Nursing Home Alert: Reliant Care Management, LLC

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Dave Kingsley


The Center for Health Information & Policy (CHIP), our nonprofit research arm, has issued a nursing home alert that we believe will be of utmost interest to our readers. CHIP has developed a nursing home data analytics system by organizing data sets available from the Center for Medicaid & Medicare Services. With that capability, we will inform the public about the good, the bad, and the ugly facets of the U.S. nursing home system on an ongoing basis.

NURSING HOME ALERT!            NOVEMBER 4, 2024

RELIANT HEALTH CARE, LLC: AN EXTREMELY LOW PERFORMING MISSOURI NURSING HOME CHAIN

    Reliant Care Management, LLC owns 21 Medicare & Medicaid funded skilled nursing  facilities in the State of Missouri – four are in the Kansas City Metropolitan area.  In our work across the United States in cities, counties, states, and regions, we have not encountered a chain with  lower federal ratings on quality of care. In this alert, we will lay out the case for a high level of concern among families, ministers, social workers and others who might have an occasion to find a skilled nursing facility for a loved one or a client.

LOOK FOR THE RED HAND

    The Center for Medicare & Medicaid Services as the federal regulatory agency for Medicare and Medicaid funded skilled nursing has a complicated rating system for each facility that ranges from l for low performing facilities to 5 for high performing facilities.  Facilities with a rating plus a red hand have incidents that present a danger to patients.  It is rare for a chain of even a few facilities to have more than one red hand.  Nevertheless, of the 21 Reliant facilities 9 have a red hand (see table below).

    Red hands are signs of poor quality of care.  In addition to incidents that place patients in immediate jeopardy, ongoing neglect often occurs due to a lack of adequate staffing.  Nursing staffing is measured by the number of nursing hours per resident day (HPRD).  The current average of the 14,516 skilled nursing facilities in our data file is 3.8 (3 hours & 48 minutes) HPRD for RN, LPN, and CNA staffing – which most experts agree is far too low.  Nevertheless, nursing homes with an HPRD of 2 or less are quite rare – only 7 tenths of 1 percent or 103 out of 14,516 facilities.

    As the table below illustrates, the hours per resident day column indicates that Reliant facilities are extremely understaffed (“HOURS” was somehow deleted from the column – it should be “HOURS PER RESIDENT DAY”).  Indeed, HPRDs in the low 2s and 1s for an entire chain is appalling.

*According to CMS, a Special Focus Facility has, “More problems than other nursing homes (about twice the average number of deficiencies),” More serious problems than other nursing homes,” and “A pattern of serious problems that have persisted over a long period of time.”

**Special Focus Candidates:” Not quite bad enough to be a Special Focus Facility yet but moving in that direction. It is truly phenomenal to see a chain of this size with one SFF and two SFF candidates.

THE NURSING HOME CLASS DIVIDE AND THE RELIANT BUSINESS MODEL

    If you’ve seen one nursing home, you’ve seen one nursing home.  If you’ve seen one nursing home chain, you’ve seen one nursing home chain.  If you’ve seen one state nursing home system, you’ve seen one state nursing home system.  Nevertheless, similarities in patterns and practices can be seen in the SKN/LTC system.  For instance, some chains accept Medicare but not Medicaid, some accept Medicaid and Medicare, some have very little Medicaid while others have mostly Medicaid as a payor.  The amount of contract labor used, and the price paid for it varies from chain to chain and so forth.

    With 90 percent of its bed days reimbursed by Medicaid, Reliant has an extremely high number of patients who are in long-term care and too poor to pay out of pocket.  The company runs mostly large facilities (120-250 beds) and a small proportion of small facilities (approximately 60 beds). Bed size varies between and within chains.  However, the pattern we see is this:  the larger facilities in number of beds tend to be in poorer neighborhoods and serve a disproportionate number of Medicaid patients.  We have also noticed that these “big” facilities with mostly Medicaid bed days tend to be rated lower in CMS Nursing Home Care Compare quality measurement system.

Some Significant Reliant Financial Information:

  • Average bed size of 113.5 (versus 90 nationwide but Reliant has a mix of a few small and very large facilities).
  • Patient revenue: $161.6 million

  • Net operating income: $3.3 million

  • Payments to Home Office & Wholly Owned Subsidiaries:  $28.8 million

  • Reliant owned businesses supplying goods and services: management, therapy, pharmaceuticals, medical supplies, laundry subsidiaries (real estate side of the business is unknown at this time due to a lack of information)

  • All therapy services are contracted out to Reliant owned therapy subsidiary

  • Reduced labor costs through extreme low staffing and below average wages

WHO OWNS RELIANT CARE MANAGEMENT, LLC AND WHAT ARE OFFICIALS AND AUTHORITIES DOING ABOUT THIS CHAIN?

    According to CMS ownership records, Reliant is owned by one individual – Mr. Rick DeStefane (see, e.g.: Find Healthcare Providers: Compare Care Near You | Medicare).  Information (perhaps PR and propaganda) about Mr. DeStefane can be found on the Reliant website (Rick DeStefane | Reliant Care Management, LLC | St. Louis).  We cannot be a judge of Mr. DeStefane’s character.  We can only ask why his SKN/LTC facilities are rated lower than even some of the most scurrilous chains we have analyzed.

    We would also ask Mr. DeStefane to show the taxpaying public Reliant’s consolidated financial reports, e.g. income statement, balance sheet, and cash flow statement.  We have no idea the extent of personal wealth accruing to Mr. DeStefane and his family’s assets but we believe that the public has the right to know.  Our federal and state governments have failed the public by allowing nursing home providers to hide their finances. 

    What are Missouri and federal legislators and regulators planning to do about Reliant? Are they even tuned into the ratings discussed in this bulletin? What are local politicians, health departments, ministerial alliances, and other individuals and organizations with an obligation to protect the vulnerable aging and disabled populations with a need for institutional nursing care doing about Reliant?  Certainly, it is not OK to allow nursing homes this bad to operate below the radar.

Shame on the New York Times and Their Phony, Baloney Polling Enterprises

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Dave Kingsley

   As a political scientist trained and experienced in statistics and psychometrics, I’m appalled by the by the lack of professionalism and scientific integrity in media polling enterprises such as the New York Times Quinnipiac and Siena college polls.  For instance, the contents of an article appearing in the New York Times today (October 11th) under this headline (above the fold): “New Poll Shows G.O.P. Edge to Seize Senate” is terribly irresponsible journalism.  These down and dirty little polls are nothing more than pseudoscience and charlatanism. They serve the need of print media to attract interest and sell advertising.  Unfortunately, they also influence public opinion and voting behavior.

    The polls at issue in the article pertain to the races of  Democrats John Tester in Montana, Collin Allred in Texas, and Debbie Marcasel-Powell in Florida.  Based on a faux-scientific “Times/Sienna” boiler room calling operation and some mindless mathematical calculations, the article headline on page A9 blares “New Poll Shows the G.O.P. With an Edge to Seize Control of the Senate.” 

    The implication is that Tester and Marcasel-Powell are finished, and, therefore, the Republicans will take back the Senate.  This article will certainly put some wind to the back of the Republicans.  A couple of hours after I read the article in my print edition, I saw and heard anchor person Anna Cabrera on MSNBC ask a field correspondent if “the race was slipping away from John Tester.”  He indicated that it indeed did seem that way.

