Now or Never: Long-Term Care Strategy with Kosta Yepifantsev

How to Prevent the Next American Eldercide with Margaret Morganroth Gullette

February 14, 2023 Kosta Yepifantsev Season 1 Episode 23
Now or Never: Long-Term Care Strategy with Kosta Yepifantsev
How to Prevent the Next American Eldercide with Margaret Morganroth Gullette
Show Notes Transcript

Join Kosta and his guest: Margaret Morganroth Gullette, Resident Scholar at the Women's Studies Research Center for Brandeis University. An Author, essayist, and activist. Her contributions to the field of cultural studies of age include five books, the latest of which is Ending Ageism, or How Not to Shoot Old People.

Today we’re talking about How to Prevent the Next American Eldercide.

Find out more about Margaret Morganroth Gullette's research:
https://scholar.google.com/citations?user=kgAc468AAAAJ&hl=en

Find out more about Kosta Yepifantsev:
http://kostayepifantsev.com/

Margaret Morganroth Gullette:

and some of the states care about residents and some of them don't care at all. Many states could have gotten more Medicaid money earlier from the Affordable Care Act. They didn't even ask for it. They just don't care.

Caroline Moore:

Welcome to Now or Never Long-Term Care Strategy with Kosta Yepifantsev a podcast for all those seeking answers and solutions in the long term care space. This podcast is designed to create resources, start conversations and bring awareness to the industry that will inevitably impact all Americans. Here's your host Kosta Yepifantsev.

Kosta Yepifantsev:

Hey, y'all. This is Costa and today I'm here with my guest Margaret Morgan Roth, Colette resident scholar at the Women's Studies Research Center for Brandeis University, and author, essayist, and activist. Her contributions to the field of cultural studies of age include five books, the latest of which is ending ageism, or how not to shoot old people. Today, we're talking about how to prevent the next American elder side. For our audience unfamiliar with this topic, will you start by sharing your perspective on the term elder side and the importance of addressing this issue?

Margaret Morganroth Gullette:

US nursing home care is ineffective, inefficient. inequitable fragment is an unsustainable and that was the conclusion of a very thorough investigator before from the prestigious national academy of science, engineering and medicine. The acronym is NASA, here under government auspices, has also proven to be sometimes corrupt. And we feel and I believe that what happened in March of 2020, was that the government abandoned the 1.4 million people who were in nursing facility around the United States in 14 15,000, or 500. there abouts on nursing facilities, because the meaning of the elders side is it. It's not. It's an unfamiliar word. It used to mean something like Lizzie Fortin took an axe hit her mother's wood wax in Paris died. What I think we need a different term. There are some other terms floating around there a little more there are there, jet Termiticides. And aside, I like I'll decide I think it's nouns American, we know what elders are. We know what suicide is. We know what side me I have a million US debt. Over 195,000 residents in nursing homes across the nation died of quote, that's almost one in five American. So the total residents in 2019, we're about a half of 1%. Of that. That's just an extraordinary content, condensation of debt in one in one place, and one place that the government is responsible for. And I argue in the next book, which is called American l decide that they died prematurely. They died unnecessarily. And they died in the very locales where they ought to have been fit checked in. And I believe that it was indifference rooted in ageism and ableism. And a few other prejudices that I am going to distort. That indifference rooted in ageism and ableism. killed these people before their time. And I think the reason is why they were under protected is not hard. I'm going to read a quote another quote, undervaluing lives tend to the left otter, check, flee, and the more exposed to rip than more highly valued and lives the young more than the old. The rich word in the for whites more than blacks Americans more than foreigners and relatives more than strangers. The resonance had undervalues lives and they were under protected. And the reason is what I call compound ageism. As if it's just age, you're not getting all the reason they would be under protected. You're not just old. You're also some of them. less able, about 70% of them are female. They are all of though income in fact, we're talking about indigent people, most cases. They are small people. There are some of them are cognitively impaired. Small means they don't look like they could protect themselves and in fact, they are defenseless. And I think the word for that for them as a group, nothing else in common it. I mean, they're all races. They're mostly white, but there are plenty of other races, there are bolo sexualities, they're of all levels as ability there of all levels of cognitive ability. They are a heterogeneous group. But if you want to say one thing about them, it is that they are

Kosta Yepifantsev:

helping. You've written that the deaths of residence and long term care facilities during the pandemic, were not an inevitable biological catastrophe. Would you expand on the conditions and neglect that led to this tragedy? And the way that you put it is, I quote, abandonment,

Margaret Morganroth Gullette:

we have to worry the stereotype about them. And I think the stereotype is that people who move into these quarters have nothing much to live for. You people wouldn't want to move in themselves. So of course, why would these people be there? They're just waiting to die. And it can't be held. Old people die, that people die. There can't be felt. I think what per stereotype is, right, it's futile to help them. It's just futile. Now, that certainly wasn't true in 2020. In the spring of 2020, there were are one example first, Rosa Laurel is nursing home in Baltimore, run by black minister in a black neighborhood, very poor, very indigent, very many people disabled. So on he in all 2020 He had no cases and no depth.

