FDA at Senate Health, Education, Labor, & Pensions Committee Hearing
On March 3rd, Trump Administration officials responsible for pandemic preparedness, presented their views on potential threats to public health by the COVID19 outbreak at an open hearing held by the Senate Health, Education, Labor, & Pensions Committee. Dr. Robert Kadlec, Assistant Secretary for Preparedness and Response, HHS had the following to say:
“The potential global public health threat posed by this virus is high, but right now, the immediate risk to most Americans is low. The greater risk is for people who have recently traveled to an affected country or been exposed to someone with COVID19.” Page 3.
Department of Health and Human Services
Have we learned and will we be better prepared?
Millions of Americans died during the Covid19 pandemic. Nursing homes were disproportionally affected. Nearly four years later, many health experts are saying a high percentage of those deaths should have never occurred. As has become normal response to such serious negligence and consequent damage, no one has ever been held accountable.
Should we be concerned about the H5N1 (bird flu) virus that is now infecting Americans? Will we be prepared of it shows signs of aggressiveness? Ask your senator and congressman as soon as possible!
Last Updated: July 30, 2024 by David Kingsley, PhD Leave a Comment
A Discussion of Morals and Values in Institutional Care for the Elderly: How we Justify the Unjustifiable: Part I
By: Dave Kingsley
Corporate Neglect and Abuse of Nursing Home Patients: A Low Risk-High Reward Practice
Why do nursing home corporations provide suboptimal and neglectful care while earning robust profits?[i] Because they can. Although the “law” is merely the codification of our morals, values, and ethics, it is of little consequence when it is not respected and enforced. Joe Sopcich’s article that is posted in this blog file indicates how laws and regulations designed to protect patients in nursing homes are pervasively ignored by providers while agencies of government fail to pursue remedies and hold culprits accountable.
Joe writes about what desperate family members experience when they seek help from agencies charged with enforcing the rights of nursing home patients and families. This happens to poor and affluent families alike.[ii] His late mother was a patient in the skilled nursing facility of a continuing care residential community (CCRC) – one of those retirement places where people can live through and receive services from independent and assisted living to skilled-long-term nursing home care. The experience described in the article is quintessential. Neglect of this type is pervasive while agency enforcement of codified patient rights is weak and ineffective.
The industry benefits financially from lack of oversight and accountability. Understaffing and low pay results in lower costs and increased cash flow – that is, unjustifiable cost cutting enhances and protects shareholder value. Furthermore, the industry has successfully disseminated and sold a false narrative constructed on a “financial hardship” theme that has no relationship to reality. Their message is that nursing homes are “running on a thin net,” or earning skimpy amounts for shareholders. This is nonsense but has not been adequately confronted by advocates and the media.
The Larger Context of Industry Neglect and Government Nonfeasance
Agencies can fail to hold tax-funded nursing home businesses accountable because the elderly have been devalued by media misinformation/disinformation, junk science, and even by the most prominent scholars and influencers in the field of bioethics. Furthermore, medical technology and science have increased life expectancy while social attitudes toward the elderly have evolved in a rather disturbing way. Older Americans are now seen as a problem for and even a threat to younger age cohorts.
According to many highly influential economists and bioethicists, the United States simply can’t afford to provide all the healthcare needed by the growing elderly and disabled cohorts in a population of 330 million residents (approximately, based on 2020 Census). Medicare has been demonized as a budget busting monster robbing young people of needed healthcare. This is not true. Medicare expenditures are not an economic burden and threat to the U.S. economy.
More disturbing than the harmful misinformation generated by the economists and bioethicists is the lack of interest in and discourse concerning the morals and values of care of such low quality that it amounts to euthanasia by neglect. This post is the first in a series of posts that will call attention to the nature of a cruel, inhumane, institutional care system for frail patients needing skilled nursing care in the context of current medical and societal values and ethics. It is the entire money-driven system and the absence of discourse regarding morality that is harming patients and shortening their lives unnecessarily. It is to that issue we want to call attention and about which we want to stimulate discourse.
Our point of departure in this discussion is the necessity of dehumanizing groups of people before they can be scapegoated and harmed by government policy with the approval of the broader society.
[i] Apart from The Ensign Group, which owns and/or operates approximately 300 facilities, nursing home corporations are closely held. Therefore, it is not possible to obtain the exact net operating revenue from facility cash flow. Based on my analysis of cost reports, I would estimate that “free cash flow” or “owners’ earnings” ranges from 10 to 15 percent. For instance, In 2023, the Ensign Group had net operating revenue of $376.7 million on $3.7 billion in revenue or 10% in free cash flow. The distribution of earning to investors are increased through avoidance of capital gains taxes. Furthermore, the operations side of the industry is separate from the lucrative commercial real estate side. The Ensign Group is sheltering the corporation from capital gains taxes due to property appreciation by forming a captive REIT or by transferring property to an UPREIT. A large number of executives and investors have individual or family trust for sheltering their compensation and assets. Black Rock, Vanguard, State Street and other major asset managers are the dominant investors in the Ensign Group, REITs, and private equity groups. See: 0001125376-24-000018 (d18rn0p25nwr6d.cloudfront.net, page 96.
Last Updated: May 5, 2024 by Joe Sopcich Leave a Comment
Her teeth were black, she was dying of thirst…and paying $400 per day to live there…
By: Joe Sopcich
This story should shock you, and it is worrisome if it doesn’t! The details in this date log record the experience of a Kansas resident who was faced with the task of finding safe placement of an aging family member who had reached the life stage need for around the clock skilled nursing care. It is too common in America today that finding a safe, high quality care facility for this need is as difficult as surviving a walk through a minefield. This Kansan, to continue that metaphor, stepped on a mine, despite his extensive efforts to carefully research the available options in his area.
