Firefighters say they’re swamped by calls for routine care from senior homes • Hacker News Board

Re: Firefighters say they’re swamped by calls for routine care from senior homes

#211

Post by [deleted] » Mon, Oct 04, 2021, 5:38 PM UTC

edmundsauto wrote: post #210

xyzzyz wrote: post #205

Earlier quoted context omitted.

Apparently, the food, healthcare, and counseling, as administered by Baltimore schools, are not very helpful in education, given the abysmal outcomes they produce.

Those outcomes are not reasonable goals, given the profound challenges these students face. The programs are probably inefficient (many of these services are), but your statement forgets that the bar is too high for kids suffering from abuse, starvation, homelessness, etc. It could be a lot worse without this support.

[deleted]

Re: Firefighters say they’re swamped by calls for routine care from senior homes

#212

Post by xyzzyz » Mon, Oct 04, 2021, 5:40 PM UTC

edmundsauto wrote: post #210

xyzzyz wrote: post #205

Earlier quoted context omitted.

Apparently, the food, healthcare, and counseling, as administered by Baltimore schools, are not very helpful in education, given the abysmal outcomes they produce.

Those outcomes are not reasonable goals, given the profound challenges these students face. The programs are probably inefficient (many of these services are), but your statement forgets that the bar is too high for kids suffering from abuse, starvation, homelessness, etc. It could be a lot worse without this support.

This is an argument without a limiting principle. Surely, if we spent $1M/year/student in Baltimore, and got the same results as we do now, everyone would agree that we’re not getting our money’s worth. Most likely, everyone would agree to the same effect if we spent $100k/student, and probably, $50k/student. We now spend $16k/student. How do we actually know that this is not enough, “given the profound challenges students face”? Why would we think that spending more would bring outcomes to parity with Utah, which spends $9k per student?

I would very much willing to spend more on schools in Baltimore if people proposing the bump in spend showed 1) a clear goal needing this extra money, and 2) clear proof that this goal actually has significant positive impact on educational outcomes. The reality is, however, that this extra spend is typically swallowed by cost of infrastructure improvements, hiring extra administrators and bumping teacher pay. Irrespective of whether these goals are worthy (obviously, schools needs to be heated, and teachers need to be paid), these things have basically no incremental impact on educational outcomes, so why do some places spend so much more on these, exactly? And are we pushed to spend even more than that?

Re: Firefighters say they’re swamped by calls for routine care from senior homes

#213

Post by cratermoon » Mon, Oct 04, 2021, 5:51 PM UTC

fighterpilot wrote: post #197

lmm wrote: post #191

Earlier quoted context omitted.

If it's 5 bucks then it's not going to stop care homes calling them either. If you look at the numbers being thrown around in these discussions we're talking about maybe 5k or more, which can definitely be a life-changing amount for a poor person.

Then don't fine poor people. Fine private care homes only as was suggested elsewhere in this thread. In the article it explains that they're only considering a fee for facilities, not for individuals.

> Then don't fine poor people

Means-testing for public services? Please no. Means testing introduces bureaucratic hurdles, and the cost of determining and enforcing means limits can be up to 10x the actual amounts paid out. https://www.theguardian.com/social-care-network/2013/jan/14/...

Re: Firefighters say they’re swamped by calls for routine care from senior homes

#214

Post by MichaelZuo » Mon, Oct 04, 2021, 7:28 PM UTC

lmm wrote: post #171

MichaelZuo wrote: post #166

Earlier quoted context omitted.

Medicare doesn’t cover every orphan drug known to exist so surely they must? Unless they technically do for every drug, with some enormous caveats that effectively bars coverage?

They cover some treatments and not others, but those decisions are made through debate and politics, not QALY measures.

Then on what other basis do you believe they decide which orphan drugs to cover and which not? I don’t have insider knowledge but nonetheless I’m fairly certain it’s not based on pure random chance. If the implication is that it’s based on whatever political or lobbying faction is in vogue, that seems to be even worse than an economic measure?

Re: Firefighters say they’re swamped by calls for routine care from senior homes

#215

Post by thebiss » Mon, Oct 04, 2021, 7:32 PM UTC

rootsudo wrote: post #189

I just don't understand why people aren't thinking of doing this in other countries. You can hire a nurse for $500-1000 in most of South America or Asia - East Europe 50/50, but an au pair for elderly.

You CAN do this in the US, for $1000-$2000 per week.