Kosta Yepifantsev:

That's incredible.

Margaret Morganroth Gullette:

It is an it should not be. In fact, there were 437 homes out of this gene 1400. Or the other 15,000. There were 437 Read in that year, had no deaths. Now, so how do you explain that? Well, one thing Reverend DeWitt got, he got interviewed, and he was marvelous in his interview, and they said, How did you know what to do? He said, Well, as soon as President Trump said it was going to be over immediately, I blocked down. Wise Man, and right when locked down, now, he didn't just block them in, he got a cook for better food. He made sure what the nursing aides could stay there at lunchtime. So they didn't have to go out. He was paying them in such a way that they didn't have to take another job. He got more TV sets his he thought my deeper there'd be bored. And he got an activities director already pumped up the role of the activities director, and this is crucial. We already had an infection preventionist on staff, you had a nurse who knew how to keep? Well, it would have been the flu and any previous year, and other you know, viral infections, it could have been SARS in the previous decade. He knew how she knew they knew how to keep the residents safe. So my argument is, all the residents grew up and protected. Every single one of them. They didn't, they could have had resources focused on them. And that's my point,

Kosta Yepifantsev:

what a lot of people don't know, unless they're obviously working in the industry, there was a lot of funding that came about in 2020 with the Cares Act. And then President Biden also had a similar bipartisan legislation when he first got into office, I can't quite remember the name. But there was funding designed to be given to nursing facilities and to hospitals and to various other Medicaid and Medicare recipients in terms of like providers, and so not and obviously at PPP and all these other buckets of money. And we did the exact same thing, like you know, we increased our infectious infectious disease protocols. We increased our overtime thresholds so that we could mitigate the changing of shifts and so you know, if you had like one person taken care of one individual then that was the person that would be taken care of that specific individual. We wouldn't be changing out site locations with with staff. All of that was possible because of the additional funding that we received from the federal and state governments. So, if this nursing home, let's just say that they already had all these things in place, but they just excelled even more at preventing the spread of COVID-19 and the other 400 homes. Were why didn't the other nursing facilities use the money to follow suit? When obviously, that was the intent of the funds that they received from the federal government, in your opinion,

Margaret Morganroth Gullette:

when they most MIDI to be saved, was March, April, May, and June. So that's what a clusters began, began dying in terrible clusters. And it turns out that they were 30% of the day 40% of the debt 50% of that debt. In some states. They were in Massachusetts, at one point they were 66% of the debt. So I think what I want to look at first, what I think people have to look at to get the narrative straight, is why the federal government did not then provide or that or the straits to that matter, but I think the federal government is guilty as they what Trump did was, he said, we don't have PPE, it's the stock coil has been, you know, and I missed his true, the stock coil had been allowed to window, and it had not been refilled by any president. So it's not all on Trump, the previous presidents had also neglected the stockpile, otherwise, he could have gone out right, then with the nursing home there would have had to prioritize the nursing out instead of the hospitals. And that's not what happened in many states, including in my stay, the hospitals got prioritize. Now, that was that was wrong. And I mean, I'm, I'm I say this on the basis of I've been listened to many with farmers who know what they're talking about. It was recorded have saved the hospitals, right, keeping people from nursing homes out safe in their own spaces, and are some, you know, all right. I mean, I just want to say there were 300 greenhouse facility that did very, very well, the greenhouse facility. So if he's more places, and they're they have single occupancy rooms and Beth. Oh, wow, that's extremely important. And it will be extremely important in the future, if we can get it. And in the greenhouse facilities, I'm just gonna read this, the median death rate per 100 residents was so low, it was statistically zero. And in unionized workplaces, the mortality rate was lower than in those without worker union. And nonprofits, which are often run by religious groups either lose lean threads, Catholics, Quakers, they also get much better, that are the ones that when you finger or the for profits 70 If we sat down nursing homes are owned by whatnot, it's and the it used to be that they were bought up by hedge funds. And Hitchens, care about the bottom line, they don't care about the people, the resident. I like to call them residents. I mean, they're there. They're not there to die. They'd be in a hospice, if they were there to die. There, there is a new living space and see new comer get Linux fade. And if it's done right, it can be very pleasant. And it should be will be very pleasant. People should expect the minimum level of good service, good health. I mean, we know what the ideals are everybody in the business do you call it the industry but everybody in the business knows what Big O 's are. So aren't think there was a lot of negligence at this is the answer to your original question. I think that there was negligence that they didn't. They didn't hire. They didn't do work. Apparently you did. They didn't hire more people. Many of them did not have sickly they don't have paid sick leave. Many of the A's in in these prices are so underpaid. They have to work two and three jobs. They're part time they don't keep Besut at work two jobs. They carry COVID from one place to the other. I mean, they could have been protected themselves. I'm not blaming the A's. I'm blaming the the the operators, the management, that the people who just said, Well, they're I'm not sure what they said to themselves. I mean, it's hard to believe. I mean, we know what they say now, they blame the A.