    Commonsense should tell us that a poll accompanied by an article indicating that an election is all but settled a month out from that election discourages one side or the other  from supporting the predicted loser in the form of money and/or volunteer effort.  Worse than these effects on political behavior are  the noise and confusion injected into public discourse by the proliferation of unscientific polling businesses.

    The unbelievable increase in pollsters has poured a stream of noise into public discourse that contributes nothing to enlightenment regarding policy. Rather they cause unnecessary worry, anger, discouragement, and mindless conformity. The results of a recent study in the International Journal of Public Opinion suggests that poll results cause a “bandwagon effect” on voting behavior.  Other research validates this by showing that the normal human tendency to conform – often subliminally – leads to support for the candidate who is presented as the likely winner in polls.

    Pollsters add a patina of science to their nonsense by a mindless calculation they call the “margin of error.”  From the perspective of statistical theory, their understanding and interpretation of their simplistic calculations are laughable. Nevertheless, talking heads on every major news outlet parrot this nonsense by repeating something like “that is within the margin of error.” 

    NOTE:  See the post accompanying this post if you are interested in a slightly technical explanation of what pollsters call “margin of error.”  If you don’t want to take time to work through the explanation, I fully understand that.  You can take my word for it.  I’ve taught it.  I’ve applied it in my own research. And I can tell you with absolute certainty that the New York Times and their little-known colleges looking for branding are misusing statistical theory that has little to do with the kind of gross error involved in the political polling business.

    The New York Times isn’t engaged in science as they would have you believe. They are creating a narrative that they hope keeps you on the edge of your seat, your eyes on their newspaper (and advertising), and anxiously awaiting the next poll.  Nothing sells like fear and anxiety.

    How arrogant is it for journalists and media outlets to act as soothsayers and intermediaries in U.S. elections by predicting who is likely to win an election based on their faulty form of data collection and analysis?  Their job is to tell the truth as best they understand it.  They should not be engaged in reporting their own bad science and influencing elections.

    As Neil Postman warned us a few decades ago in his classic little book Amusing Ourselves to Death, “In the age of show business, public discourse will become dangerous nonsense.” And thus, it has.  So-called political polling does nothing more than add more noise in the stream of noise that now constitutes political discourse.  Noise becomes really dangerous when it is passed off as science.  In the current climate of scientific nihilism, any ridiculous claim to scientific legitimacy can be made palatable with numbers.  New York University Professor Journalism, Charles Seife, put it this way in his book Proofiness: The Dark Arts of Mathematical Deception: “If you want to get people to believe something really, really stupid, just stick a number on it.  Even the silliest absurdities seem plausible the moment that they’re expressed in numerical terms.”

    The Polling “Margin of Error:” Why Pollsters Claim They Get It Right When in Fact They Don’t

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Dave Kingsley

        How many times have you heard a talking head say that a poll result is “within the margin of error?”  It is important for the viewing audience or readers of print media to know that the media is merely parroting nonsense flowing from the polling industry, which is basically in the business of producing junk science.  Unfortunately, media representatives do not understand the simple calculations pertaining to the “margin of error” and how these calculations relate to mathematical theory. It is not the mindless calculations that are wrong.  Rather it is the statistical theory that requires serious thinking that is consistently ignored.

    Aside from the calculations, most explanations of “margin of error” I find on the internet are incorrect.  Talking heads and print journalists certainly do not understand what it means as they report ad nauseum, ad infinitum on pollsters’ never-ending supply of pseudoscience.

     The margin of error is of necessity utilized erroneously when it is applied to political polling.  MSM talking heads and writers don’t understand that the ME is based on theoretical, mathematical statistics and assumes specific conditions, which are not and cannot be met by pollsters. Let me explain.

    Researchers must have strong evidence that a sample from which responses are obtained is selected randomly and is a very close representative of the population from which it is obtained.  Given a scientifically suitable level of randomness, an error rate is estimated at a confidence level chosen by individual researchers.  Typically, confidence levels are set at 95%, which means that if the exact same population was resampled in the exact same manner 100 times, the true population mean would fall within each separate calculated confidence interval 95 out of 100 times.

    The theory from which this is derived is known as the “binomial standard error” which is simply [(p*q)/square root of n]*1.96.

    Where: P is the percentage responding to one option in a poll, Q is the percentage responding to the other option, and N is the number of individuals (respondents) providing a response. 

    The “1.96” value can be explained this way:

     If the poll were conducted 100 times in the exact same manner with respondents from the exact same population, the distribution of results, i.e., p and q would be normal, i.e., like a “bell curve” or what is mathematically known as a Gaussian Curve.  On can expect that under these conditions the population p will fall within ±1.96 standard deviations from the sample mean (p) in 95 out of 100 samples.  It is not the case that there is a 95% probability that the true population p is within ±1.96 standard deviations of the sample p.

    Example:  1,000 responses are obtained through calls to prospective respondents.  Let’s assume unrealistically that exactly 53 percent respond that they will vote for candidate A and 47 percent respond that they will vote for candidate B.  Further, let’s assume unrealistically that those responses are “random” and a representative sample of the population from which respondents are randomly selected. The ME for that sample would be:

    The correct mathematical interpretation of this result would be that the estimated true population mean for p is  .53 ±.031 or between .561 and .499 or, conversely one could assume that estimated  mean for q is .47±.031 or between .501 and .439.  However, that estimated p could be one of the 5 out of 100 samples in which the true population p falls outside of the estimated range. 

    In a presidential election, it is very easy but meaningless for a pollster to say they got it right. They hedge well because presidential elections tend to be close.  It is hard to imagine that the results would be 56.1 percent to 43.9 percent in any presidential elections held today.  Therefore, if pollsters overwhelming suggested that Hillary Clinton would win but she lost, they can always claim they weren’t wrong because the results fell within the margin of error.

 THE PRESIDENT & UNENLIGHTENED APPROACHES TO ELDERHOOD.  HOW DID IT COME TO THIS?

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Dave Kingsley

    As Americans, we are instilled with the idea that we are the most enlightened and advanced society on the planet.  That may be true in some matters, but when it comes to biological aging it is patently false.  I’m not saying that most of the other societies of the World are more enlightened in the understanding and treatment of serious physical decline in the later stages of life, but we need to take a hard look at what we do in our families, nursing homes, politics, and other institutions.

    Let’s take the current imbroglio involving President Biden as a case study in how aging people and the people who surround them create a seriously dysfunctional and hurtful situation – indeed a heartbreaking situation that is resulting in humiliation to a man and his family because of past and ongoing family, media, and political irresponsibility.

    The biology of aging cannot be ignored – should not be ignored. This is especially true when the symptoms of clinical frailty are glaringly obvious as they have been with President Biden for the past two years.  I was aghast at noticeable changes in his appearance, movement, and speech.  I watched him closely on television and looked at video of his speeches in 2020.  The changes were palpable. 

