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Welcome to Stuff You Should Know. A production of IHOP Radio's HowStuffWorks. Hey, and welcome to the podcast, I'm Josh Clark, and there's Charles W. Chuck Bright and Clear. He's out there wandering around in the ether and that makes this stuff you should know. She's been wandering around the ether for weeks, at least, I daresay, months by now, Chuck. Yeah, she's, uh. I actually just chatted with Jerry from ten feet away.

Oh, that's nice, man. That must have felt really special. I did her hair as long of a man. My hair's really long, too. Yeah. I feel like I saw Jerry a couple of months ago in her hair was long, so she must have like a full. I'm like do now.

Yeah. You know, she looks like a proper lady. I'm not touching that one. All right. So Chuck, this one was one of yours. It was a nursing homes, is the idea, right? Yeah. So I have a question for you. What what made you decide that you want to do one on nursing homes? You know, I mean, I'm almost 50. My parents are in their mid 70s. Emily's grandmother is edging toward one hundred.

Wow. So, you know, this is the kind of stuff that just you got to start thinking about at some point.

And Emily and I are old parents and have an only child that we don't want her to have to like have to take care of us or anything. So, like, we're just starting to have all these thoughts. And I was like, yeah, you know what? I'm not so sure America does it right here. Yeah. And after studying this stuff, it's we do it OK, but it's also like, hey, work your whole life and then go broke at the end.

Yeah.

That's that's a real bummer about the whole thing, is you're just kind of like expected to spend whatever money you have on care at the end of your life. And it just seems a little wrong to me too.

Yeah. And we need to shout out first of all, our buddy Dave Ru's helped us put this together and he actually did a real deal interview with Dr Muriel Jilek, who was an author of Old and Sick in America Coolen The Journey through the health care system and was quite a resource in the history of this stuff in this country, I think was pretty fascinating. Yeah, it is.

It's super fascinating. And the whole thing kind of started out, you know, we're talking about nursing homes in particular, but there's just no way we can't talk about other kinds of homes in particular because nursing homes grew out of this kind of system that developed that seemed to really kind of take shape and take hold around the the second industrial revolution, the one that happened here in the States. And because of that, because people were like, you know, I don't feel like swinging the site any longer.

I'm going to go into town and see what they have in the way of jobs. Yeah. So long, mom and Dad. All of a sudden, mom and dad were like golpe because they were on their own, not just, you know, one set of parents in particular, but is like a general intergenerational trend where kids were moving away from the farm and all of a sudden there weren't multigenerational homes like there were before. Because when you have a multigenerational home, you don't have to worry about what's going to happen to you when you get older.

Where are you going to live? You're going to live in the same house. You raised your your bratty little kid in to take care of you until you die.

And that's the way it was for years and years and years in America.

Yeah, there's a stat here. In 1900, 57 percent of adults over 65 lived in a multigenerational household. And by 1980, 80 years later, that went down to 17 percent. Wow. And a big reason for that, like you were talking about, you know, moving away from the farm. But just nowadays, people just move away. I mean, 63 percent of American adults have moved to a completely new community at least once. Right.

And as Dr. Jilek points out, she says not only are people not living with their adult children, they're not even living near them many times now.

Yeah, because they finally wised up and went like, gosh, I can get away from my kids once and for all of their adult.

Well, I think it's more like the kids, like, hey, gee, I want to go live in wherever the heck I want to. Yeah. And we'll just think of a plan for my parents. Oh yeah.

My generation doesn't have any hangups about guilt or morality, you know. But the thing is, it's not just the kids moving away. Like my grandmother moved far away. She moved to Florida. She moved to Arizona. Yeah, she moved here.

She was like, so long, everybody, I got this. But she was very fortunate that she had the one of the things that nursing homes exist for is to take care of people who don't got it, who either don't have family, who don't have the money to hire people, to take care of them, who don't have the money to go live and, you know, say like assisted living or something. That's what nursing homes have kind of evolved to take care of.

And in that sense, they're actually directly related to what came were originally called almshouse. Houses or county houses or poor houses, which if you were old and you didn't have anyone to take care of you in like the late 18th, early 19th century in America, you could go to like a farm that the county maintained and there would be a bed there for you and you would be housed with a bunch of different people with a bunch of different conditions.

And the one thing that you all had in common was that society didn't quite know what to do with you.

Yeah. So, I mean, it could range from people who had no living family to and just, you know, needed care that had nothing else wrong with them except just being old and needing care and having no one around to people that were mentally ill, maybe people who were suffering from dementia or people who were alcoholics or drug addicts.

And like you said, they you could get a bed, but there were no doctors. There were no nurses. You couldn't get medical care. And that was sort of the the beginnings of the shame, almost, if you want to look at it that way.

Yeah, kind of. But it does say something that society did say we have a responsibility people. We can't just be true. Well, there's a cornfield for you to go lay in until you die of exposure. Good luck. You know, there was a bed that was provided as meager and horrific as that whole thing was.

