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

#161

Post by brandonmenc » Mon, Oct 04, 2021, 5:18 AM UTC

neither_color wrote: post #63

bpodgursky wrote: post #40

Earlier quoted context omitted.

The worst part is the payment structure and how it doesn't allow real choice. If you told the 88 year old: "We can (a) pay $500,000 on treatments that will likely extend your life 1 year, or (b) put $250,000 in a tax-advantaged account to put your great-grandchildren through college", I bet that 99% of those 88 year olds would take option B and take hospice care instead. They would all prioritize their children, gran…

And in the rest of the non-nihilistic world those grandchildren would rather have one more year of grandma than any amount of money 15 years later. This whole discussion of letting seniors die to optimize economic potential is gross.

> And in the rest of the non-nihilistic world those grandchildren would rather have one more year of grandma than any amount of money 15 years later.

Not in families that have regular, frank discussions about death and quality of life.

My worst nightmare is having people in charge of my care who are unwilling to pull the plug. Doubly so if they are also paying for it.

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

#162

Post by fighterpilot » Mon, Oct 04, 2021, 5:18 AM UTC

cratermoon wrote: post #158

fighterpilot wrote: post #146

Earlier quoted context omitted.

This snarky reply isn't a rebuttal of any substance. A frivolous call-out fee is a clear and simple solution. If you fix the price then the problem goes away because the incentive for the frivolous call-out no longer exists. It's cheaper for them to hire another staff member than rely on the fire department.

No really. Turning a public service into a fee-based means-tested public/private program is the basic neoliberal program. The polices are always put forward with the rubric that the so-called free market is the best way to solve problems of distribution and fairness. To used a tired example, https://www.villagevoice.com/2010/10/11/libertarian-fire-dep...

I'm not disputing that it's a neoliberal solution, I'm disputing the claim that it's a non-solution. If you charge a sufficient amount for frivolous calls from private homes then private homes will stop making frivolous calls.

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

#163

Post by tehwebguy » Mon, Oct 04, 2021, 5:26 AM UTC

tomrod wrote: post #30

john_yaya wrote: post #15

Senior homes and assisted living centers are a national disgrace. They are entirely about profit maximization (what business isn’t?), and as such hire people at the exact minimum and have well over 100% yearly turnover. The staff commonly steal from residents, and the management do not care. They’d rather retain a larcenous pig who barely executes her duties than have to go back and scrape the barrel for a replacemen…

So the solution is to spend less money but pay people more, and shoulder the rest on taxpayers? This probably won't work very long since the population isn't as triangular as it used to be (to my understanding this is what happened to Japan). I get the justified call to fix things for people that require these services. The US can barely afford to school its children, purchase its homes, or enact reasonable public he…

We print money for bombs & bailouts because there is a valuable enough carrot for our policy makers.

Maybe we can think of a carrot (or better yet a stick) that would stop those things and start printing money for things like education, healthcare, end of life care.

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

#164

Post by analog31 » Mon, Oct 04, 2021, 5:30 AM UTC

davidbanham wrote: post #103

mtnGoat wrote: post #67

Playing devils advocate here but maybe we have too many fire fighters? I have four good friends that work in metropolitan fire houses all making well into the six figures. They constantly joke about how they get paid to do nothing and haven’t been on a fire in years, mainly they respond to calls at old folks homes. Oh and the only work a four or five days a month.

I think the root cause is that you lump fire and EMS into the same basket. You don’t need six qualified firefighters on a half million dollar pumper to attend a nanna down call. Here in Australia the ambulance service is totally separate to the fire services. The public calls the same number (000) but after that it’s separate dispatch centres, different staff, different depots. From the fire side we occasionally get…

>>> You don’t need six qualified firefighters on a half million dollar pumper to attend a nanna down call.

A friend of mine is a former EMT. He told me that they would usually send out 4 people if possible, because in fact you do need that many if someone has had a heart attack while sitting on the toilet in an upstairs apartment, and weighs 350 pounds. Getting people out of their homes can actually be dangerous for the EMT's.

In my locale, all of the firefighters are also EMTs. Same service. When I had my medical "event," a fire truck showed up first because the ambulance was on another call. They started working on me right away, then the ambo showed up and hauled me out.

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

#165

Post by BoHerfVIJrEsq » Mon, Oct 04, 2021, 5:44 AM UTC

whatshisface wrote: post #126

Lammy wrote: post #121

Earlier quoted context omitted.