    Cruel, agist jokes and snide remarks on late night television and in conversations I was having seemed to be on the increase.  The President ignored what so many people could see but couldn’t understand, or at least they couldn’t understand how to discuss it and deal with it appropriately.  The people around the President out of ignorance or venal political motivation rationalized, denied, or repressed the obvious when they had a duty to confront the president responsibly and compassionately.  All the political elites in the President’s circle had a responsibility to do the same thing.  It shouldn’t take a whole lot of brilliance to know when to consult geriatricians and neuroscientists.

    Unfortunately, politics in the United States have become increasingly characterized by delusion, narcissism, and self-interest over the public interest. Politicians are far too often deluded and overcome with narcissism.  The attitude is “what’s in it for me politically?” not “what’s my duty to the country?” I write this with the New York Times sitting on my desk with an above the fold headline: “Top Democrats Swallow Fears and Back Biden.”  Senate Majority Leader Schumer is quoted as saying, “I’m with Joe.” Congressman James Clyburn stated, “We are ridin with Biden.”

    This is despicable behavior on the part of two of the most powerful leaders in the Democratic party.  It is also an example of how congress is failing the American people.

    The president of a business corporation, a nonprofit, or a university would be asked to retire under the same set of circumstances – probably privately and compassionately.  Indeed, a few years ago the Chancellor of the University of Kansas was asked to step down because of confusion and lapses of memory due to aging.

    But the President’s top advisors and the First Lady are doubling down on their irresponsible claims that he can run a grueling race for President and serve our country for the next four years and a half years.  He cannot do that.  He won’t be fit to take office and carry out one of the most important jobs on the planet.  To say otherwise is sheer folly and dangerous.

    What we are seeing is sad and tragic.  It should never have come to this.  No doubt, the President’s opponent is a dangerous man leading a dangerous movement.  That is a primary issue in this looney political race.  But the American people deserve better than what is currently shoved down their throat on both sides.  Ordinary people can see what is happening.  The danger is that they might not show up to vote and a man will be elected who will do so much damage that the country will never be the same – in a negative way.

Supreme Court Decision in Loper Bright Enterprises v. Raimondo:  A Blow to Americans’ Health & Our Democracy as We Know It.

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Dave Kingsley

Free Rein for the Increasingly Powerful Insurance Industry in the Increasingly Privatized Medicare & Medicaid Programs

    Make no mistake about it, the Supreme Court this week in Loper Bright Enterprises v. Raimondo and Relentless v. Department of Commerce [1] handed over supreme power to the corporations of America.  These decisions didn’t just weaken federal agencies, they gutted them. OSHA, CMS, EPA, NLRB and other major regulatory agencies have been incrementally weakened for decades through legislation and raw political power. These cases are the coup de grace for our mortally wounded regulatory agencies.

    In the massive healthcare sector of our economy – funded mostly by taxpayers – major corporations will now be able to ride roughshod over the rights and needs of beneficiaries who have paid for and earned qualification for benefits.  For instance, UnitedHealth, which has exploded to the top of the Fortune 500 in a mere two decades and other insurance behemoths can continue their takeover of Medicare and Medicaid, reduce care, increase cash flow, and ignore attempts by HHS to rein them in.

    Any attempt at regulation by CMS will be challenged in court.  It is likely that regulators will lose.  No matter how rational, technical and scientific the agencies’ arguments are, the Supreme Court will have the final say.  Although nine justices on the court do not have the expertise, the resources, or the time to make appropriate decisions that congress and the courts have historically left to qualified experts in agencies, this Supreme Court will hand down decisions based on the majority’s perverse right-wing, religious ideology.   As Justice Kagan wrote in her dissent:

    “Its justification comes down, in the end, to this: Courts must have more say over regula­tion—over the provision of health care, the protection of the environment, the safety of consumer products, the efficacy of transportation systems, and so on. A longstanding prec­edent at the crux of administrative governance thus falls victim to a bald assertion of judicial authority. The major­ity disdains restraint, and grasps for power.”

    Make no mistake about it, that power will be exercised on behalf of UnitedHealth, CVS, Cigna, Molina, the Ensign Group and any other corporation wanting relief from government oversight.  We are already seeing this in the American Healthcare Association’s judge shopping suit against CMS for regulations requiring adequate staffing in nursing homes (through their Texas affiliate).

The Philosophy and Structure of the U.S. Constitution Provides Ultimate Power to the People – not to the Biggest Corporations & Six Ideologues on the Supreme Court.

    The people pay the taxes to fund government healthcare and elect representatives to enact and implement programs such as Medicaid and Medicare.  And I believe we the people still have the power – if we are willing to exercise it. Last week I was speaking to the National Association of Attorney’s General/Medicaid Fraud Control Units Association in San Diego.  My evaluation of the nursing home industry is not complimentary to say the least. At the end of my talk, I was asked what could be done about the scurrilousness of this industry.  My answer to that is first things first: expose them. Expose them to the media, expose them to legislators, expose them to colleagues, friends, and neighbors.  The American Healthcare Association (AHCA) and LeadingAge perpetually lie and propagandize about finance.  In my view, the pushback on their claims about low nets and thin margins needs to be stepped up. 

    Anyone can see the income statement, cash flow statement, and balance sheet of the Ensign Group – it is public.  Attorney General Jame’s suit in New York exposes a cabal of investors who are not required to disclose their consolidated financial statements.  The Ensign Group has over $500 million setting on their balance sheet – that is double what they had a couple of years ago.[2] The New York AG’s suit against Comprehensive at Orleans indicates cash extraction of 22% on $86.4 million in revenue over approximately three years.[3]

    Does anyone seriously doubt that these examples are exceptions in the whole scheme of things?  They are not.  We have plenty of other evidence to undermine the lies of AHCA and LA.  We need to put that in the face of legislators.  Organize, organize, organize, and relentlessly shove information at Senators and Congresspersons.  No doubt, the majority on the Supreme Court will do what we know they will do.  It will be ugly.  But they need public support to remain legitimate and survive as a credible juristic institution.  If the court continues down its current path, the citizens will eventually change the court.

[1] 22-451_7m58.pdf (supremecourt.gov)

[2] See their 2024 10K filing with the S.E.C. here: https://investor.ensigngroup.net/financials/sec-filings/default.aspx

[3] https://ag.ny.gov/press-release/2022/attorney-general-james-sues-orleans-county-nursing-home-years-fraud-and-resident

The Choice between a Humane Health Care System or an Industrialized Medical System for the Benefit of Shareholders & Executives: What would the People Choose?

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Dave Kingsley

    Elites sneer at the idea that people in general are intelligent enough to make good decisions in democratic elections. This is a disgusting and ill-informed attitude mostly aimed at the middle- and lower-income classes. But historical evidence indicates that people en masse are not as dumb as the self-anointed educated class and the mainstream media would have us believe. 

    Hubris and ignorance on the part of political elites and the intelligentsia have led pollster charlatans, journalists, bureaucrats, and politicians to assume that public opinion is little more than clueless folderol, rife with nonsensical conspiracy theories.  In so many ways, the “people” are viewed by the affluent and college educated classes and opinion influencers in the media as “lesser thans” and “lower types.”

