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Subject: Unearthing an Avoidable Tragedy - Florida's Nursing Homes rss

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https://www.nytimes.com/2017/09/13/us/nursing-home-deaths-fl...

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The first patient was rushed into the emergency room of Memorial Regional Hospital at 3 am on Wednesday escaping a nursing home that had lost its air-conditioning in the muggy days after Hurricane Irma splintered power lines.

Another arrived at 4 am. After a third rescue call at 5 am, the hospital's staff was concerned enough to walk down the street to check the building itself.

What they found was an oven.


They found 3 people already dead, 4 people were so ill that they died upon arrival at the hospital, and then there was another person that was uncounted at first because the body had already been transferred to a funeral home.

It seems to me that criminal charges should be filed against someone as this was completely avoidable. You can see that everyone is already pointing the finger at someone else.

The finger pointing:

The storm knocked out the transformer. The heating and cooling guy says that he needed a fuse from Florida Power and Light. A relative says she called FPL and they said they would send someone out. No one ended up responding. Also Broward County had called FPL and had asked them to escalate priority on restoration of power to nursing homes that had lost power, but FPL says there were too many nursing homes to prioritize all of them.

FPL blames Broward County for their poor emergency planning. The County had not identified nursing homes as top tier infrastructure that would need restoration of power first.

Broward County blames FPL because their documents said that nursing homes were non-critical but play a decisive role in community recovery, which supposedly suggested to the County (in retrospect I guess) that nursing homes would be prioritized as to power restoration.

The nursing home says it had mobile cooling units and fans and had called FPL.

REMOVAL OF LINE FOR PEDANTRY


The bottom line to me is that the nursing home was required by law to evacuate under conditions like these and they didn't. While there was a breakdown at the emergency planning stage, none of that excuses the nursing home. I put 90% of the blame with them.

As a side-note, one of the causes of death may have been carbon monoxide poisoning from the mobile cooling units.

I really shouldn't be surprised given that I dealt with Florida's so-called elderly care system for years when my father was ill, but it's still fairly appalling. I predict it won't get much press because we seem to just shrug and move on when older persons are involved.



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Chief Slovenly
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Related: Louisiana learned from Katrina. Yes, regulation has a place, believe it or not.
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bbenston wrote:
Related: Louisiana learned from Katrina. Yes, regulation has a place, believe it or not.


Yes, of course it does. I may be troubled by the high compliance costs of some regulations, but that doesn't mean that we should somehow not address something that is likely to cause loss of life through regulations. Or that all regulations are bad or something silly like that.
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If only we had irrational free market advocates around to remind us that if there was less government regulation people wouldn't assume that they were protected and would shop for facilities that had documented disaster recovery plans and then the invisible hand would make it a standard operating procedure. Self-policing is of course trustworthy enough to protect lives. And anyway, if your loved one dies you can always sue them So of course, cut 2 for every 1 regulation.
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Carl Parsons
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The unfettered free market advocates would say that this identifies the nursing home as one that shouldn't be patronized and would therefore go out of business naturally.
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Mac Mcleod
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Sue_G wrote:
bbenston wrote:
Related: Louisiana learned from Katrina. Yes, regulation has a place, believe it or not.


Yes, of course it does. I may be troubled by the high compliance costs of some regulations, but that doesn't mean that we should somehow not address something that is likely to cause loss of life through regulations. Or that all regulations are bad or something silly like that.


Lives lost or saved to regulation is set by society generally at 2 million dollars per life. While we may set these discrete actual lives at an infinite level while emotionally distraught, if it turns out the regulations to prevent this in the future exceeds 2 million dollars per life, they will be watered down or not be implemented at all.

Some of the talk about excess regulation arises from various groups valuing the "wrong prevented/likelihood of lives lost" at different values.

Both groups are thinking logically yet come to different conclusions.

It could be the cost of compliance with new regulations about this issue would result in some elderly dying homeless ibstead of in a nursing home.
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maxo-texas wrote:
Sue_G wrote:
bbenston wrote:
Related: Louisiana learned from Katrina. Yes, regulation has a place, believe it or not.


Yes, of course it does. I may be troubled by the high compliance costs of some regulations, but that doesn't mean that we should somehow not address something that is likely to cause loss of life through regulations. Or that all regulations are bad or something silly like that.


Lives lost or saved to regulation is set by society generally at 2 million dollars per life. While we may set these discrete actual lives at an infinite level while emotionally distraught, if it turns out the regulations to prevent this in the future exceeds 2 million dollars per life, they will be watered down or not be implemented at all.

Some of the talk about excess regulation arises from various groups valuing the "wrong prevented/likelihood of lives lost" at different values.

Both groups are thinking logically yet come to different conclusions.

It could be the cost of compliance with new regulations about this issue would result in some elderly dying homeless ibstead of in a nursing home.


