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A History of Nursing Homes · Stuff You Should Know

0:01
Speaker 1: Welcome to Stuff you should know, a production of My
0:03
Speaker 1: Heart Radios How Stuff Works. Hey, and welcome to the podcast.
0:12
Speaker 1: I'm Josh Clark, and there's Charles w Chuck Bryant and
0:15
Speaker 1: Jerry's out there wandering around in the ether and that
0:19
Speaker 1: makes this stuff. You should know. She's been wandering around
0:23
Speaker 1: the ether for weeks at least, I dare say months
0:27
Speaker 1: by not Chuck. Yeah, she's uh, actually just chatted with
0:32
Speaker 1: Jerry from ten feet away. Oh that's nice, man, that
0:35
Speaker 1: must have felt really special. Did in her hair is long? O? Man?
0:40
Speaker 1: My hair is really long too. Yeah. I feel like
0:43
Speaker 1: I saw Jerry a couple of months ago and her
0:45
Speaker 1: hair was long, So she must have like a full
0:47
Speaker 1: on like do now? Uh? Yeah, you know she looks
0:52
Speaker 1: like a proper lady. I'm not touching that one, all right, So, Chuck,
0:59
Speaker 1: this one was of yours. It was a nursing homes
1:02
Speaker 1: is the idea? Right? Yeah? So I have a question
1:04
Speaker 1: for you. What what made you decide that you want
1:07
Speaker 1: to do on nursing homes? You know, I mean, I'm
1:11
Speaker 1: almost fifty, My parents are in their mid seventies. Emily's
1:15
Speaker 1: grandmother is edging towards one so you know, this is
1:20
Speaker 1: the kind of stuff that just you gotta start thinking
1:22
Speaker 1: about at some point. And Emily and I are old
1:25
Speaker 1: parents and have an only child that we don't want
1:28
Speaker 1: her to have to like have to take care of
1:31
Speaker 1: us or anything. So like we're just starting to have
1:34
Speaker 1: all these thoughts. And I was like, yeah, you know what,
1:36
Speaker 1: I'm not so sure America does it right here. Um,
1:39
Speaker 1: And after studying this stuff, it's we do it, okay.
1:44
Speaker 1: But it's also like, hey, work your whole life and
1:47
Speaker 1: then go broke at the end. Yeah, that's that's a
1:50
Speaker 1: real bomber about the whole thing is just you're just
1:52
Speaker 1: kind of like expected to spend whatever money you have
1:55
Speaker 1: on care at the end of your life. And it
1:58
Speaker 1: just seems a little wrong to me too. Yeah, and
2:00
Speaker 1: we need to shout out first of all, our buddy
2:02
Speaker 1: Dave Ruse helped us put this together, and he actually
2:05
Speaker 1: did a real deal interview with Dr Muriel Gillick, who
2:10
Speaker 1: was an author of Old and Sick in America colon
2:14
Speaker 1: the Journey through the health Care system and was quite
2:17
Speaker 1: a resource, and that the history of this stuff in
2:20
Speaker 1: this country I think was pretty fascinating. Yeah, it is.
2:22
Speaker 1: It's super fascinating. Um, and the whole thing kind of
2:25
Speaker 1: started out. Um, you know, when we're talking about nursing
2:28
Speaker 1: homes in particular, but there's just no way we can't
2:31
Speaker 1: talk about other kinds of homes in particular, because nursing
2:34
Speaker 1: homes grew out of this kind of system that developed
2:38
Speaker 1: that seemed to really kind of take shape and take
2:41
Speaker 1: hold around the Second Industrial Revolution, the one that happened
2:45
Speaker 1: here in the States, and because of that, because people
2:49
Speaker 1: were like, you know, I don't feel like swinging the
2:52
Speaker 1: scythe any longer. I'm gonna go into town and see
2:54
Speaker 1: what they have in the way of jobs. So long
2:57
Speaker 1: mom and dad. All of a sudden, Mom and dad
2:59
Speaker 1: were like gulp, because they were on their own, not
3:02
Speaker 1: just you know, one set of parents in particular, but
3:05
Speaker 1: as like a general intergenerational trend where kids were moving
3:08
Speaker 1: away from the farm, and all of a sudden, there
3:10
Speaker 1: weren't multi generational homes like there were before. Because when
3:13
Speaker 1: you have a multigenerational home, you don't have to worry
3:16
Speaker 1: about what's going to happen to you when you get older.
3:19
Speaker 1: Where you're gonna live. You're gonna live in the same
3:20
Speaker 1: house you raised your your Brady, little kid in to
3:23
Speaker 1: take care of you until you die. And that's just
3:26
Speaker 1: the way it was for years and years and years
3:28
Speaker 1: in America. Yeah, there's a stat here. Uh In nineteen hundred,
3:33
Speaker 1: fifty seven percent of adults over sixty five lived in
3:37
Speaker 1: a multigenerational household, and by nineteen eighty eight years later,
3:41
Speaker 1: that went down to seventeen percent. And big reasons for that,
3:45
Speaker 1: Like you were talking about, you know, moving away from
3:47
Speaker 1: the farm. But just nowadays people just move away. I mean,
3:52
Speaker 1: sixty percent of American adults have moved to a completely
3:56
Speaker 1: new community at least once. And as uh Dr Gillick
4:01
Speaker 1: points out, she says, not only are people not living
4:04
Speaker 1: with their adult children, they're not even living near them
4:07
Speaker 1: many times now, Yeah, because they finally wised up and
4:11
Speaker 1: we're like, gosh, I can get away from my kids
4:13
Speaker 1: once and for all now that they're adults. Well, I
4:15
Speaker 1: think it's more like the kids are like, hey, gee,
4:17
Speaker 1: I want to go live in wherever the heck I
4:19
Speaker 1: want to and we'll just think of a plan for
4:24
Speaker 1: my parents at home. My generation doesn't have any hangups
4:27
Speaker 1: about guilt or morality, you know. But the thing is,
4:32
Speaker 1: it's not just the kids moving away. Like my grandmother
4:34
Speaker 1: moved far away. She moved to Florida, she moved to Arizona.
4:37
Speaker 1: She moved. She was like, so long, everybody, I got
4:41
Speaker 1: this UM. But she was very fortunate that she had.
