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Private equity turned vulnerable elderly people into human ATMs

theguardian.com

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Re: Private equity turned vulnerable elderly people into human ATMs

#71

Post by jfengel »

CPLX wrote: post #29
bradleyjg wrote: post #23

Earlier quoted context omitted.

I’m sure the new owners are scummy, but the fundamental problem isn’t scummy people. There’s lots of markets that are okay-ish notwithstanding scummy people. Even those with natural lock in effects. The fundamental problem is it is at the intersection of two out of the three areas of the economy that have had insane cost growth over the last 30 years—-housing and healthcare (the third is education.) For the first one…

That's not the fundamental problem. The fundamental problem is that we have ceased demanding that our government produce reasonable outcomes. The reasons for that are many, but it's a core sign of how far we've fallen that there's even a discussion or argument about this obvious fact. We are in charge. We can just ban private equity companies from doing this you know. There didn't used to be ambiguity about the point…

We have done quite the opposite. We have insisted that the government allow, and even encourage, unreasonable outcomes, so long as they benefit the right people at the cost of... well, if you have to ask, it's you.

Re: Private equity turned vulnerable elderly people into human ATMs

#72

Post by Spooky23 »

rawgabbit wrote: post #19
lisper wrote: post #17

My parents ended up being forced by circumstances to move into a retirement home about five years ago. Fortunately, the place turned out to be run by people who mostly cared about their clients and so my parents' lives were basically OK, except that the food sucked (which AFAICT is par for the course at retirement homes). But a few months ago the place was acquired by a different company, which is trying to squeeze o…

Where I live Medicare and Medicaid want people to live (and die) in their own homes. They send out nurses and nurse practitioners to you. That is what I want. After some research I realized the provider that I want which is UTSW in Dallas has a geographical radius that they serve. I am planning to eventually move to be within that radius. https://utswmed.org/medblog/geriatrics-cove-team-makes-house...

That’s totally doable and encouraged, as it’s by far more cost effective.

But you really, really need a support system of willing people who care about you, and are savvy enough to effectively advocate for you when you lose that ability. Independent home care works well when you need help, not constant care.

Our family worked with this for 6 years with my bad post stroke and for about a year with my mom and cancer. My siblings were all on board and my mom was uniquely positioned - she was a regulator at the state level who was adept with the rules (and had in fact wrote many!).

Even so, as things progressed it was hard. My mom was devoted to my dad, and filled every gap. We depended on hired help for mom, and despite the financial resources it was difficult to get staff.

Family and friends are key.

Re: Private equity turned vulnerable elderly people into human ATMs

#73

Post by Spooky23 »

bradleyjg wrote: post #23
lisper wrote: post #17

My parents ended up being forced by circumstances to move into a retirement home about five years ago. Fortunately, the place turned out to be run by people who mostly cared about their clients and so my parents' lives were basically OK, except that the food sucked (which AFAICT is par for the course at retirement homes). But a few months ago the place was acquired by a different company, which is trying to squeeze o…

I’m sure the new owners are scummy, but the fundamental problem isn’t scummy people. There’s lots of markets that are okay-ish notwithstanding scummy people. Even those with natural lock in effects. The fundamental problem is it is at the intersection of two out of the three areas of the economy that have had insane cost growth over the last 30 years—-housing and healthcare (the third is education.) For the first one…

Scummy people are like flies to shit - they thrive in the chaos.

People buying up nursing homes are using tactics like what you’d see in the movie Goodfellas. They’ll structure the buy so that they are assuming the license to operate while “renting” the facility from an affiliated entity, cut opex, fraudulently bill Medicare and Medicaid for rehab, and exit through bankruptcy of the operating entity.

Re: Private equity turned vulnerable elderly people into human ATMs

#74

Post by Spooky23 »

FireBeyond wrote: post #31
bradleyjg wrote: post #23

Earlier quoted context omitted.

