I think a lot more people would be willing to swallow the cost of a nursing home, if the loved one was guaranteed proper care and respect.
And let me tell you, I've worked in a lot of nursing homes (not in a medical position), and it doesnt matter how high end the nursing home is, the treatment is the same across the board.
There are ways you can try to tip the system in your favor to increase the chances of getting better care for your loved one.
Visit Frequently. Every Day is best (but if you had that kind of free time you'd probably have your loved one at home instead of a facility). Residents who get frequent, regular visits tend to get better taken care of.
Try not to have a visitation pattern, To avoid staff taking care of your loved one in preparation for that day. If you do have a schedule to visit every saturday, then atleast a few times a month try to pop in on different day at random (and don't make it a pattern)
If your loved one can not advocate for themselves, put a granny cam in the room. You can decide if you want an overt one or a hidden one. Preferably one you can log into from home/where ever and monitor live, though this may require some kind of subscription.
3a) If your loved one can advocate for themselves, make sure they feel safe and secure to tell you any mistreatment/bad things/unacceptable response times they may be suffering. You'd be surprised how hard it can be to get an at risk relative to confess any mistreatment to you.
Be respectful to the staff until they prove otherwise. Sometimes sucking up, and little gifts, and just generally getting to know the staff involved in your loved one will get your loved one better treatment.
Do not hesitate to take issues up with the building administrator. The administrator is the highest authority in the building, and doubly do not hesitate to escalate things to your state oversight agency if the administrator fails to satisfy the issue.
4&5 TLDR) Be sweet and kind to staff, but don't hesitate to be a roaring asshole when needed.
and I want to be clear, none of this will guarantee good/better treatment for your loved one. It just increases the chances of good/better treatment. Some people are just too lazy, cruel, and lack a single ounce of give-a-fuck to care. and some facilities try to cut costs by hiring only people that have all but been blackballed from other facilities, at low wages, because the choice for worker is either continue to use the education and experience they have or start over at even lower wage in a whole new job they know nothing about, which means they are typically at the end of their give-a-fuck. But sometimes you can have a facility run by absolute goddamn angels.. and its too random to be able to predict.
Edit
Oh, and one last thing..if you do have something you need to elevate to regulatory boards, make sure you get photo/video evidence if you can. and I mean of bed sores, unattended diapers, personal diary logs of wait times when the clal nurse button is hit, etc etc etc. Evidence is key.
We were paying double daycare until recently. While it was never inexpensive, it was more manageable when our daycare center was locally owned. Then Kindercare came in and bought 80% of daycares in my major city. When we tried changing daycares we found that many daycares not explicitly named Kindercare were still under the Kindercare umbrella but retained their old name. I guess they caught on.
As SOON as the corporate takeover was complete they started increasing rates 8% per year BEFORE we had high inflation, instituted mandatory annual fees just to enroll, and mandatory fees for supplies that we use to be able to bring but now they charged us MORE than the supplies cost and they were super shitty quality items. So if you wanted to bring in supplies for your kid, you still got to pay the fee for supplies but then also had to buy the non shitty quality ones and bring them in.
To the point of the topic though, what pissed me off the most was that even though we paid 3k/month for two our center started bleeding employees because they simply wouldn't pay them anything. So what this meant is veteran teachers left for more pay and new ones were only there long enough to get experience.
Services are expensive. Where I'm from daycare is socialized but still considered expensive. I imagine a full price in for profit daycare must be brutal.
The USA is just 3 Corporations in a trench coat. And corporations are just pyramid schemes.
People will lose their minds if you suggest giving someone medical care for free, but they keep ignoring all the landlords and CEOs and private equity groups and all the middlemen extracting the vast majority of all the wealth out, while also contributing the absolute least.
The fact that we have a system where one person works every waking minute of their life and still can't afford basic food and housing and another person sits around all day on their 3rd yacht sipping one of a kind wines and rakes in billions is insanity.
I skimmed the comments and didn't catch this, but don't forget about all the PRIVATE EQUITIES buying up nursing home facilities, banking on SSI, Medicare and Medicaid funding, upcharging perscriptions, "maximizing efficiencies" (aka paying as little wages as possible), and the revolving door of customers...
Don't forget those private equities buying up life insurance companies that are being used for dumping grounds for bad loans that'll be bailed out through state-based guaranty funds instead of passing through bankruptcy. In other words, these private equities are using life insurance subsidiaries to offload the risk of bad loans (mostly AI-related) to taxpayers if those life insurance companies become insolvent, which will likely happen when the AI bubble pops.
Thats the billionaires squeezing profits out of every transaction, not just the enrollment fees, the rent on the property, the Healthcare and insurance premiums for the staff and the operation.
Everything they do is being optimized to squeeze wealth Into the mouths of billionaires.
The solution is this: every sector of the economy has been optimized to extract as much money from everyone as possible. This is the implicit role of government--to help the rich get richer. Have an idea that makes money? The government will help you make it happen. Does it materially harm the public, like sports gambling? Then you better make a lot of money to pay off the politicos!
This through-and-through corruption means that we now graduate in lifelong debt, working jobs that don't cover the rent of places we can never own and spend money on health insurance we can never use because we can't afford the co-pays. We are forced to finance expensive car because that's the only way to get to work because the bus routes have all been purchased by car companies and liquidated long ago while regulations keep out cheaper foreign cars for "safety" while massive trucks and SUVs are killing pedestrians and cyclists at record rates. Forced to work longer hours and with less money in our pockets, our third spaces disappear. Now stuck at home, we are forced to buy electronics now at inflated prices because of the AI bubble and use oligopoly internet that should have long ago been regulated as a utility but for the massive campaign contributions those companies make to politicians to have a shadow of a social connection with each other.
It's about money. But a nice side effect is that it keeps the people busy so they have little down time to reflect on why they are in that condition, or more importantly, no time left to take action, as well as the threat that if they do anything, it could endanger their job and life. That's why they don't take away too much from too many, otherwise suddenly those masses don't have anything to threaten and a lot of free time to notice what happened and by whom. Bread and circuses.
It's rent, and advertising. Shit costs so much and yet the landlord's and advertising industry makes ya think it's the cost of labour. I know alot of restaurant owners who work 5 days a week(alot close two days a week) and only vacation once a year just to visit family. they have steady business but still struggle due to costs. Only places I know are doing well are ones who own their building.
First, there is corporate gouging. Anyone owning stocks wants to see a return, not a moderate one but a big one, on their investment.
Second, it isn't a straight one to one employee to patient ratio. 24 hour care is 8760 hours per year and full time work is 2000 (with 2 weeks paid vacation) meaning 4.38 employee years for 24hrs, 365 days. It isn't quite that much because staffing is never 1:1. If it were 1:1, at $20 per hour paid to the caregiver, with vacation, sick days, health care, CPP, EI, WCB, it is a minimum of $58,000 per employee. That alone would work out to $4800 per month without housing, food, cleaning, equipment. It isn't cheap to house people who cannot live independently. We need a different model for care to keep the costs lower while providing care that is necessary.
This used to all be "free" in-home by older women (Boomer, Silent Gen, Greatest Gen) and still often is, if they cannot access care for family members. Much like child care, that again women used to do for 'free", it costs real money to have someone else cover that work.
Labor $200
Land $150
Materials $800
CEO pay and profits $1,000,000,000
Utility $150
someone who is good at the economy please help me budget this. my family is dying
This makes me think of an issue we had around here recently. We have a public company running the majority of school buses in our area. They receive funding from the government that should be enough to pay their drivers around 24$ an hour. Yet, they've been paying them 18$ or less for years.
This year the drivers tried to negotiate for a higher wage and the owners weren't even willing to go over 19$... So they went on strike and buses stopped; parents had to make alternative arrangements. This went on for weeks, the employer just kept playing hard ball and not budging.
Surprisingly, parents were overwhelmingly on the driver's side which I was happy to see. It reached a point where the owners almost had their contract taken away. After about 2 months, they finally gave in and agreed to an increase to about 21$.
What kills me is that in another town nearby with a different company running the buses, divers are being paid 23-24$ an hour like they're supposed to. So the employer still came out ahead after everything was said and done. Apparently, the owners are from Toronto (about 3-4 hours away from us) and are just using this company to make money which explains their unwillingness to increase their workers pay.
Unrelated rant: Typical big city rich assholes fucking over people in smaller communities. It happened during covid with housing, they came over and scooped up every house they could just to rent them out for profit. I was paying 1000$ for a 3 bedroom apartment and some asshole from Toronto came over and bought it. Then when I moved out, they increased the rent to fucking 2500$....
I'm a school bus driver myself. We're unionized (Teamsters) and the district operates its own buses. We make about $34 an hour and get subsidized health insurance and a small pension (after 10 years) as well. A neighboring district privatized their school bus service a few years ago; their drivers make $22 an hour with no benefits at all, their accident rate is 4X ours and the drivers keep getting busted for positive drug tests and drunk driving, and their operating costs (as measured per student/per mile transported) went up about 50%.
It is such an absolute no-brainer to realize that the only advantage of privatizing a service like this is to put money into the pockets of the bus service owners (as well as the officials and school board members that they bribe), and the disadvantages are literally every possible other aspect of the deal. And yet surprise surprise my district is discussing privatization to "save money". It doesn't help that our newly-hired transportation director is a member of the family that owns the largest private bus service in the area.