    Machiavelli knew better. As he wrote in Discourses on Livy, “But as for prudence and stability, I say that the people are more prudent, more stable, and better judges than a prince. And not without reason is the voice of the people compared to that of God, for popular opinion has been seen to predict things in such a marvelous way that it is as if some occult power[virtu] enables it to foresee the evil and the good that may befall it.”[1]

    Harry Truman knew better. Among other issues, he ran on the principle of universal, single payor health care and won. Elites, pollsters, and journalists predicted that he would lose in a landslide.   We didn’t get the health care – thanks to the bigotry of Southern Democrats – but we got the people’s opinion about government’s role in medicine for the masses. There is no evidence that it has changed.[2] 

    Women fighting for reproductive rights know better and are winning ballot measures to enshrine those rights in state constitutions across the U.S. Extremist conservative legislators are consistently trying to undermine the efforts of citizens for a “right of choice” through anti-democratic legislative maneuvers.

    In Missouri, where I live and where the Republican majority in the legislature has gone extremist right-wing bonkers, Medicaid expansion was passed by “the people” through a referendum.  Ballot measures on reproductive rights and a minimum wage will be on the ballot in November and will likely pass.

    Oracles from left-to-center-to-right elitist political ingroups were shocked when voters from so-called “red states” voted to enshrine reproductive rights of women in state constitutions.  The media – all the media from right to left – would have you believe that we are a “divided nation.”  We aren’t. But that story is good fodder for television and newspapers.  The truth is most Americans share the same values and want the same things from government.  The broad middle (the overwhelming majority) of the voting public can best be described as ambivalent with some conservative views and some liberal views – mostly commonsensical views.

    I will stipulate that a pathological, narcissistic-sadistic fascist was able to win the electoral college and become president – but like every other Republican since George H.W. Bush he didn’t win the popular vote. He lost by an even wider margin in 2020.  Furthermore, many counties in states like Pennsylvania that Barack Obama won in 2012 by an overwhelming margin flipped to Trump by a wide margin in 2016.  I believe there is an explanation for that – which is ignored by the media and political intelligentsia.

In this Age of Show Business, the Role of Media is to Entertain You – Not Inform You.

    No doubt, in a country with a population of 334 million people (231 million are 18 and older) [3] and 161.42[4] million registered voters, an unstable tyrant can round up tens of millions of ardent, true believer followers. Given the spread of mental illness, fractured egos, instability, financial stress, and other psychologically damaging stresses of toxic capitalism, it should come as no surprise that a demagogue could and would come along and with the help of the MSM drive the electoral process into nonsense and chaos. 

    This should be even less surprising when the demagogue’s persona is the creation of NBC, which is owned by Comcast, one of the most powerful corporations in the oligopolistic media industry. It was, therefore, the mainstream media that led a significant mass of busy stressed-out people into believing that Trump was a kick ass, savvy businessman who could and would straighten things out and lessen their pain.  For years, he was a corporate created caricature foisted onto unwitting and economically hurting television viewers looking for escape. 

    Since 2015 when Trump descended on the escalator in Trump Tower – and after setting up Mexican immigrants as America’s enemy – the media has feasted on his burlesque politics.  Nothing attracts attention like dangerous cartoonish politicians with slapstickish, outrageous performances.  For nearly a decade, Trump has been a prop for feeding the much needed noisy, shallow product on cable channels, morning talk-entertainment shows, and nightly news. Although we “have nothing to fear but fear itself,” fear plus titillation keeps people tuned in.  The corporate need to enhance and protect shareholder value enhances the value of all Trump all the time on cable political entertainment channels such as CNN, FOX, and MSNBC plus all of the NBC, CBS, ABC, and FOX Sunday talk shows.

    The media is responsible for Trump – not public stupidity.  The media has a vested interest in keeping him going.  The public does not. 

Venal Media & Political Forces with Dangerous, Self Interest Designs Have Hijacked Political Narratives through Propaganda, Chutzpah, and Manipulation

    As we have learned from history, industrialists, media, and other powerful institutions (think religion) with the intent to install a strong man and a fascist movement in power for their own benefit, have the capability to misinform the public about real conditions and move them to participate in their own destruction. Once falsehoods are instilled in desperate and unwitting citizens, it is very difficult to tear them down.   

    As the American people are subjected to another round of election time insanity, the MSM is at it again – minimizing the severe pathologies and dangers of Trump and magnifying real and imagined negatives of President Biden.  In their stressful, busy attempts at survival, ordinary people naturally and unconsciously process signals – memes and narratives sometimes subtle, sometimes not so subtle.  It is to the benefit of media corporations to create and maintain an appearance of normality and a “horse race” so that their customers don’t lose interest.  As former President Obama said last week “behavior that used to be disqualifying is now normal.”

Let “We the People” have Honest Information – not Propaganda – and then Let Us Decide

    U.S. leadership values have dragged mass culture downhill since the post World War II robust and optimistic middle-class and Golden Age of Capitalism (circa 1945-1975). Since that time, the former Republican Party has degenerated into a full-blown fascist movement – a phenomenon filtered out of MSM narratives. It is dangerous for the media to ignore the resilience of fascism [5] and concentration of wealth and power in mammoth corporations and super-rich individuals/families.

    The fascists have clearly laid out their agenda. The MAGA Project 2025 will take the American people to a place where an overwhelming majority does not want to go.  It is a blueprint for dismantling the administrative state, stacking the courts, white supremacist rule, repression of dissent, and oppression of the middle and lower classes.  The healthcare program is misogynistic, religiously fundamentalist, and identitarian.[6]

    None of the theocratically fascist program offered to the American people by the fanatics of a movement that could gain control of government in a few months would pass muster in a referendum on healthcare or any of the other scary elements of Project 2025.  The cruelty of the current healthcare system would become cruel in spades.  I believe that the media should be less sanguine about rising fascism for the sake of appeasing shareholders and provide truth instead of pablum to consumers of television and print publications. 

    Furthermore, the Democratic Party should stop its political poll idolatry and naïve idealism about “working across the aisle” and wage a more robust fight.  The overwhelming majority of the American people can see through all of this political theatre and are disgusted.  Why don’t we just have a national referendum on what the people want?

[1] Niccolo Machiavelli (2003) The Prince and Other Writings.  New York:  Barnes & Noble Books, 182.

[2] David McCullough (1992) Truman. New York: Simon & Schuster, p. 532. It is widely believed by historians and social scientists that the American Medical Association blocked Truman’s single-payer, universal, healthcare program by convincing the American people that it was a slippery slope into socialism.  That’s false.  Southern Democrats killed Truman’s proposal for a national health insurance program that would look like the “Medicare for All” proposals devised by progressive Democrats.  The Democrats with a majority in Congress could have passed Truman’s plan and the AMA could not have stopped it.  However, Senators and Congressmen from the former Confederate States had to power to block any legislation that would threaten the racial hierarchy and plantation capitalism of the South.  When it came to healthcare, he American people in general did not share the Jim Crow agenda of the Southern Delegation. 

[3] National Population by Characteristics: 2020-2023 (census.gov)

[4] Number of registered voters U.S. 2022 | Statista

[5] The Allies defeated Hitler and  Mussolini, but fascism has been quite robust and is now more potent than ever. Consider the strength of Marine LePen’s National Front in France and the results of the recent EU elections.  See also: Richard Wolin (2004) The Seduction of Unreason:  The Intellectual Romance with Fascism from Nietzsche to Postmodernism.  Princeton, N.J.: Princeton University Press.