4:44
Speaker 1: One of the things that UM nursing homes exist for
4:47
Speaker 1: is to take care of people who don't got it,
4:49
Speaker 1: who either don't have family, who don't have the money
4:52
Speaker 1: to hire people to take care of them, who don't
4:54
Speaker 1: have the money to go live in and you know,
4:56
Speaker 1: say like assisted living or something. UM. That's what nursing
5:00
Speaker 1: homes have kind of evolved to take care of. And
5:02
Speaker 1: in that sense, they're actually directly related to what came
5:06
Speaker 1: what were originally called alms houses or county houses or
5:10
Speaker 1: poor houses, which if you were old and you didn't
5:13
Speaker 1: have anyone to take care of you, in like the
5:15
Speaker 1: late eighteenth early nineteenth century in America, you could go
5:19
Speaker 1: to like a farm that the county maintained and there
5:23
Speaker 1: would be a bed there for you, and um, you
5:26
Speaker 1: would be housed with a bunch of different people with
5:29
Speaker 1: a bunch of different conditions, and the one thing that
5:31
Speaker 1: you all had in common was that society didn't quite
5:34
Speaker 1: know what to do with you. Yeah. So I mean
5:37
Speaker 1: it could range from people who had no living family
5:41
Speaker 1: two and just you know, needed care that had nothing
5:44
Speaker 1: else wrong with them except just being old and needing
5:46
Speaker 1: care and having no one around, uh, to people that
5:49
Speaker 1: were mentally ill, maybe people who were suffering from dementia,
5:54
Speaker 1: or people who were alcoholics or drug addicts, and like
5:58
Speaker 1: you said, they you could get a bed, but there
6:00
Speaker 1: were no doctors, there were no nurses, you couldn't get
6:03
Speaker 1: medical care. Uh. And that was sort of the the
6:07
Speaker 1: beginnings of of the shame almost if you want to
6:10
Speaker 1: look at it that way. Yeah, kind of. But it
6:12
Speaker 1: does say something that society did say, we have a
6:16
Speaker 1: responsibility of people. We can't just be like, well, there's
6:19
Speaker 1: a corn field for you to go lay in until
6:21
Speaker 1: you die of exposure, good luck, you know, Like there
6:24
Speaker 1: was a bed that was provided. As meager and horrific
6:28
Speaker 1: as that whole thing was, it was at at least
6:30
Speaker 1: an experiment or an attempt to do something. Yeah. And
6:34
Speaker 1: you know, the next big change happened, um, sort of
6:37
Speaker 1: midway through the nineteenth century when uh, sort of around
6:41
Speaker 1: the time in the Civil War, we started getting our
6:43
Speaker 1: first big hospitals like medical hospitals, public medical hospitals and
6:48
Speaker 1: the big cities around the country, and they, you know,
6:52
Speaker 1: they were sort of the the beginnings of modern um
6:55
Speaker 1: large scale public healthcare. And here's the thing, though, is
7:00
Speaker 1: they were back then they focused on acute care. So
7:03
Speaker 1: if you again were a senior and you uh they
7:08
Speaker 1: called them old chronics, like you had maybe a chronic
7:11
Speaker 1: condition and no one to take care of you, then
7:14
Speaker 1: you uh, basically you were too too dependent to go
7:19
Speaker 1: to one of these places because it was a hospital,
7:21
Speaker 1: and they're like, you can't stay here, right because even
7:24
Speaker 1: though you know you're called an old chronic, you might
7:26
Speaker 1: not have anything wrong with you aside from being really old,
7:29
Speaker 1: and maybe you can't make it to the bathroom very
7:31
Speaker 1: easily something like that, but not necessarily anything that a
7:34
Speaker 1: hospital could treat you for. It was just they had
7:37
Speaker 1: a bed about hospitals. Very quickly, we're like, we can't,
7:41
Speaker 1: like this isn't working. You're gonna stay here indefinitely and
7:44
Speaker 1: there's really nothing wrong with you. We gotta find a
7:46
Speaker 1: place for you. And so about that time, some charities,
7:50
Speaker 1: especially either ethnic or religious based charities like the um
7:54
Speaker 1: Baptists or the German Aid Society was was a big
7:59
Speaker 1: one in Boston. I think, um, the German Ladies Aid
8:03
Speaker 1: Society of Boston. I'm sorry. Um, they kind of said,
8:05
Speaker 1: you know what, we we have members who are uh
8:08
Speaker 1: they're members of our church or you know, they're German,
8:11
Speaker 1: they're part of our community and they don't have anybody,
8:14
Speaker 1: so we we need to make sure that they're taken
8:16
Speaker 1: care of. And they actually started founding what we're called
8:19
Speaker 1: old age homes, which is basically they would get like
8:22
Speaker 1: a large home and um kind of outfit it with
8:25
Speaker 1: different Each room was like a different room for a
8:27
Speaker 1: different tenant, and they would take care of like old
8:30
Speaker 1: widows basically who didn't have the money or the children
8:34
Speaker 1: to take care of them. Yeah. But specifically, what they
8:37
Speaker 1: deemed as worthy poor uh, And here's what differentiated them
8:41
Speaker 1: from the almshouses was, uh, if you were worthy poor
8:45
Speaker 1: and you know that's in air quotes, that meant that
8:48
Speaker 1: you were the wife of of a man who who
8:53
Speaker 1: worked hard all his life but never made a lot
8:55
Speaker 1: of money, maybe worked at a shipyard or just had
8:59
Speaker 1: sort of a very low paying, blue collar but respectable job,
9:03
Speaker 1: but certainly not the kind of dough to pay for
9:05
Speaker 1: like private nursing homes or anything like that, but not
9:09
Speaker 1: alcoholic or drug addict or you know, there was no UM.
9:13
Speaker 1: They didn't like force a shame attachment to it. So
9:16
Speaker 1: these widows who were you know, in their sixties or seventies,
9:19
Speaker 1: depending on you know, how their husband lived their lives,
9:22
Speaker 1: They're like, I've been morphine free since seventy three, so
9:25
Speaker 1: let me in. Uh. They didn't have these big pensions
9:28
Speaker 1: or anything because of the jobs their husbands had. So
9:31
Speaker 1: they were taken into one of these homes like a
9:33
Speaker 1: Baptist m or something, and they were given to bed
9:35
Speaker 1: and they were given again, not medical care, but they
9:37
Speaker 1: were at least given meals in a bed. Right. Um.
9:42
Speaker 1: A lot of times they were expected to kind of
9:44
Speaker 1: pay for their their room and board. Um. It was
9:48
Speaker 1: kind of like a needs based sliding scale. I got
9:51
Speaker 1: the impression some of them, UM just straight up said hey,
9:55
Speaker 1: give us five hundred dollars. At the time, I think
9:58
Speaker 1: around nine or uh, late nineteenth century, I don't remember
10:02
Speaker 1: exactly when it was, um, the Winchester Home for Aged
10:05
Speaker 1: Women in Massachusetts, the Winchester Mystery House. I looked it up.
10:09
Speaker 1: I was like, is that the same one? But it was.
10:11
Speaker 1: It was bequeathed by a Lucy Winchester, who I couldn't
10:14
Speaker 1: find anything about. But it's not the same person. A
10:16
Speaker 1: lot of people in the house, you would, um, although
10:19
Speaker 1: you gain a lot more ghosts, it's true. But um,
10:22
Speaker 1: they said, you pay us five hundred dollars. So this
10:24
Speaker 1: is in nineteen o four. You pay us five hundred
10:26
Speaker 1: dollars and you can stay here for the rest of
10:28
Speaker 1: your life. And five hundred dollars back then was worth
10:30
Speaker 1: about fifteen thousand today, And exactly I was thinking about that.
10:34
Speaker 1: It's a bit of a gamble on both sides. But
10:36
Speaker 1: it's a bit like insurance. It's like some sort of
10:39
Speaker 1: long term care um insurance where you're like, okay, let's
10:44
Speaker 1: stretch my five dollars as far as I can go,
10:46
Speaker 1: or you know, you could die two days after they
10:49
Speaker 1: still kept your five hundred dollars. But then hopefully it
10:52
Speaker 1: was used to make life better for the other people
10:54
Speaker 1: who's who had used up their five hundred dollars long ago.
10:58
Speaker 1: You know. So there was this kind of idea that
11:01
Speaker 1: if you could pay for it, you should pay for it.
11:04
Speaker 1: And then as time went on, it was like, oh,
11:07
Speaker 1: you just you know, you sold your house. We need
11:09
Speaker 1: that money if you're gonna stay here, And people would
11:12
Speaker 1: take in more and more money from that person's estate
11:15
Speaker 1: um as they were alive to take care of them.
11:18
Speaker 1: And this was starting in like the beginning of the
11:21
Speaker 1: twentieth century into the nineteenth century. So that's a very
11:23
Speaker 1: long tradition of extracting everything from old people as they're
11:27
Speaker 1: dying to to pay for their care. And I'm got you,
11:31
Speaker 1: I'm bothered by that. Yeah, I mean the question became U,
11:35
Speaker 1: not how how much is it for your care facility,
11:38
Speaker 1: and it's more like how much you got how much
11:41
Speaker 1: you got here? Graham by the ankles and turn them
11:43
Speaker 1: upside down, or if they you know, if they weren't charging.