We would like to ask our readers to share any experiences you have had or are having pertaining to struggles with advocacy and support agencies you are attempting to receive assistance from.
Prelude…
Due to Covid protocols being applied as the result of testing positive at her SNF residence, my mother was sequestered to a room that was sealed off to everyone except care staff. She had been alone in the room for two weeks. She was 92 years old, suffering from Alzheimer’s and she was immobile. All of her personal needs required assistance by a skilled care staff member.
When I was finally allowed to see her again I immediately observed that her teeth had turned black, and she was literally gasping for water. She was not able to speak, but hand signals and the expression on her face clearly communicated she desperately needed a drink. I found her large tumbler and filled it with water. She grasped it with both hands and drank it dry. She wanted more. I refilled her tumbler and she downed half of it.
Is this what should be expected in an acclaimed five star rated SNF facility that charged $400 per day for a resident? Or $146,000 per year.
What was the management team’s explanation for this travesty? Staff shortages. This consistent excuse was intended to end the conversation with no further commentary.
While this particular incident is shamefully dramatic, it is not the only one experienced by my mom during her end of life stay. The rest of this story will document, in a daily diary form, the effort and outcome of seeking redress through regulatory and advocate channels in Kansas.
The KDADS journal —
This incident occurred in the state of Kansas. I made the decision to reach out to KDADS (Kansas Department for Aging and Disability Services) to report the details of my mom’s experience regarding her care, or rather the lack of care. It was recommended to my family that we make contact with KDADS to report the details of our experience and observations regarding our mother’s care, rather the lack of care. Upon reading this report, you will not have learned much, if anything, about how this agency is supposed to advocate for patients in the confines of eldercare businesses in Kansas. The descriptions of mission and purpose on their website makes all the proclamations one would expect. Despite the discouraging advice of many, I filed my complaint.
The journal of events follows:
January 2023 – I am the patient’s son. I thoroughly studied the KDADS website to learn their required procedures for communication a grievance. It informed me that upon submitting a request for assistance, I would promptly receive an email that provided a case number to initiate the assistance process.
March 20, 2023 – I forwarded my complaint via registered mail to the KDADS office in Topeka. I followed all the protocols as required on the website.
April 11, 2023 – Having received no acknowledgement from KDADS, I called and left a message that I had not heard from them.
April 12, 2023 – I received a call at 8:50 AM informing me they had not received my complaint. I called the local Post Office, and they said it was delivered at 11:57 AM on March 21. I called KDADS at 10:36 MM to give them the exact date and time of delivery. The person looked for it, found it, and apologized for “misspeaking” earlier. I was told it was assigned to a “surveyor” and once the process was over I would be contacted. I figured my complaint was laying on a desk in the KDADS office for 22 days. A number was assigned to the case, #9003.
May 9, 2023 – Upon receiving no further contact from KDADS, two calls were placed during the day, neither of which were answered.
May 16, 2023 – Again, a call was placed and not answered. I a message on the recorder. The call was returned at 1:45 PM to inform him that the investigation ongoing. I was provided with the name, email address, and phone number of the KDADS regional manager.
June 22, 2023 – More than one month has passed with no contact or report from KDADS on the status or outcome of the investigation. Another call was placed at 11:00 AM with a message left to ask for an update. The call was returned later in the day, and this time I was informed that a “surveyor” had not yet been assigned, despite being told two months earlier that an investigator was on the case. I was referred again to the regional director. It was three months since I filed my complaint.
June 23, 2023 – Frustrated, I wrote a letter to the Governor’s office including my original complaint and concerns. I never received an acknowledgement.
June 28, 2023 – I called the regional director’s office at 1:40 PM and left a message. The call was never returned.
July 11, 2023 – I received a call from KDADS. I missed the call. I thought maybe the Governor forwarded my complaint to the KDADS office, hence the call.
July 12, 2023 – I returned the call from the day before and again it was not answered.
July 18, 2023 – The call I referred to in the two previous entries was finally returned at 4:45 PM. The person asked, on the recording, “if there was anything they could do.” This occurred almost five months after I submitted my complaint.
July 19, 2023 – I returned the call again and had to leave a message due to no one answering. The call was never returned.
August 17, 2023 – Six months after filing the formal complaint, another call was placed to the KDADS office at 2:30 PM. This time I was informed that too much time had passed since my mother had expired when I originally filed the complaint. This was the first time he was told there was a time statute for such complaints, despite the fact that a case number was assigned and an investigation had been supposedly launched. I asked her to have the person I spoke with earlier to call me. I never received a call.
October 17, 2023 – I received a call in late afternoon from the surveyor who had apparently been assigned to the case even though two months earlier I was informed the case was rejected do to the statute. Upon the confirming the case number was correct she told about to walk into the SNF facility to examine and review the information on file about my mom.
December 17, 2023 – Nine months after filing the complaint I received a letter from KDADS informing me that the investigation of the complaint had been completed and the facility was found to be in compliance with regard to all allegations. The case was closed. The letter also cited various state codifications related to the required confidentially of the findings. They are not available to the public.
All of the dates and details contained in this catalog are accurate according to my recollections. As the saying goes, you can’t make this stuff up. But most important, KDADS once again failed a citizen of Kansas, his loved ones, and, most importantly, my mother. The fact is that in the state of Kansas when it comes to accountable care facilities, you are on your own.