I’m sure the new owners are scummy, but the fundamental problem isn’t scummy people. There’s lots of markets that are okay-ish notwithstanding scummy people. Even those with natural lock in effects. The fundamental problem is it is at the intersection of two out of the three areas of the economy that have had insane cost growth over the last 30 years—-housing and healthcare (the third is education.) For the first one…

> housing and healthcare (the third is education.) For the first one we know roughly what we need to do but won’t. For the second we don’t even have that. Healthcare costs increasing is of very little concern to nursing facility ownership. Almost none of that is borne by the facility itself. They'll often hire skeletal crews of CNAs and LPNs (I was a paramedic, rare was it to see a facility in our area that even had…

It’s worse than that — not only are the subcontracted entities often affiliated with the owners, but when your EMTs transport a resident, the SNF “holds their spot” (ie invoices the government) for 30 days.

It’s in their interest to dump the resident on the hospital and get paid for services not rendered. Also, as residents decline they need more care, are often on Medicaid (lower reimbursement), each time they go to the hospital there is a probability they they won’t come back, and will be replaced by a Medicare patient (Medicare pays for ~90 days) at a higher rate, and perhaps higher margin services like PT/OT.

It’s an evil system. Most of the people who died in NYC during early phases of COVID did because of intense lobbying to send them back to the SNF.

Re: Private equity turned vulnerable elderly people into human ATMs

#75

Post by JumpCrisscross »

youarentrightjr wrote: post #56
JumpCrisscross wrote: post #38

Earlier quoted context omitted.

Broadly speaking, private equity is used to describe anything leveraged we don’t like. When we like it, we tend to describe it as a start-up, family business or simply “firm.”

Hey, it's you again! I was wondering if you would pop up in the comments defending private equity as you've done in the past. Continuing our discussion from last time, can you elaborate on why you think quoting Revlon is sufficient to excuse the practical differences between public and PE companies?

> Continuing our discussion from last time

I have genuinely no idea who you are or what we were talking about.

> can you elaborate on why you think quoting Revlon is sufficient to excuse the practical differences between public and PE companies?

Revlon duties concern hostile takeovers [1]. You’re confusing orthogonal concepts.

[1] https://en.wikipedia.org/wiki/Revlon,_Inc._v._MacAndrews_%26....

Re: Private equity turned vulnerable elderly people into human ATMs

#76

Post by PaulDavisThe1st »

PearlRiver wrote: post #55

People who think the government is bad have never met a corporation.

People who think the government is bad generally point out that there's only one government, but typically multiple corporations.

I am not one of those people, but their point does need to be fully addressed.

Re: Private equity turned vulnerable elderly people into human ATMs

#77

Post by PaulDavisThe1st »

Esophagus4 wrote: post #11
lokar wrote: post #7

Earlier quoted context omitted.

Don’t require states to uniformly respect limited liability granted in other states. Allow them to add limits, requirements, etc. let the different states explore the trade off.

Oof, talk about making compliance difficult and expensive if a company has 50 different sets of regulations to comply with to do business in the US.

Do you believe that states are the laboratories of democracy, and have rights, or do you believe that reducing the cost of regulatory compliance is a more important goal?

I take no position on this currently, but it's an important question that deserves a serious answer. Trading off the costs of "state experimentation" and "enforced regulatory conformity" is non-trivial to do.

Re: Private equity turned vulnerable elderly people into human ATMs

#78

Post by jmyeet »

I read recently that companies are getting almost resentful that they have to go through yuo to get your money. I keep thinking about that because I think it's true.

I read some of comments here and on other threads about PE and I keep seeing some variation of "this particular PE crime is an outlier, we can fix it". No, no you can't. PE isn't an aberration. It's just the natural extension to capitalism. It's inevitable.

This can be understood easily in Marxist terms, as unpopular as that is. What we're talking about is the workers relationship to the means of production.