They also have their equity firms buy up anything still quality and decent, enshittify the product and wait for people to catch on and stop buying the product. Then they do it all over again with another company.
I've said for years that daycares and nursing homes are extremely expensive, and they're probably not charging enough. The profit margins for both of these businesses are extremely thin.
I think posts like this are narrow-minded because they don't take into consideration the cost of operating these kinds of facilities.
Fundamentally, the reason daycares and nursing homes are so expensive is because the overhead is insane, much like in the American healthcare industry. A portable X-ray machine at a hospital can cost over $100,000, and even the metal slab they slide under you can cost around $10,000.
These machines don't cost nearly that much to produce. The manufacturers are milking the system.
My gas company charges a minimum monthly fee. I've never paid less than $70, no matter how little gas I use.
If you want to make these kinds of services cheaper, especially in America, you have to start with the fundamentals and bring down the cost of the things these businesses are forced to buy and pay for.
It's almost like capital aggregates over time, slowly absorbing or driving out competition, and eventually crystallizing into a single monopolized sector.
If only we had, like, tomes of philosophy predicting this over the last century, and maybe just a smidge of foresight, we could have stopped it before it became a problem. I propose that once a company monopolizes like this and makes itself a threat to the general public, we just absorb it into another branch of government services. This has happened before, usually under wartime laws, but rules and precedent don't seem to matter nowadays...
The world could be fixed overnight with the right cooperation and motivation.
But I don't disagree with you. We let things get totally out of control.
What we need is sweeping legislation, and it needs to start with the legislators themselves: term limits, harsher penalties for abuse of power, and reforms to executive authority, especially the use of executive orders.
Lobbying should be outlawed entirely. It should be illegal for elected officials to trade, own, or even discuss individual stocks.
There also need to be much stricter limits on what corporations can do and how much market power they can accumulate.
Did you know the U.S. has some of the weakest antitrust enforcement among developed countries? You know why? Lobbying by corporations that want to become monopolies. It's complete insanity.
And the worst part is they've figured out ways to limit the American people's ability to speak out against it. Most major media is owned by large corporations. People are drowning in debt and diabetes. Sports are on around the clock across multiple channels. We're distracted. We're unhealthy, and we're uneducated.
To add insult to injury, a small minority of people have somehow been convinced that their race is more important than others' in a country made up of people from every race and background.
Long-term direct care for humans at any stage of life in the US (that aren't of extreme wealth) is both obscenely expensive and yet woefully inadequate. I work in brain and spinal rehab AFCs and we're far worse than most average nursing homes.
I might not even put it on owners per-say. A lot of this money goes to landlords, lenders, and other higher-level extraction agents. When you get under the hood of some of these nursing homes and care facilities, what you'll often find is Vulture Capitalism. An institution that did work and was humane, but got bought out and turned into a vehicle for siphoning away other people's money.
At another level, they can be used by real estate companies looking to gentrify family homes. An elder person shows up and is roped into a reverse mortgage as a condition of residency. The nursing center might be fine enough on its face, but the costs are exorbitant in a way that's invisible to the tenant. Bank accounts are drained. Housing is seized. And then the company makes its money effectively liquidating the assets of those in their care.
I was shocked when I learned what the monthly cut for referral services like "A Place for Mom" is. After going through this with a parent, my #1 advice is to avoid every single place they recommend. Their "recommendation" is entirely based on how much money they get from the facility. And these kinds of referral "services" are increasingly being offered as a workplace benefit for a lot of people. It's not the scummiest part of that economic sector, but it is straight up payola masquerading as healthcare advice, and should be illegal.
We used a recommended provider for a few months and it was a nightmare. We eventually moved to a facility A Place for Mom "couldn't recommend" but was recommended by a hospice nurse. It was about half the price and 100x better.
Because it means "job creators" who do nothing but posses titles to land and company stocks are syphoning off money.
If they need 3 staff for 21 kids, they're going to pay as little as they can to keep 3 staff. And charge as much as they can to keep 21 kids.
There's no correlation between what staffing costs and what prices are charged, why would there be?
Both are just line items, and the person in charge just wants the profit line to have the biggest number.
The larger the company is, the worst that becomes. Or if the company is small, but owned by someone with a dozen other companies.
Expecting salary to match what people pay is toddler logic, sure it would be great if it worked like that, but any adult thinking more than 2 seconds can see why that's not related in the modern age. Hell, its been decades since the "if we pay workers a living wage a value meal goes up $0.02!".
Americans literally all said they were fine with that, almost zero companies increased pay, and all of them.increaswd prices anyways
Labor is often the biggest expense, but it's far and away not the only one. Any business might pay extractive rent, property upkeep costs, property taxes, business tax, administrative costs like bookkeeping and legal advisory, and insurance. (Any business involving the safety and well-being of more than a couple kids has to have unbelievable premiums just for liability.)
I wouldn't be so quick to point fingers at the people running a fucking daycare ffs. If they run a tight ship, the owners are making at best a very basic, decent salary. they're not fleecing parents. Even if they wanted to, they literally can't.
Look instead at all those auxiliary industries which are required for legal compliance - especially the "consultant class" - legal, tax/accounting, and insurance. They have leeches attached all the way up the chain, starting with individual workers.
Sadly this math adds up. In my country those are public services. So no corporate greed is involved and no significat ammount goes to corruption or overpaid management.
Sadly this formula for example in daycare is true:
("Huge payment from us" x "number of kids") / " number of people getting paid" = "low number"
We usually just do not account for cooks, cleaners, janitors, administration in our intuition.
Yet somehow a struggling mom can take on babysitting as a gig and watch four kids a day by herself, for like $50 each. That includes cooking, cleaning, changing, and a smile on your kiddos face when they come home.
My sister does this. Shes the cook, cleaner, janitor, and administration.
I think part of the problem is also the fact that entrepreneurial types have convinced us that the necessary architecture for a successful business also happens to be the architecture which makes us give up most of our proceeds.
You are capable and can make a difference by yourself. You don’t need them.
True facts. The "missing" money in the equation is all the boring expensive stuff, and those who benefit from those expenses love how obscure they are. Rent, utilities, property upkeep, property taxes, legal, administration (bookkeeping, compliance), insurance (child safety/liability is a convenient excuse for sky-high premiums).
We need to make it far easier for people to operate businesses out of their homes. So many of these costs disappear if you can use the structure you already have to pay for.
We had those for child care. Then government added additional regulations for safety after some incidents, and a lot of them quit because the additional costs made it not worth it anymore. Now the government complains about a shortage of child care places.
It's a hard problem. It's also what prevents meaningful criminal justice reform. Some people just have a very hard time accepting that bad things are going to happen. If you make the justice system less punitive, yes, you're going to get some number of extra crimes, as some people who should have stayed locked up will be freed. People have a very hard time grasping the concept that you need to do a cost benefit analysis for any policy. Sure, criminal justice reform will result in some small number of additional crime victims, but it will prevent orders of magnitude more people from being victimized by overly punitive laws and extreme jail sentences.
My state has a framework for at-home daycare operations, but good luck finding one that's not already at capacity. I've heard of other states scrapping their programs or not creating one to begin with, citing imagined "potential for abuse".
It's always easier to just sit on your hands instead of improving things, and "think of the children" does an insane amount of heavy lifting while managing to hurt the very children and families it claims to protect.
Yeah people fall for it. Hell, look at the mass downvoting of my comment here.
I'm a leftist myself, but folks on the left are just as vulnerable to knee jerk reactionary thinking as conservatives. They see someone saying that regulations can be bad, and their mind immediately jumps to the conclusion, "THIS PERSON MUST BE A REPUBLICAN!!!" and all thought ceases.
Regulations can just as easily be a tool of big business as they are a tool to protect the public. And the easiest way for governments to take away people's rights or for big business to stifle competition via regulation is "think of the children."
Assuming a 9hr work day to cover another persons workday... Likely closer to 10hr due to commute... but I wouldn't know.
200/9hr=22/hr
BSing utils at 300/mo is a mere 0.40/hr
BSing rent/mortgage at 1200/MO is 1.64/hr
So basically she's getting $20/hr assuming she does all 3 jobs just within that 9hr.
Not terrible but it does raise more questions and definitely doesn't scale well. Like presumably these are older kids that can be ignored while cooking and cleaning or that 9hr estimate is low.... And prob isn't carrying insurance for this? Doesn't include additional supplies - anything from extra paper towels to defibs. And utils, rent/mortgage is quite possibly off considerably...
Comparing someone doing it out their house vs an actual business is always going to be silly.
E: Oof... Lunch and snack.. each kid prob consumes $4 in food... 16/9... pushing down to 18/hr.
There’s absolutely tradeoffs. Yet, the parents that take their kids to my sister have a different kind of tradeoff: don’t go to work, or find affordable childcare. My sister winds up in this halfway point, servicing those people.
It’s true she doesn’t stock a defib. She watches those kids well enough, though, and has a cell phone to call 911 in case of emergency.
It’s not the picture perfect setup. It is making sure plenty of families can continue putting food on their table, though. Sometimes that’s what’s important (imo).