[6] Project 2025 – Wikipedia:

“Project 2025 accuses the Biden administration of undermining the traditional nuclear family and wants to reform the Department of Health and Human Services (DHHS) so that this household structure is promoted.[18] According to Project 2025, state governments should have the authority impose stricter work requirements for beneficiaries of Medicaid,[23] the federal government should promote the Medicare Advantage program, which consists of private insurance plans,[56]: 464–65  federal healthcare providers should deny gender-affirming care to transgender people, and eliminate insurance coverage of the morning-after-pill Ella required by the Affordable Care Act of 2010 (Obamacare).[18] Project 2025’s healthcare plan would also remove Medicare‘s ability to negotiate drug prices.[18]

Project 2025 aims at dramatically reforming the National Institutes of Health (NIH) by making it easier to fire employees and to remove DEI programs. Conservatives consider the NIH to be corrupt and politically biased.[15]

Project 2025 accuses social media networks—directly naming Facebook, Instagram, Twitter, and TikTok—of jeopardizing the mental health and social ties of young Americans by creating a form of addiction. “Federal policy cannot allow this to continue,” it states.”[56]: 5–6 

If We Forget Our COVID Pandemic History, We Will be Forced to Relive it.

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By:

Dave Kingsley

The COVID Tragedy Was System Failure that Didn’t Need to Happen

    The U.S. health care system, which includes preventative and public health, is complex and dynamic. Unfortunately, this necessary and critical system for the good of the public interest has been declining into catastrophic failure mode for at least two decades. We struggled to manage and survive a systemic collapse of the economy along with medical systems due to an inept response to a deadly pandemic during 2020 and 2021.

    Because private interests had taken precedence over the health needs of the public, approximately 2000 nursing home patients and employees had died of COVID by April of 2022.[1] They are victims of industry greed and neglect, government deregulation, and venal, corrupt, and indifferent politicians.  Given the lack of Trump Administration concern and preparation and given what happened in the Senate Intelligence Committee discussed below, it should come as no surprise that dangerous and destructive conspiracy theories abound. How easy it is to see why government failure has inflamed cynicism among such a widespread number of Americans.

    The previous administration, bureaucrats, and legislators knew that the probability of a plague was high but did not have the capacity to respond when it did happen. Successful response to a rapidly moving scourge requires: (1) a plan, (2) a strategy, (3) adequate equipment/supplies, (4) technology (5) trained personnel, and (6) and competent, honest leadership willing to implement the plan.

    The consequence of a blasé attitude on the part of government in January of 2020 was devastating. There was no plan, no strategy, adequate personal protective gear, enough ventilators, bed capacity and other equipment and supplies needed in a pandemic. 

    The question is why? Public health and infectious disease experts had been warning for decades that pandemics would grow more severe and more frequent (In 1993, global public health expert Laurie Garrett warned us of that in The Coming Plague). Indeed, since the 1980s, we have seen HIV, H1N1, SARS, and Ebola outbreaks spread across the planet. It is not as if there have not been dire health scares in our past that could have informed us of the critical need for preparedness in the future.

Who Knew What and When Did they Know it?

    The CIA was aware of something serious going on in China in December of 2019. The Chinese economy was practically brought to a halt and serious isolation practices were implemented as only an authoritarian government can implement population control. The disease quickly spread to other Asian countries. Singapore, South Korea, Taiwan, and Japan implemented extensive organized and effective prevention efforts. Singapore, South Korea, and Taiwan had prior experience with the SARS epidemic and undertook impressive campaigns to keep the outbreak from overwhelming their medical systems. They succeeded.

  Why were administration officials in the United States so sanguine about a novel virus that prompted massive public health efforts in China and other Asian nations? Even after it was known that a case of COVID had been discovered in a Washington state nursing home, the U.S. government remained unconcerned. Or did it?

    Former Senator Richard Burr, Chair of the Senate Intelligence Committee, was a leading legislative figure in the development of a national plan to thwart pandemics. He was not a neophyte in public health policy. Nevertheless, having been present at a “closed door” COVID19 briefing presented by the Trump Administration National Security Council on January 24th of 2020, he announced to the public that the virus would be contained and that grave worries about a pandemic weren’t justified.  

    By late February, Senator Burr had dumped stock worth between $628,000 and $1.7 million.. Intelligence Committee Members Feinstein, Loeffler, Purdue, Inhofe, and Johnson also unloaded a considerable amount of stock.[2]  The public was not immediately aware of these financial transactions.  The contents of the briefing have never been disclosed to the public. In a search of the Senate Intelligence Committee website, no evidence could be found that a meeting regarding COVID 19 was held.[3]

    Journalists uncovered an audio recording of Senator Richard Burr, Republican chair of the Senate Intelligence Committee, telling some donors in a private meeting that the coming pandemic could be as serious as the global flu pandemic of 1918. He was not at all as laid back and buoyant as he was in public at that time. The donor meeting occurred on February 27th.[4] 

     At the time Senator Burr was not expressing the same alarm in public he imparted to his close political allies, the President of the United States declared at a South Carolina rally on February 28th – one day after Burr’s ominous statements caught on audio – that the corona virus was a Democratic Party hoax.

    Throughout February and most of the month of March, Trump and his powerful propaganda machine consisting of Fox News, an assortment of well-funded and well-organized Christian nationalist organizations, and most of the Republican Party repeated the corona virus hoax lie. A phalanx of right-wing virus deniers, conspiracy theorists, and Fox bloviators were egged on by the president who at best was recognizing that the disease did exist, but claimed that it was primarily China’s problem and wouldn’t amount to much in the U.S.

Minimizing by the CDC, NIH, HHS, and the FDA at Senate Health, Education, Labor, & Pensions Committee Hearing

    On March 3rd, Trump Administration officials responsible for pandemic preparedness, presented their views on potential threats to public health from the COVID19 outbreak at an open hearing held by the Senate Health, Education, Labor, & Pensions Committee. Dr. Robert Kadlec, Assistant Secretary for Preparedness and Response, HHS stated that, “The potential global public health threat posed by this virus is high, but right now, the immediate risk to most Americans is low. The greater risk is for people who have recently traveled to an affected country or been exposed to someone with COVID19.”

    After the SARS epidemic, Asian countries developed pandemic guidelines for nursing homes. The nursing home industry and HHS/CMS were totally indifferent to the steps taken by countries affected by SARS to prepare for the eventuality of another plague.[5]

Will Our Government Fail Us the Next Time?

    Over a million Americans died during the raging Covid19 pandemic. Nursing homes have been disproportionally affected. Over four years after the outbreak, two major nursing home commissions have avoided direct confrontation with the industry and CMS over lack of preparation prior to COVID and misfeasance and nonfeasance during the Pandemic. Little to no attention has been devoted to the issue of responsibility. As has become a normal response to serious negligence and consequent damage to the public by industry and government inaction, no entities or persons have been held accountable.