There are already regulations in place, Mac, that say you have to evacuate when temperatures rise like they did at this home. I'm not sure why you're talking about how they won't be implemented. They ARE implemented. Further, the cost of compliance only comes into effect on a pretty rare basis like a hurricane knocking out power. I'm having trouble seeing how the cost of compliance is high here. I'm sure nursing homes have plenty of other regulations that make up the bulk of their compliance costs.
 
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batman wrote:
The unfettered free market advocates would say that this identifies the nursing home as one that shouldn't be patronized and would therefore go out of business naturally.


Ugh. That attitude works, maybe, for certain businesses, but not for ones that cater to vulnerable populaces like the elderly (who often suffer from dementia) and children.
 
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batman wrote:
The unfettered free market advocates would say that this identifies the nursing home as one that shouldn't be patronized and would therefore go out of business naturally.


I'm not sure that's a super good way for a "market" to work. It isn't like the victims are going to get to take their business to a different nursing home after they're dead.
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This one is almost certainly going out of business after the owner goes to jail.

Also this will almost certainly make it go under:

https://www.cbsnews.com/news/rick-scott-pulls-nursing-home-f...

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People taking care of the elderly in positions of authority often don't care about anything except the payments, which are never predicated on whether the patient receives proper care or not, almost by definition, as if they're in a home there's probably someone else paying for it, or managing the payments.
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Not indicating the Home is not at fault here, but there are 56 other such homes that currently have no electricity 5 days after the hurricane. I surely hope they are being checked as well, to avoid another such tragedy.

I have been to homes like these, and my experience has been, they do things right when you are there, when you leave, it might be a different story. one relative was staying at a place, I consistently urged the facility to keep the phone next to them on a table, that it made them feel comfortable to know they could call me at a moments notice. The relative was chair bound, so could not get up to get the phone if it was not next to them, within arms reach. Wouldn't you know that every single time I visited, the phone was nowhere to be found within arms reach.

Also, it was cool in the room, so we asked to have the room heated more. But there was no separate thermostatic control for the room, and they offered no solution to the problem, other than "put on another blanket".

I don't think these were conscious efforts to do poorly, but nonetheless, they could be handled with more effort and diplomacy. The staffs at these places are sadly, probably overworked and underpaid.
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Mac Mcleod
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Sue_G wrote:
maxo-texas wrote:
Sue_G wrote:
bbenston wrote:
Related: Louisiana learned from Katrina. Yes, regulation has a place, believe it or not.


Yes, of course it does. I may be troubled by the high compliance costs of some regulations, but that doesn't mean that we should somehow not address something that is likely to cause loss of life through regulations. Or that all regulations are bad or something silly like that.


Lives lost or saved to regulation is set by society generally at 2 million dollars per life. While we may set these discrete actual lives at an infinite level while emotionally distraught, if it turns out the regulations to prevent this in the future exceeds 2 million dollars per life, they will be watered down or not be implemented at all.

Some of the talk about excess regulation arises from various groups valuing the "wrong prevented/likelihood of lives lost" at different values.

Both groups are thinking logically yet come to different conclusions.

It could be the cost of compliance with new regulations about this issue would result in some elderly dying homeless ibstead of in a nursing home.


There are already regulations in place, Mac, that say you have to evacuate when temperatures rise like they did at this home. I'm not sure why you're talking about how they won't be implemented. They ARE implemented. Further, the cost of compliance only comes into effect on a pretty rare basis like a hurricane knocking out power. I'm having trouble seeing how the cost of compliance is high here. I'm sure nursing homes have plenty of other regulations that make up the bulk of their compliance costs.


If the procedures,were in place then its a training issue, readiness issue, or inspection issue.

1) the training needs to be done. And it needs to be verified by a third-party, probably the government, that it was done on a regular basis.

2. If it is a Readiness issue, then remaining ready may be too expensive or Readiness needs to be checked for compliance by a third-party on a regular basis.

3. Additionally having an inspection of the nursing homes for Readiness and training by all workers should probably be subject to random inspections by a third-party, probably the government.

If those procedures are already in place, then we need to study why those procedures failed. If the resources were ready and the people were trained then why were the nursing home patients not evacuated?

Off the top of my head it seems expensive to keep Transportation ready so it's likely they would rely on a third-party for transportation. And then they need some way to validate that in time of emergency that third-party will actually have transportation available. If the third party has 40 buses but there are 56 nursing homes Contracting that need evacuation things are going to go badly.

And sure as shit, if enough time passes without a problem, the humans in charge of the process are going to start cutting corners and rationalizing shortcuts.

And that even includes the third party, probably the government.
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Mac Mcleod
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I wonder if nursing homes will be much more expensive next year.
 
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"Early Wednesday morning, three patients arrived at the hospital across the street with extremely high body temperatures. One of the nurses became alarmed and walked over to find out what was happening."

There is a hospital across the street? And a nurse had to walk over to find out why multiple residents were being admitted? What the actual fuck?
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I spent years in health care. This is, unfortunately, not remotely surprising.
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damiangerous wrote:
"Early Wednesday morning, three patients arrived at the hospital across the street with extremely high body temperatures. One of the nurses became alarmed and walked over to find out what was happening."