11:46
Speaker 1: There was the expectation that they didn't need so much
11:50
Speaker 1: care that they couldn't also contribute, like here, we got
11:52
Speaker 1: a room for you. We'll feed you, but you gotta
11:54
Speaker 1: make your bed, and you gotta clean your room and
11:56
Speaker 1: maybe help keep the property up. So I got the
11:59
Speaker 1: idea that these were people who, like I said, you know,
12:03
Speaker 1: a senior widow who just didn't have anywhere else to
12:07
Speaker 1: go and otherwise was doing okay, yeah, but forced to
12:11
Speaker 1: make knockoff Gucci wallets during craft arts and craft. Should
12:15
Speaker 1: we take a break? All right, I got a Gucci
12:18
Speaker 1: wallet to work on myself. Okay, So we've got alms
12:53
Speaker 1: houses are still around. They have they stayed around until
12:56
Speaker 1: like the nineteen forties. From what I could see, these
12:58
Speaker 1: county houses poor houses, um, and then alongside of those
13:01
Speaker 1: you've got old age homes. But then, um, the government
13:05
Speaker 1: was kind of like, we can do we can do
13:07
Speaker 1: better than this. New York itself, I think, became the
13:10
Speaker 1: first state in the United States to say, um, it's
13:14
Speaker 1: a ten ninety it's modern era, we need to do
13:17
Speaker 1: more to take care of like our our elderly and
13:20
Speaker 1: in particular are mentally infirm. Um. They and they that
13:25
Speaker 1: state made a commitment to take care for the state,
13:28
Speaker 1: to take responsibility for its mentally ill and that included
13:33
Speaker 1: people with dementia of all sorts, which they would have
13:36
Speaker 1: called senility back then. Um. And so that was kind
13:40
Speaker 1: of like the first entree of the state into caring
13:44
Speaker 1: for elderly people. And that actually kind of opened a
13:47
Speaker 1: bit of a floodgate. I think, um. Other states started
13:50
Speaker 1: to kind of follow suit, but it was like a
13:53
Speaker 1: it was a step in a really dark direction, because
13:57
Speaker 1: by World War One, if you were elderly, especially if
14:01
Speaker 1: you had some sort of um declined, some sort of
14:04
Speaker 1: cognitive decline from age, there was a really good chance
14:09
Speaker 1: that you were in a mental asylum um with everybody else.
14:13
Speaker 1: And in a lot of cases, I think even if
14:15
Speaker 1: you were just elderly, you would find yourself in a
14:17
Speaker 1: mental asylum in that right, Yeah, I mean absolutely. So
14:20
Speaker 1: you've got a situation where the states start to say, hey,
14:24
Speaker 1: we need to take care of our mentally ill, but
14:27
Speaker 1: seniors just started getting kind of lumped in if they
14:30
Speaker 1: didn't have anywhere else to go. So you might have
14:34
Speaker 1: you know, someone's someone's grandmother who just didn't have family
14:37
Speaker 1: and who was really doing okay upstairs and and was
14:41
Speaker 1: in pretty good health, might find themselves in, like you said,
14:46
Speaker 1: a mental hospital with people with severe mental illness. Uh.
14:50
Speaker 1: And I think there's a couple of stats here that
14:52
Speaker 1: Dave dug up by there were more elderly Americans and
14:56
Speaker 1: mental hospitals than in those almhouses and the price that
15:00
Speaker 1: old age homes combined. And he mentioned one in particular,
15:04
Speaker 1: Chicago State Hospital, which was a mental hospital in the
15:08
Speaker 1: nineteen thirties, of the patients there were quote aged or
15:12
Speaker 1: infirm that had no other underlying psychosis or mental health condition. Right.
15:18
Speaker 1: So that's a really dangerous place for old people to
15:20
Speaker 1: be because if you act up, they can put you
15:22
Speaker 1: on medications, they can give you, um, the hydrotherapy treatment,
15:26
Speaker 1: they can do all sorts of stuff to you because
15:28
Speaker 1: you're in a mental hospital. And I think it's kind
15:30
Speaker 1: of like one of those things where, um, if you're
15:33
Speaker 1: a hammer, everything looks like a nail. Well, if you're
15:35
Speaker 1: a nineteen thirties old timing psychiatrist, everything looks like a um,
15:40
Speaker 1: a mental condition, a mental condition, right, you know, um,
15:43
Speaker 1: and you're gonna treat all of the people the same way.
15:45
Speaker 1: And so luckily Francis Perkins arrived on the scene around
15:50
Speaker 1: this time. So World War One is when old people
15:53
Speaker 1: really started to get shuffled off to mental hospitals by
15:57
Speaker 1: the government. Swoop James like, whoa, whoa, this is way wrong,
16:00
Speaker 1: Like we need just because these people are old doesn't
16:03
Speaker 1: mean that they're um, they're mentally ill. So let's extract
16:07
Speaker 1: them from that environment and figure out if we can
16:09
Speaker 1: do something else. And thanks to Social Security that that
16:13
Speaker 1: really began to change. Fairly quickly. Yeah, so this is
16:16
Speaker 1: nineteen thirty five. Again, you mentioned the great Francis Perkins.
16:19
Speaker 1: If you didn't listen to that episode, go listen to it.
16:22
Speaker 1: It's fantastic out the Social Security Act. Um. Basically like
16:28
Speaker 1: when we think of Social Security now, we think of
16:31
Speaker 1: the program where you pay in your whole life from
16:35
Speaker 1: your paycheck and then when you retired you get a
16:37
Speaker 1: monthly income and if you work longer than your checks
16:41
Speaker 1: are gonna be bigger. Um. I started working when I
16:44
Speaker 1: was thirteen, so imagine I'm gonna be rolling in dough.
16:47
Speaker 1: You're always boasting about that of hearing about that about
16:50
Speaker 1: my thirteen year old bus boy job. Yes, it's a
16:53
Speaker 1: title Max. Now, by the way, yeah dry Max, got
16:58
Speaker 1: your money, your mind, real money. Oh man, that's some
17:02
Speaker 1: good free advertising. Yeah. I drove. I drive by there
17:06
Speaker 1: on the way to my mom's and Emily's parents house sometimes,
17:09
Speaker 1: and I always pointed out to my daughter and say, hey,
17:12
Speaker 1: that's the barbecue restaurant I worked at. It's now a
17:15
Speaker 1: title Max. Is that the one where the guy put
17:17
Speaker 1: his foot in the Brunswick sto? Yeah? God, I wonder
17:22
Speaker 1: where that guy is now. Randy, he's in he's in
17:25
Speaker 1: I don't know. I'm not even going to guess the
17:27
Speaker 1: feeling Randy's in prison, do you think so? I mean,
17:31
Speaker 1: he saw him do a lot worse than put his
17:33
Speaker 1: foot in the Brunswicks, do you know what I mean?
17:35
Speaker 1: Oh jeez, I don't put My mind is rased at
17:38
Speaker 1: life behind bars and I'm not laughing at that. It's
17:42
Speaker 1: it's very sad. But Randy, you know, he made his
17:44
Speaker 1: own decisions. That reminds remember Randy the hippie from MTV
17:49
Speaker 1: and like the late eighties, early nineties, No, he ran
17:53
Speaker 1: for president. He was like just this total weirdo burnout
17:57
Speaker 1: who was yeah, who looked today like he could have
18:00
Speaker 1: been in l m f A. Oh okay, Like really
18:05
Speaker 1: he dressed like that, but this is like decades before.
18:07
Speaker 1: But anyway, I remember like he he like ran for
18:10
Speaker 1: president and I think he lost and he's like, I've
18:13
Speaker 1: made my bed now I must lie in it. I'll
18:15
Speaker 1: never forget that. For some reason, I thought it was hilarious.
18:18
Speaker 1: But yeah, that was Randy. Well, I mean maybe it
18:20
Speaker 1: was d Randy Brunswich, it was the Rands. What I'm saying, um, so, yeah,
18:25
Speaker 1: that that was old age insurance is what they called
18:28
Speaker 1: it originally. But then there was also Old Age Assistance
18:32
Speaker 1: oh a A, which was you're gonna get payments when
18:36
Speaker 1: you're older, even if you didn't work, which was a
18:39
Speaker 1: big deal because so many women were not allowed to
18:42
Speaker 1: work and have jobs, so like what were they going
18:45
Speaker 1: to do? They're like, say, hey, you didn't pay anything
18:47
Speaker 1: in sorry, you just raised your kids and grandkids. That's
18:51
Speaker 1: a great that's a great point. I think we still
18:54
Speaker 1: do that today though, unfortunately, but at least women can
18:57
Speaker 1: actually work in the workforce if they want to. But yeah,
19:00
Speaker 1: if they if they stay home and raise kids, then
19:02
Speaker 1: they're still treated the same way, which is pretty shameful.