It doesn’t scale. But, you could have a lot of nonscalable businesses — a “gig economy” as they call it. A gig economy can scale even if the independent pieces don’t.
As counterpoint, I know at least a couple home daycares, which were more convenient and less expensive for their customers but:
my aunt had an unhealthy basement rec room after multiple floods, and was not very mobile
an old college friend had gone conservative and refused to either get Covid vaccinations or to require any vaccinations of their customers. Can you imagine if you found out you were sending your kids to a germ factory where any kid could have anything? Or could you imagine something happening and then to find that out?
I’m more confident that a larger daycare at least has someone actively watching and comply with health mandates
We could have nice things, but logistically it’s not feasible at an affordable cost. So a gig economy steps up to fill those gaps. Yes, that comes with risks. You will find horror stories, they’re valid. Nonetheless, this is closer to how childcare had been done for centuries. It’s a regression from the modern liberal way, but it certainly isn’t unfamiliar.
In a sense, you can say trust has replaced expense. Pay less, require more trust. In fairness, my sister knows her clients pretty well. She’s not running ads or anything like that.
What would be more ideal is if the state could partner with gig workers to ensure adequate resources. Perhaps there’s a way to redraw the lines here, so that we don’t find ourselves in a situation where you work to afford childcare and are otherwise broke. That’s also not a way to live.
So true. When we had our second kid, we found the cost of daycare for two younger ones was approaching her salary as a teacher. That’s ridiculous. Luckily I made enough to support us and she always said she didn’t mind staying home to care for them, but most people probably can’t afford that
Your "yet somehow a struggling mother can take on babysitting" is wholly because of these tradeoffs.. and depending on specifics, may be getting paid less than minimum wage.
She effectively is operating in the gig economy. That's a whole can of worms itself.
Concerning you did not list educator in her tasks, and instead focused on the least important aspects of “childcare”.
Children shouldn’t be a business model, but proper ECE is vital at that age where they learn more than any other time in their life.
I work for a non-profit, and assuming your $50 is American we would charge about $75 and with that comes along with a team of professionals who have studied how to do all this and can support each other and the children’s development while minimising risks.
Sure, I’m not saying that it meets every need prescribed to kids in our modern enlightened era. $25 extra a day (or rather, $500 extra a month) doesn’t sound like much for the professionalism, the standardized and trusted procedures, and the army of workers available to meet your kids needs.
Most daycare centers in my area don’t have a curriculum, they’re for profit, and the online reviews are utter trash. My sister worked for one and has plenty of stories about staff members cursing around children, being rude to them, … the whole “I just work here” treatment.
My sister isn’t a licensed educator, so I won’t be saying she educates the kids. She does play with them, though. They are learning more than they otherwise would; probably would be cooped up in a grandparents house with their tablet or something. Who knows? But she wouldn’t have customers if there wasn’t a problem.
This is tangential, but I recently learned quite a bit about hospice care in Oregon. I was dating someone who worked in the industry. She said that private equity was buying up the industry, intending to bill Medicare for as much as possible. I asked why she and her hard-working co-workers didn't start up their own hospice. Don't quote me on the specifics, but 1) a new hospice here has to generate no profit for the first X years and 2) you have to have something like half a million in reserves in order to be allowed the license to start one.
The laws were well-intentioned, but they end up being a way for the wealthy to continue generating income on the backs of everyone else. If you have the industry knowledge and funding to start a hospice, you can do it, then sell it off to private equity after a few years. Rinse and repeat. The rich get richer and we all pay for it, largely via Medicare.
Yeah, if you are looking for waste, fraud, and abuse it's this right here. It's endemic in all things health related. Very few individual patients are wasting social welfare money, instead it's almost entirely the providers who are milking the government.
Yet for some reason (hmmm) basically all the laws to "stop fraud" focus around the patients and not the providers. May have something to do with the fact that senators like Rick Scott being one of the biggest medicare fraudsters in the US.
Waste in government happens when private businesses get involved. There's very little real waste (beyond, ironically, laws which create waste to try and stop waste or means test recipients).
Healthcare should be nationalized. We'd save huge amounts of money by eliminating all these private company hucksters stealing public funds.
Jesus Christ. Hospice and private equity do not belong in the same universe together. The fact that this isn't swiftly and easily prevented by the courts is an incredibly basic failure of society. We cannot have a civilization while something like that exists.
My dad went into hospice a year ago and died less than a week later. We keep getting letters from Medicare indicating that his hospice program keeps submitting bills for services to them.
basically "higher quality" laws always make it very difficult for new players (such as your friend) to enter the market, because you have to have a whole lot of assets to start. which means there's less competition -> providers don't have to optimize on price so much -> they can get away with higher mark-ups.
the same is happening with cars, and housing. in the EU for example they require that every car have a few extra sensors (such as driving assistance, check whether the driver falls asleep, etc.). this makes manufacturing cars more expensive -> cars get more expensive. we all (everyone who buys a car) pay for this. they "improve quality" (mandatorily) at our expense.
I'm making ~10-15% off stocks while putting 1hr of slow chilly work a month into it. Guess someone had to actually earn that for me.
And no, while I highly profit off this rotten system does not mean I love it. I do not, and would gladly trade my wealth for a normal society, in which everyone is equally happy and content.
But noone wants my input on dismantling the system and start anew.
Nothing against you as a person, but how exactly would telling you any idea possibly change the world? Are you elon musk? Then it might help. But he also would be the last person on earth who would want a change.
I could give you the ultimate idea that would solve everything, and it would be pointless.
I have had many long debates about this for the last 4 decades, and I just got tired. It's even more fruitful to discuss god with a religious nutjob.
And why should I not use stocks? To be poor and matter not? I'm also not rich enough to matter, but it still beats the prior.
Same with universities and overworked, underpaid professors without tenure, doctors getting minimum wage out of medical school. Really any industry parasitized by Wall Street.
Tangentially related a bit, but I feel like this is part of why the "no one wants to work" became a meme after COVID.
Because everything shutdown, some of these people realized just how much they were paying for day care and getting lunch and gas, and how little they made formit, that they realized they were better off just, not working that secondary income job and didn't go back.
On the other hand, that was also the time where there seemed to be an increase in the online bullshittiness jumping through flaming hoops to apply for jobs that ultimately didn't exist because companies had to show that they were trying to hire so they didn't have to pay back loans, while saying people weren't taking the positions or weren't qualified so they could keep the money.
I remember at the tail end of things waiting for my order in a burger place where the owner was working because they were short staffed and he was bitching about "no one wants to work anymore" with a customer. The guy sounded like a dick, and all I could think was that either he's not paying enough or he's treating his employees like shit - that's probably why they don't want to work for him. Either way that was the first and last time I went there.
I would seem to me, there's a market for opening a daycare that pays livable wages, and another where you could both undercut nursing facilities and pay the staff living wages.
I'm not a fan of capitalism by any means, but it does seem that this should market correct no? What's stopping that from happening?
For a daycare, it's because setting up a new one is expensive and risky. You need property, insurance, and licensing. You need employees you've vetted and trained. It takes months to do all this and during these months you aren't making any income.
Nursing homes are even worse because they have a lot of legal requirements (that should exist!) which raises the barrier even further.
It's hard to get the loans needed for these new businesses if you aren't already wealthy.
The people that are wealthy enough to do this are instead investing in PE firms which buy up daycares and run them into the ground for profit. You are looking at "I could invest here for 10 or 20% return and I don't have to do any of the management work" or "I can invest here for 3 to 5% return and it's a full time job running the place".
Mind you, once these places are established, a LOT of the owners just do "market rates" for everything because, of course, they are quite greedy and the returns doesn't really improve when you treat your employees well.
With regards to nursing homes there's a second level. I'm going to borrow from my own past writing here :
Due to the way that insurance pays these days and that they can take up to 18 months to review and deny a claim at which point you have to pay them back, it's becoming harder and rarer for single practitioners or small groups to have the ability to have a practice (unless cash based, which is difficult and excludes a lot of people from care which I have FEELINGS about). Corporations have the administrative ability to have a dedicated coder, dedicated team for denial challenges etc. However corporations are predictably exploitative.
I really don't see any way to run anything medial based without a dedicated admin team ensuring cashflow. Which sucks. It also costs a ton of money up front.
Nursing homes in my area are like $3500 a month and they'll have one or two people working the 12 hour shift from 7pm to 7 am making jack shit who don't know a damn thing and then call the fire department for free labour if an elderly person has fallen to the ground and needs help getting up. The nursing home doesn't want the financial risk of their employees getting hurt, or hurting a patient getting them off the ground. That might cost them a tiny sliver of the profits they take in.
FWIW, I'm a massage therapist who works in hospice. Legally, if someone falls I'm not allowed to try to get them up because that's not an area of training for licensing/my scope of practice does not allow it. Someone working in a nursing home would be trained on safe transfers, BUT if there's a chance the patient experienced an injury or is unable to assist in getting up themselves, it really is safer for all parties to get a lift assist from the fire department. If I had a loved one that needed to stay in a rehab/nursing facility and they sustained a fall, I'd rather the extra set of eyes assess before just putting them back in bed.