    The behavior of U.S. Senators privy to information not available to the public and acting on that information in their interests and to the detriment of the public is disgusting. It is in fact criminal. A flurry of activity by the DOJ, SEC, and Senate Ethics Committee was initiated and then dropped.  No one was held accountable. The government failed the American people, Senators behaved criminally, responsible parties escaped accountability, and the country moved on.

    It is delusional to believe that another scourge is not likely.  Advocates need to begin asking questions about protocols in nursing homes, stockpiling of personal protective equipment, and responsibility of the industry for preparation and administration of facilities during a pandemic.  We are dealing with an industry in which shareholders have intrinsic value and patients have instrumental value. Investors’ mission is to maximize cash flow.  To do that, they will naturally minimize care.  That is immoral and medically unethical.

[1] Over 200,000 Residents and Staff in Long-Term Care Facilities Have Died From COVID-19 | KFF

[2] The Senator Who Dumped His Stocks Before the Coronavirus Crash Has Asked Ethics Officials for a “Complete Review” — ProPublica.  Senator Feinstein sold stock worth $7 million dollars.

[3] https://www.intelligence.senate.gov/, “HEARINGS” tab.  I checked this URL in the Spring of 2020 and could not find any information about the hearing.

[4] The audio of the Senator warning his wealthy supporters about the coming plague can be heard at https://media.crooksandliars.com/2020/03/44593.mp3_standard.mp3. 

[5] (2) Care homes and COVID-19 in Hong Kong: how the lessons from SARS were used to good effect (researchgate.net); see also: https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(23)00062-4/fulltext

The “Budget Busting Baby Boomer Hypothesis:” Bogus Theories and Misguided Bioethicists

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By:

Dave Kingsley

Yes We Can Afford to Care for Babies and the Elderly

    A mere thirty years ago, babies born at 24 weeks weighing 750 grams rarely survived.  Today, 70% of these children survive, thrive, and go home to continue their development as healthy human beings.[1] That is the wonderful side of medical technology.  Keeping pre-term babies alive is expensive – these are the rare multi-million-dollar hospital cases. No doubt, the 0- to 5-year age category includes a large proportion of the highest cost acute care patients.[2] But I believe it is fantastic that medical technology can accomplish that.  I also believe that it is the moral and medically ethical thing to do.

    The 65 to 70 age cohort is the other group with the most expensive hospital charges.  Most of the exceedingly high charges for this age-group are related to heart disease.  Charges drop precipitously for patients past the age of 70.  I discovered this phenomenon while doing research and teaching at Kansas University Medical School and discussed it with famed cardiologist Caldwell Esselstyne at the Cleveland Clinic.  Dr. Esselstyne explained that we were seeing the natural history of a disease – namely atherosclerosis.  Autopsies on soldiers during the Korean War revealed that this disease was well developed in a large number of young adults, which was a revelation to the U.S. medical profession.  Typically, it progresses untreated and results in a crisis by a person’s mid to late 60s. [3]

    The question that has arisen in treating patients with costly medical care is “should we provide or withhold care based on age?” Treating complicated diseases with advanced medical technologies is expensive, but the United States with the most abundant financial resources in the world can easily afford to save pre-term babies and 65- to 70-year-old patients with heart disease. If provided with necessary information regarding the realities of public finance and medical necessity and outcomes, the American people, would, I believe, want to spend whatever is possible, reasonable, and feasible to save and extend life regardless of disease and age.

The Dominant Bioethicist View in Scholarly Debate about Healthcare Justice: Depriving the Elderly of Beneficial Care is Justified

    In the past few decades, a consensus has formed among the most influential American bioethicists that the escalating cost of healthcare in the United States is unsustainable and, therefore, bioethics demands rationing of beneficial medical care.   Rationing of medical care could, in their view, be justified primarily by an individual’s years of future economic productivity and contributions to society. This is a chilling and horrifying mantra within a constricted context of neoliberal economics, erroneous conventional wisdom about public finance, and medical-industrial (Wall Street) narratives.

    Not surprisingly, in the grand theories and scheme of the poohbahs of bioethics, the elderly and Medicare are primarily blamed for running up the cost of cost of medical care.  In an article titled “Rationing Just Medical Care,” [4] Lawrence Schneiderman, a proponent of medical care rationing, has incorporated and summarized the rationale of the rationing movement. Schneiderman states that a “decent minimum of care” would be at a level that “enables a person to acquire an education, seek or hold a job, or raise a family.” [5]

    In Schneiderman’s proposed system, age and productivity are criteria for providing or withholding care rather than individual medical diagnoses and prognoses.  The nature of care for persons with impaired health, unable to meet the three goals for qualifying for expensive, lifesaving, life extending care should, in his view, include “a reasonable level of comfort, whether it be from pain or other forms of suffering.”[6] A person not acquiring an education, seeking or holding a job, or raising a family would be accorded just enough health to ensure “a reasonable level of function within the person’s limits that is respectful of the person’s dignity, as well as a reasonable level of comfort, whether it be from pain or other forms of suffering.[7]

    Schneiderman is speaking for America’s preeminent bioethicists such as Peter Singer, Daniel Callahan, Zeke Emmanuel, and Norman Daniels – to name the top few.  Their utilitarian philosophy is compatible with neoliberal economics and Wall Street claims that Medicare plus an aging population is a major threat to the economic wellbeing of the United States.  Utilitarian ethicists consider individuals and their treatment in the medical system as “means to an end” – a perceived economic “greatest good for the greatest number” – rather than ends in themselves. This philosophical position is illustrated by the quote Schneiderman borrows from economist Paul Krugman:

“America has a long-run budget problem. Dealing with this problem will require, first and foremost, a real effort to bring healthcare costs under control – without that, nothing will work.”[8]

    This is an accurate quote, but one taken out of context.  Krugman also emphasized a flawed tax code, which has become even more obscenely tilted in favor of the wealthy and against the working classes since 2010 when he wrote the opinion piece in the New York Times.  He also refrained from blaming Medicare and the elderly for excessive healthcare spending.  If Krugman were engaged in a serious budget discussion today, he would probably agree that waste, fraud, and inefficiencies in privatized healthcare, defense, and other government programs turned over to industrial complexes are major contributors to federal deficits and debt.

Cruel Capitalism and Wall Street Hegemony over the U.S. Healthcare System:  The Elderly Can be Sacrificed for the Sake of Money

    The bioethics enterprise is dominated by a handful of white male neoconservatives. As their theoretical framework and publications make clear, their views are compatible with the mostly wealthy male financiers on Wall Street.[9] These doyens of neoliberal economic bioethics attack Medicare and fall in line with superrich financiers’ misinformation regarding “entitlements caused” deficits and debt white at the same time they ignore the ravages of privatization on the U.S.  healthcare system.

    Financiers at the top of the wealth pyramid want to distract attention from an obscene tax code, which is fueling deficit spending and draining resources from public health, education, and other major institutions that enhance the quality of a society.  Mainstream bioethicists are a perfect ancillary to their strategy.  The real out of control costs in the U.S. healthcare system is due to the amount of the public treasure funneled into dividends, stock buybacks, and executive/board compensation. Nevertheless, this incontrovertible fact is nowhere to be found in writings of the leaders in the bioethics enterprise.