19:05
Speaker 1: But I get your point. And the point is is
19:07
Speaker 1: that we needed to be able to UM take care
19:10
Speaker 1: of people who hadn't necessarily worked in the workforce and
19:14
Speaker 1: paid into Social Security, and then also we had to
19:17
Speaker 1: offset that first basically generation that we're like, Okay, we're
19:22
Speaker 1: the first ones nobody's been paying in, but why do
19:26
Speaker 1: we Why are we the ones who have to pay
19:27
Speaker 1: him but we get nothing from it? So the Old
19:29
Speaker 1: Age Assistance the o a A really helped with that
19:33
Speaker 1: UM and I guess that's kind of gone the way
19:35
Speaker 1: of disco because the only thing I know about is
19:37
Speaker 1: the Old Age insurance that's still around, and I know
19:40
Speaker 1: they don't call it that any longer, but that Old
19:43
Speaker 1: Age assistance where it's like, I guess that would be Medicaid, right, yeah,
19:47
Speaker 1: I think so okay, So so we'll and we'll talk
19:51
Speaker 1: a lot more about Medicaid and medicare. Just put a
19:53
Speaker 1: button in that all of you bureaucrat walks. You're gonna
19:56
Speaker 1: love it. Yeah, but uh, you know, FDR, this is
19:59
Speaker 1: when things really changed. And the reason we're talking about
20:02
Speaker 1: social security and stuff like this is because it really
20:05
Speaker 1: it's sort of laid out the roadmap for what was
20:07
Speaker 1: going to happen and how we cared for our grandparents
20:11
Speaker 1: and what kind of places they were going to be.
20:14
Speaker 1: So because he went in there with a new deal
20:16
Speaker 1: and he was like these all houses are terrible. He's like,
20:19
Speaker 1: we need to get rid of these. And he said
20:21
Speaker 1: in these state mental hospitals, they're overburdened. And that's not
20:25
Speaker 1: right either. So here's what I'll do. Part of the
20:27
Speaker 1: o A A the Old Age Assistants. A big provision
20:31
Speaker 1: here is that you can't um you can't get any
20:34
Speaker 1: of that money if you're living in a public institution
20:36
Speaker 1: like an alms house or like a state mental hospital,
20:39
Speaker 1: No money come in your way. No. So suddenly the
20:42
Speaker 1: people who were stuck in state mental hospitals or alms
20:46
Speaker 1: houses not only were like, oh, well I could get
20:49
Speaker 1: out of here. Now I have the funds to get
20:52
Speaker 1: out of here and go somewhere better. And this led
20:54
Speaker 1: to a huge boom in the growth of private um
20:58
Speaker 1: uh living facilities for the elderly. Yeah. I think that
21:01
Speaker 1: was the big change. I mean, surely people were like, great,
21:04
Speaker 1: I can get out of here, but I think people
21:07
Speaker 1: saw dollar signs said wait a minute, I can get
21:11
Speaker 1: paid by the government to take in these people and
21:13
Speaker 1: take care of them, right, sometimes directly get paid by
21:15
Speaker 1: the government. Yeah. That was kind of like an amendment
21:18
Speaker 1: that they made later on where it was like, um yeah,
21:21
Speaker 1: that that incentivized it even more. It's like, well, we'll
21:24
Speaker 1: pay you directly. There's not even this person as gonna
21:27
Speaker 1: have to be involved. Just take care of them, you know,
21:29
Speaker 1: follow these guidelines and we'll send you this check every month.
21:32
Speaker 1: And the people is there any money left over for me?
21:35
Speaker 1: You know? And no, no, no, no, this just don't
21:38
Speaker 1: ask any questions. It's as a matter of fact, now
21:39
Speaker 1: that you bring it up, do you have any money,
21:41
Speaker 1: you're gonna give it to them first before we give you.
21:43
Speaker 1: There's a balance on your account, sir. So. Um, this
21:46
Speaker 1: is kind of how it went for like the first
21:49
Speaker 1: you know, fifteen twenty years after so Security Act was
21:52
Speaker 1: introduced in nineteen thirty five, where um it fueled this
21:56
Speaker 1: boom of retirement homes. Basically the retirement home into Tree
22:00
Speaker 1: found its its birth there. And then about fifteen years
22:03
Speaker 1: after the government was like, you know what, we've been
22:05
Speaker 1: sinking a lot of money into this, maybe we should
22:08
Speaker 1: look around and see if any of these places are
22:10
Speaker 1: any good. And they found that no, in a lot
22:12
Speaker 1: of cases they weren't really good. There was, um, you know,
22:15
Speaker 1: if you if you converted an old Victorian mansion into
22:19
Speaker 1: an old age home with a dozen rooms, you probably
22:23
Speaker 1: didn't add a fire exit onto every room and fire
22:26
Speaker 1: stairs on the second and third floor. Um, there's probably
22:30
Speaker 1: not sprinkler system because they weren't very prevalent by that time,
22:34
Speaker 1: and so if there was a fire, all of these uh,
22:37
Speaker 1: the dozen ages and infirm people who lived there were
22:40
Speaker 1: going to die in a fire. Um that was the
22:42
Speaker 1: one big one that they turned up that came out
22:44
Speaker 1: of these early investigations into into what came to be
22:47
Speaker 1: called nursing homes. Yeah, so this is when Congress steps
22:50
Speaker 1: in again, like you said, about fifteen to twenty years
22:53
Speaker 1: later in the nineteen fifties, and said, all right, here's
22:56
Speaker 1: the deal. If you're getting this dough from us, we
23:00
Speaker 1: need to regulate, um, what's going on there, and they
23:02
Speaker 1: need to be safe. And a lot of these mom
23:05
Speaker 1: and pops that, like you said, converted an old house,
23:08
Speaker 1: they couldn't make those upgrades. You can't just slap on
23:11
Speaker 1: a fire escaped to an old Victorian. I guess you could,
23:13
Speaker 1: but it wouldn't look that great or probably work that well.
23:16
Speaker 1: And so a lot of these smaller ones floundered and
23:20
Speaker 1: all of a sudden, and this is things where things
23:22
Speaker 1: really start to change. There's a big market for just
23:26
Speaker 1: basically I don't even know if I would call it
23:28
Speaker 1: the corporatization yet, but maybe to a certain degree, these
23:32
Speaker 1: bigger facilities for residents that had this money that could
23:36
Speaker 1: go straight to them. And uh so these sort of
23:40
Speaker 1: larger places that weren't individual houses started popping up. Yeah, well,
23:44
Speaker 1: that's like an ongoing and recurring theme in a big
23:47
Speaker 1: criticism among conservatives of big government or government regulation is
23:51
Speaker 1: that it homogenizes things because usually the mom and pop operations,
23:55
Speaker 1: even if they are well meaning and not nefarious, like
23:59
Speaker 1: they don't have money to add those fire exits on.
24:02
Speaker 1: But say like a corporation that's going to own several
24:05
Speaker 1: of these things, they can build new ones with all
24:07
Speaker 1: the modern fire exits and fire sprinklers. And so those
24:10
Speaker 1: bigger corporations start owning more and more and more, and
24:14
Speaker 1: by building more and more and more, they're not gonna
24:16
Speaker 1: make each one like really unique and and embedded in
24:19
Speaker 1: the community. They're going to plunk down the same one
24:22
Speaker 1: in every place they build one. And so there's this
24:25
Speaker 1: homogenization that occurs as a result of that. And that's
24:27
Speaker 1: exactly what happened with what came to be called nursing homes,
24:30
Speaker 1: which really started to find their advent in the nineteen
24:33
Speaker 1: fifties from these reforms where the government was like, you
24:36
Speaker 1: guys need to be able to do this, this, and this, um,
24:38
Speaker 1: we're gonna assign the Public Health Service to to lay
24:42
Speaker 1: out guidelines. The Public Health Service knows about regulating hospitals,
24:46
Speaker 1: so they really added onto that homogenization, this this underlying
24:51
Speaker 1: medicalization of caring for older people, which makes sense. You know,
24:56
Speaker 1: you think of older people, olderally people, senior adult you think, gosh,
25:01
Speaker 1: the you know, the body is starting to wear down.
25:03
Speaker 1: There have they have all these conditions or whatever, So
25:05
Speaker 1: it makes sense that you a couple hospitalization or medicalization
25:09
Speaker 1: with that. But that's not always the case. And the
25:12
Speaker 1: problem is, as it became the case, whether you needed
25:14
Speaker 1: it or not, that was the kind of place you
25:16
Speaker 1: lived was basically a bland institutional extension of a hospital. Yeah,
25:23
Speaker 1: I mean it's not like in Uh. I kept thinking
25:27
Speaker 1: of the movie Say Anything when I was researching this
25:32
Speaker 1: because that was a prominent storyline in that movie. I
25:36
Speaker 1: never saw it. You never saw Say Anything. I didn't
25:40
Speaker 1: do you wonder what happens every time a guy in
25:42
Speaker 1: a trench coat holds up a boom box over his head. So,
25:44
Speaker 1: I mean, I know you need the cultural reference. Yeah,
25:47
Speaker 1: of course, I just wondered up all this time. You're like,
25:49
Speaker 1: what is the deal with this boom box? Yeah, it's
25:52
Speaker 1: like a reference to Kevin Smith and Clark. Okay, sure,
25:55
Speaker 1: exactly now Ione Sky's father, the late great John Mahoney.