Exactly nothing prevents a NURSING home from having a nurse or first responder on the payroll there. Also keep in mind that they are calling for a lift assist. Not an injury. They're making the determination that the patient isn't hurt and opting to not have an ambulance show up. They're calling for a literal $1,000,000 truck that gets 4 mpg with 4 people to show up and provide labor.
Look up Welltower Inc. According to equilar, welltower's CEO, Shankh S. Mitra, received $821 million in compensation last year. Welltower boasted $10.8 billion in earnings.
Oversimplifying but I think it's worth thinking about an angle I haven't seen here yet:
People to tend to trust Big Corporate care-givers and distrust private individual caregivers.
There are of course Good Reasons for this (Who do you sue if they hurt your loved one? Who licenses and trains them?), but among the Bad Reasons are: People just inherently trust a big name they've heard of before, especially if that big name has similarly gargantuan PR and legal departments who scrub any bad press away.
In other words, you could hire your neighbor to take care of your kids all day, but most people choose not to, and instead send much more money towards big businesses with massive overhead costs because people trust So And So National Healthcare more than Jane Doe.
True. I have been catching myself trusting big and familiar name over something new for years now. And then I remember that the bigger the name, the more their interests are against mine, and things become way trickier
A lot of people need more care than just a nurse, they need meds and to be monitored and medical aids or devices, like special beds or lifts. Inpatient care was also subsidized previously
I'll never understand the economy. To me it's just imaginary money.
I did understand some parts of it thanks to the explained with bananas videos by Primate economics but that's about it.
Just like with everything, the US economic system creates a bunch of rent-seeking middle men who need to get paid to deliver any service that the public needs. The more necessary the service the bigger the piece they get, we call these "insurance companies" and their job is to take money out of every public service and they are effective because they can get the government to create a system that makes the mandatory in order to conduct business.
A lot of it (definitely not all of it) seems to be that Americans want things and don't want to pay for them. They demand care for the elderly but refuse to pay what it costs to staff a decent facility. They want healthcare but refuse to pay what healthcare workers are worth. But far more than that, they refuse to pay more than absolutely minimal taxes, unless they are terrified into doing so--fear of foreigners, Black people, immigrants, communism, etc. They've been believing politicians for decades who promise them the moon with no tax increases.
So Americans want healthcare but refuse to vote for a candidate who will divert money from cops or weapons toward making it affordable. They want college education for all their kids but keep voting for candidates who are Tough On Crime and Tough On Government Corruption while dodging questions about funding public education. They want better wages and jobs but keep voting for "pro business" candidates who remove regulations so companies can outsource the jobs to nations with cheaper labor. They want cheaper prices on everything but keep voting for candidates who block antitrust regulations and remove barriers to shareholder stock buybacks.
There's just enough distance between the voting decisions and their consequences that voters can convince themselves--they're motivated to--that the consequences are not connected to their decisions, and they're always provided with a raft of rationalizations in case they figure it out. It's motivated reasoning on top of ignorance. Like all good cons, these prey on the selfishness and greed of the hundred million or so marks.
The issue isn't paying for it. It's paying for it and not getting anything in return.
Daycare costs the same as a full time job, and there are a dozen kids there, yet the workers there earn minimal wages.
Healthcare is the same, pay thousands yearly for insurance just to pay thousands more of you ever need to go to the hospital or anything outside a routine preventative checkup
This is not up to your average American worker. They don't choose where their money goes after they spend it and they don't have a real choice otherwise. There is no well known burger joint that pays their workers a living wage. These are ultimately the decisions American business leaders make.
American managers do generally pay a much better salary to healthcare workers but only because the profit margins are insane and often literally made up.
As far as paying taxes it really depends on where you live. Certainly the fear of paying taxes exists in depressed red states but most blue states and metropolitan areas pay more taxes and get more services because of it. People live in these areas because they are good for families.
What America wants and what they vote for are two different things and this is related to politicians not being held accountable for anything. You can say you will do one thing and the moment you are elected you can do just the opposite without consequence.
Voting in the US has pretty much become just a rubber stamp for what the wealthy want. If people won't vote for it, they just do it anyways as seen in the current administration. This is because the government was designed by the wealthy for the wealthy and democracy exists only as a facade at the Federal level.
I'm no libertarian, but a major problem is that a lot of our industries are severely over regulated. Regulations are usually a good thing, but often they are pushed by big business to prevent future competition. If the only way to comply with the law is to retain a staff of lawyers, then it becomes impossible for individuals to set up small operations.
For example, there's no reason we couldn't have micro nursing homes set up in individual private homes. Maybe a trio of licensed nurses can operate one out of a home. Maybe they can care for up to half a dozen patients.
Yes, this does induce additional risk of abuse and neglect, but I would argue that is probably less likely to occur at such a human facility than one run by a big corporation. And maybe accepting a bit more risk is worth it if it allows people to get card they otherwise would be shut out from.
Supposedly “The Villages” in Florida has phased life care where you can live in a setting for the care you need, then move up to more care as needed.
This is directly from a friend, so I don’t know the facts behind it, but also the claim that it makes in-home care much cheaper. You not only have appropriate settings for the care you need but there’s a lot of them in one spot, and of course it’s Florida so the caregivers are probably exploited to hell and back, so it’s all cheaply available.
While there’s a lot of negativity to that specific retirement area, I really think they have something by doing it at scale
There are many places across the country with staged levels of care offered. I'm in the Chicago suburbs, where based on the facility it can cost $3500-5000/mo per person for independent living (essentially your own apartment/townhome space where support services are available very quickly) $4000-10,000/mo for assisted living (someone is checking on you multiple times a day and potentially delivering meals/helping with meds) or $9000-16,000+/mo for nursing care (full care.)
The devil is in the details though. I know many facilities have different practices, but it's not uncommon for a facility to require proof that you already have 2 years worth of payments on hand before letting you move in. Also some will just let you sign over your property/home as security.
I knew a man a few years ago that had moved with his mother to an independent living where he cared for her. He was there over 30 years, having "purchased" the unit for $275,000 and paid around $3000 mo in maintenance fees. She had passed away at some point, he continued to live there. When he sustained a fall and hit his head, they moved him into the nursing unit as it appeared he would pass soon. They cleaned out his home and sold it, "securing" the proceeds to pay for his care. He ended up recovering more than anyone expected, at which point he was told he only had enough money for about 18 months of care, then he would be moved to a Medicaid room where he would have to share his room. A friend helped him find a less expensive place, but with his belongings sold he had to buy furniture. He passed alone a couple years later. Through all of this he never questioned whether or not any of this was right or wrong, just shrugged it off and accepted that this is the way things happen.
(22*1.20)/5=5.28 per hour
24 hours per day
So 126.72 a day
Roughly 3,8000 a month per patient just for nurse care. Not including housing, utilities, food, or medication.
Alternatives could be mandatory civic or military duty at 18 for a few years and nursing duty could be in there?
Another alternative could be inmate care, paying minimum wage in municipal bonds, as a way to work off a sentence?
Pay nurses less, requiring less certification?
Outsource nursing to countries where wage arbitrage can be leveraged?
Obviously this was fast and dirty but illustrates the expense.
"Sorry, we can't afford $3,800/month for nurses; this year, we only made $100 billion more than last year. Sorry, it just isn't in the budget. You know times are hard, we all have to be a team player and buckle down here if we're all gonna get through this together."
None of that makes any sort of sense, it just sounds like you heard some "business words" and are saying them without knowing what they mean...
Edit:
You're just copy/pasting a chatbot, right?
That would be plain this. If that's what you do, you should be upfront about it or at least admit when asked.
It's essentially tricking everyone into interacting with a chatbot, and people are going to get frustrated at you thinking it's your words, eventually realize what it is, then get even more upset at the human doing the copy/paste because you're wasting everyone's time and burning our planet down.
I assure you that you will get better answers and more effort from others if you think and type for yourself.
Using the chatbot means no one is helping you, just training a chat or for free
My post is supposed to illustrate some baseline. I used just an off-the-cuff, arbitrary yet heuristic figure from my experience working in, of all things, elderly care. I was a nurses aide and certified as a one-on-one for Alzheimer’s and dementia patients, helping the nurses feed and bathe, keeping the patients occupied…. Walking walking walking… and not falling out of bed etc.
I did this for 5 years.
So if you are running a business, and you have nurse employees, there are expenses, overhead, risks, and profit to take for your efforts. What should that number be? I picked 20% in the hopes someone would give perhaps a more realistic figure. Instead I get cut down.
And no, Im not copy and pasting anything.
What strikes me is, who can pay 3000 a month to watch granny? and that was just nurse salary, not meds, housing, etc. My numbers are made up, I chose 22 per hour for nurse pay, I have no idea what it really is, just wanted to get to get something going and im looking for others to post more data, though the conclusion will probably be the same… its a no win situation unless you’re extremely wealthy, granny dies.
While better pay for care workers could end up being a problem resulting in higher costs, when people like you bring up this topic it is without addressing the potential cost savings to be had by clawing back "administrative" costs.
Yes, there is absolutely some level of administration needed, and no one is arguing that we should make some aspect of care worse to enable better pay for nurses and other care staff.
The argument generally is that there is more than significant overpay happening at high levels (executive and levels close to them) which could be drawn from at little to no noticable difference to the executives and overpaid themselves while significantly improving things for the levels below them.