Re: Firefighters say they’re swamped by calls for routine care from senior homes

#216

Post by nradov » Mon, Oct 04, 2021, 8:51 PM UTC

MichaelZuo wrote: post #214

lmm wrote: post #171

Earlier quoted context omitted.

They cover some treatments and not others, but those decisions are made through debate and politics, not QALY measures.

Then on what other basis do you believe they decide which orphan drugs to cover and which not? I don’t have insider knowledge but nonetheless I’m fairly certain it’s not based on pure random chance. If the implication is that it’s based on whatever political or lobbying faction is in vogue, that seems to be even worse than an economic measure?

This page provides a good description of how CMS determines which prescription drugs are covered under Medicare Part D.

https://medicareadvocacy.org/medicare-info/medicare-part-d/

Re: Firefighters say they’re swamped by calls for routine care from senior homes

#217

Post by nradov » Mon, Oct 04, 2021, 8:57 PM UTC

lmm wrote: post #175

MichaelZuo wrote: post #168

Earlier quoted context omitted.

I’m fairly certain people of all classes, ranks, and social situations in ancient Mesopotamia, China, India, and Egypt sometimes swept ‘unpleasant’ grief under the carpet too… unless you have some credible reason to believe otherwise?

The proportion of multi-generational homes in modern western cultures is far lower, and the emphasis on taking care of your parents as a sacred social duty is gone. I'm sure that there were plenty of individuals in those historic cultures who fell short of what was expected, but widespread care homes are a relatively recent change.

Those historic cultures had shorter lifespans and essentially forced women to work as unpaid home caregivers. Times have changed.

Re: Firefighters say they’re swamped by calls for routine care from senior homes

#218

Post by ErikVandeWater » Mon, Oct 04, 2021, 10:50 PM UTC

burkaman wrote: post #99

ErikVandeWater wrote: post #72

Earlier quoted context omitted.

Humor me, by what measure is the US the richest nation on earth, or even close? Anything per capita will be dominated by Monaco/other tax havens. Anything on a gross level will be dominated by China.

By net wealth (assets - liabilities). Here's a Wikipedia list ( https://en.wikipedia.org/wiki/List_of_countries_by_total_wea... ) based on the Credit Suisse Global Wealth Report ( https://www.credit-suisse.com/about-us/en/reports-research/g... ). You're right that it's not even close, the US is almost twice as rich as China in the #2 spot.

Add in underfunded liabilities and lets see what it shows us. Of course if a country doesn't require all liabilities to be counted it's going to show up at the top of the list.

Re: Firefighters say they’re swamped by calls for routine care from senior homes

#219

Post by GaryTang » Mon, Oct 04, 2021, 11:10 PM UTC

stickfigure wrote: post #207

GaryTang wrote: post #147

Earlier quoted context omitted.

I have been. Not one of them are forced to be firefighters. They volunteer

...and FYI, those volunteers get to pick and choose which calls they respond to. Not sure what axe you're grinding, but I'm glad you don't live in my district.

If there was a scale representing job difficulty — firefighter would be among the lowest difficult. I can respect those that volunteer but the ones who are career have no sympathy from me seeing that they are easily in the top 5% of society for doing something that 80% of us can do.

Re: Firefighters say they’re swamped by calls for routine care from senior homes

#220

Post by nyokodo » Mon, Oct 04, 2021, 11:50 PM UTC

lazide wrote: post #181

nyokodo wrote: post #150

Earlier quoted context omitted.

> the extensive and expensive care of their elders. Granted cognitive decline and other conditions are extremely difficult to manage, however it’s remarkable how easy and cheap a disturbingly large chunk of elder care is. Just someone there to make sure elders take their meds on time, monitor their blood pressure, making sure they’re eating or go to the doctor if anything bothers them etc; all these tasks could be do…

I take it you haven’t actually tried to do this? I’ve been involved in several instances of trying to do this now, and it varies from nearly a full time job to 2 full time jobs for anyone who would be otherwise going to a home - and often scary, stressful, and traumatizing to boot.

> I take it you haven’t actually tried to do this?

What is “this?” I’m talking about cheap and simple early interventions that delay or even avoid needing to put elders in a home by avoiding the negative effects of badly managed healthcare. Incidentally, this level of care is the vast majority elder care that gets no funding or attention; instead, the focus is put on the hard cases or intervention when it’s too late and too difficult. What are you talking about?