There is a hospital across the street? And a nurse had to walk over to find out why multiple residents were being admitted? What the actual fuck?


it's the best health care system for old people in the world USA#1!!

Guess Walmart (fema) was shut that day so they made do.

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Speaking of regulation, please don't do this:
Sue_G wrote:
==========...

It screws up page formatting for the whole page. Narrow your window to see the effect; the === line won't allow the page text to narrow. The line won't wrap to two lines, and forces the entire page to that width. It's especially an issue on a phone, but also a PC if you're using multiple windows.

You can use [hr] for a full width horizontal rule:


I saw this article and agree with you.



Of course this is fake news because the Free Market would have bankrupted such a lousy excuse for a nursing home before it killed someone. Because, you know, the Invisible Hand can see the future.
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The risks that the free market will help us with, and the ones it's ill equipped to deal with are well understood: It's the same things that humans are really bad at preventing.

We are terrible at estimating tail risks. Big, company ending risks that aren't there every day. Equifax's hack? Computer security seems like a non factor until your entire system is broken in half. A dozen deaths due to crappy hurricane preparation are not different. Systemic, market destroying risk taking that we saw in the financial crisis was more of the same.

And this is why instead of having a problem of having too much regulation, or too little regulation, what we have is a problem of dumb regulation, and regulation overfitting to the problems of an industry that changes, like we can see in Cabs or copyright protections.

 
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but computer security is different it's quite predictable. It however takes time and spending money on training , policing and changing company culture. All things that eat in the bottom line and hence the directors bonuses.
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batman wrote:
The unfettered free market advocates would say that this identifies the nursing home as one that shouldn't be patronized and would therefore go out of business naturally.

Well it is the fault of all the people (or their caretakers) who moved people into improperly ran nursing homes. It is up to the buyer to be completely informed about every aspect of a product they are buying. If they don't fully understand everything and buy anyway they are just suckers and deserve what they get.
 
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sfox wrote:
batman wrote:
The unfettered free market advocates would say that this identifies the nursing home as one that shouldn't be patronized and would therefore go out of business naturally.

Well it is the fault of all the people (or their caretakers) who moved people into improperly ran nursing homes. It is up to the buyer to be completely informed about every aspect of a product they are buying. If they don't fully understand everything and buy anyway they are just suckers and deserve what they get.


Of course. Why didn't they check the "how did this nursing home react during a hurricane and subsequent week long power outage" website to see what kind of a nursing home they were getting themselves into? It's clearly all on them.
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Tall_Walt wrote:
Speaking of regulation, please don't do this:
Sue_G wrote:
==========...

It screws up page formatting for the whole page. Narrow your window to see the effect; the === line won't allow the page text to narrow. The line won't wrap to two lines, and forces the entire page to that width. It's especially an issue on a phone, but also a PC if you're using multiple windows.

You can use [hr] for a full width horizontal rule:


I saw this article and agree with you.



Of course this is fake news because the Free Market would have bankrupted such a lousy excuse for a nursing home before it killed someone. Because, you know, the Invisible Hand can see the future.




Oh Neat!



That takes less typing too (tho brackets are mildly painful on the phone).

It could be will all protections in place, very few could afford a nursing home.

Say the cost of full compliance is $1200 higher per year. That will probably increase the price by $1800 per year ($150 per month). That might price a lot of old people right out of the market.

I think in a free market, it would be better to have a nursing home which says up front, "We are $1850 a month but can't evacuate you when hit by a hurricane. We will do our best to ask the government to evacuate you." And another nursing home says, "We are $2000 per month and we have sufficient buses to evacuate you when a hurricane threatens your area."

People could say, "Well hurricanes that are a problem hit about every 20 years. I'll take the risk since I literally can't afford $2,000 per month".
 
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maxo-texas wrote:
I think in a free market, it would be better to have a nursing home which says up front, "We are $1850 a month but can't evacuate you when hit by a hurricane. We will do our best to ask the government to evacuate you." And another nursing home says, "We are $2000 per month and we have sufficient buses to evacuate you when a hurricane threatens your area."

But in a free market, companies never even mention the worst features of their products, much less headline them. "Suga'Cola makes you fat faster!" Or are you going to regulate them on that?

You still need regulation to keep Medicaid nursing homes from burying bodies to still collect payments, too.
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Tall_Walt wrote:
Speaking of regulation, please don't do this:
Sue_G wrote:
==========...

It screws up page formatting for the whole page. Narrow your window to see the effect; the === line won't allow the page text to narrow. The line won't wrap to two lines, and forces the entire page to that width. It's especially an issue on a phone, but also a PC if you're using multiple windows.

You can use [hr] for a full width horizontal rule:


I saw this article and agree with you.



Of course this is fake news because the Free Market would have bankrupted such a lousy excuse for a nursing home before it killed someone. Because, you know, the Invisible Hand can see the future.


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