Kosta Yepifantsev:

Well, and I'd say, I would say that most likely, yeah, I'd say that most likely it was probably profit over people. And that's the that was kind of the, if you look back now hindsight being 2020, that's the only way to explain it. And I also I have to ask, do the issues permeating facilities and ability to act and protect their residents in 2020 and prior, still persists today? But also, have we improved at all?

Margaret Morganroth Gullette:

There are people there are centenarian in nursing home, and there was one centenarian Her name is Sophia gotoh. She survived the flu of 2018 2019. And she survived COVID These are people with resilient, you're not, they're not biologically helpful, right sort of be eiendom, that particular issue, then, so they didn't need to died. They were not all frail and susceptible, and most did not die. And that is an important statistic for people to remember. Hold on. If if you are out there, if you think that they're just waiting to die, let him tell you, over 80% of them got COVID got COVID and did not die. So amazing. They're there. They're more vulnerable than some of us in the general population. That's certainly true. So but now to get back to your your other question. You want to talk about whether there has been improvement?

Kosta Yepifantsev:

Well, and I also want to know if the if the problem persists today as well.

Margaret Morganroth Gullette:

Oh, here? Oh, yes. I think all the problems all the palace persist. I mean. In fact, in some ways, they may be worse. I mean, one of the odd things that happened in the in the spring of 2020. Is and in some places, there'll be better, no. But what happened in the spring of 2020, you're seeing all these clusters of deaths, right? So you'd say to yourself, Well, Mike, God, let's get out of this. Because this is a terrible business. It's gonna have a terrible reputation. But in fact, the large companies and some hedge funds started buying up nursing homes. That's an almost incredible fact. But it's why was it huge. It was a real estate. Well, they were going cheap, selling but selling cheap, and they were buying low. And they thought, Look, particularly if these places had been well gone. They had a reputation of people that were relatively safe. It is an industry as as you have called it. So but that that doesn't answer the larger question of where it's better and where it is. I mean, I think one of the problems with the business is that the government set it up wrong. It's a system that is a hybrid system. It's federally it's one out of a federal agency, the Centers for Medicare and Medicaid, but it's run by the states, he states and Washington's. And some of the states care about residents and some of them don't care at all. I mean, they could have gotten many states could have gotten more Medicaid money earlier. From the Affordable Care Act. They didn't even ask for it. They just don't care. And I think near now, you have to think about racism and and xenophobia, you have to say dates it had foreigners or if it were in the legislature, a lot of races of they are going to care less about caring well for these people. And it's not and also I guess I you have to study when you work at a legislature, and it hasn't done any reform in 2022. And and many of them did no reforms for included shit. You work at the delays and you the way things Dutch Shell, and then you will get half ordered measures that deep vote room and you say to yourself, we're so clogged news, walking into the air of those legislators. And it and it is certainly true that the lobbyists ran that there's a there's a trade association When it has lobbyists, seat lobbies, Congress, he lobbies of the states, it's really extremely wealthy, and Ray, how, and they, and they pour mat all the time. They don't admit that they have ways of hiding the money that they're getting from the government. So it could be that they're paying the CEOs, a lot of different entities and different entities get different amounts of money. And so if very few don't look at their, if you don't order it, then you don't know what they do it at all. But when you do it, then you often find that they have these ways of hiding pockets of money. And, and so they have, and then they go to the legislature and they pour them out. They say, We just need more money. And I think that some of them may need help from the midfoot. I think what you want to do is audit them now in Massachusetts, that's my home state. Now, I know more about Massachusetts in about a lot of other places. The Department of Public Health is not ordered yet in recent years.

Kosta Yepifantsev:

But so if you know that the conditions are bad, and that it's pretty much common knowledge that the conditions and nursing facilities are close to horrendous. Obviously, there was 400 some odd facilities that maybe didn't experience deaths. And let's give it let's give him the benefit of the doubt and say that there was a couple of 1000 that did the right thing. But ultimately, there's I don't know, fit, what 15,000 nursing homes, I think I think I saw you write down or 13,000 right around there. So I'd say 80% 75% are not doing the right thing. Now we know that's the problem. In Massachusetts, your home state, have conditions improved since the 2020 pandemic?