Not only that, but the United States' shift in mindset toward disinvestment came about during the civil rights era. Not hard to read between the lines in e.g. https://files.eric.ed.gov/fulltext/ED050960.pdf :/ "The time has come to ask what level of population growth is good for the United States. There was a period when rapid growth made better sense as we sought to settle a continent and build a modern industrial N…

I think the Club of Rome were the first major international policy group to take resource finitude seriously. Although I read a bit of their final report, and their projections were ridiculous and we've already blown well past them with no trouble at all. https://en.m.wikipedia.org/wiki/The_Limits_to_Growth

They're still on that neo-Malthusian thing hot and heavy, though. They have a Twitter account and it seems clear they consider themselves vindicated.

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

#166

Post by MichaelZuo » Mon, Oct 04, 2021, 5:47 AM UTC

nradov wrote: post #133

rrrrrrrrrrrryan wrote: post #95

Earlier quoted context omitted.

> And it’s time to stop spending $500K on medical care just so an 88 year old can make it to 89. Does U.S. Medicare not use QALYs? (Quality Adjusted Life-Years) The WHO recommends using 3x GDP/capita for each QALY, which would set America's threshold somewhere around $150k, not the $500k in your example.

Medicare doesn't use QALY thresholds to decide which treatments to cover. From a pure economic efficiency standpoint it probably should, but the politics around care rationing are so toxic that it can't be done.

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?

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

#167

Post by bserge » Mon, Oct 04, 2021, 5:51 AM UTC

neither_color wrote: post #63

bpodgursky wrote: post #40

Earlier quoted context omitted.

The worst part is the payment structure and how it doesn't allow real choice. If you told the 88 year old: "We can (a) pay $500,000 on treatments that will likely extend your life 1 year, or (b) put $250,000 in a tax-advantaged account to put your great-grandchildren through college", I bet that 99% of those 88 year olds would take option B and take hospice care instead. They would all prioritize their children, gran…

And in the rest of the non-nihilistic world those grandchildren would rather have one more year of grandma than any amount of money 15 years later. This whole discussion of letting seniors die to optimize economic potential is gross.

"Live miserable and alone for 364 days grandma, so we can see you one more day"

Talk about gross.

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

#168

Post by MichaelZuo » Mon, Oct 04, 2021, 5:53 AM UTC

TrispusAttucks wrote: post #59

MattGaiser wrote: post #3

If there is an industry that needs startups, it is long term care and senior care in general. Expensive, nearly universally badly done, and it seems like a lot of people could stay in their homes with some automated appliances/thoughtful redesigns of everyday items. Hoping that when my grandparents start needing it in 5-10 years that the options have dramatically improved.

Capitalism can't save this. This is fundamentally a social decay problem. Modern social behavior sweeps all "unpleasant" grief under the carpet. Out of place out of mind.

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?

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

#169

Post by lacker » Mon, Oct 04, 2021, 5:54 AM UTC

dmckeon wrote: post #117

mtnGoat wrote: post #67

Playing devils advocate here but maybe we have too many fire fighters? I have four good friends that work in metropolitan fire houses all making well into the six figures. They constantly joke about how they get paid to do nothing and haven’t been on a fire in years, mainly they respond to calls at old folks homes. Oh and the only work a four or five days a month.

Emergency services in the US have gone from 80:20 fire:medical to 80:20 medical:fire over the last 70 years or so. We retain the framework of firefighting, but devote those valuable and important resources to using custom built fire trucks much of the time as taxis staffed by paramedics.

It seems like you still need fire trucks though even if only 20% of your incidents are fires.

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

#170

Post by bserge » Mon, Oct 04, 2021, 5:56 AM UTC

wikibob wrote: post #23

MisterBastahrd wrote: post #9

In all my time living in Louisiana, the only time I saw a fire truck near a home was when the house was actually on fire or under threat of fire. In Texas? EVERY SINGLE TIME I see an ambulance, I see a fire truck. It makes ZERO sense most of the time. Texas municipalities are using medical emergencies to fund their fire departments (and jack up insurance rates in the process) by sending fire trucks to people even whe…

There is a reason for this. In most municipalities, there aren’t nearly enough fires to keep a fire department busy. So fire departments also are often first responders for medical incidents.

Jesus, can't they just... be on standby?

On that note, it would be hilarious if that applied to IT.