26:00
Speaker 1: Was he ran a mom and pop nursing home. Yes,
26:05
Speaker 1: and was in spoiler coming if you haven't seen a
26:08
Speaker 1: thirty something year old movie. Uh, he was found to
26:11
Speaker 1: be ripping them off and that was a big sort
26:13
Speaker 1: of subplot in that movie. All I heard was that
26:17
Speaker 1: was a big subplot in that movie. Very good, but uh,
26:21
Speaker 1: say anything aside. They um, like you said, became more
26:25
Speaker 1: hospitalized for lack of a better word, And if you
26:29
Speaker 1: went to one of them back then, there was very
26:31
Speaker 1: little to differentiate it from a hospital, from the central
26:34
Speaker 1: nurses station to the cafeteria food. I remember going to
26:38
Speaker 1: visit my my grandmother on my my paternal grandmother, who
26:42
Speaker 1: lived to be a hundred and one before my dad
26:45
Speaker 1: and his wife took her in. She was in one
26:48
Speaker 1: of these places and uh, or actually maybe it was
26:51
Speaker 1: the other way around. She went afterward. But it was
26:54
Speaker 1: it was terrible, you know, it was awful and very
26:57
Speaker 1: very sad. And if I was not a young man
27:00
Speaker 1: with nothing, you know, nothing going on in my life,
27:03
Speaker 1: I might have done something about it, but you know,
27:05
Speaker 1: I didn't know what to do back then. You would
27:07
Speaker 1: have opened all the doors and been like, go free,
27:09
Speaker 1: go free. I would have ripped her out of there
27:11
Speaker 1: at least and said come home with me. Yeah, I
27:13
Speaker 1: mean they were pretty bad, especially by the time I'm
27:15
Speaker 1: guessing you were there in the eighties or nineties. Maybe
27:18
Speaker 1: this was in would have been the nineties. Yeah, So
27:20
Speaker 1: in the fifties, in the mid fifties, even these things
27:23
Speaker 1: made a little more sense at the very least they
27:25
Speaker 1: were newer. By the seventies and eighties, they were so
27:28
Speaker 1: bad that we had a reform Act that kicked in seven,
27:33
Speaker 1: which is basically like this place is wrong, and like
27:37
Speaker 1: maybe we don't know what to do or replace him with,
27:40
Speaker 1: but here are some things that that you have to
27:43
Speaker 1: treat these people with, like dignity. They have to be
27:46
Speaker 1: able to have a say in what they wear or
27:49
Speaker 1: what they um, what they eat, or what they do
27:51
Speaker 1: during the day. And it really kind of got off
27:54
Speaker 1: the rails within a couple of decades after their advent.
27:57
Speaker 1: The thing is is like I was saying, nobody knows
28:00
Speaker 1: what to do about nursing homes, and we'll talk a
28:02
Speaker 1: little more about that later, but just just kind of
28:04
Speaker 1: put a pin in that nursing homes were not not great,
28:07
Speaker 1: and they're still not great. Yeah, should we take a
28:10
Speaker 1: break and then come back and talk about medicaid and
28:12
Speaker 1: medicare and how that figures in. Yeah, all right, Well
28:15
Speaker 1: we'll be right back with those two tiny little things
28:18
Speaker 1: right after this. Alright, So we promised talk of Medicare
28:52
Speaker 1: and medicaid, and I think Dave kind of put it
28:55
Speaker 1: really on the nose here he said no to government
28:58
Speaker 1: programs have shaped a nursing home care model over the
29:01
Speaker 1: last fifty years more than than those two programs. UH.
29:05
Speaker 1: Created in nineteen Lyndon Johnson amended the Social Security Act.
29:11
Speaker 1: And UH, if you still get confused, if you're like
29:14
Speaker 1: a young hip and heppen and millennial and you don't
29:18
Speaker 1: know what those two words mean and you get them
29:20
Speaker 1: mixed up. Medicare is health insurance universal, one might dare
29:26
Speaker 1: say socialized medicine. That's a red herring for Americans over
29:32
Speaker 1: sixty five. Medicaid is long term care for Americans lower
29:37
Speaker 1: income status. That's right, Yeah, and it can. You don't
29:42
Speaker 1: necessarily have to be elderly for um Medicaid. I believe. Yeah, Medicare,
29:46
Speaker 1: you do Medicaid. You could be lower income and have
29:49
Speaker 1: a lifelong disability and you'd be eligible for Medicaid too. Yeah,
29:53
Speaker 1: so Medicare again, this is if you're over sixty five,
29:57
Speaker 1: it's gonna pay for acute medical care when you're in
29:59
Speaker 1: a hospital. But if you need something long term UM
30:03
Speaker 1: kind of like what we're talking about at the beginning,
30:06
Speaker 1: then uh, it won't pay for that. Like you can't
30:09
Speaker 1: just say all right, I'm gonna go to a nursing
30:10
Speaker 1: home now and it's gonna just pay for that in full,
30:13
Speaker 1: but Medicaid would. And for a while everybody's like, okay, well,
30:16
Speaker 1: we'll just take Medicaid. This is UM after Lyndon Johnson's
30:20
Speaker 1: Great Society in UM. So they were like, this is fine.
30:25
Speaker 1: And then somebody realized that Medicare pays way more than
30:29
Speaker 1: Medicaid does, and so all of the bottom line people said,
30:34
Speaker 1: how can we can we do this? What are we
30:35
Speaker 1: gonna do? So they read the the act um and
30:38
Speaker 1: they found that, uh, there was language in there that
30:42
Speaker 1: says Medicare will pay for uh stay up to a
30:47
Speaker 1: hundred days in a skilled nursing facility UM after three
30:53
Speaker 1: days or more of treatment in the hospital. And so
30:56
Speaker 1: all of those nursing homes were like, well, we have
30:58
Speaker 1: we have nurses, we have doctors. Well, let's just rebrand
31:02
Speaker 1: ourselves as skilled nursing facilities. And so there was a huge,
31:05
Speaker 1: massive transition from nursing homes where you would go live
31:10
Speaker 1: potentially the rest of your life and there were not
31:12
Speaker 1: nurses and doctors and all of that. Um, and this
31:15
Speaker 1: was your new home until you died. To you guys
31:18
Speaker 1: got to go because we're now a skilled nursing facility,
31:21
Speaker 1: which means the most you could stay as a hundred days,
31:23
Speaker 1: but we're gonna make way more off of flipping people
31:27
Speaker 1: every hundred days than we would because Medicare is gonna
31:30
Speaker 1: pay then we would letting you stay here as a
31:32
Speaker 1: nursing home because Medicaids paying for that. That, like I said,
31:36
Speaker 1: just caused a huge change in the industry. Yeah, and Americans,
31:41
Speaker 1: uh in the eighties and nineties, UM, generally we're like,
31:44
Speaker 1: you know what, we need better um facilities and more
31:47
Speaker 1: comfortable facilities that feel more like uh, feel less like
31:51
Speaker 1: a hospital and more like an apartment, let's say. And
31:54
Speaker 1: that was sort of the birth of what's known now
31:56
Speaker 1: as assisted living facilities, where they're different levels of care
32:01
Speaker 1: that you can pay for um. And the idea is
32:05
Speaker 1: that if you go to one of those, you have
32:07
Speaker 1: a little bit more independence. Um, you have a little
32:10
Speaker 1: bit more uh say, and like how your day goes,
32:15
Speaker 1: um like and that's just at a just like a
32:17
Speaker 1: daily schedule level. Um. And you know that it's like
32:20
Speaker 1: a little more social like it it's it's sort of
32:23
Speaker 1: like you what you I mean. The best ones are
32:25
Speaker 1: like what you would hope they would be, which is
32:27
Speaker 1: a place for your grandparents to go hang out and
32:30
Speaker 1: hang out with other seniors who and and you know,
32:33
Speaker 1: have a social life and tell stories and be with
32:36
Speaker 1: one another and not just sort of be in a
32:38
Speaker 1: hospital room. Right, So, like if you can't just stay
32:42
Speaker 1: in your house or something as you're getting older, this
32:45
Speaker 1: is a real alternative for you. Um. And because there's
32:49
Speaker 1: different levels of care, you can age in place there,
32:53
Speaker 1: like you can just keep getting older and older and
32:54
Speaker 1: then they'll start, you know, adding greater and greater layers
32:57
Speaker 1: of care. The thing is is assisted living is expensive
33:01
Speaker 1: and it's outside of the federal purview. Like the Feds
33:04
Speaker 1: went all in on nursing homes. They regulate nursing homes,
33:07
Speaker 1: they don't regulate assisted care. Um. They they will pay
33:11
Speaker 1: for nursing homes, they won't pay for assisted care. Um,
33:15
Speaker 1: there's a lot of differences, and they're almost they're they're
33:18
Speaker 1: very much intertwined nursing homes and assisted living, but um,
33:22
Speaker 1: they're very they're very separate as far as the US
33:25
Speaker 1: government is considered. There are two different things, and the
33:28
Speaker 1: government recognizes nursing homes. Um. The thing is, it's like
33:31
Speaker 1: you were saying, in the eighties and nineties, people were like,
33:34
Speaker 1: we we don't want to live in nursing homes anymore,
33:36
Speaker 1: we want to move over here. And all the nursing
33:38
Speaker 1: homes were like, fine, we're skilled nursing facilities now, and
33:42
Speaker 1: we can get some of that sweet sweet medicare money.