Oh no, one of them made 3m in a year instead of 4m? That's 5 whole six-figure positions even with your 20% overhead.
Until such time as these sorts of hypothetical talks about the impact of raising pay begin to also including the hypothetical that this additional pay could come by redirecting money that already exists and already goes into these systems, examining executive compensation packages and the like, you aren't going to make any ground on the "costs" argument.
Because there's currently a lot more than 20% of expenses going to "overhead". Maybe 20% to administrative overhead, plus 50% to executive compensation packages.
And look, I get that not every exec is Musk, and the margins can be smaller than people may assume. I have family that run a small family business who have to make those sorts of decisions and costs absolutely do add up fucking quick.
But that's all the more reason to be open and honest about this shit instead of trying to frame this with only one side.
There probably are some hospitals out in podunk nowhere where there isn't anything left to cut from the execs and administration, but there are plenty of places (at least in the US) that are explicitly for profit.
So just as I have family running a small family business where things are fair for their grand total of... four employees I think, my wife's family used to be close with the elder care magnate in their area. Wife's family matriarch was close friends with the lady who married the elder care magnate.
We had to sit and watch this entitled bitch have a puff-piece novel ghost-written about the trauma of having a dedicated live in care team for her own mother while she declined, dedicated driver and multiple handlers so they could go on beach days still... while her former supposed best friend (my wife's mother) suffered in one of her husband's facilities. Had the audacity to message asking if there was anything she could do, but couldn't even get off her ass and visit. To even risk seeing the true mess of elder care as her husband ran it.
So yeah, all that shit to say: Yes, the money has to come from somewhere, but there's a whole bunch of fucking money right fucking there that keeps going into hoards instead of actually being put to use for the betterment of the company/workers/etc.
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I think a lot more people would be willing to swallow the cost of a nursing home, if the loved one was guaranteed proper care and respect.
And let me tell you, I've worked in a lot of nursing homes (not in a medical position), and it doesnt matter how high end the nursing home is, the treatment is the same across the board.
There are ways you can try to tip the system in your favor to increase the chances of getting better care for your loved one.
Visit Frequently. Every Day is best (but if you had that kind of free time you'd probably have your loved one at home instead of a facility). Residents who get frequent, regular visits tend to get better taken care of.
Try not to have a visitation pattern, To avoid staff taking care of your loved one in preparation for that day. If you do have a schedule to visit every saturday, then atleast a few times a month try to pop in on different day at random (and don't make it a pattern)
If your loved one can not advocate for themselves, put a granny cam in the room. You can decide if you want an overt one or a hidden one. Preferably one you can log into from home/where ever and monitor live, though this may require some kind of subscription.
3a) If your loved one can advocate for themselves, make sure they feel safe and secure to tell you any mistreatment/bad things/unacceptable response times they may be suffering. You'd be surprised how hard it can be to get an at risk relative to confess any mistreatment to you.
Be respectful to the staff until they prove otherwise. Sometimes sucking up, and little gifts, and just generally getting to know the staff involved in your loved one will get your loved one better treatment.
Do not hesitate to take issues up with the building administrator. The administrator is the highest authority in the building, and doubly do not hesitate to escalate things to your state oversight agency if the administrator fails to satisfy the issue.
4&5 TLDR) Be sweet and kind to staff, but don't hesitate to be a roaring asshole when needed.
and I want to be clear, none of this will guarantee good/better treatment for your loved one. It just increases the chances of good/better treatment. Some people are just too lazy, cruel, and lack a single ounce of give-a-fuck to care. and some facilities try to cut costs by hiring only people that have all but been blackballed from other facilities, at low wages, because the choice for worker is either continue to use the education and experience they have or start over at even lower wage in a whole new job they know nothing about, which means they are typically at the end of their give-a-fuck. But sometimes you can have a facility run by absolute goddamn angels.. and its too random to be able to predict.
Edit
Oh, and one last thing..if you do have something you need to elevate to regulatory boards, make sure you get photo/video evidence if you can. and I mean of bed sores, unattended diapers, personal diary logs of wait times when the clal nurse button is hit, etc etc etc. Evidence is key.
We were paying double daycare until recently. While it was never inexpensive, it was more manageable when our daycare center was locally owned. Then Kindercare came in and bought 80% of daycares in my major city. When we tried changing daycares we found that many daycares not explicitly named Kindercare were still under the Kindercare umbrella but retained their old name. I guess they caught on.
As SOON as the corporate takeover was complete they started increasing rates 8% per year BEFORE we had high inflation, instituted mandatory annual fees just to enroll, and mandatory fees for supplies that we use to be able to bring but now they charged us MORE than the supplies cost and they were super shitty quality items. So if you wanted to bring in supplies for your kid, you still got to pay the fee for supplies but then also had to buy the non shitty quality ones and bring them in.
To the point of the topic though, what pissed me off the most was that even though we paid 3k/month for two our center started bleeding employees because they simply wouldn't pay them anything. So what this meant is veteran teachers left for more pay and new ones were only there long enough to get experience.
Services are expensive. Where I'm from daycare is socialized but still considered expensive. I imagine a full price in for profit daycare must be brutal.
The USA is just 3 Corporations in a trench coat. And corporations are just pyramid schemes.
People will lose their minds if you suggest giving someone medical care for free, but they keep ignoring all the landlords and CEOs and private equity groups and all the middlemen extracting the vast majority of all the wealth out, while also contributing the absolute least.
The fact that we have a system where one person works every waking minute of their life and still can't afford basic food and housing and another person sits around all day on their 3rd yacht sipping one of a kind wines and rakes in billions is insanity.
Truly, Land of the Free (to exploit).
I hope Washington is enjoying the show.
He fought to keep America the way it was. Ya he was part of the problem.
I skimmed the comments and didn't catch this, but don't forget about all the PRIVATE EQUITIES buying up nursing home facilities, banking on SSI, Medicare and Medicaid funding, upcharging perscriptions, "maximizing efficiencies" (aka paying as little wages as possible), and the revolving door of customers...
Don't forget those private equities buying up life insurance companies that are being used for dumping grounds for bad loans that'll be bailed out through state-based guaranty funds instead of passing through bankruptcy. In other words, these private equities are using life insurance subsidiaries to offload the risk of bad loans (mostly AI-related) to taxpayers if those life insurance companies become insolvent, which will likely happen when the AI bubble pops.
https://papers.ssrn.com/sol3/papers.cfm?abstract_id=7152239
Thats the billionaires squeezing profits out of every transaction, not just the enrollment fees, the rent on the property, the Healthcare and insurance premiums for the staff and the operation.
Everything they do is being optimized to squeeze wealth Into the mouths of billionaires.
Tax wealth not work.
The solution is this: every sector of the economy has been optimized to extract as much money from everyone as possible. This is the implicit role of government--to help the rich get richer. Have an idea that makes money? The government will help you make it happen. Does it materially harm the public, like sports gambling? Then you better make a lot of money to pay off the politicos!
This through-and-through corruption means that we now graduate in lifelong debt, working jobs that don't cover the rent of places we can never own and spend money on health insurance we can never use because we can't afford the co-pays. We are forced to finance expensive car because that's the only way to get to work because the bus routes have all been purchased by car companies and liquidated long ago while regulations keep out cheaper foreign cars for "safety" while massive trucks and SUVs are killing pedestrians and cyclists at record rates. Forced to work longer hours and with less money in our pockets, our third spaces disappear. Now stuck at home, we are forced to buy electronics now at inflated prices because of the AI bubble and use oligopoly internet that should have long ago been regulated as a utility but for the massive campaign contributions those companies make to politicians to have a shadow of a social connection with each other.
We are no longer citizens. We are livestock.
This is unsustainable.
It's about money. But a nice side effect is that it keeps the people busy so they have little down time to reflect on why they are in that condition, or more importantly, no time left to take action, as well as the threat that if they do anything, it could endanger their job and life. That's why they don't take away too much from too many, otherwise suddenly those masses don't have anything to threaten and a lot of free time to notice what happened and by whom. Bread and circuses.
100%, The New Deal in the USA was largely a result of the fear of a communist revoltuion during the Great Depression.
so what would be your first act as president
After that speech, I guess I'd start trust-busting, but that's presuming just being president would give me that power.
long way to go after that i guess
at least the markets might regain some of their function
This is not the explicit role of government in a functional social democracy. Which the USA obviously are not.
The U.S. is an open air prison
Open-air farm.
You forgot to add the billionaire shareholders variable to the equation
It's rent, and advertising. Shit costs so much and yet the landlord's and advertising industry makes ya think it's the cost of labour. I know alot of restaurant owners who work 5 days a week(alot close two days a week) and only vacation once a year just to visit family. they have steady business but still struggle due to costs. Only places I know are doing well are ones who own their building.
First, there is corporate gouging. Anyone owning stocks wants to see a return, not a moderate one but a big one, on their investment. Second, it isn't a straight one to one employee to patient ratio. 24 hour care is 8760 hours per year and full time work is 2000 (with 2 weeks paid vacation) meaning 4.38 employee years for 24hrs, 365 days. It isn't quite that much because staffing is never 1:1. If it were 1:1, at $20 per hour paid to the caregiver, with vacation, sick days, health care, CPP, EI, WCB, it is a minimum of $58,000 per employee. That alone would work out to $4800 per month without housing, food, cleaning, equipment. It isn't cheap to house people who cannot live independently. We need a different model for care to keep the costs lower while providing care that is necessary. This used to all be "free" in-home by older women (Boomer, Silent Gen, Greatest Gen) and still often is, if they cannot access care for family members. Much like child care, that again women used to do for 'free", it costs real money to have someone else cover that work.
