The Importance of Words & More About the “Elder Justice Past, Present and Future 2022” Conference in Albany, New York


Dave Kingsley

“Words Matter!”  Has This Important Message Become Trite and Banal?

Words do matter but does anyone in the “nursing home system” really care about the importance of linguistics in the political process – a process crucial to how we care about people in skilled nursing facilities. Let’s take the terms “resident,” “home,” “memory care,” “the elderly,” and “low net income,” as examples of commonly used words and phrases injected into the stream of communication about Americans institutionalized for lengthy periods in medical facilities. 

In leveraging government on behalf of special interests, lobbyists commonly use words, phrases, and aphorisms as major instruments for moving legislators to give them what they want and to quell resistance from adversaries.  The terms I mentioned above pertaining to skilled nursing facilities are inappropriate for describing reality. Nevertheless, advocates, media, and the public in general have failed to appreciate the potency of these terms in guiding politicians’ voting and oversight activities.

I do want to reiterate what I told attendees at the Albany conference last week – the so-called “nursing home” system is all about politics.  To call institutions for long-term medical care “homes” is to engage in a political act.  At the very least it is an act that validates and legitimizes political acts undergirded by propaganda.  To ignore a meaningless and misinforming term like “low net income” is to reinforce the use of corporate finance terminology for justification of inhumane and medically unethical treatment of human beings.

The 800-Pound Gorilla in the Room that We All Too Often Ignore

The all-important political process and the blatant use of propaganda by a powerful and wealthy industrial lobbying system is the 800-pound gorilla in the room that is commonly ignored by media, advocates, and professionals.  To be fair, professionals working for government agencies such as CMS are constrained by the increasingly corrupt nature of politics and the pressure from legislators that can be brought to bear on them if they stray into taboo territory.  Nevertheless, I think that professionals in these regulatory agencies are far too compliant and passive in the face of industry political pressure and the cheating, lying, and stealing it generates.

The American Health Care Association (AHCA) as just one piece of the conglomeration lobbying congress on behalf of SKN profiteering is extremely well-funded.  With an annual revenue of $30 million and the better part of a century of practicing propaganda, the AHCA can summarily steamroll advocates in Washington and in the statehouses of the 50 states.  They have borrowed the “big lie” principle from Goebbels – tell a lie so big and so preposterous that the masses believe a person wouldn’t tell it if it weren’t true.  What is the main big lie?  It is this: “Although it is a losing proposition financially, highly sophisticated investors are investing in Medicaid funded SKN and need more government help to survive.”

Although I put quotes around the above lie by practiced liars like Mark Parkinson, AHCA CEO, that is not exactly how they phrase this masterfully scurrilous lie.  But a continuous implication that operators are making a very low to nonexistent return on their investment, can only lead to an inference that SKN on a long-term basis is not a good investment.

The Need for an Advocacy Narrative & Strategy

For the past decade, I have been hectoring my colleagues in the LTC/SKN advocacy community to develop a narrative and political strategy of their own because they have none now.  Legislative hearings, publications, media, and other forms of communication I have observed suggest to me that those of us attempting to change the god-awful, “nursing home” (so-called) system need to come together and design the frames and narratives for countering industry propaganda and legislator corruption.

For instance, I have yet to see coherent, effective, frames and narratives regarding the industry’s financial prowess employed by anyone at legislative hearings.  The industry only needs to continue its “low net” big lie for justification of how we treat patients in facilities because an opposite narrative is nonexistent.  There is no doubt that plentiful amounts of capital are flowing into the system – much of it from taxpayers – and excessive amounts of cash are flowing out at the expense of decent, humane care. 

I will continue to hector leading advocates, activists, and professionals to take the necessary steps to consider the importance of narratives and political strategies and to take further steps to work together to develop narratives and effectively utilize them in the political process.  I may be whistling in the wind, but if you continue to watch this blog, I will be writing about propaganda, narratives, and the politics of poor medical care.

What Has Reaganomics Wrought?