It was at least an experiment or an attempt to do something.

Yeah. And, you know, the next big change happened sort of midway through the 19th century when sort of around the time of the Civil War, we started getting our first big hospitals like medical hospitals, public medical hospitals in the big cities around the country.

And they you know, they were sort of the the beginnings of modern large scale public health care. And here's the thing, though, is they were back then, they focused on acute care. So if you, again, were a senior and you they called them old chronic, like you had maybe a chronic condition and no one to take care of you, then you basically you were too, too dependent to go to one of these places because it was a hospital.

And they're like, you can't stay here.

Right. Because even though, you know, you're called an old chronic, you might not have anything wrong with you aside from being really old. And maybe you can't make it to the bathroom very easily, something like that. Right. But not necessarily anything that a hospital could treat you for. It was just they had a bed, but hospitals very quickly were like, we can't like, this isn't working. You're going to stay here indefinitely and there's really nothing wrong with you.

You got to find a place for you. And so about that time, some charities, especially either ethnic or religious based charities like the Baptists or the German Aid Society, was a was a big one in Boston. I think the German Ladies Aid Society of Boston I'm sorry. They kind of said, you know what, we we have members who are there, members of our church or, you know, they're German, they're part of our community and they don't have anybody.

So we need to make sure that they're taken care of. And they actually started founding what were called old age homes, which is basically they would get like a a large home and kind of outfit it with different. Each room was like a different room for a different tenant.

And they would take care of, like old widows, basically, who didn't have the money or the children to take care of them.

Yeah, but specifically what they deemed as worthy poor. And here's what differentiated them from the almshouses was if you were worthy, poor and you know, that's in air quotes that meant that you were the wife of of a man who who worked hard all his life but never made a lot of money, maybe worked at a shipyard or just had sort of a a very low paying blue collar, but respectable job, but certainly not the kind of dough to pay for like private nursing homes or anything like that.

Right. But not alcoholic or drug addict or you know, there was no they didn't like force, shame, attachment to it.

So these widows who were, you know, in their 60s or 70s, depending on, you know, how their husband lived their lives, they're like, I've been morphine free since seventy three, so let me in.

They didn't have these big pensions or anything because of the jobs their husbands had. So they were taken into one of these homes like a Baptist home or something. And they were given a bed and they were given, again, not medical care, but they were at least given meals in a bed. Right.

A lot of times they were expected to kind of pay for their room and board. It was kind of like a needs based sliding scale. I got the impression some of them just straight up said, hey, give us 500 dollars. At the time, I think around nineteen hundred or the late 19th century, I don't remember exactly when it was the Winchester home for aged women in Massachusetts, the Winchester Mystery House.

I looked it up, I was like, is that the same one? But it was it was bequeathed by a Lucy Winchester who I couldn't find anything about. But it's not the same person.

Lose a lot of people in that house.

Yeah, you would, although you gain a lot more ghosts. That's true. But they said you pay us 500 dollars. So this is in 1984. You pay us five hundred dollars and you can stay here for the rest of your life. And five hundred dollars back then was worth about 15000 today. And then like, how old are you again. Exactly. I was thinking about that. It's a bit of a gamble on both sides, but it's a bit like insurance.

Yes. Like some sort of long term care insurance where you're like, OK, let's stretch my five hundred dollars as far as I can go. Or, you know, you could die two days after they still kept your five hundred dollars. But then hopefully it was used to make life better for the other people who's who had used up their 500 dollars long ago. Right. You know, so there was this kind of idea that if you could pay for it, you should pay for it.

And then as time went on, it was like, oh, you just you know, you sold your house. We need that money if you're going to stay here. And people would take in more and more money from that person's estate as they were alive to take care of them. And this is starting in like the beginning of the 20th century into the 19th century. So this is a very long tradition of extracting everything from old people as they're dying to to pay for their care.

Yeah, and I tell you, I'm bothered by that. Yeah.

I mean, the question became not how much is it for your care facility?

It's more like how much you got, how much you got here grubin by the ankles and turn them upside down.

Or if they you know, if they weren't charging, there was the expectation that they didn't need so much care that they couldn't also contribute. Like we got a room for you will feed you, but you got to make your bed and you got to clean your room and maybe help keep the property up. Right. So I got the idea that these were people who, like I said, you know, and a senior widow who just didn't have anywhere else to go and otherwise was doing OK.

Yeah, but forced to make knockoff Gucci wallets during craft, arts and crafts time. Should we take a break? Sure. All right. I got a Gucci wallet to work on myself.

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We'll see through the eyes of London's East Enders as they try to make sense of the violence taking place right in their midst. And we'll explore the alleys, yards and homes where a series of monstrous murders became the most infamous true crime story of modern history. Unobscured Season three premieres on Wednesday, October 7th. Subscribe today on Apple podcasts, either radio or wherever you listen to podcasts. OK, so we've got almshouses are still around, they have they stayed around until the 1940s, from what I could see, these county houses, poor houses, and then alongside of those, you've got old age homes.