Margaret Morganroth Gullette:

Well, let me let me give one example of something that the government did right here. Very sad. We're going to have to one store though, will mandate who to her will very well almost never get a man. I mean, he will get the federal government, they in under Trump, they strongly recommended infection control do I recommend is not a mandate, you know, recommending that you vaccinate your age is a recommendation. It's not a mandate. But in Massachusetts, but government said we are going to go for to a room. That's not ideal. Everybody knows that the ideal is one to a room with their own bathroom. And that would have prevented a lot of infection. Because if one person got sick, their roommate got sick. I mean, that was sick. Look, I mean, they could have shields between in some places, they could have shields to cumulate. Okay, so Massachusetts looks like it's doing right. And in fact, most of the nursing homes are going along with it. And they can do that, in part, because there are empty beds. And one of the reasons they're empty fence is because people are avoiding nursing homes. They just don't want to go and they are trying to find any kind of alternative. And some of the alternatives are not good. I mean, we can't, you can't move back into a house when you've sold it. You know, we can't move in with your kids. If everybody is working on their young children. And you're not capable, it's carried to the unsheltered I mean, but at any rate, most of the nursing homes did act correctly. But about 26 of them sued the state and said, Nope, we can't do it. So is this going to the courts? Now? i I hope that the court will say it says private or public health mandate. It's crucial for human dignity and hell. That this, that this be honored. So that's one way we get it right. The new governor who's coming every she has shown some interest in another she just got an order a lid there she beat a few days ago, actually. She's shown some interest in nursing homes. She's, she's loving to heavy, heavier fines. But everybody believes that the fines are just a tap on the wrist, but you're not really charging them What name should Ellen charge them when they have abused a patient or filled a patient with neglect? So I think there's a lot of work to be done with the by the Attorney General and by the governor. And, you know, we're just I belong to a wonderful group. It's called the dignity Alliance messages. And they got started immediately in 2020, when I became so agitated about what was going on in the news, and the deaths were just rising. All these people who had been in reform movements around the state for 20 and 30 years, and they were anti ages, they were pro aging activist, they were disability people. They they came in, there were lawyers, and doctors and nurses, and people who would have been in Alzheimer's units, and they know what they're talking about. And I love them. They're just and they sponsored bills in the legislature. So if you want to know where we are in Massachusetts now is we're waiting for the next legislator. For to do it right with roll ring, a new governor who may, you know, lashed the whip a little bit more over the legislature. With, we may get a lot more. I mean, there are agencies, there are foods organizations all over the country, now, who are very exercised, and in some of them are the children of the last Western nuts. And Bray, never forget, they've never gone. They were locked out. They didn't see if their parents are there. That is the sisters, nieces and nephews. They didn't even die. They didn't hold their hands. They're just the suffering was it, she waited, and they are not wanting to forget. Now the question is whether we can bring these people who will experience this suffering and know the urgency of these. It's total transformation that is needed deal. If you can bring them together with the legislators around the country. That's what's needed.

Kosta Yepifantsev:

You know, I think as we're talking about transformational change with regards to the nursing, essentially the nursing home business, and I know a lot of it is underpinned by federal and state policy. The reason why I don't have a lot of confidence in it is because, you know, if we can't pass gun control, after however many school shootings, how in the world are we can get legislatures mobilized to pass a Nursing Home Reform Act like they did in the 80s.

Margaret Morganroth Gullette:

You know, we don't have a gun lobby. I mean, I think you can discredit the lobbies bid in, in the States, and then at the federal. I made, I believe it is a powerful lobby, depending upon who runs Health and Human Services in Washington, and who is in the state legislators, legislatures, and governors, I think, certainly with this, with this data, at least, this mortality data, and this level of suffering, and this isn't nearly no more people who are relatives and want this to happen. I think something may happen. But there is something else is another direction we should go in Costa well, that people don't want to be in nursing homes. And we need to and realize Massachusetts recognizes that deinstitutionalization is one of the ways that we could go, we could have far fewer than once weren't 1 million people. I mean, estimates vary, but certainly a third to a half of them could be living in, in assisted housing. Sure. And there isn't a program, there's a government program, and we got some of it and Massachusetts and we may get it again. And it's called Money Follows the Person. And it means if you have that would like know something about it. That if you are in bulging and and partially disabled or disabled, or have cognitive impairments, or have mental impairments, there are many ways that you can use the money now. If you have to find housing, correct that that I mean, somebody has to help you find housing, and my mom was in for a while, actually when Renee was functioning here, it helps people find the housing, but I think we need all this kind of housing specialized housing for this population. And that is a whole other, you know, hobble ematic, in which he get developers involved. Right and

Kosta Yepifantsev:

right. Well, yeah, so it's a three pronged problem with regards to MFP. And money falls a person. Number one, it's the affordable housing problem number two states that didn't expand Medicaid. There's, you know, there's very small percentage of people who qualify for that program. But the third one, and I think the one that's probably the most significant is the fact that Money Follows the Person is a Medicaid specific program, and Medicare, which is available to everyone over the age of 65, does not participate to the same capacity. And at the same time, because we're trying to, I just don't want to pivot just a little bit backwards, because we're trying to affect 50 different state legislatures. When whenever we talk about Medicaid, we could just very simply have Medicare pay for long term care. And then that's there's actual federal governance over what long term care looks like. Because when you're trying to create a standard of practice around 50 different states and their own practices, it's very hard to create benchmarks, measurable benchmarks for quality of care outcomes. But the federal government doesn't want to pay for long term care, or they would have by now, so well.