Labor $200 Land $150 Materials $800 CEO pay and profits $1,000,000,000 Utility $150 someone who is good at the economy please help me budget this. my family is dying
Land more like 150,000
Oh yeah. I just left most of the numbers from the original meme because I didn’t feel like deciding on new ones.
Burn the CEO with candles until he accepts the unions demands.
One candle per worker and their loved ones they support
This makes me think of an issue we had around here recently. We have a public company running the majority of school buses in our area. They receive funding from the government that should be enough to pay their drivers around 24$ an hour. Yet, they've been paying them 18$ or less for years.
This year the drivers tried to negotiate for a higher wage and the owners weren't even willing to go over 19$... So they went on strike and buses stopped; parents had to make alternative arrangements. This went on for weeks, the employer just kept playing hard ball and not budging.
Surprisingly, parents were overwhelmingly on the driver's side which I was happy to see. It reached a point where the owners almost had their contract taken away. After about 2 months, they finally gave in and agreed to an increase to about 21$.
What kills me is that in another town nearby with a different company running the buses, divers are being paid 23-24$ an hour like they're supposed to. So the employer still came out ahead after everything was said and done. Apparently, the owners are from Toronto (about 3-4 hours away from us) and are just using this company to make money which explains their unwillingness to increase their workers pay.
Unrelated rant: Typical big city rich assholes fucking over people in smaller communities. It happened during covid with housing, they came over and scooped up every house they could just to rent them out for profit. I was paying 1000$ for a 3 bedroom apartment and some asshole from Toronto came over and bought it. Then when I moved out, they increased the rent to fucking 2500$....
I'm a school bus driver myself. We're unionized (Teamsters) and the district operates its own buses. We make about $34 an hour and get subsidized health insurance and a small pension (after 10 years) as well. A neighboring district privatized their school bus service a few years ago; their drivers make $22 an hour with no benefits at all, their accident rate is 4X ours and the drivers keep getting busted for positive drug tests and drunk driving, and their operating costs (as measured per student/per mile transported) went up about 50%.
It is such an absolute no-brainer to realize that the only advantage of privatizing a service like this is to put money into the pockets of the bus service owners (as well as the officials and school board members that they bribe), and the disadvantages are literally every possible other aspect of the deal. And yet surprise surprise my district is discussing privatization to "save money". It doesn't help that our newly-hired transportation director is a member of the family that owns the largest private bus service in the area.
They also have their equity firms buy up anything still quality and decent, enshittify the product and wait for people to catch on and stop buying the product. Then they do it all over again with another company.
Damn, the school should make the contract have heavy penalties for each failed pick up.
I've said for years that daycares and nursing homes are extremely expensive, and they're probably not charging enough. The profit margins for both of these businesses are extremely thin.
I think posts like this are narrow-minded because they don't take into consideration the cost of operating these kinds of facilities.
Fundamentally, the reason daycares and nursing homes are so expensive is because the overhead is insane, much like in the American healthcare industry. A portable X-ray machine at a hospital can cost over $100,000, and even the metal slab they slide under you can cost around $10,000.
These machines don't cost nearly that much to produce. The manufacturers are milking the system.
My gas company charges a minimum monthly fee. I've never paid less than $70, no matter how little gas I use.
If you want to make these kinds of services cheaper, especially in America, you have to start with the fundamentals and bring down the cost of the things these businesses are forced to buy and pay for.
It's almost like capital aggregates over time, slowly absorbing or driving out competition, and eventually crystallizing into a single monopolized sector.
If only we had, like, tomes of philosophy predicting this over the last century, and maybe just a smidge of foresight, we could have stopped it before it became a problem. I propose that once a company monopolizes like this and makes itself a threat to the general public, we just absorb it into another branch of government services. This has happened before, usually under wartime laws, but rules and precedent don't seem to matter nowadays...
The world could be fixed overnight with the right cooperation and motivation.
Well, no, it can't.
But I don't disagree with you. We let things get totally out of control.
What we need is sweeping legislation, and it needs to start with the legislators themselves: term limits, harsher penalties for abuse of power, and reforms to executive authority, especially the use of executive orders.
Lobbying should be outlawed entirely. It should be illegal for elected officials to trade, own, or even discuss individual stocks.
There also need to be much stricter limits on what corporations can do and how much market power they can accumulate.
Did you know the U.S. has some of the weakest antitrust enforcement among developed countries? You know why? Lobbying by corporations that want to become monopolies. It's complete insanity.
And the worst part is they've figured out ways to limit the American people's ability to speak out against it. Most major media is owned by large corporations. People are drowning in debt and diabetes. Sports are on around the clock across multiple channels. We're distracted. We're unhealthy, and we're uneducated.
To add insult to injury, a small minority of people have somehow been convinced that their race is more important than others' in a country made up of people from every race and background.
Long-term direct care for humans at any stage of life in the US (that aren't of extreme wealth) is both obscenely expensive and yet woefully inadequate. I work in brain and spinal rehab AFCs and we're far worse than most average nursing homes.
You see, honey, when a billion dollars and a billionaire love each other very much ...
owners of these establishments are removing money from your pocket to there’s and their shareholders. Us common folk always get the shaft
I might not even put it on owners per-say. A lot of this money goes to landlords, lenders, and other higher-level extraction agents. When you get under the hood of some of these nursing homes and care facilities, what you'll often find is Vulture Capitalism. An institution that did work and was humane, but got bought out and turned into a vehicle for siphoning away other people's money.
At another level, they can be used by real estate companies looking to gentrify family homes. An elder person shows up and is roped into a reverse mortgage as a condition of residency. The nursing center might be fine enough on its face, but the costs are exorbitant in a way that's invisible to the tenant. Bank accounts are drained. Housing is seized. And then the company makes its money effectively liquidating the assets of those in their care.
I was shocked when I learned what the monthly cut for referral services like "A Place for Mom" is. After going through this with a parent, my #1 advice is to avoid every single place they recommend. Their "recommendation" is entirely based on how much money they get from the facility. And these kinds of referral "services" are increasingly being offered as a workplace benefit for a lot of people. It's not the scummiest part of that economic sector, but it is straight up payola masquerading as healthcare advice, and should be illegal.
We used a recommended provider for a few months and it was a nightmare. We eventually moved to a facility A Place for Mom "couldn't recommend" but was recommended by a hospice nurse. It was about half the price and 100x better.
This is also a very good possibility
It adds up...
It adding up is the problem.
Because it means "job creators" who do nothing but posses titles to land and company stocks are syphoning off money.
If they need 3 staff for 21 kids, they're going to pay as little as they can to keep 3 staff. And charge as much as they can to keep 21 kids.
There's no correlation between what staffing costs and what prices are charged, why would there be?
Both are just line items, and the person in charge just wants the profit line to have the biggest number.
The larger the company is, the worst that becomes. Or if the company is small, but owned by someone with a dozen other companies.
Expecting salary to match what people pay is toddler logic, sure it would be great if it worked like that, but any adult thinking more than 2 seconds can see why that's not related in the modern age. Hell, its been decades since the "if we pay workers a living wage a value meal goes up $0.02!".
Americans literally all said they were fine with that, almost zero companies increased pay, and all of them.increaswd prices anyways
There's obviously no correlation
"In reality high profits tend much more to raise the price of work than high wages."
But that quote is from famously woke Adam Smith in his wokeism opus magnum Wealth of Nations.
Labor is often the biggest expense, but it's far and away not the only one. Any business might pay extractive rent, property upkeep costs, property taxes, business tax, administrative costs like bookkeeping and legal advisory, and insurance. (Any business involving the safety and well-being of more than a couple kids has to have unbelievable premiums just for liability.)
I wouldn't be so quick to point fingers at the people running a fucking daycare ffs. If they run a tight ship, the owners are making at best a very basic, decent salary. they're not fleecing parents. Even if they wanted to, they literally can't.
Look instead at all those auxiliary industries which are required for legal compliance - especially the "consultant class" - legal, tax/accounting, and insurance. They have leeches attached all the way up the chain, starting with individual workers.
Sadly this math adds up. In my country those are public services. So no corporate greed is involved and no significat ammount goes to corruption or overpaid management.
Sadly this formula for example in daycare is true:
("Huge payment from us" x "number of kids") / " number of people getting paid" = "low number"
We usually just do not account for cooks, cleaners, janitors, administration in our intuition.
Yet somehow a struggling mom can take on babysitting as a gig and watch four kids a day by herself, for like $50 each. That includes cooking, cleaning, changing, and a smile on your kiddos face when they come home.
My sister does this. Shes the cook, cleaner, janitor, and administration.
I think part of the problem is also the fact that entrepreneurial types have convinced us that the necessary architecture for a successful business also happens to be the architecture which makes us give up most of our proceeds.
You are capable and can make a difference by yourself. You don’t need them.