Dave Kingsley

“In the Age of Show Business, Public Discourse Has Become Dangerous Nonsense” Neil Postman in Amusing Ourselves to Death

Shareholder Value is the Only Value:  Even the Taxpayer Funded
Life & Death Care in the Healthcare System Has been Reduced to a Matter of
Return on Investment

Welltower, Inc. – one of the major players in the senior living industry – states in its annual report to the Securities and Exchange Commission that the company’s primary goal is to “protect and enhance shareholder value.”  Although Welltower is a dominant force in the taxpayer funded, skilled nursing and long-term care system, nothing is mentioned in company financial reports about a duty to provide ethical medical care to patients.

I consider these nursing home corporations to be no less evil than corporations in the fossil fuel industry, tobacco industry, and the assault weapons industry.  Like big oil, big tobacco, and big firearms, they value people only as consumers with little to no human worth other than parting with their money for the benefit of investors.

Unlike the tobacco, fossil fuel, and gun industries, nursing home corporations earning extraordinary returns from taxpayer funded medical care are excused for their pervasive patient neglect and abuse by carefully selected members – often naïve academics or industry shills – of various commissions (e.g., the recent National Academy of Sciences and the COVID-related Mitre Corporation Commissions).  Without any empirical, scientific, justification, the industry’s propagandistic claims about skimpy Medicaid reimbursement are taken at face value in the media and generally by the public.  The industry has a richly funded a very effective PR machine.

Unquestioned misinformation – whether intentional or unintentional – is creating a crisis in American governance and the well-being of residents.  The anti-vax, anti-science, assault on the public health system during this era of COVID has long been in the making.  What has become known as proofiness (or truthiness) has polluted public discourse.  I have spent untold hours collecting, organizing and analyzing corporate financial reports submitted by nursing home corporations to state and federal agencies.  Much of it is fraudulent, much of it is financial machination, and much of it is laughably ridiculous, but hardly any of it is seriously questioned. So, deadly conditions in nursing homes continue unabated.

“Nihilism, the devaluation of the highest values of Western culture.”  Ashley Woodward in Understanding Nietzscheanism

Ronald Reagan Propelled a Destructive Economic & Social Philosophy Forward Through Government Policy:  Trumpism is the Apotheosis of Reaganomics

The previous post by Kent Comfort chronicles the economic revolution that commenced with the Reagan Administration. This post addresses the values wrought by the economic superstructure described by Kent.  A deep dive into philosophical movements that seeped into the American zeitgeist along with Friedman/University of Chicago radical free market nonsense is beyond the purview of this post.  Suffice it to say that Ayn Rand’s philosophy of selfishness, dog-eat-dog capitalism, and Nietzschean ubermensch (John Gault) seeped far deeper into the American zeitgeist than is readily apparent to most observers.  Along with the Randian virtue of selfishness, the nihilism and rejection of Enlightenment values of the postmodernist philosophical movement became de rigueur among intelligentsia – eventually on the right of American politics.

The changes we’ve seen entrenched in U.S. culture over the past 40 or more years can be characterized as the triumph of self-interest over public interest and community, the prevalence of wealth and power over equality, and the weakening of science engendered by disregard of and disrespect for reason and objectivity.  We are in a post-truth age characterized by deceit, manipulation, and cheating without accountability.  Any claim based on pseudoscience is deemed legitimate – especially if it is legitimated by journalists, politicians, and influential voices in academia.

In the winner take all, survival of the fittest, milieu, it is OK to spout falsehoods and engage in practices that would have been otherwise unethical and unacceptable in the pre-Reaganomics era.  Lying, cheating, stealing, and preying on the vulnerable and weak can be justified by absolutist beliefs in abstract principles.  In its most extreme form, Reaganomics is conflated with Christian fanaticism and right-wing, proto-fascist political movements.  Furthermore, extreme principles of the movement include total deregulation and dismantlement of the administrative state except insofar as it can further a free-wheeling corporate state.

In post-truth America, shareholder value as the highest value of business enterprise, doesn’t need to be justified scientifically as beneficial to the American people in general.  Universal human rights of equality and fairness handed down to us from the Enlightenment have been devalued while the powerful and wealthy leverage their power to degrade democratic processes and direct more and more economic resources from the middle- and low-income classes to themselves.  In the long run, we will see an increasing amount of tragedy and farce detrimental to the future of the planet and all living things.