Margaret Morganroth Gullette:

It Yes. Is our it's not. It's not impossible. I mean, I hear everything you're saying. And it came up. As a matter of fact, in the Affordable Care Act, it was part of the Affordable Care Act, and then just have to explain to people who don't know anything about the meetings, programs, that they're there, you pay into them over the course of your life, or, you know, you start paying into them. Re are a bit like Social Security and you've paid your quarters and you get Social Security at a certain point in your life. Well, long term care insurance and run like that. And it was in the Affordable Care Act. But it was this is under Obama. He had a Republican. Yeah, the Republican legislature, Congress didn't want to do it. They said, it wouldn't pay for itself. But it would have paid for itself. If you don't have best immediately, it would eventually pay for itself. And if you have not had theirs, it could still happen. It couldn't happen. Now, it can't happen in 2023. But we have an election coming up. Sure. And what I'm hoping is that these agency, these organizations, and this really isn't a movement yet. But there could be. And it couldn't be a movement for more affordable care coming out of the federal government. And it wouldn't being money that you could spend, it would be your money once you are invested. Well, what I would like to tell you about it, you've done this already, but your readers, your viewers don't probably, Washington State has it. Yeah, it's gonna depart this spring. And it's going to be very interesting. It will take three years to vest. It won't give you and I know the guy who runs it. So if you haven't had him on, we'd love to have him on. I think I'll give him your name. I mean, I'll give you his name, and you could get in touch with him. It will be interesting to see it starts, that it's people start putting their money in this spring. And so in the you know, it will be three years we've invested a whole lot of money.

Kosta Yepifantsev:

It's a 2% payroll tax, if I'm not mistaken, right, a 2% annual tax with a business match or maybe a 1% payroll tax and a 1% match. It's lower than that.

Margaret Morganroth Gullette:

I think it's worth 67 cents leaps in my mind. Were 100 Would it be? But I I'm not sure Sorry. Okay, so no, so what

Kosta Yepifantsev:

impact what impact did the lack of representation in the voices and experiences of residents have on the media coverage of elder side and subsequently, our collective perspective?

Margaret Morganroth Gullette:

Oh, the media was pretty bad. I had, I had an intern and she was reading a Google word that I had set up for resident Nursing Homes interviews. So I was trying to get quotations from the people themselves, who were either, you know, who are suffering and enduring or who felt safe. It didn't matter to me. I just wanted to hear their voices. I wanted them to be represented. And she read 1500 articles, and I read a couple of 100 more. And viewers. Now many of those articles quoting resident, well, could get 10, one of you 20 Wow. Okay, so I'm grateful for all those four years for doing a very good job. And I use those. I use those interviews, as many of them as I could get into the book in American elders side, because they're wonderfully rich interviews. I mean, they're white people with people like Sylvia goto, who survive, and others survive. And well, I mean, they had just survived in failure. They couldn't have been interviewed. But they're just, they're just a marvelous set of people. So I think I think it's sad that they weren't considered to be witnesses, but it tested reality to be able to give authentic testament, because when they were able to do it, they did it. And nobody sort of asking them, I mean, that's just the simplest question in the world, sort of asking them, but you can't ask them. So you blame the media. Okay, fine. I mean, there is waste. We're journalists out there who are interested in old people. But there are fewer of them than there used to be. They're just the way, you know, in papers and just appearing there some TV shows were very good. Actually. That's where I got to see a lot of residents on when they were interviewed on, you know, little TV shows in little Podunk cities and towns, they seem to be able to find them. So not many of them but still want to evolve.

Kosta Yepifantsev:

But what about like the major syndicated networks, do they, you know, they obviously know what people will and won't watch. So I guess the question is, is, aside from sensationalizing the deaths that happened, and you know, the in Kirkland and Washington state, you know, and obviously, the significance around the the deaths that occurred, and in New York City, nursing and New York State's nursing homes, no one really went like you were saying and talk to the residents to hear their stories, as they are essentially navigating the front lines of a major pandemic they did with hospitals, but long term care facilities are like, and you said it perfectly in the article, you said they're warehouses for old people. And I paraphrase that, of course, but the term that I want to extrapolate from that is warehousing, you know, out of sight out of mind, it's it's quite, I

Margaret Morganroth Gullette:

think, I think your own heat on something else there, I would like to emphasize, and that is, the media thinks they know what people want to hear about. And I think, and that's why the mortality statistics were so sensationalized, they were counted. They weren't, you do it. But what we have to look at the American populace as I don't want to say guilty, although in some sense, you have to yet. I mean, people were, you have to think back to 2020. How terrifying a time it would how often close people got. If I think they would have liked to hear more voices of us, I joke, I wouldn't say that they were indifferent to that degree. But I think what you have to work at is inference before COVID. And now, and I think what we are facing now is another fall into they're not really human.

