Monday, December 18, 2023
In bed around 9, up at 7:30 but pss every hour during the night, no REM? GALE WARNING, snow is possible @ 8:45. 28°, WC is 14°, high of 30°, wind NW at 24 mph, 20 kts-30kts, 4 to 8' waves on Lake Michigan. Sunrose at 7:19, smset at 4:17, 8+59.
Treadmill; pain. Considerable spasms last night & IC during the night w/pss every hour. Chili dinner? CrystalLight lemonade? More RP this morning. 30.28 & 0.60, slo-mo watching Dana Bash's show with Jim Acosta. Nasty pain before I got on the treadmill and nasty pain after I got off.😡
I'm grateful for being able to rant today. Pathetic, but still . . . I'm hobbled with various CPPs and grumpy.
Righteous ageism? Nikki Haley's new ads expressly attack Joe Biden for his age, saying bluntly he's too old. She also calls Congress "the most exclusive nursing home in America," and calls for mandatory mental competency tests for politicians over 75. I"'m sure she is striking a chord with many voters, including me. I don't buy the notion that Joe Biden is running for re-election as a matter of public service and duty, thinking he's the only candidate who can beat Trump. He has lusted after being the top dog in Washington for decades and started campaigning for the presidency 37 years ago. Now that he has won once and got the nomination for another term locked up, he's not going to give it up. I can't help thinking of him as a glorified, back-slapping, glad-handing, Irish ward heeler who has a long, long, history of embellishing his own history and qualifications to defend against being seen as a pretty ordinary guy who likes to drive a Corvette and live in a mansion. That he can be friendly and empathetic I don't challenge, but he's milked those qualities to let him live the life of power and prestige that he loves. He's always been a "moderate" Democrat, not a progressive or liberal, meaning in part that he was always willing to serve the corporate interests of the financial and other businesses chartered and headquartered in Delaware, e.g., by making student loan debt and some credit card debt non-dischargeable in bankruptcy. He was always too interested in maintaining his cozy friendships with Republicans, witness the way he chaired the Clarence Thomas confirmation hearings. One final point: among Democrats, Biden has one of the most punitive, “tough on crime” records on criminal justice issues. Biden was at the center of building federal policies that escalated the war on drugs and mass incarceration. When President George H. W. Bush released his 'Tough on Crime' program, Biden criticized it for being not tough enough. Biden wanted "to hold every drug user accountable." I think of this now with all the attention on his son Hunter and his notorious drug abuse and other bad behavior. I haven't been a fan of Joe Biden for many years. If his creaky candidacy leads to another term for Donald Trump, I will move from "not a fan" to simply loathing him, but by then of course little about Joe Biden will matter except his most significant legacy to this country: having led to a second term for Trump and the failure of the American experiment.
Assisted living and memory care facilities, private equity & REITS. If we want to see American capitalism at work, there are few better exemplars than the $34B assisted living and memory care industry. The other great example is the hospital industry, witness the scandalous decline of health care at Columbia-St. Mary's under the Ascension Catholic Hospital conglomerate. The WaPo has been running bone-chilling investigative pieces on the assisted living/memory care industry. Excerpts:
Conceived about 40 years ago to give seniors more freedom in their final years of life, the assisted-living industry has been reshaped by real estate speculators looking to cash in on an aging nation. They were aided by Congress in 2008, when a new law gave certain investors the ability to hold senior-housing properties tax-free while also taking a slice of their annual income.
As a result, many facilities across the nation are now held by investors under pressure to produce profits for shareholders. In some places, a bare-bones approach to staffing and pay has produced a chaotic environment where medications are missed, falls and bed sores go unnoticed, residents are abused and confused seniors wander away undetected, according to a review of 160,000 state inspection reports and interviews with more than 50 current and former employees of assisted-living businesses and relatives of current and former residents.
Long-term investors in senior home real estate, which includes assisted living, receive returns of nearly 9 percent a year on average — more than double the yield for offices and hotels, according to the National Council of Real Estate Investment Fiduciaries.
Investors prefer to buy the buildings that house senior homes — instead of buying equity in the businesses — because they gain rental income and valuable property portfolios without being directly exposed to the legal risks of caring for a fragile population. Typically, a real estate owner will approve a detailed business plan that sets out budgets for labor and care, and pay a management company a fee to run the facility according to plan.
Residents may never know the names of the investment firms that own their buildings, but these firms typically collect about 30 percent of their monthly rent checks, according to commercial real estate researcher Green Street. In a typical arrangement, about 65 percent of income goes to cover costs such as labor, marketing and supplies, while 5 percent goes to a management company, such as Balfour.
Hundreds of properties change corporate owners every year, and staffing and pay are often the first expenses trimmed by investors focused on profits, according to interviews with industry experts and current and former employees at multiple companies.
The financiers included private-equity firms — investors who manage giant pools of money on behalf of even larger investors such as pension funds and endowments. These firms typically try to boost the value of assets and sell them after five to 10 years, providing returns to themselves and their outside investors.