But then the government was kind of like, we can do we can do better than this. New York itself, I think, became the first state in the United States to say it's 1890, its modern era. We need to do more to take care of like our our elderly and in particular are mentally infirm. They and they that state made a commitment to take care for the state, to take responsibility for its mentally ill. And that included people with dementia of all sorts, which they would have called senility back then.

Yeah. And so that was kind of like the first entree of the state into caring for elderly people. And that actually kind of open a bit of a floodgate.

I think other states started to kind of follow suit, but it was like a it was a step in a really dark direction because by World War One, if you were elderly, especially if you had some sort of decline, some sort of cognitive decline from age, there was a really good chance that you were in a mental asylum with everybody else. In a lot of cases, I think even if you were just elderly, you would find yourself in a mental asylum in that, right?

Yeah, I mean, absolutely. So you've got a situation where the states start to say, hey, we need to take care of our mentally ill. But seniors just started getting kind of lumped in if they didn't have anywhere else to go. So, yeah, you might have, you know, someone's someone's grandmother who just didn't have family and who was really doing OK upstairs and and was in pretty good health, might find themselves in, like you said, a mental hospital with people with severe mental illness.

Right. And I think there's a couple of stats here that they've dug up. By 1930, there were more elderly Americans in mental hospitals than in those almshouses and the private old age homes combined.

And he mentioned one in particular, Chicago State Hospital, which was a mental hospital in the 1930s, 70 percent of the patients there were, quote, aged or infirm that had no other underlying psychosis or mental health condition. Right.

So that's a really dangerous place for old people to be, because if you act up, they can put you on medications, they can give you the hydrotherapy treatment. They can do all sorts of stuff to you because you're in a mental hospital. And I think it's kind of like one of those things where if you're a hammer, everything looks like a nail. Well, if you're a 1930s old timey psychiatrist, everything looks like a mental condition. A mental condition.

Right. You know, and you're going to treat all of the people the same way. And so luckily, Frances Perkins arrived on the scene around this time. So World War One is when old people really started to get shuffled off to mental hospitals. By 1935, the government swooped in is like, whoa, whoa, this is way wrong. Like we need. Just because these people are old doesn't mean that they're they're mentally ill. So let's extract them from that environment and figure out if we can do something else.

And thanks to Social Security, that that really began to change fairly quickly.

Yeah. So this is 1935. Again, you mentioned the great Frances Perkins. If you didn't listen to that episode, go listen to it. Fantastic. Missing out the Social Security Act.

Basically like when we think of Social Security now, we think of the program where you pay in your whole life from your paycheck, and then when you retire, you get a monthly income. And if you work longer than your checks are going to be bigger. I started working when I was thirteen, so I imagine I'm going to be rolling in dough.

You're always boasting about that. It's like of hearing about that, about my thirteen year old busboy job.

Yes, it's a TitleMax now, by the way, that really dry Biomax get your money, your money, your real money.

Oh, man. That's a good free advertising. Yeah, I drove by. I drive by there on the way to my mom's and Emily's parents house sometimes. And I always pointed out to my daughter and say, hey, that's the barbecue restaurant I worked at. It's now a TitleMax.

Is that the one where the guy put his foot in the Brunswick's, too? Yeah.

Guyman So wrong. So wrong. Whatever that guy is now. Randy he's in.

He's in. I don't know. I'm not even going to guess the feeling Randy is in prison. Do you think so? I mean, he doesn't do a lot worse than put his foot in the Brunswick's.

Do you know what I mean? Oh, jeez, I don't. But my mind's rate, he was headed for life behind bars, I think.

And I'm not laughing at that. It's very sad. But Randy, you know, he made his own decisions.

There must remember Randy, the hippie from MTV and like the late 80s or. Early 90s now, he ran for president, he was like just this total weirdo burnout, who was the character? Yeah. Who looked today like he could have been in L.A. MFA's. Oh, OK. Like, really, he dressed like that. But this is like decades before. But anyway, I remember like he he like ran for president and I think he lost and he's like, I've made my bed now I must lie in it.

I'll never forget that adversaries. And I thought it was hilarious. But yeah, that was Randi.

Well I mean maybe it was the Randy Brunswick's. It was the Rantes what I'm saying.

So yeah. That that was old age insurance is what they called it originally. But then there was also old age assistance, NOAA, which was you're going to get payments when you're older, even if you didn't work, which was a big deal because so many women were not allowed to work and have jobs. So, like, what were they going to do there? And they say, oh, you didn't pay anything in sorry, you just raised your kids and grandkids.