True facts. The "missing" money in the equation is all the boring expensive stuff, and those who benefit from those expenses love how obscure they are. Rent, utilities, property upkeep, property taxes, legal, administration (bookkeeping, compliance), insurance (child safety/liability is a convenient excuse for sky-high premiums).
We need to make it far easier for people to operate businesses out of their homes. So many of these costs disappear if you can use the structure you already have to pay for.
We had those for child care. Then government added additional regulations for safety after some incidents, and a lot of them quit because the additional costs made it not worth it anymore. Now the government complains about a shortage of child care places.
It's a hard problem. It's also what prevents meaningful criminal justice reform. Some people just have a very hard time accepting that bad things are going to happen. If you make the justice system less punitive, yes, you're going to get some number of extra crimes, as some people who should have stayed locked up will be freed. People have a very hard time grasping the concept that you need to do a cost benefit analysis for any policy. Sure, criminal justice reform will result in some small number of additional crime victims, but it will prevent orders of magnitude more people from being victimized by overly punitive laws and extreme jail sentences.
My state has a framework for at-home daycare operations, but good luck finding one that's not already at capacity. I've heard of other states scrapping their programs or not creating one to begin with, citing imagined "potential for abuse".
It's always easier to just sit on your hands instead of improving things, and "think of the children" does an insane amount of heavy lifting while managing to hurt the very children and families it claims to protect.
Yeah people fall for it. Hell, look at the mass downvoting of my comment here.
I'm a leftist myself, but folks on the left are just as vulnerable to knee jerk reactionary thinking as conservatives. They see someone saying that regulations can be bad, and their mind immediately jumps to the conclusion, "THIS PERSON MUST BE A REPUBLICAN!!!" and all thought ceases.
Regulations can just as easily be a tool of big business as they are a tool to protect the public. And the easiest way for governments to take away people's rights or for big business to stifle competition via regulation is "think of the children."
Assuming a 9hr work day to cover another persons workday... Likely closer to 10hr due to commute... but I wouldn't know.
200/9hr=22/hr
BSing utils at 300/mo is a mere 0.40/hr
BSing rent/mortgage at 1200/MO is 1.64/hr
So basically she's getting $20/hr assuming she does all 3 jobs just within that 9hr.
Not terrible but it does raise more questions and definitely doesn't scale well. Like presumably these are older kids that can be ignored while cooking and cleaning or that 9hr estimate is low.... And prob isn't carrying insurance for this? Doesn't include additional supplies - anything from extra paper towels to defibs. And utils, rent/mortgage is quite possibly off considerably...
Comparing someone doing it out their house vs an actual business is always going to be silly.
E: Oof... Lunch and snack.. each kid prob consumes $4 in food... 16/9... pushing down to 18/hr.
There’s absolutely tradeoffs. Yet, the parents that take their kids to my sister have a different kind of tradeoff: don’t go to work, or find affordable childcare. My sister winds up in this halfway point, servicing those people.
It’s true she doesn’t stock a defib. She watches those kids well enough, though, and has a cell phone to call 911 in case of emergency.
It’s not the picture perfect setup. It is making sure plenty of families can continue putting food on their table, though. Sometimes that’s what’s important (imo).
It doesn’t scale. But, you could have a lot of nonscalable businesses — a “gig economy” as they call it. A gig economy can scale even if the independent pieces don’t.
As counterpoint, I know at least a couple home daycares, which were more convenient and less expensive for their customers but:
I’m more confident that a larger daycare at least has someone actively watching and comply with health mandates
Yeah, I don’t really disagree.
We could have nice things, but logistically it’s not feasible at an affordable cost. So a gig economy steps up to fill those gaps. Yes, that comes with risks. You will find horror stories, they’re valid. Nonetheless, this is closer to how childcare had been done for centuries. It’s a regression from the modern liberal way, but it certainly isn’t unfamiliar.
In a sense, you can say trust has replaced expense. Pay less, require more trust. In fairness, my sister knows her clients pretty well. She’s not running ads or anything like that.
What would be more ideal is if the state could partner with gig workers to ensure adequate resources. Perhaps there’s a way to redraw the lines here, so that we don’t find ourselves in a situation where you work to afford childcare and are otherwise broke. That’s also not a way to live.
So true. When we had our second kid, we found the cost of daycare for two younger ones was approaching her salary as a teacher. That’s ridiculous. Luckily I made enough to support us and she always said she didn’t mind staying home to care for them, but most people probably can’t afford that
Yes there are tradeoffs.
Your "yet somehow a struggling mother can take on babysitting" is wholly because of these tradeoffs.. and depending on specifics, may be getting paid less than minimum wage.
She effectively is operating in the gig economy. That's a whole can of worms itself.
Concerning you did not list educator in her tasks, and instead focused on the least important aspects of “childcare”.
Children shouldn’t be a business model, but proper ECE is vital at that age where they learn more than any other time in their life.
I work for a non-profit, and assuming your $50 is American we would charge about $75 and with that comes along with a team of professionals who have studied how to do all this and can support each other and the children’s development while minimising risks.
Sure, I’m not saying that it meets every need prescribed to kids in our modern enlightened era. $25 extra a day (or rather, $500 extra a month) doesn’t sound like much for the professionalism, the standardized and trusted procedures, and the army of workers available to meet your kids needs.
Most daycare centers in my area don’t have a curriculum, they’re for profit, and the online reviews are utter trash. My sister worked for one and has plenty of stories about staff members cursing around children, being rude to them, … the whole “I just work here” treatment.
My sister isn’t a licensed educator, so I won’t be saying she educates the kids. She does play with them, though. They are learning more than they otherwise would; probably would be cooped up in a grandparents house with their tablet or something. Who knows? But she wouldn’t have customers if there wasn’t a problem.
Jesse Welles - The Poor
This is tangential, but I recently learned quite a bit about hospice care in Oregon. I was dating someone who worked in the industry. She said that private equity was buying up the industry, intending to bill Medicare for as much as possible. I asked why she and her hard-working co-workers didn't start up their own hospice. Don't quote me on the specifics, but 1) a new hospice here has to generate no profit for the first X years and 2) you have to have something like half a million in reserves in order to be allowed the license to start one.
The laws were well-intentioned, but they end up being a way for the wealthy to continue generating income on the backs of everyone else. If you have the industry knowledge and funding to start a hospice, you can do it, then sell it off to private equity after a few years. Rinse and repeat. The rich get richer and we all pay for it, largely via Medicare.
Yeah, if you are looking for waste, fraud, and abuse it's this right here. It's endemic in all things health related. Very few individual patients are wasting social welfare money, instead it's almost entirely the providers who are milking the government.
Yet for some reason (hmmm) basically all the laws to "stop fraud" focus around the patients and not the providers. May have something to do with the fact that senators like Rick Scott being one of the biggest medicare fraudsters in the US.
Waste in government happens when private businesses get involved. There's very little real waste (beyond, ironically, laws which create waste to try and stop waste or means test recipients).
Healthcare should be nationalized. We'd save huge amounts of money by eliminating all these private company hucksters stealing public funds.
Jesus Christ. Hospice and private equity do not belong in the same universe together. The fact that this isn't swiftly and easily prevented by the courts is an incredibly basic failure of society. We cannot have a civilization while something like that exists.
My dad went into hospice a year ago and died less than a week later. We keep getting letters from Medicare indicating that his hospice program keeps submitting bills for services to them.
Report them for Medicare fraud
I don't think it's fraud per se. The dates for the services are all from when he was still alive.
basically "higher quality" laws always make it very difficult for new players (such as your friend) to enter the market, because you have to have a whole lot of assets to start. which means there's less competition -> providers don't have to optimize on price so much -> they can get away with higher mark-ups.
the same is happening with cars, and housing. in the EU for example they require that every car have a few extra sensors (such as driving assistance, check whether the driver falls asleep, etc.). this makes manufacturing cars more expensive -> cars get more expensive. we all (everyone who buys a car) pay for this. they "improve quality" (mandatorily) at our expense.
I'm making ~10-15% off stocks while putting 1hr of slow chilly work a month into it. Guess someone had to actually earn that for me.
And no, while I highly profit off this rotten system does not mean I love it. I do not, and would gladly trade my wealth for a normal society, in which everyone is equally happy and content. But noone wants my input on dismantling the system and start anew.
I want your input.
Share your ideas.
I have some as well.
See, its that easy.
Awesome! And what does that bring? Ideas i have enough. And now? what to do with it? See? It's not that easy.
Someone asks for your input like you wanted and you shit on them.
Keep buying stocks and bury your head in your wealth.
Nothing against you as a person, but how exactly would telling you any idea possibly change the world? Are you elon musk? Then it might help. But he also would be the last person on earth who would want a change.
I could give you the ultimate idea that would solve everything, and it would be pointless. I have had many long debates about this for the last 4 decades, and I just got tired. It's even more fruitful to discuss god with a religious nutjob.
And why should I not use stocks? To be poor and matter not? I'm also not rich enough to matter, but it still beats the prior.
Middleman economy.
The American dream:
Do no work, Create no product, Have no ideas, Take a ever growing cut on everything in life.
A leech provides value to a ecosystem, the same cannot be said for landed lords and lender lords.
Same with universities and overworked, underpaid professors without tenure, doctors getting minimum wage out of medical school. Really any industry parasitized by Wall Street.