Some senior homes were also bought by real estate investment trusts, or REITs, an investment class created by Congress in the 1960s to give stock market investors the ability to buy and sell shares in real estate. REITs pay no corporate income tax and distribute dividends to shareholders. Nearly half of Americans — around 45 percent of U.S. households — are invested in some type of commercial real estate REIT through retirement funds or pensions, according to industry group Nareit.
Congress gave these businesses a boost in 2008 with a new law allowing senior-housing REITs to share in the profits from operations, rather than act as passive landlords. This corporate structure, also common in hotels, incentivizes REIT investors to replace management teams that fail to generate expected profits.
“They hold the hammer,” said David Kingsley, a researcher with the nonprofit Center for Health Information & Policy.
Welltower, the biggest owner of senior homes in the country, distributes more than $1 billion in dividends to shareholders annually, including mutual fund giants Vanguard and BlackRock and the pension fund of Norway. Other senior-housing investors have collectively generated hundreds of millions of dollars for public pension plans in Arizona, Indiana, Maryland, North Carolina, Texas and other states, investor filings show.
The business of big business managers is making money. It's Jamie Dimond managing JPMorgan Chase Bank, the chief executives of Ascension Healthcare calling itself a Catholic health care "ministry", and the managers of a private equity firm or REIT owning senior living facilities. The business of all for-profit corporations is to make money for its owners, the shareholders. Making money = profits. Profits = excess of revenue over costs. Well-paid employees are a cost, a very big cost for most businesses and the way to increase profits is to decrease labor costs, by minimizing the number of employees and keeping their compensation as low as the managers can get away with. The WaPo story reports that the average wage of AL/MC employees is $15/hour, less than baristas at many Starbucks outlets. What a surprise: the AL/MC facilities complain of having a hard time finding and retaining good help to care for the approximately 1,000,000 persons living in their facilities.
The WaPo story reports that "Hundreds of properties change corporate owners every year." Why? Because the tax advantages of ownership decline over time so owners dump current properties and purchase new properties, as happened at Newcastle Place, when Jimmy A. lived for 4 years, when it was sold for $49M in 2012 and then sold again in 2021. The owners are not in the business to care for people; they're in the business to make as much money as possible. Health and safety care are not the ends, they are just the means to make more money.
And about those "non-profit" hospitals I mentioned, consider this from an op-ed in the NYT on 11/30/23 titled "Why Are Nonprofit Hospitals Focused More on Dollars Than Patients?":
Nonprofit hospitals have been caught doing some surprising things, given how they are supposed to serve the public good in exchange for being exempt from federal, state and local taxes — exemptions that added up to $28 billion in 2020.
Detailed media reports show them hounding poor patients for money, cutting nurse staffing too aggressively and giving preferential treatment to the rich over the poor. Nurses and other workers recently resorted to strikes to improve workplace safety at Kaiser Permanente and the Robert Wood Johnson University Hospital in New Brunswick, N.J.
That’s not the end of it. Nonprofit executives have embarked on an acquisition spree, assembling huge systems of hospitals and physician practices to raise prices and increase profits. Ample evidence indicates that the growth of these giant systems makes health care less affordable for patients, families and businesses.
Calling these hospitals nonprofits can be confusing. It doesn’t mean they can’t make money. What it means is that they are considered charities by the Internal Revenue Service (as opposed to being owned by investors, like for-profit hospitals). And in return for their tax exemptions, these institutions are supposed to invest the money that would have gone to taxes into their communities by lowering health care costs, providing community health services and free care to those unable to afford it and conducting research. These hospitals proliferated after federal tax rules about 50 years ago made it easier to qualify for tax exemptions. They now make up more than half of the nation’s hospitals.
So why are nonprofit hospitals behaving in ways that seem to focus more on dollars than patients? Hospitals are undergoing a reckoning about their role in the national health system. The United States will require fewer hospital beds in the future if current trends continue. This looming likelihood — plus financial challenges from the pandemic, a severe worker shortage, rising inflation and stock market volatility — has put nonprofit hospitals in survival mode.
Accordingly, they have prioritized protecting their finances, focusing on scale and market power. Unfortunately, these actions too often come at the expense of their mission to serve their communities. This has meant less charity care for patients who cannot afford expensive surgeries or emergency room visits and higher prices for those who can.
'nuf said.
LTMW at a young tom wild turkey eating his fill under the sunflower & safflower feeder. Magnificent cerise-colored wattle, He is followed by a gray squirrel munching on his leavings. I filled the feeder last night so I could avoid going out this morning and I am glad I did, now that the wind chill is almost in the single digits.
Throne room reading. I've been reading some Whitman, including his Song of Myself, and #32.
I think I could turn and live with animals, they are so placid and self-contain’d,
I stand and look at them long and long.
They do not sweat and whine about their condition,
They do not lie awake in the dark and weep for their sins,
They do not make me sick discussing their duty to God,
Not one is dissatisfied, not one is demented with the mania of owning things,
Not one kneels to another, nor to his kind that lived thousands of years ago,
Not one is respectable or unhappy over the whole earth.
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