That's a great that's a great point. I think we still do that today, though, unfortunately. But at least women can actually work in the workforce if they want to. But, yeah, if they if they stay home and raise kids, then they're still treated the same way, which is pretty shameful. But I get your point. And the point is, is that we needed to be able to take care of people who hadn't necessarily worked in the workforce and paid into Social Security.

And then also we had to offset that first basically generation that, yeah, we're like, OK, we're the first ones nobody's been paying in.

But why do we why are we the ones who have to pay him? But we get nothing from it. It's good for their old age assistance. The ACA really helped with that. And I guess that's kind of gone the way of Desco, because the only thing I know about is the old age insurance that's still around. And I know they don't call it that any longer, but that old age assistance where it's like I guess that would be Medicaid, right?

Yeah, I think so.

OK, so so we'll and we'll talk a lot more about Medicaid. Medicare just put a button in that. All of you bureaucrat wonks, you're going to love it.

Yeah, but you know, FDR, this is when things really changed. And the reason we're talking about Social Security and stuff like this is it really it's sort of laid out the roadmap for what was going to happen and how we cared for our grandparents and what kind of places they were going to be, because he went in there with a new deal and he was like, these old houses are terrible things, like we need to get rid of these.

And he said in these state mental hospitals, they're overburdened. And that's not right either. So here's what I'll do. Part of the AAA, the old age assistance, a big provision here is that you can't you can't get any of that money if you're living in a public institution like an almshouse or like a state mental hospital. No money coming your way. No.

So suddenly the people who were stuck in state mental hospitals are almshouses.

Houses not only were like, oh, well, I could get out of here. Now I have the funds to get out of here and go somewhere better. And this led to a huge boom in the growth of private living facilities for the elderly.

Yeah, I think that was the big change. I mean, surely people were like, great, I can get out of here. But I think people saw dollar signs that said, wait a minute, I can get paid by the government to take in these people and take care of them. Right. Sometimes directly get paid by the government.

Yeah, that was kind of like an amendment that they made later on where it was like, yeah, that incentivized that even more is like, well, we'll pay you directly. There's not even this person is you have to be involved. Just take care of them, you know, follow these guidelines and we'll send you this check every month.

And the people like, is there any money left over for me, you know, and they just don't ask any questions. It's as a matter of fact, how you bring it up. Do you have any money? You're going to give it to them first before we give you.

Yeah, there's a balance on your account, sir.

So this is kind of how it went for like the first, you know, fifteen, twenty years after Social Security Act was introduced in 1935 where it fueled this boom of retirement homes, basically the retirement home industry found its its birth there. And then about fifteen years after the government was like, you know what, we've been thinking a lot of money into this. Maybe we should look around and see if any of these places are any good. And they found that.

No, and a lot of cases, they weren't really good. There was you know, if you if you converted an old Victorian mansion into an old age home with a dozen rooms, you probably didn't add a fire exit on to every room and fire stairs on the second and third floor.

There's probably no sprinkler system because they weren't very prevalent by that time. And so if there was a fire, all of these the dozen aged and infirm people who lived there were going to die in a fire. That was the one big one that they turned up that came out of these early investigations into into what came to be called nursing homes. Yeah.

So this is when Congress did. And again, like you said, about 15 to 20 years later in the 1950s and said, all right, here's the deal.

If you're getting this dough from us, we need to regulate what's going on there and they need to be safe. And a lot of these mom and pops that, like you said, converted an old house.

They couldn't make those upgrades. You can't just slap on a fire escape to an old Victorian. I guess you could, but it wouldn't look that great or probably work that well.

And so a lot of these smaller ones floundered and all of a sudden and this is things where things really start to change, there's a big market for just basically I don't know if I would call it the corporatization yet, but maybe to a certain degree, these bigger facilities for residents that had this money that could go straight to them. And so these sort of larger places that weren't individual houses started popping up.

Yeah, well, it's like an ongoing and recurring theme in a big criticism among conservatives of big government or government regulation is that it homogenizes things because usually the mom and pop operations, even if they are well-meaning and not nefarious, like they don't have the money to add those fire exits on, but say like a corporation that's going to own several of these things, they can build new ones with all the modern fire exits and fire sprinklers. And so those bigger corporations start owning more and more and more.

And by building more and more and more, they're not going to make each one, like, really unique and embedded in the community. They're going to plunk down the same one in every place they build one. And so there's this homogenization that occurs as a result of that. And that's exactly what happened with what came to be called nursing homes, which really started to find their advent in the 1950s from these reforms where the government was like, you guys need to be able to do this, this and this.

We're going to assign the public health service to to lay out guidelines. The Public Health Service knows about regulating hospitals. So they really added on to that homogenisation, this this underlying medicalisation of caring for older people, which makes sense. You know, you think of older people, elderly people, senior adults, you think, gosh, the you know, the body's starting to wear down there. Have they have all these conditions or whatever. So it makes sense that you would couple hospitalization or medicalisation with that.