    Bioethicists like Peter Singer,[10] Zeke Emmanuel,[11] Norman Daniels,[12] and Daniel Callahan [13] have shown a shocking disregard for scientific thinking and science in general.  They have failed to seriously examine their basic assumptions, nor have they engaged in serious data analysis based on medical care data and public finance – they accept the Wall Street narrative at face value. 

    One would think that the role of ethicists is philosophical and moral rather than budgetary and macroeconomic.  But that is not the role they are playing.  They have joined forces with conservative deficit and debt hawks by taking up the invalid argument that Medicare is not affordable; that given the continuing growth of the elderly population and costs of medical technology, the only means of sustaining the healthcare system is rationing – essentially shortening human life for the purpose of reducing costs.

     Daniels, Emanual, Singer, Callahan, and other economic-oriented bioethicists have no original scientific studies of their own to support their claim that a condition of growing elderly cohorts (65+ and 80+), advancing medical technology, and the constraints of limited U.S. wealth on government expenditures is unsustainable.  They rely solely on the Wall Street generated budget busting Medicare myth to make the case that beneficial medical care should be withheld from frail older Americans. Hence, their one solution and primary proposal are buttressed through confirmation bias.

    Callahan, founder of the prestigious and powerful Hastings Center on Bioethics, has stated that he believes the “only reasonable approaches are to concede the greater importance of children and younger age groups for the future than for the elderly and to make certain the economic imbalance does not increase.” [14] This arbitrary ingroup-outgroup construction typifies ordinary prejudice, stereotyping, scapegoating and discrimination that it generates. [15]

We cannot ignore the relationship between the cavalier attitude toward medical ethics in the warehousing and neglect of elderly and disabled “nursing home” patients and the ageism/physicalism of the bioethicists.

    There is no scientific evidence that the elderly are responsible for causing budget deficits and debts.  Conversely, considerable evidence is available to debunk the baby boomer budget busting narrative,[16] which has been ignored by policymakers, the media, and advocacy groups.

    Right wing narratives and political strategies for reducing Medicare and Social Security benefits have been effective and harmful to the well-being of older age groups in the United States.  The harm extends beyond Medicare and Social Security.  It is difficult to claim that patients in so-called “nursing homes” should receive better care than the pervasive neglect, abuse, and warehousing characteristic of the current profit-oriented system when the leading bioethicists are pushing Wall Street narratives.  The elderly have no powerful lobby with the mission of pushing back on the reduction of healthcare to dollars and care for the deserving.

    Unfortunately, the public is led to believe that the AARP is an advocacy group for “retirees,” when in fact over $1 billion of their revenue is from royalties for selling their brand to corporations preying on the elderly while $2 hundred million is from selling memberships.  They need to walk that fine line by burnishing their false image as a pro-senior organization.

    Other aging enterprises such as the National Council on Aging, National Institute of Aging, Area Agencies on Aging, and a plethora of other advocacy groups and organizations spawned by the Older Americans Act have been tepid at best in the fight against excess extraction of Medicare funds by mammoth insurance corporations, medical device manufacturers, pharmaceutical companies, and a host of financial intermediaries.

    Commissions and think tanks on nursing homes have shown no interest in a public discussion regarding medical ethics or the lack thereof in the outrageously poor care of patients.  Instead, I see an implicit sympathy with industry financial hardship disinformation. Consequently, the elderly are vulnerable to euthanasia by neglect – not just in nursing homes but throughout the healthcare system. Indeed, the categorization of human beings as more or less worthy of medical care is eerily similar to the 1930s eugenics movement in the United States – adopted and utilized in Nazi-era Germany as justification for extermination of seriously frail and physically limited people.

[1] Sandra Lane (2015) Why are Our Babies Dying. New York:  Imprint Routledge.

[2] David Kingsley (2015) “Aging & Healthcare Costs:  Narrative Versus Reality,” Poverty & Public Policy, 7:1, 9-15.

[3] Jack P. Strong (1986) “Coronary Atherosclerosis in Solders: A Clue to the Natural History of Atherosclerosis in the Young.”  JAMA, 256(20) 2863-2866; Young Mi Hong (2010) “Atherosclerosis Cardiovascular Disease Beginning in Childhood,” Korean Circ J 40, 1-9.It may very well be that playgrounds and “happy meals” along with double patty, cheese, bacon, hamburgers are a bigger threat to healthcare expenditures than health per se at any age.

[4] Lawrence Schneiderman (2011), “Rationing Just Medical Care,” American Journal of Bioethics, 11-7, pp. 7-14.

[5] Ibid., page 8.

[6] Ibid., page 8.

[7] Ibid., page 9.

[8] Opinion | Budget Deficits: Spend Now, Save Later – The New York Times (nytimes.com)

[9] The late Peter G. Peterson, multi-billionaire co-founder of Blackstone committed over a billion dollars to funding an anti-Medicare and anti-Social Security lobby in Washington, which includes the Concord Coalition, the Committee for a Responsible Budget, and other projects for providing disinformation and misinformation about programs for the elderly.  His lobbying organizations have been effective in injecting a political narrative into the mainstream media.  In his book Running on Empty (2004, New York: Picador), he states that, “whatever reforms talked about – be they more use of information technology or medical malpractice reform – we are going to have to give up some medical care that may be of some benefit,” p. xvii.

[10]Peter Singer,  “Why We Must Ration Health Care” New York Times, July 19, 2009.

[11] Zeke Emmanuel, “Why I Hope to Die at 75,” The Atlantic, October 2014.

[12] Norman Daniels (2013) “Global Aging and the Allocation of Health Care Across the Life Span,” American Journal of Bioethics. 13(8): 1-2.

[13] Daniel Callahan (2009) Taming the Beloved Beast: How Medical Technology Costs are Destroying Our Health Care System.  Princeton, NJ: Princeton University Press.

[14] Callahan, Ibid., p. 218.

[15] On prejudice, discrimination, & scapegoating, see:  Gordon Allport (1989),  The Nature of Prejudice. New York: Addison-Wesley, 243-260.

[16] Kingsley, (2015), Op. Cit.

A Discussion of Morals and Values in Institutional Care for the Elderly:  How we Justify the Unjustifiable: Part I

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By:

Dave Kingsley

Corporate Neglect and Abuse of Nursing Home Patients: A Low Risk-High Reward Practice

    Why do nursing home corporations provide suboptimal and neglectful care while earning robust profits?[i]  Because they can.  Although the “law” is merely the codification of our morals, values, and ethics, it is of little consequence when it is not respected and enforced.  Joe Sopcich’s article that accompanies this post indicates how laws and regulations designed to protect patients in nursing homes are pervasively ignored by providers while agencies of government fail to pursue remedies and hold culprits accountable.

    Joe writes about what desperate family members experience when they seek help from agencies charged with enforcing the rights of nursing home patients and families. This happens to poor and affluent families alike.[ii]  His late  mother was a patient in the skilled nursing facility of a continuing care residential community (CCRC) – one of those retirement places where people can live through and receive services from independent and assisted living to skilled-long-term nursing home care.  The experience described in the article is quintessential.  Neglect of this type is pervasive while agency enforcement of codified patient rights is weak and ineffective.