Kosta Yepifantsev:

I mean, do you think we still have that sentiment?

Margaret Morganroth Gullette:

Well, I said, I use the word utility. I think what we need to find those of us who are the reformers and continue what we need to fight is the idea that it's Utah to rescue these indigent, old women. I mean, I think it was easy for Trump to do it if he's in a beleaguered soul. I mean, most attached to the culture view is all near the hero, he just couldn't imagine rescuing those people. Now, so. So, in part, we need to overcome this compound ageism, in our own head. We got we need the imagination to recognize that they are human, and all the things that I said, we will be there. I mean, that's the other argument that people use all the time. You have to think, and it's very hard to say thank you will be old or needy, right? Maybe it's easier to think that you'll be old, but not that he will be older knee and yet, people over 65 are going to be about 3% of the population. And about 70% of them at that age is going to need long term care of some form. It may be in the family, it may be money follows a perfect person that may have to be institutionalized care, that we can't forget any of those options. We have. And many people have those 70% and we'll need something won't be able to afford it. Whatever it is, though, I think we have you have a population out there that's watching your show. And and maybe there's not much else.

Kosta Yepifantsev:

It's hard. It is hard to find topics and shows specific to long term care, even though it's like you were just saying 80% I'm sorry, 70% of people over the age of 65. But I'll tell you this, people over the age of 75. It goes up to 80%. I know it's a negligible statistic, but it's still 10%. So instead of seven out of 10, it's eight out of 10 people are going to need access to some form of long term care. The baby boomer generation born between 1946 and 1964. You know, the first person that was born in 1946, has turned 75. Now, I mean, obviously, you know the first person that's still alive, has turned 75 and 2021. Which means that we are now on this eight out of 10. You know not not precipice, but but process. And so every year, more and more people are going to need access to the services. Now, my question is, and this is this is something that I pose to a lot of people. If Medicare and Social Security are two mandatory line items, mandatory spending line items in the federal budget, and they're the two largest line items in the federal budget. How do you navigate the conversation to say there's a there is a necessity for expanding long term care to Medicare. It's a responsibility and a duty when we're already fighting about spending cuts now, and not willing to increase funding for those two items. Instead, we want to do the opposite. How do you how do you say, Well, no, we need to spend even more money now?

Margaret Morganroth Gullette:

No? Well, you really need at a political scientist who has read the experience with the kind of rhetoric that you knew he's for Congress, but Biden put your sing home into the State of the Union address. No one serious that had never happened before. And I think a lot of people were heartened by that. Now, he didn't get the Congress he wanted. So it may be that we're going to have another two years in which in which it's harder to make these arguments, all the arguments that I have made and that you already know what it's not even impossible now, because there are Republicans have relatives to in nursing homes and they themselves sometimes wind up in nursing. And there are some parts of the legislation that Writing it might light. I mean, you break down to legislation, and it's, um, you know, it's more money for a Senate. So you know, one person to a role, man, it's more a government oversight and it's more, you know, something so binds for the industry, probably not fire phones, you know, I mean, but

Kosta Yepifantsev:

you're saying just the sheer size of the population that will be accessing Long Term Care, we'll have to move the government in a direction where they have to act. No,

Margaret Morganroth Gullette:

not saying that, because I think we fooled ourselves too long with the idea that the pointless the boomers, just by their weight of their numbers, were going to change culture. They haven't changed culture I have my book, actually, is it is another book of mine that I want to mention, because it is my latest is actually called ending ageism. Or how not just shoot old people. Now, not just shouldn't old people, it came out 90s 2017. And I didn't know that, you know, in effect in three years in March of 2020, we would basically start potshots at an old keep working. No, I think we that boomers have not the change age isn't there? I can't many of them are trying. I think we exercise or move into that. That time of life in which they also were thinking, Can we do something about ageism? Because now of course, it's also a job. Goblin has said that work discrimination. Man, it's not getting better, it's getting worse. And we were seeing that, I think, in people over 50, who are unable to find jobs after they lose them in the pandemic recession. So I think there's a you know, I'm not, I'm not very sanguine, but I'm not going to lose hope about any aspect of our culture, that where there might be an entry point, or transformational change.

Kosta Yepifantsev:

So how can we ensure moving forward that all residents, regardless of race, or socio economic status, have access to quality care in congregate living facilities?