But that's not always the case in the problem is as it became the case, whether you needed it or not, that was the kind of place you lived was basically a bland institutional extension of a hospital.

Yeah, I mean, it's not like and I kept thinking of the movie. Say anything. When I was researching this, because that was a prominent storyline in that movie, I never saw it. You never saw say anything?

I didn't do you wonder what happens every time a guy in a trenchcoat holds up a boombox over his head? I mean, I know the cultural references.

Yeah, of course. I just wondered if all this time you're like, what is the deal with this boombox?

Yeah, it's like a reference to Kevin Smith and Clark. OK, sure. Exactly.

Now, I only Skye's father, the late great John Mahoney, was he ran a mom and pop nursing home.

Really? Yes. And was and spoiler coming.

If you haven't seen the 30 something year old movie, he was found to be ripping them off. And that was a big sort of subplot in that movie.

All I heard was that was a big subplot in that.

Very good. Good.

But say anything aside, they, like he said, became more hospitalized for lack of a better word. And if you went to one of them back then, there was very little to differentiate it from a hospital, from the central nurses station to the cafeteria food. Yeah, I remember going to visit my my grandmother on my my paternal grandmother, who lived to be 101 before my dad and his wife took her in. She was in one of these places and are actually maybe it's the other way around.

She went afterward. But it was it was terrible.

You know, it was awful and very, very sad.

And if I was not a young man with, you know, nothing going on in my life, I might have done something about it. But, you know, I didn't know what to do back then.

You would have opened all the doors and been like, go free, go free. I would have ripped her out of there at least and said, come out with me. Yeah. I mean, they were pretty bad, especially by the time I'm guessing you were there in the 80s or 90s. Maybe this was it would have been the 90s. Yeah. So in the 50s, in the mid 50s, even these things made a little more sense.

At the very least, they were newer by the 70s and 80s. They were so bad that we had a reform act that kicked in in 1987, which is basically like this place is wrong and like maybe we don't know what to do or replace him with. But here are some things that that you have to treat these people with like dignity. They have to be able to have a say in what they wear or what they what they eat or what they do during the day.

And it really kind of got off the rails within a couple of decades after their advent. The thing is, is like I was saying, nobody knows what to do about nursing homes. And we'll talk a little more about that later. But just kind of put a pin in that nursing homes were not not great and they're still not great.

Yeah. Should we take a break and then come back and talk about Medicaid and Medicare and how that figures in. Yeah.

All right. Well, we'll be right back with those two tiny little things right after this.

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All right, so we promised talk of Medicare and Medicaid, and I think they've kind of put it really on the nose here, he said. No to government programs have shaped the nursing home care model over the last 50 years, more than than those two programs created in 1965. Lyndon Johnson amended the Social Security Act. And if you still get confused, if you're like a young, hip and happening millennial and you don't know what those two words mean and you get them mixed up, Medicare is health insurance universal?

One might dare say socialized medicine.

That's a red herring for Americans over 65. Medicaid is long term care for Americans lower income status.

That's right. Or the difference. Yeah, and you don't necessarily have to be elderly for Medicaid, I believe. Yeah. Medicare, you do Medicaid. You could be lower income and have a lifelong disability. And you'd be eligible for Medicaid, too.

Yeah. So Medicare again, this is if you're over 65, it's going to pay for acute medical care when you're in a hospital. But if you need something long term, kind of like what we're talking about at the beginning, then it won't pay for that. Like, you can't just say, all right, I'm going to go to a nursing home now and it's going to just pay for that in full.

But Medicaid would and for a while, everybody's like, OK, well, we'll just take Medicaid. This is after Lyndon Johnson's Great Society in 1965. So we're like, this is fine. And then somebody realized that Medicare pays way more than Medicaid does. And so all of the bottom line people said, how can we can we do this? What are we going to do? So they read the act and they found that there was language in there that says Medicare will pay for a stay up to 100 days in a skilled nursing facility after three days or more of treatment in the hospital.

And so all of those nursing homes are like, well, we have we have nurses, we have doctors. Let's just rebrand ourselves as skilled nursing facilities.

And so there was a huge, massive transition from nursing homes where you would go live potentially the rest of your life. And there were nurses and doctors and all of that. And this was your new home until you died, too. You guys got to go because we're now a skilled nursing facility, which means the most you could stay is 100 days. But we're going to make way more off of flipping people every hundred days than we would because Medicare is going to pay.

Then we would be letting you stay here as a nursing home because Medicaid's paying for that. And that, like I said, just caused a huge change in the industry.

Yeah. And Americans in the 80s and 90s generally were like, you know what? We need better facilities and more comfortable facilities that feel more like feel less like a hospital and more like an apartment, let's say.