33:45
Speaker 1: So if you did you see that stat Yeah, sixty
33:50
Speaker 1: three there were five hundred and seventy thousand skilled nursing
33:52
Speaker 1: beds into there were one point two millions. So they
33:56
Speaker 1: definitely were like, oh, that that money needs to become
33:59
Speaker 1: in our way exactly so, and that's exactly what they did.
34:02
Speaker 1: They said, you know, we're we're skilled nursing facilities now,
34:05
Speaker 1: and you know they probably are owned by the hospitals
34:08
Speaker 1: where you do three days in there and then get
34:10
Speaker 1: moved to the skilled nursing facility and then maybe if
34:12
Speaker 1: it's a large enough group, they might own an assisted
34:15
Speaker 1: living facility to that you can say move into after
34:19
Speaker 1: that hundred days or something. Um. The thing is is
34:24
Speaker 1: the assisted living is great. Um. It can be really
34:28
Speaker 1: really good, and nursing homes can be good too. There's
34:30
Speaker 1: not like all nursing homes aren't bad, and they all
34:33
Speaker 1: of them have like their their upsides. Like you were saying,
34:36
Speaker 1: assisted living is very social. There's probably you know, a
34:38
Speaker 1: lot more going on, a lot more activity, just because
34:41
Speaker 1: a lot of the people who live there these days
34:44
Speaker 1: are going to be more active still, whereas in nursing homes.
34:49
Speaker 1: It's now the people who live in nursing homes tend
34:51
Speaker 1: to be much sicker, more infirm. Um, But there's still
34:55
Speaker 1: socialization where there's not necessarily if you just you know,
34:59
Speaker 1: live alone your house and somebody comes by a couple
35:01
Speaker 1: of times a week. So there are definitely good things
35:04
Speaker 1: to nursing homes. The problem is is se of them
35:07
Speaker 1: are for profit. Some of them are owned by um
35:11
Speaker 1: private equity firms. We shouldn't let private private equity firms
35:15
Speaker 1: anywhere near the aged population. Ever in any country. That's
35:20
Speaker 1: just a terrible combination. And apparently, in fact, their studies
35:24
Speaker 1: that show when private equity firms take over nursing homes
35:28
Speaker 1: there is a measurable decline in health outcomes for the
35:32
Speaker 1: residents because their whole thing is there they you know,
35:35
Speaker 1: they're dedicated to making you know, corporate profits, and so
35:39
Speaker 1: you've cut costs and you cut services, and you just
35:41
Speaker 1: approach things differently than you should. And that's kind of
35:44
Speaker 1: like this evolution that's going on now, is we we've
35:48
Speaker 1: been providing services to elderly people as they age, as
35:53
Speaker 1: if their customers where instead we should be providing care.
35:57
Speaker 1: And those are two different things. Even though from you know,
36:00
Speaker 1: a few paces back they might look similar, they're not.
36:03
Speaker 1: They're different. And that's kind of the push that we're
36:05
Speaker 1: going toward now. Yeah, So where we find ourselves today
36:08
Speaker 1: statistically is uh. And I was kind of surprised about this.
36:13
Speaker 1: I had a feeling that more Americans were in these
36:18
Speaker 1: facilities than I thought. Um, I guess it's a little
36:21
Speaker 1: bit heartening to hear the numbers. Um, there are about
36:24
Speaker 1: one point four million Americans in residential nursing homes and
36:28
Speaker 1: then another one point seven million cycling through those skilled
36:32
Speaker 1: nursing nursing facilities if they have like a surgery or
36:36
Speaker 1: an illness or something they're recovering from or rehabbing from,
36:39
Speaker 1: which is only about four point five percent of all
36:42
Speaker 1: Americans over sixty five and ten of all Americans over
36:47
Speaker 1: eighty five. I thought it would be higher than that. Um,
36:52
Speaker 1: you know, if you want to look at the downside, though,
36:54
Speaker 1: is one big reason why. Maybe the cost um It
36:58
Speaker 1: depends on where you are, of course, but if you
37:01
Speaker 1: um are in a private room at a nursing home,
37:05
Speaker 1: and I guess was this in Georgia, Yeah, two hundred
37:08
Speaker 1: and thirty five dollars a night in New York, that's
37:11
Speaker 1: about four hundred dollars a night and change on average
37:14
Speaker 1: a night like at that point, just move them into
37:19
Speaker 1: the w Hotel, right, pretty pretty much. Yeah. The only
37:23
Speaker 1: thing is that they don't have nurses at the the
37:25
Speaker 1: W Hunt. But that's a lot of money, man, And
37:29
Speaker 1: you can just get bled dry at the end of
37:31
Speaker 1: your life. Well you do. And as a matter of fact,
37:33
Speaker 1: to pay four a place like that a nursing home,
37:38
Speaker 1: Medicaid says you have to have paid in which basically says,
37:43
Speaker 1: you need to have if you if you don't own
37:45
Speaker 1: your house anymore, you have to um give the proceeds
37:48
Speaker 1: from your house. Um. Yeah, you have to liquidate your
37:52
Speaker 1: your your inheritance, you have to you have to pay
37:55
Speaker 1: down to usually something like I saw like maybe seven
37:57
Speaker 1: hundred dollars a month income is the cut off. Anything
38:01
Speaker 1: over that, and you have to be contributing. Um. Anything
38:04
Speaker 1: under that, the Medicaid will kick in and pay the
38:06
Speaker 1: place directly for letting you stay there. Um. But the
38:09
Speaker 1: thing is, it's like, of course, the the better alternative
38:13
Speaker 1: is assisted living. Some state Medicaid programs will pay or
38:20
Speaker 1: help pay for assisted living. But for the most part,
38:22
Speaker 1: if you're if you are paying for if you're living
38:25
Speaker 1: in an assisted living facility, you might have a reverse
38:27
Speaker 1: mortgage on your house. You are probably you've liquidated all
38:31
Speaker 1: of your um, your investments. Um, you're you're you're paying
38:35
Speaker 1: for it out of pocket. In the United States for
38:38
Speaker 1: the good kind of retirement home. Yeah, and you know
38:43
Speaker 1: there are people out there that are trying to further
38:45
Speaker 1: reform uh what these places look like. Uh. There's a
38:49
Speaker 1: gentleman named Dr Bill Thomas, who is a geriatrician who
38:54
Speaker 1: has something called the Eden Alternative. Um. That is he's
38:57
Speaker 1: trying to basically reframe these nursing home uh residents in
39:04
Speaker 1: caregivers as care partners. And you know it sounds kind
39:07
Speaker 1: of hippie dippy, but um, he wants people to be
39:11
Speaker 1: able to still grow in life and to still flourish
39:14
Speaker 1: and to still learn. Um, just because you're a senior
39:18
Speaker 1: doesn't mean you just have to to sit in a
39:20
Speaker 1: room and watch Judge Judy or push checkers around a checkerboard. Uh.