Margaret Morganroth Gullette:

Well, that's everything we've talked about. Is there, we can't guarantee we can't guarantee it until we have long term care insurance, along with, you know, Medicare for All something, in other words, you we can't guarantee we can't party it for the indigent. So we certainly can't guarantee it to the middle class. I mean, I think one of the things that middle class people don't realize is the spend down. I mean, you we go into a nursing home, and it turns out that Medicare, we're paying free with for 100, diny, 103 months, or after that, if you still need to be there, you are burning down whatever assets you had, and that's why people lose their homes. And I mean, I followed a middle class woman who was a dear friend of my mother's wheelchair, I had water since by childhood. And, and something, you know, through abbreviate a whole complex story. He, he said, I don't, I never thought as of wind at the nursing home, he had on their own house, and she married and she had three children. But but so it happened. I mean, I don't, you don't just want to scare people into carrying that and sell.

Kosta Yepifantsev:

But I mean, fear is an important tool was probably one of the most important to cultivate change. I know that may sound dark and cynical, but I believe that one of the main reasons why we're going to see significant change in the coming years is not just the size of the group of people that need long term care, access to long term care and scale. But it's because those Gen those Gen X populations that are having to care for their family members, and they're also in poorer health than their family members were at the time that they're in their 50s. They're obviously relative to to other populations like millennials and Gen Z. They may have they may require access to long term care events. Sooner than 65 depending on conditions like obesity and diabetes and things like that. And so I think that telling people that they should be scared because the system's not set up for you to be properly cared for, is a very important tool to changing the narrative and setting us up for success instead of what what seems to be at this point. Dire failure?

Margaret Morganroth Gullette:

Gaming? Yeah. Yeah, I mean, I think we need all these rhetorics, I think lean around, right, didn't get where you need to walk up the sensation with data, with the caveats that I had put into it, you know, that's that if people did not need to die, but I think you don't want to convince people that you can prevent another pandemic, and that this was and will affect them. Alright, so I mean, our fit my, my book, American, Ill decide, tries to do a whole range of tug togas on mind in a heart. Absolutely. Yeah. And I think what, what I'm hoping for is, it's called that house into doom in German. It's the expansion of the heart. So, in expanding the heart, maybe you need a little fear. But you also need a lot of work.

Kosta Yepifantsev:

Absolutely. You're right, Margaret, what tools can we use to address the underlying societal attitudes and stereotypes that lead to the neglect and mistreatment of older adults during the pandemic?

Margaret Morganroth Gullette:

Yeah, well. We've said some part of this, I think, you have to work on your own anti ageism and your anti ableism. And also, on your own fascism. I mean, this is this may be the hardest winter in the United States, because we are trained in an ideology of independence. And everybody's supposed to then have their own two feet and put their own bootstraps and save their own money. And, you know, and add six feed and save and be independent while they walk. And this is less and less plausible. In the United States. I mean, we have a capitalist system that is bringing greater inequality. You know how to fight classism is a horrible other subject. Sure. But we start, I think, defining the problem, which a lot of political scientists, and religious people have done a lot of socialists there's a good deal more validity to socialism. These days, young people seem to have like bittern. They like what they know about the one, the project, the programs that it inspires and would work for and add it. And then we also have to fight what I call dementia ism. I think this has two forms. One is the belief that people in nursing homes are all cognitively impaired or have some kind of mental defect, because it's not true empirically. But there is a range of cognitive impairments in nursing. There's no doubt about that. So how do you overcome demented? Well, when you know, the facts help a little bit? I mean, there's a whole raves, I mean, we need to talk about the cottage of the salmon on a spectrum, the way we have learned how to talk about autism. And I think we need to just stick with the people we know who will begin to can cognitively impaired, and yes, and be good, be good talk to them, figure out how to talk to them. It for a long time. They're going to be conversable. Probably, you know many of them will die before they stop being conversable I just think was a whole world of dementia experts. I don't like to use the word dementia, but they use it dementia experts, and they have been telling us for decades, how much better we could deal with this population, which of course is people all around us that hit people in nursing home.

Kosta Yepifantsev:

And I mean, if you consider how many people go into a long term care facility, whether it's a nursing home or some other type of facility, And they're prescribed opioids and antipsychotic meds, and they're, and they may, and people that aren't familiar with their background. You know, they don't see them daily, may consider them to have some type of cognitive impairment because they're under the influence of hard drugs. You know. And so and I'll tell you this, the statistics that I've come across is that Medicaid recipients that are elderly, so Medicaid, long term care recipients receive opioids in the 80% range, some type of pain medication, that has a high A psychoactive effect to the pain relief. And if you're a sitter, this those statistics, how could you not if you're under the influence of such significant drugs have the the perception that you have a cognitive impairment, there's all these chicken and eggs that we're that we're not connecting the dots on. And, and we're building we're building an industry with, with bad information.