Yeah. And that was sort of the birth of what's known now as assisted living facilities, where there are different levels of care that you can pay for. And the idea is that if you go to one of those, you have a little bit more independence, you have a little bit more say in like how your day goes like and that's just added just like a daily schedule level. And, you know, it's like a little more social. Like it's it's sort of like you what you I mean, the best ones are like what you would hope they would be, which is a place where your grandparents to go hang out and hang out with other seniors who in and you know, have a social life and tell stories and be with one another and not just sort of be in a hospital room.

Right.

So, like, if you can't just stay in your house or something as you're getting older, this is a real alternative for you. And because there's different levels of care, you can age in place there, like you can just keep getting older and older and then they'll start, you know, adding greater and greater layers of care. The thing is, is assisted living is expensive and it's outside of the federal purview. Like the feds went all in on nursing homes.

They regulate nursing homes. They don't regulate assisted care. They they will pay for nursing homes. They won't pay for assisted care. There's a lot of differences. And they're almost there. They're very much intertwined nursing homes in assisted living, but they're very they're very separate. As far as the U.S. government is concerned, there are two different things. And the government recognizes nursing homes. The thing is, it's like you were saying in the 80s and 90s, people were like, we we don't want to live in nursing homes anymore.

We want to move over here. And all the nursing homes were like, fine, we're skilled nursing facilities now and we can get some of that sweet, sweet Medicare money.

So did you see that stat? Yeah, 1963, there were five hundred and seventy thousand skilled nursing beds, and in 1980 there were one point two million. So yeah, they definitely were like, oh, that that money needs to be coming our way.

Exactly. So and that's exactly what they did. They said, you know, we're we're skilled nursing facilities now. And, you know, they probably are owned by the hospitals where you do three days in there and then get moved to a skilled nursing facility. And then maybe if it's a large enough group, they might own an assisted living facility, too, that you can say move into after that 100 days or something. The thing is, is that assisted living is great.

It can be really, really good. And nursing homes can be good, too. There's not like all nursing homes aren't bad. And they all of them have like they're they're upside. Like you were saying, assisted living is very social.

There's probably, you know, a lot more going on, a lot more activity just because a lot of the people who live there these days are going to be more active still, whereas in nursing homes, it's now the people who live in nursing homes tend to be much sicker, more infirm. But there's still socialization where there's not necessarily if you just, you know, live alone at your house and somebody comes by a couple of times a week. So there are definitely good things.

Nursing homes. The problem is, is 70 percent of them are for profit. Some of them are owned by private equity firms. We shouldn't let private private equity firms anywhere near the aged population ever in any country. That's just a terrible combination. And apparently, in fact, there studies that show when private equity firms take over nursing homes, there is a measurable decline in health outcomes for the residents because their whole thing is they're you know, they're dedicated to making, you know, corporate profits.

So you cut costs and you cut services and you just approach things differently than you should. And that's kind of like this evolution that's going on now is we we've been providing services to elderly people as they age, as if their customers were instead we should be providing care. And those are two different things, even though from, you know, a few paces back they might look similar. They're not they're different. And that's kind of the push that we're going toward now.

Yeah. So where we find ourselves today statistically is and I was kind of surprised about this.

I had a feeling that more Americans were in these facilities than I thought. I guess it's a little bit heartening to hear the numbers. There are about one point four million Americans in residential nursing homes and then another one point seven million cycling through those skilled nursing facilities. If they have like a surgery or an illness or something they're recovering from or rehabbing from, which is only about 4.5 percent of all Americans over 65 and 10 percent of all Americans over 85.

I thought it would be higher than that. You know, if you want to look at the downside, though, is one big reason why maybe the cost. It depends on where you are, of course.

But if you are in a private room at a nursing home and I guess was this in Georgia?

Yeah. Two hundred and thirty five dollars a night in New York, that's about 400 dollars a night.

And change on average a night like at that point. Just move up into the hotel, right?

Pretty. Pretty much, yeah. The only thing is they don't have nurses that the w I know you're kidding but but that's a lot of money man.

And you can just get bled dry at the end of your life.

Well you do. And as a matter of fact, to pay for a place like that, a nursing home, Medicaid says you have to have paid in which basically says you need to have if you if you don't own your house anymore, you have to give the proceeds from your house. Yeah. You got to liquidate. Yeah. You have to liquidate your your your inheritance. You have to pay down to usually something like I saw like maybe 700 dollars a month income is the cutoff.

Anything over that. And you have to be contributing anything under that. The Medicaid will kick in and pay the place directly for letting you stay there.

But the thing is, it's like, of course, the the better alternative is assisted living. Some state Medicaid programs will pay or help pay for assisted living. But for the most part, if you're if you are paying for if you're living in an assisted living facility, you might have a reverse mortgage on your house. You are probably you've liquidated all of your your investments. You're you're paying for it out of pocket in the United States for the good kind of retirement home.

Yeah.