39:25
Speaker 1: And you know that they're depending on where you are,
39:28
Speaker 1: they might be adopting these methodologies of the Eden Alternative
39:32
Speaker 1: or UM the greenhouse movement. Another thing he helps spawn,
39:35
Speaker 1: which is you're in an in an individualized home. It's
39:38
Speaker 1: not a big facility. You got a private room, you've
39:40
Speaker 1: got a bathroom, and there's outdoor space for you to
39:44
Speaker 1: go and garden and to walk around and to again
39:47
Speaker 1: try and flourish in your in your last years on
39:49
Speaker 1: this planet. Right. Um. And that's a that's there's also
39:54
Speaker 1: a push for um for aging in place at home.
39:58
Speaker 1: Yeah sure, which can be really been official, but again
40:00
Speaker 1: it can also be isolating, depending on you know what
40:03
Speaker 1: kind of friends or family maybe if you live in
40:05
Speaker 1: a condo it would be a little more. But if
40:07
Speaker 1: you're living in the house that you spent your entire
40:09
Speaker 1: life in and all the neighbors have moved away and
40:11
Speaker 1: you don't know anybody anymore, that can be isolating. So
40:14
Speaker 1: in that sense, assisted living or even a nursing home
40:17
Speaker 1: could be a better alternative. But a lot of people say, no,
40:19
Speaker 1: this is my house, I want to stay here at home.
40:22
Speaker 1: The problem is is um I've seen I've seen it
40:25
Speaker 1: put that medicaid has an institutional bias, which means that
40:29
Speaker 1: like they'll pay for you to go to a institution
40:32
Speaker 1: like the definition of the word institution, they don't really
40:34
Speaker 1: pay for you to be able to stay at home.
40:37
Speaker 1: Some programs do, but a lot of them don't, even
40:39
Speaker 1: if you do want to stay at home, which is
40:41
Speaker 1: kind of heartbreaking to me. Yeah, I mean, you know
40:44
Speaker 1: Emily's grandmother Mary, who was very popular with the stuff.
40:48
Speaker 1: You should know Army as the eldest general. She you know,
40:51
Speaker 1: we had to move her out of her house that
40:53
Speaker 1: she was in, you know, not our whole life, but
40:55
Speaker 1: for a large portion of of her life. But you know,
40:58
Speaker 1: it was one of those deals where it's out in
41:00
Speaker 1: the middle of the country in Ohio. Uh, there was
41:03
Speaker 1: no family close by, there was no hospital close by,
41:06
Speaker 1: and it's just it's hard to say it's okay to
41:08
Speaker 1: stay there, you know. Um. And it was sad when
41:11
Speaker 1: she left, but she was also like, no, this is great,
41:14
Speaker 1: I'll move in with you guys. Like she didn't kick
41:18
Speaker 1: and scream, you know, she was she was willing and
41:20
Speaker 1: understood it was the best thing. And uh, you know,
41:23
Speaker 1: it's probably one reason why she's pushing one right now.
41:26
Speaker 1: I think for sure where she live, she lives with
41:28
Speaker 1: Emily's parents and here in Georgia. Now that's great. Yeah, um, well,
41:33
Speaker 1: I'm yeah, I'm I'm very glad that that worked out
41:36
Speaker 1: for um. But I was also looking at like the
41:38
Speaker 1: antithesis of that, like what happens in the United States
41:42
Speaker 1: to people who who don't have any family, who don't
41:46
Speaker 1: have any children, and who don't have any money, like
41:48
Speaker 1: what happens to them, And they seemed to be they
41:55
Speaker 1: seem to be kind of left on their own, Like
41:57
Speaker 1: if they have a house, they're they're probably just to
42:00
Speaker 1: be left in their house and maybe meals on wheels
42:02
Speaker 1: will come by. Um. The County Social Services might be
42:05
Speaker 1: able to help them. But this is if they reach
42:07
Speaker 1: out for help, if they need assistance, they might not
42:10
Speaker 1: get it at home because again, there's a lot of
42:12
Speaker 1: UM services that aren't paid for. And if you don't
42:14
Speaker 1: I mean money, you're s o l. You could go
42:17
Speaker 1: to a UM uh nursing home. But if you don't
42:21
Speaker 1: have any ability to pay UM, they can kick you out. Uh,
42:25
Speaker 1: they can kick you out for a bunch of different reasons.
42:27
Speaker 1: They're The most oppressing thing that I've looked up in
42:31
Speaker 1: a while was nursing home evictions, and they there are
42:35
Speaker 1: there's a there was a loophole that was recently closed
42:37
Speaker 1: in two thousand sixteen that said UM, if you if
42:41
Speaker 1: the nursing home is not able to UM to offer
42:45
Speaker 1: care for the person, then they can be discharged. And
42:51
Speaker 1: they use that as like a huge loophole. They'd be like,
42:54
Speaker 1: we're sorry, we can't offer you the care you need
42:56
Speaker 1: any longer. You have to leave. And you know, if
42:58
Speaker 1: you don't have anybody to advocate for you, you're you're
43:01
Speaker 1: you know, where are you going to go? And I
43:04
Speaker 1: couldn't get a really good answer, but I get the
43:06
Speaker 1: impression that it's there are it's not huge and rampant,
43:10
Speaker 1: but there are a lot of people who are still
43:13
Speaker 1: falling through the crack society as they age because we
43:17
Speaker 1: don't have a robust, nationalized UM plan to care for
43:24
Speaker 1: the elderly no matter what. And I thought, well, of
43:27
Speaker 1: course the United States is super behind in that respect,
43:29
Speaker 1: but apparently we're in line with other countries like Canada.
43:33
Speaker 1: You think Canada would have like a place for every
43:36
Speaker 1: senior and they're all happy and taking care of and
43:38
Speaker 1: everybody gets a pet beaver or something like that. Now
43:41
Speaker 1: you're on your own, kind of like your state might
43:43
Speaker 1: help you out a little bit, the local city might,
43:46
Speaker 1: but that's about it. Same with the UK too, which
43:49
Speaker 1: I was really surprised because both of them have nationalized medicine. Yeah.
43:53
Speaker 1: I will say that this is where UM. Social media
43:57
Speaker 1: has been beneficial UM as far as neighborhood and neighbors
44:01
Speaker 1: go UM. I mean all the time on our neighborhood pages,
44:05
Speaker 1: we see people stepping up, and especially in a place
44:09
Speaker 1: like Atlanta, Atlanta, where gentrification has happened, UM, you do
44:13
Speaker 1: see a lot of neighbors stepping up to help take
44:16
Speaker 1: care of UM, the senior African American community that is um,
44:21
Speaker 1: still living in their houses and they haven't been bought
44:24
Speaker 1: out for a shamefully low price by a greedy contractor
44:28
Speaker 1: to to flip it into a little McMansion. But you
44:31
Speaker 1: see it all the time that we work with a
44:32
Speaker 1: group called Neighbor in Need that really does great things.
44:35
Speaker 1: And aside from just the the official organizations. All the
44:39
Speaker 1: time you'll see someone that lives next door to someone
44:43
Speaker 1: like that. They'll be like, hey, she's having a hard
44:45
Speaker 1: time paying her power bill this winter, and you know,
44:49
Speaker 1: in an hour it is funded for for the rest
44:52
Speaker 1: of the year. Uh, the neighbors step up and and
44:55
Speaker 1: pay for her power bill. And it's just it's little
44:57
Speaker 1: things like that. But um, these are in unities where
45:00
Speaker 1: the houses are close together and people are you know,
45:03
Speaker 1: each other's business, like um, Emily's grandmother out there in
45:06
Speaker 1: the middle of the country, and a lot of rural
45:08
Speaker 1: America like that might not be the case. You might
45:11
Speaker 1: not have someone checking up on you, and people you
45:15
Speaker 1: know bleeding hearts like you, and I feel that they
45:18
Speaker 1: should be taking care of no matter what. You know. Yeah,
45:20
Speaker 1: but I mean, isn't that something everybody can get behind?