You have a nusing home. The people who work there should own it. There's no reason not to. Instead there's this intermediary, some capital owner, who demands to extract profits from that. We've simply replaced the feudal lords of old with investment bankers. It's the ultimate in rent-seeking behavior.

Years ago I remember hearing about PE firms buying up trailer parks. For many this is their last refuge from being homeless. When they are homeless, it's not only devastating to them but it's expensive for everyone. Health issues, going to the ER more often, violence, law enforcement making sure homeowners don't have to see homless encampments, people can't hold down drugs, self-medication with drugs and so on.

We absolutely shouldn't drive up the price of mobile home pricing so rent-seekers can extract profits but we as a society choose that over housing security for people. That's not just wrong. It's state-sanctioned violence.

This nursing home PE squeeze is also state-sanctioned violence. Make no mistake. Arguably, it's even social murder [1].

And once again, it's super easy to understand in terms of the workers relationship to the means of production. Yet everybody thinks they'll be Jeff Bezos one day so it's super-important now to vote in the interests of the billionaire class. Yo uwon't be. And even if you are, do you really want to become rich this way? Is that what you want your legacy to be? That you made the last years of elderly people who needed care miserable?

Why do people think this is good? Or fixable by the politicians who are bought and paid for by the people profiting off of this?

[1]: https://en.wikipedia.org/wiki/Social_murder

Re: Private equity turned vulnerable elderly people into human ATMs

#79

Post by yowayb »

Spooky23 wrote: post #72
rawgabbit wrote: post #19

Earlier quoted context omitted.

Where I live Medicare and Medicaid want people to live (and die) in their own homes. They send out nurses and nurse practitioners to you. That is what I want. After some research I realized the provider that I want which is UTSW in Dallas has a geographical radius that they serve. I am planning to eventually move to be within that radius. https://utswmed.org/medblog/geriatrics-cove-team-makes-house...

That’s totally doable and encouraged, as it’s by far more cost effective. But you really, really need a support system of willing people who care about you, and are savvy enough to effectively advocate for you when you lose that ability. Independent home care works well when you need help, not constant care. Our family worked with this for 6 years with my bad post stroke and for about a year with my mom and cancer. M…

This is going to sound a bit wild, and only viable under 70 or so, but I've met a lot of 55-70 expats in walkable southeast asian cities. There's obviously varying circumstances so do the research, but you can almost get adopted by your landlord family, where you're getting home cooked meals, rides, doors held open, etc. This part of the world is so family oriented, it just comes naturally to many of them.

Re: Private equity turned vulnerable elderly people into human ATMs

#80

Post by youarentrightjr »

JumpCrisscross wrote: post #75
youarentrightjr wrote: post #56

Earlier quoted context omitted.

Hey, it's you again! I was wondering if you would pop up in the comments defending private equity as you've done in the past. Continuing our discussion from last time, can you elaborate on why you think quoting Revlon is sufficient to excuse the practical differences between public and PE companies?

> Continuing our discussion from last time I have genuinely no idea who you are or what we were talking about. > can you elaborate on why you think quoting Revlon is sufficient to excuse the practical differences between public and PE companies? Revlon duties concern hostile takeovers [1]. You’re confusing orthogonal concepts. [1] https://en.wikipedia.org/wiki/Revlon,_Inc._v._MacAndrews_%26... .

> Revlon duties concern hostile takeovers [1]. You’re confusing orthogonal concepts.

No sir, it was you who were confused - you brought them up here:

https://news.ycombinator.com/item?id=46186549

> > There is a legal requirement for directors of public companies to act in the financial interests of all shareholders

> No, there isn't. The whole point of Revlon duties is that they trigger "in certain limited circumstances indicating that the 'sale' or 'break-up' of the company is inevitable" [1]. Outside those conditions, "the singular responsibility of the board" is not "to maximize immediate stockholder value by securing the highest price available."

I'll leave it up to you to recontextualize with the remainder of that thread if you want to continue discussing.

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