And, you know, there are people out there that are trying to further reform what these places look like. There's a gentleman named Dr. Bill Thomas, who is a geriatrician who has something called the Eden Alternative, that is he's trying to basically. Reframe these nursing home residents and caregivers as care partners and, you know, it sounds kind of hippy dippy, but he wants people to be able to still grow in life and to still flourish and to still learn.

Just because you're a senior doesn't mean you just have to to sit in a room and watch Judge Judy or push checkers around a checkerboard. And, you know, they're depending on where you are. They might be adopting these methodologies of the Eden Alternative or the Green House Movement. Another thing he helped spawn, which is you're in a in an individualized home.

It's not a big facility. You got a private room, you got a bathroom, and there's outdoor space for you to go and garden and to walk around and to, again, try and flourish in your in your last years on this planet.

Right. And that's that's there's also a push for for aging in place at home. Yeah, sure. Which can be really beneficial. But again, it can also be isolating, depending on, you know, what kind of friends or family. Maybe if you live in a condo, it would be a little more. But if you're living in the house that you spent your entire life in and all the neighbors have moved away and you don't know anybody more, that can be isolating.

So in that sense, assisted living or even a nursing home could be a better alternative. But a lot of people say, no, this is my house, I want to stay here. Yeah, the problem is, is I've seen I've seen it put that Medicaid has an institutional bias, which means that they'll pay for you to go to a institution like the definition of the word institution. They don't really pay for you to be able to stay at home.

Some programs do, but a lot of them don't, even if you do want to stay at home, which is kind of heartbreaking to me.

Yeah. I mean, you know, Emily's grandmother, Mary, who was very popular with this stuff, you should know Ami as the eldest general. She you know, we had to move her out of her house that she was in, you know, not her whole life, but for a large portion of of her life. But, you know, it was one of those deals where it's out in the middle of the country. In Ohio. There was no family close by.

There was no hospital close by. And it's just it's hard to say it's OK to stay there, you know? Yeah. And it was sad when she left, but she was also like, no, this is great. I'll move in with you guys. Like, she didn't kick and scream. You know, she was she was willing and understood it was the best thing. And, you know, that's probably one reason why she's pushing 100 right now.

I think for sure where she live. She lives with Emily's parents. And that's feinted here in Georgia. Now, that's great.

Yeah. Um, well, yeah, I'm very glad that that worked out for. But I was also looking at like the antithesis of that, like what happened in the United States to people who. Who don't have any family, who don't have any children and who don't have any money like what happens to them, and they seem to be they seem to be kind of left on their own.

Like if they have a house there, they're probably just going to be left in their house and maybe Meals on Wheels will come by the county. Social services might be able to help them. But this is if they reach out for help, if they need assistance, they might not get it at home because again, there's a lot of services that aren't paid for. And if you don't have money, you're so well, you could go to a nursing home.

But if you don't have any ability to pay, they can kick you out. They can kick you out for a bunch of different reasons. The most depressing thing that I've looked up in a while was nursing home evictions. No, God. And they there are there's there was a loophole that was recently closed in 2016 that said if you if the nursing home is not able to to offer care for the person, then they can be discharged and they use that as like a huge loophole.

They'd be like, we're sorry. We can't offer you the care you need any longer. You have to leave. And, you know, if you don't have anybody to advocate for you, you're you're, you know, where are you going to go? And I couldn't get a really good answer, but I get the impression that it's there are it's not huge and rampant, but there are a lot of people who are still falling through the cracks of society as they age because we don't have a robust, nationalized plan to care for the elderly no matter what.

And I thought, well, of course, the United States is super behind in that respect. But apparently we're in in line with other countries like Canada. You'd think Canada would have like a place for every senior and they're all happy and taken care of and everybody gets a pet beaver or something like that. No, you're on your own. Kind of like your state might help you out a little bit. The local city might, but that's about it.

Same with the UK, to which I was really surprised because both of them have nationalized medicine.

Yeah, I will say that this is where social media has been beneficial as far as neighbourhood and neighbors go. I mean, all the time on our neighborhood pages, we see people stepping up and especially in a place like Lanta Atlanta, where gentrification has happened, you do see a lot of neighbors stepping up to help take care of the senior African-American community that is still living in their houses. And they haven't been bought out for a shamefully low price by a greedy contractor to to flip it into a little McMansion.

But you see it all the time that we work with a group called Neighbor in Need that really does great things. And oh, that's great. And aside from just the the official organizations all the time, you'll see someone that lives next door to someone like that.

They'll be like, hey, she's having a hard time paying her power bill this winter. And, you know, in our it is funded for for the rest of the year, the neighbor step up and pay for her power bill. And it's just it's little things like that. But these are in communities where houses are close together and people are, you know, each other's business, like Emily's grandmother out there in the middle of the country. And a lot of rural America like that might not be the case.

You might not have someone checking up on you and people, you know, bleeding hearts like you. And I feel that they should be taking care of no matter what, you know.

Yeah, but I mean, isn't that something everybody can get behind? You would think so, but that's just not true. I'll remind you of our episode on homelessness many years ago.