45:23
Speaker 1: You would think so, But that's just not true. I'll
45:26
Speaker 1: remind you of our episode on homelessness many years ago. Yeah,
45:29
Speaker 1: that one's tough for me to swallow. Those are the
45:31
Speaker 1: people who believed in the unworthy poor. Huh, and we're
45:35
Speaker 1: to send him to alms houses back in the day. Yeah. Um.
45:39
Speaker 1: The good news is if you're looking for a home
45:42
Speaker 1: for a family member these days, Medicare dot gov has
45:45
Speaker 1: a lot of resources. Oh, I'll tell you another place
45:47
Speaker 1: to u S News and World Report is really hot
45:50
Speaker 1: and heavy on um an assisted living in nursing home ratings. Yeah,
45:54
Speaker 1: nursing home compares another website. And you know there are
45:57
Speaker 1: places where you can go to really dig in see
46:00
Speaker 1: which ones you feel are a good fit. Uh. They're
46:02
Speaker 1: rated on you know, how the people are really doing.
46:06
Speaker 1: They're not just like how pretty it is. And if
46:08
Speaker 1: you go and visit one, they said to be aware
46:10
Speaker 1: of the chandelier effect. Like in fact, if you walk
46:13
Speaker 1: in and you see a grand piano and a lobby,
46:15
Speaker 1: just turn around and leave. Well yeah, that's I mean,
46:17
Speaker 1: that's one of the ways that they get you. You
46:19
Speaker 1: want to do a little more digging than just that,
46:21
Speaker 1: and you want to talk to residents, You want to
46:24
Speaker 1: read like actual like, uh, inspections and reports on those places.
46:28
Speaker 1: You want to look at stats like how many patients
46:31
Speaker 1: had to get were taken to the e er or
46:33
Speaker 1: were readmitted in the hospital, how many have bed sores?
46:37
Speaker 1: Um any allegations of abuse. Apparently abuse has doubled between
46:41
Speaker 1: two thousand thirteen and two thousand seventeen. Still low. I
46:45
Speaker 1: think it was like eight hundred and forty five, which
46:47
Speaker 1: is too many, but it's still doubled since two thousand thirteen.
46:52
Speaker 1: So you want to like really look for that kind
46:53
Speaker 1: of thing. Are they over prescribing medications like for psychosis
46:58
Speaker 1: to to people who are um who are problematic when
47:02
Speaker 1: you don't really think they're problematic. There's a lot of
47:04
Speaker 1: stuff you want to look for that you can look for.
47:06
Speaker 1: It's out there. Just do some digging because this is
47:09
Speaker 1: somebody you care about, don't forget. Yeah, and we really
47:12
Speaker 1: want to point out that, uh, it's easy to zero
47:15
Speaker 1: in on things like abuse cases and unnecessary medication. But UM,
47:21
Speaker 1: we really salute you if you are the lion share
47:25
Speaker 1: of these people, UM that are in nurses that are
47:27
Speaker 1: taking care of our seniors and doing a great, great
47:31
Speaker 1: job and a very very tough job. Yeah, and one
47:33
Speaker 1: of the things actually I saw I'm glad you said
47:35
Speaker 1: that was that, um, it's it's a really a thankless
47:40
Speaker 1: kind of job because traditionally people who work in elder care,
47:45
Speaker 1: like the actual workers are treated like garbage by management.
47:49
Speaker 1: It's just like an industry wide problem. And that was
47:52
Speaker 1: actually one of those things from the the Eden alternative
47:55
Speaker 1: was that workers are treated with the respect that you
47:59
Speaker 1: want the workers to treat the patients with like everyone
48:02
Speaker 1: is treated with respecting dignity, not just ideally the patients,
48:05
Speaker 1: the workers too, because they deserve it for the work
48:07
Speaker 1: they're doing. It's amazing. Ah, you got anything else about
48:11
Speaker 1: nursing homes, I've got nothing else. We can do. Better
48:14
Speaker 1: start thinking about stuff, you know. I mean, you're never
48:16
Speaker 1: too young to get a plan in places. That's all
48:19
Speaker 1: I'm saying. Great point, um, And since I say great point,
48:23
Speaker 1: it's time for a listener, man. I mean, maybe if
48:28
Speaker 1: you're like twenty five, you don't need to be thinking
48:30
Speaker 1: about your nursing home options. Okay, but you know what
48:35
Speaker 1: I mean, well, not necessarily, I'm your parents. I saw
48:38
Speaker 1: that of nursing home residents were under sixty five, so
48:42
Speaker 1: there are some younger residents in there that I think
48:45
Speaker 1: get overlooked a lot, like by us. You know what
48:48
Speaker 1: you call those people? What the party crowd? That's right, Oh,
48:54
Speaker 1: that's gonna be me. Man. What the party crowd at
48:58
Speaker 1: the at the nursing home. I'm be mixing it up
49:01
Speaker 1: like scat Man Cruthers in the Twilight Zone movie. I
49:04
Speaker 1: could see that. Let's go play kick the can. Everyone.
49:05
Speaker 1: It's midnight. It's time. It's time to take off that
49:08
Speaker 1: gown and live. Good things happen. You're ready, I'm ready, Well,
49:13
Speaker 1: bread away. I'm gonna call this one. Uh goots follow up? Okay,
49:19
Speaker 1: this is a good one about the great, great Steve Guttenberg.
49:24
Speaker 1: I'm hoping someone throws the stuff his way, by the
49:27
Speaker 1: way he needs he needs to know. I can feel
49:31
Speaker 1: him right now listening to all right this from Dave. Hey, guys,
49:33
Speaker 1: on a recent episode, you discuss the episode of Party
49:35
Speaker 1: Down which the wonderful Steve Guttenberg allows the caters to
49:39
Speaker 1: throw a party at his house. You knew this had
49:41
Speaker 1: come up before and wondered in what episode in what context.
49:44
Speaker 1: By chance, the next day, I was scrolling randomly through
49:47
Speaker 1: older episodes and selected Barefoot running uh boy, remember that one.
49:54
Speaker 1: When in this episode you started talking about Steve Guttenberg,
49:57
Speaker 1: I had an intensely existential experience. I was listen thing
50:00
Speaker 1: in the present to you talk about Steve Gutenberg in
50:02
Speaker 1: the past, having listened in the more recent past to
50:05
Speaker 1: you also for more from a more recent past talk
50:08
Speaker 1: about Steve Gutenberg, unable to remember the more distant past,
50:12
Speaker 1: and which you were talking about Steve Gutenberg, which I
50:14
Speaker 1: was now listening to in the present, which knowledge of
50:17
Speaker 1: the future, in which you would again discussed Steve Gutenberg.
50:20
Speaker 1: Steve Gutenberg the center of our cosmos, the nexus around
50:23
Speaker 1: which space and time and God swirl until they've become one.
50:27
Speaker 1: The answer to this question for which our souls cry out,
50:30
Speaker 1: I can only speculate yes. Anyway, I wanted to let
50:33
Speaker 1: you guys know in which previous episode he featured Steve Gutenberg.
50:38
Speaker 1: As to the context, there was none. You you started
50:41
Speaker 1: talking about Steve Gutenberg for no discernible reason. It sounds
50:44
Speaker 1: like me, which is as it should be, and that
50:47
Speaker 1: is from Dave. And Dave was very excited that this
50:51
Speaker 1: was getting read, and he said, to be honest, I
50:53
Speaker 1: had a little bit to drink when I wrote that,
50:55
Speaker 1: and I didn't fully remember the whole experience, so good
51:00
Speaker 1: job there go. This would be proud. Yeah, I think
51:04
Speaker 1: Dave's going to be part of the mixing it up
51:06
Speaker 1: crowd at the nursing home to kicking that can you know, Well,
51:10
Speaker 1: thanks a lot, Dave. That was pretty great. Um. And
51:13
Speaker 1: if you have something great to tell us, especially if
51:16
Speaker 1: it's in reference to something we said about something we
51:18
Speaker 1: said in the past, we'd love to hear from you.
51:22
Speaker 1: You can send us an email to Stuff podcast at
51:25
Speaker 1: iHeart radio dot com. Stuff you Should Know is a
51:30
Speaker 1: production of iHeart Radios How Stuff Works. For more podcasts.
51:33
Speaker 1: For my heart Radio, visit the iHeart Radio app, Apple Podcasts,
51:36
Speaker 1: or wherever you listen to your favorite shows.