Margaret Morganroth Gullette:

Wherever letting the industry get away with a lot of bad behavior, that's for sure. I mean, in my view, says, we are about a quarter of the people in nursing homes, get anti-psychotic, that is one of the highest statistics in the nation. It's insane. People young, old need anti psychotic. And if we could get them to institutionalize, they would not probably get prescribed anti psychotics to that degree, or, you know, the opioids that you were that you were discarding. I mean, we always I, we could go on and on with the people who are guilty. I mean, medical directors, that's a whole layer of responsibility that I rarely hear anybody talking about. Every nursing home is supposed to have a Medical Directive. But in many claims, that medical director is going to be overseeing, who knows how many residences, and how many residents, it's impossible is to understand at that level, give that percent and not realize that things are going to go wrong in that, you know, that there are nursing directors too. I mean, that there, there's just there's a lot of malfeasance in this system. And so, when we talk about, I mean, we're really talking about two different sets, I think at this particular point, or we have been talking about stupid things all day. One is popular stereotypes, misinformation, indifference, the base, real evasion, or real evasion, actually, the C wire aversion, even the version with these people, but we're also talking about the people who are responsible to them in the government, and why they are not doing their job that we've been talking about from the beat Kinney, in terms of the the lack of PPE, and their lack of it, and the lack of inspections. I mean, it's a whole section of my book, we haven't even touched on it. So I think we, there there is an awful lot to do. And I think what we've done, and and maybe at some length is we've reached names, the problem. And I think that's extremely important, right? Well, your, your viewers know, much more at the end of this session than they knew beforehand about the carbon. Now one thing that that is clear, they can change their mind. Oh, they are able to Harrison bills dog up to here, if they cannot be institutions, and we won't get the change that we will indeed.

Kosta Yepifantsev:

And I'll tell you, it'll take us about an hour to identify the problem. And so it would take us many more hours for the rest of the conversation. And so maybe we'll we'll turn this into a four or five part discussion. But, Margaret, we always like to end the show with a call to action. What steps can individuals, families, and communities take to advocate for better care of elders? in long term care facilities and beyond to prevent the next American elder side.

Margaret Morganroth Gullette:

Yeah, well, we'd need an hour for that, too. So I'm just gonna say, a few, if you will think, sure. What is it, the people who like to be activists, there's certainly plenty to do. You can go to a nurse and you can bring snacks, and you can be a visitor to somebody. You can be ombudsman, yep, every state has an ombudsman program. Now, some states, it's run better than other states, the ombudsman is a person who goes into a nursing home, and is without a warning, which is very important. Prisoner can look at anything can look at record, but it also can look at, you know, commonly and look at the kitchen and look at the nursing station can come in either shift change the see how many people are actually there, when the beginning, you know, the owner says, X are supposed to be there. And it's x minus 17. Yeah, here's, I love that program. And some of the people I quote, or actually, there, there are states that have programs in nursing home, in which you get training to be a friend. And they have different names, but you are sort of like an inside observer, and you have a credential from the training that you have been given, I think more states should have that's the other thing is, I would support nonprofits that are doing this work. In Massachusetts, I would say dignity life, Massachusetts, it just became, we It could take about no money at all, I mean, everything in for and volunteer, and they have done amazing things. But now they suddenly need this reasonably, rather became a fiber wincy grape, though, so you can give them a little money. And they'll use it wisely. You know, they they do, and they need a little for the service, you know, where national organizations, Justice an agent is, is one of the best. I liked them a lot, because they're lawyers. And I think, for many of these fights, we must fill the ball, you must get the attorneys general, and Bob, let's hold justice to aging holes, government agencies, feet to the fire. And, and so and you can look around in your state, for the disability organizations that seem to be doing good work. I mean, Massachusetts, again, it has a number of visa agencies, and they are now that their leaders are incorporated into the beauty life as a tussocks. So I know, when we go when we sponsor legislation, we're not just looking at one population, we're looking at a lot of overlapping population. And they that they can be served. I mean, if you add housing, but requires assistance, you're adding it for a whole bunch of population that could benefit some that though, so that's that's my bios together. Who said Ah, yes, with wherever thing that was maybe too activist for some people. Dog was writing a letter to the editor. whenever something comes up about nursing homes, and you now know about his say, Wow, all real, please write a letter to the editor. You're even more ambitious. Write an op ed to your paper. There's a lot of local papers. What this is interesting, actually, this is another hopeful flyer. The papers really want anti ageism material. There are really willing to publish it. The editors are looking for it. And he right. People eat and with a little knowledge and maybe drop it to stick to a little passion. You're probably gonna get polls. And of course, it's all for the good it's Porter the mission.

Caroline Moore:

Thank you for joining us on this episode of Now or Never Long-Term Care Strategy with Kosta Yepifantsev. If you enjoyed listening and you wanna hear more make sure you subscribe on Apple podcast Spotify or wherever you find your Podcasts, leave us a review or better yet share this episode with a friend. Now or Never Long-Term Care Strategy is a Kosta Yepifantsev production. Today’s episode was written and produced by Morgan Franklin. Want to find out more about Kosta? Visit us at kostayepifantsev.com

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