    The industry benefits financially from lack of oversight and accountability.  Understaffing and low pay results in lower costs and increased cash flow – that is, unjustifiable cost cutting enhances and protects shareholder value. Furthermore, the industry has successfully disseminated and sold a false narrative constructed on a “financial hardship” theme that has no relationship to reality.  Their message is that nursing homes are “running on a thin net,” or earning skimpy amounts for shareholders.  This is nonsense but has not been adequately confronted by advocates and the media.

The Larger Context of Industry Neglect and Government Nonfeasance

    Agencies can fail to hold tax-funded nursing home businesses accountable because the elderly have been devalued by media misinformation/disinformation, junk science, and even by the most prominent scholars and influencers in the field of bioethics. Furthermore, medical technology and science have increased life expectancy while social attitudes toward the elderly have evolved in a rather disturbing way. Older Americans are now seen as a problem for and even a threat to younger age cohorts.

    According to many highly influential economists and bioethicists, the United States simply can’t afford to provide all the healthcare needed by the growing elderly and disabled cohorts in a population of 330 million residents (approximately, based on 2020 Census). Medicare has been demonized as a budget busting monster robbing young people of needed healthcare.  This is not true. Medicare expenditures are not an economic burden and threat to the U.S. economy.

    More disturbing than the harmful misinformation generated by the economists and bioethicists is the lack of interest in and discourse concerning the morals and values of care of such low quality that it amounts to euthanasia by neglect.  This post is the first in a series of posts that will call attention to the nature of a cruel, inhumane, institutional care system for frail patients needing skilled nursing care in the context of current medical and societal values and ethics.  It is the entire money-driven system and the absence of discourse regarding morality that is harming patients and shortening their lives unnecessarily. It is to that issue we want to call attention and about which we want to stimulate discourse.

    Our point of departure in this discussion is the necessity of dehumanizing groups of people before they can be scapegoated and harmed by government policy with the approval of the broader society.

[i] Apart from The Ensign Group, which owns and/or operates approximately 300 facilities, nursing home corporations are closely held.  Therefore, it is not possible to obtain the exact net operating revenue from facility cash flow.  Based on my analysis of cost reports, I would estimate that “free cash flow” or “owners’ earnings” ranges from 10 to 15 percent.  For instance, In 2023, the Ensign Group had net operating revenue of $376.7 million on $3.7 billion in revenue or 10% in free cash flow.  The distribution of earning to investors are increased through avoidance of capital gains taxes.  Furthermore, the operations side of the industry is separate from the lucrative commercial real estate side.  The Ensign Group is sheltering the corporation from capital gains taxes due to property appreciation by forming a captive REIT or by transferring property to an UPREIT.  A large number of executives and investors have individual or family trust for sheltering their compensation and assets.  Black Rock, Vanguard, State Street and other major asset managers are the dominant investors in the Ensign Group, REITs, and private equity groups. See: 0001125376-24-000018 (d18rn0p25nwr6d.cloudfront.net, page 96.

[ii] Joe is the former president of one of the best community colleges in the United States. 

Her teeth were black, she was dying of thirst…and paying $400 per day to live there…

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My KDADS Journal

By:

Joe Sopchich

    This incident occurred in the state of Kansas. I made the decision to reach out to KDADS (Kansas Department for Aging and Disability Services) to report the details of my mom’s experience regarding her care, or rather the lack of care. It was recommended to the family that we make contact with KDADS to report the details of our experience and observations regarding our mother’s care, rather the lack of care. Upon reading this report, you will not have learned much, if anything, about how this agency is supposed to advocate for patients in the confines of eldercare businesses within the state. The descriptions of mission and purpose on their website makes all the proclamations one would expect. Despite the advice of many, I filed my complaint.

The journal of events follows:

January 2023 – I am the patient’s son. I thoroughly studied the KDADS website to learn their required procedures for communicating a grievance. It informed me that upon submitting a request for assistance, I would promptly receive an email that provided a case number to initiate the assistance process.

March 20, 2023 – I forwarded my complaint via registered mail to the KDADS office in Topeka. I followed all the protocols as required on the website.

April 11, 2023 – Having received no acknowledgement from KDADS, I called and left a message that I had not heard from them.

April 12, 2023 – I received a call at 8:50 AM informing me they had not received my complaint. I called the local Post Office, and they said it was delivered at 11:57 AM on March 21. I called KDADS at 10:36 MM to give them the exact date and time of delivery. The person looked for it, found it, and apologized for “misspeaking” earlier. I was told it was assigned to a “surveyor” and once the process was over I would be contacted. I figured my complaint was laying on a desk in the KDADS office for 22 days. A number was assigned to the case, #9003.

May 9, 2023 – Upon receiving no further contact from KDADS, two calls were placed during the day, neither of which were answered.

May 16, 2023 – Again, a call was placed and not answered. I left a message on the recorder. The call was returned at 1:45 PM to inform me that the investigation ongoing. I was provided with the name, email address, and phone number of the KDADS regional manager.

June 22, 2023 – More than one month has passed with no contact or report from KDADS on the status or outcome of the investigation. Another call was placed at 11:00 AM with a message left to ask for an update. The call was returned later in the day, and this time I was informed that a “surveyor” had not yet been assigned, despite being told two months earlier that an investigator was on the case. I was referred again to the regional director. It was three months since I filed my complaint.

June 23, 2023 – Frustrated, I wrote a letter to the Governor’s office including my original complaint and concerns. I never received an acknowledgement.

June 28, 2023 – I called the regional director’s office at 1:40 PM and left a message. The call was never returned.

July 11, 2023 – I received a call from KDADS. I missed the call. I thought maybe the Governor forwarded my complaint to the KDADS office, hence the call.

July 12, 2023 – I returned the call from the day before and again it was not answered.

July 18, 2023 – The call I referred to in the two previous entries was finally returned at 4:45 PM. The person asked, on the recording, “if there was anything they could do.” This occurred almost five months after I submitted my complaint. 

July 19, 2023 – I returned the call again and had to leave a message due to no one answering. The call was never returned.

August 17, 2023 – Six months after filing the formal complaint, another call was placed to the KDADS office at 2:30 PM. This time I was informed that too much time had passed since my mother had expired when I originally filed the complaint. This was the first time I was told there was a time statute for such complaints, despite the fact that a case number was assigned and an investigation had been supposedly launched. I asked her to have the person I spoke with earlier to call me. I never received a call.

October 17, 2023 – I received a call in the late afternoon from the surveyor who had apparently been assigned to the case even though two months earlier I was informed the case was rejected do to the statute. Upon confirming the case number was correct she told me she was about to walk into the SNF facility to examine and review the information on file about my mom. 

December 17, 2023 – Nine months after filing the complaint I received a letter from KDADS informing me that the investigation of the complaint had been completed and the facility was found to be in compliance with regard to all allegations.  The case was closed. The letter also cited various state codifications related to the required confidentially of the findings. They are not available to the public.

All of the dates and details contained in this catalog are accurate according to my recollections. As the saying goes, you can’t make this stuff up. But most important, KDADS once again failed a citizen of Kansas, his loved ones, and, most importantly, my mother. The fact is that in the state of Kansas when it comes to finding accountable care facilities, you are on your own.