You know, that one's tough for me to swallow. Those are the people who believed in the unworthy poor, huh? Yeah. And where to send them to alms houses back in the day.

Yeah.

The good news is if you're looking for a home for a family member these days, Medicare dot gov has a lot of resources.

Oh, I'll tell you another place to U.S. News and World Report is really hot and heavy on an assisted living and nursing home ratings.

Yeah, Nursing Home compares another website. And, you know, there are places where you can go to really dig in, see which ones you feel are good fit. They're rated on, you know, how the people are really doing. They're not just like how pretty it is. And if you go and visit one, they said to beware of the chandelier effect, like, in fact, if you walk in and you see a grand piano in the lobby, just turn around and leave.

Well, yeah, that's I mean, that's one of the ways that they get to you want to do a little more digging than just that. And you want to talk to residents. You want to read like actual like inspections and reports on those places. You want to look at stats like how many patients had to be were taken to the E.R. or were readmitted in the hospital. How many have bedsores? Any allegations of abuse? Apparently, abuse has doubled between 2013 and two thousand.

Seventeen, yeah, still low, I think it was like eight hundred and forty five, which is 845 too many, but it's still doubled since 2013. So you want to like really look for that kind of thing. Are they overprescribing medications like for psychosis to people who are who are problematic when you don't really think they're problematic? There's a lot of stuff you want to look for that you can look for that's out there. Just do some digging because this is somebody you care about.

Don't forget. Yeah.

And we really want to point out that it's easy to zero in on things like abuse cases and unnecessary medication. But we really salute you if you are the lion's share of these people that are and nurses that are taking care of our seniors and doing a great, great job in a very, very tough job. Yeah.

And one of the things actually I saw I'm glad you said that was that it's a really thankless kind of job because traditionally people who work in elder care, like the actual workers, are treated like garbage by management. It's just like an industry wide problem.

And that was actually one of those things from the Eden alternative, was that workers are treated with the respect that you want the workers to treat the patients with, like everyone is treated with respect and dignity, not just ideally the patients, the workers, too, because they deserve it for the work they're doing. It's amazing.

You got anything else about nursing homes?

I got nothing else we can do. Better start thinking about stuff, you know? I mean, you're never too young to get a plan in place. That's all I'm saying.

Great point. And since I said great point, it's time for listening.

I mean, maybe if you're like twenty five, you don't need to be thinking about your nursing home options. Okay, but you know what I mean.

Well, not necessarily your parents or grandparents. I saw that 17 percent of nursing home residents were under 65. So there are some younger residents in there that I think get overlooked a lot like by us.

You know, you call those people, what, the party crowd?

That's right. That's going to be me, man. What the party crowd at the at the nursing home. I'm going to be mixing it up like Scatman Crothers in the Twilight Zone movie. I could see that it's going to play kick the can everyone. It's midnight. It's time, time to take off that gown and live.

Good things happen. You ready? I'm ready. All right. Away, uh, I'm going to call this one gets follow up.

OK, this is a good one about the great, great Steve Guttenberg. I'm hoping someone throws this stuff his way, by the way. You know, he needs to know I can feel him right now listening to.

All right. This from Dave. Hey, guys, on a recent episode, you discuss the episode of Party Down, which the wonderful Steve Guttenberg allows the caterers to throw a party at his house.

You knew this had come up before and wondered in one episode in what context? By chance, the next day I was scrolling randomly through older episodes and selected Barefoot Running Boy.

Remember that one was a rough one when in this episode he started talking about Steve Guttenberg.

I had an intensely existential experience.

I was listening in the present to you talk about Steve Guttenberg in the past, having listened in the more recent past to you.

Also, for more from a more recent past, talk about Steve Guttenberg, unable to remember the more distant past which you were talking about, Steve Guttenberg, which I was now listening to in the present, which knowledge of the future in which you would again discuss Steve Guttenberg, Steve Guttenberg, the center of our cosmos, the nexus around which space and time and God's world.

And so they become one. The answer to this question for which our souls cry out. I can only speculate. Yes.

Anyway, I want to let you guys know in which previous episode you featured Steve Guttenberg. It's great as to the context. There was none. You started talking about Steve Guttenberg for no discernible reason. It sounds like me. Yeah.

Which is as it should be. And that is from Dave. And Dave was very excited that this is getting ready. And he said, to be honest, I had a little bit to drink when I wrote that.

And I didn't, uh, fully I remember the whole experience. So good job. Oh, you would be proud. Yeah.

Uh, I think Dave's going to be part of the mixing it up crowd at the nursing home to be kicking that can. Yeah, well, thanks a lot, Dave. That was pretty great. Um, and if you have something great to tell us, especially if it's in reference to something we said about something we said in the past, we'd love to hear from you. You can send us an email to staff podcast and I heart radio dotcom.

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