The math definitely adds up.
Shit Policies + Shit Wages = Shit Country
Tangentially related a bit, but I feel like this is part of why the "no one wants to work" became a meme after COVID.
Because everything shutdown, some of these people realized just how much they were paying for day care and getting lunch and gas, and how little they made formit, that they realized they were better off just, not working that secondary income job and didn't go back.
On the other hand, that was also the time where there seemed to be an increase in the online bullshittiness jumping through flaming hoops to apply for jobs that ultimately didn't exist because companies had to show that they were trying to hire so they didn't have to pay back loans, while saying people weren't taking the positions or weren't qualified so they could keep the money.
I remember at the tail end of things waiting for my order in a burger place where the owner was working because they were short staffed and he was bitching about "no one wants to work anymore" with a customer. The guy sounded like a dick, and all I could think was that either he's not paying enough or he's treating his employees like shit - that's probably why they don't want to work for him. Either way that was the first and last time I went there.
*boomers finally cashing in there absurd housing appreciation
Younger generations: we can finally use some of our family money to get on the housing ladder
Private equity nursing homes: not so fast, you gotta give us half of that or grannies going to the streets.
I would seem to me, there's a market for opening a daycare that pays livable wages, and another where you could both undercut nursing facilities and pay the staff living wages.
I'm not a fan of capitalism by any means, but it does seem that this should market correct no? What's stopping that from happening?
For a daycare, it's because setting up a new one is expensive and risky. You need property, insurance, and licensing. You need employees you've vetted and trained. It takes months to do all this and during these months you aren't making any income.
Nursing homes are even worse because they have a lot of legal requirements (that should exist!) which raises the barrier even further.
It's hard to get the loans needed for these new businesses if you aren't already wealthy.
The people that are wealthy enough to do this are instead investing in PE firms which buy up daycares and run them into the ground for profit. You are looking at "I could invest here for 10 or 20% return and I don't have to do any of the management work" or "I can invest here for 3 to 5% return and it's a full time job running the place".
Mind you, once these places are established, a LOT of the owners just do "market rates" for everything because, of course, they are quite greedy and the returns doesn't really improve when you treat your employees well.
With regards to nursing homes there's a second level. I'm going to borrow from my own past writing here :
I really don't see any way to run anything medial based without a dedicated admin team ensuring cashflow. Which sucks. It also costs a ton of money up front.
Interesting info, thank you!
Capitalism, actually. The purpose of a system is what it does.
insurance, frivolous lawsuits, lack of cooperation from regulating authorities, take your pick
Nursing homes in my area are like $3500 a month and they'll have one or two people working the 12 hour shift from 7pm to 7 am making jack shit who don't know a damn thing and then call the fire department for free labour if an elderly person has fallen to the ground and needs help getting up. The nursing home doesn't want the financial risk of their employees getting hurt, or hurting a patient getting them off the ground. That might cost them a tiny sliver of the profits they take in.
FWIW, I'm a massage therapist who works in hospice. Legally, if someone falls I'm not allowed to try to get them up because that's not an area of training for licensing/my scope of practice does not allow it. Someone working in a nursing home would be trained on safe transfers, BUT if there's a chance the patient experienced an injury or is unable to assist in getting up themselves, it really is safer for all parties to get a lift assist from the fire department. If I had a loved one that needed to stay in a rehab/nursing facility and they sustained a fall, I'd rather the extra set of eyes assess before just putting them back in bed.
Exactly nothing prevents a NURSING home from having a nurse or first responder on the payroll there. Also keep in mind that they are calling for a lift assist. Not an injury. They're making the determination that the patient isn't hurt and opting to not have an ambulance show up. They're calling for a literal $1,000,000 truck that gets 4 mpg with 4 people to show up and provide labor.
Look up Welltower Inc. According to equilar, welltower's CEO, Shankh S. Mitra, received $821 million in compensation last year. Welltower boasted $10.8 billion in earnings.
Oversimplifying but I think it's worth thinking about an angle I haven't seen here yet:
People to tend to trust Big Corporate care-givers and distrust private individual caregivers.
There are of course Good Reasons for this (Who do you sue if they hurt your loved one? Who licenses and trains them?), but among the Bad Reasons are: People just inherently trust a big name they've heard of before, especially if that big name has similarly gargantuan PR and legal departments who scrub any bad press away.
In other words, you could hire your neighbor to take care of your kids all day, but most people choose not to, and instead send much more money towards big businesses with massive overhead costs because people trust So And So National Healthcare more than Jane Doe.
True. I have been catching myself trusting big and familiar name over something new for years now. And then I remember that the bigger the name, the more their interests are against mine, and things become way trickier
Yeah, the bigger the company, the more your money goes to their overhead rather than the product or service itself.
The smaller, the smaller their pockets when it comes time to sue for something they did wrong.
Pros and Cons, like most things.
What’s the cost difference between this and hiring rotating shifts of nurses anyway? I know the equipment wouldn’t be there but yeah
A lot of people need more care than just a nurse, they need meds and to be monitored and medical aids or devices, like special beds or lifts. Inpatient care was also subsidized previously
Also the social aspect is pretty significant
You can't wrap your head around the economy being a wealth extraction system Masquerading as a functional society?
Factor in owner profit and executive compensation and it all sums up.
![email protected]
The money is flowing upwards
The 'I just don't understand' shit pisses me off so much.
Corporate greed pal. No one tell Luigi
I'll never understand the economy. To me it's just imaginary money. I did understand some parts of it thanks to the explained with bananas videos by Primate economics but that's about it.
Something something government is bad something something private industry.
Just like with everything, the US economic system creates a bunch of rent-seeking middle men who need to get paid to deliver any service that the public needs. The more necessary the service the bigger the piece they get, we call these "insurance companies" and their job is to take money out of every public service and they are effective because they can get the government to create a system that makes the mandatory in order to conduct business.
It adds up when you consider the parasites.
The rent is super expensive, that's the answer
A lot of it (definitely not all of it) seems to be that Americans want things and don't want to pay for them. They demand care for the elderly but refuse to pay what it costs to staff a decent facility. They want healthcare but refuse to pay what healthcare workers are worth. But far more than that, they refuse to pay more than absolutely minimal taxes, unless they are terrified into doing so--fear of foreigners, Black people, immigrants, communism, etc. They've been believing politicians for decades who promise them the moon with no tax increases.
So Americans want healthcare but refuse to vote for a candidate who will divert money from cops or weapons toward making it affordable. They want college education for all their kids but keep voting for candidates who are Tough On Crime and Tough On Government Corruption while dodging questions about funding public education. They want better wages and jobs but keep voting for "pro business" candidates who remove regulations so companies can outsource the jobs to nations with cheaper labor. They want cheaper prices on everything but keep voting for candidates who block antitrust regulations and remove barriers to shareholder stock buybacks.
There's just enough distance between the voting decisions and their consequences that voters can convince themselves--they're motivated to--that the consequences are not connected to their decisions, and they're always provided with a raft of rationalizations in case they figure it out. It's motivated reasoning on top of ignorance. Like all good cons, these prey on the selfishness and greed of the hundred million or so marks.
Swing and a miss
The issue isn't paying for it. It's paying for it and not getting anything in return.
Daycare costs the same as a full time job, and there are a dozen kids there, yet the workers there earn minimal wages.
Healthcare is the same, pay thousands yearly for insurance just to pay thousands more of you ever need to go to the hospital or anything outside a routine preventative checkup
I never said we get what we think we're refusing to pay for, just that Americans think they can get something for nothing.
This is not up to your average American worker. They don't choose where their money goes after they spend it and they don't have a real choice otherwise. There is no well known burger joint that pays their workers a living wage. These are ultimately the decisions American business leaders make.
American managers do generally pay a much better salary to healthcare workers but only because the profit margins are insane and often literally made up.
As far as paying taxes it really depends on where you live. Certainly the fear of paying taxes exists in depressed red states but most blue states and metropolitan areas pay more taxes and get more services because of it. People live in these areas because they are good for families.
What America wants and what they vote for are two different things and this is related to politicians not being held accountable for anything. You can say you will do one thing and the moment you are elected you can do just the opposite without consequence.
Voting in the US has pretty much become just a rubber stamp for what the wealthy want. If people won't vote for it, they just do it anyways as seen in the current administration. This is because the government was designed by the wealthy for the wealthy and democracy exists only as a facade at the Federal level.
I'm no libertarian, but a major problem is that a lot of our industries are severely over regulated. Regulations are usually a good thing, but often they are pushed by big business to prevent future competition. If the only way to comply with the law is to retain a staff of lawyers, then it becomes impossible for individuals to set up small operations.
For example, there's no reason we couldn't have micro nursing homes set up in individual private homes. Maybe a trio of licensed nurses can operate one out of a home. Maybe they can care for up to half a dozen patients.
Yes, this does induce additional risk of abuse and neglect, but I would argue that is probably less likely to occur at such a human facility than one run by a big corporation. And maybe accepting a bit more risk is worth it if it allows people to get card they otherwise would be shut out from.
Like a group home? There’s one up the street from me, although it’s not for elder care
Yes, but more for nursing home care.
Supposedly “The Villages” in Florida has phased life care where you can live in a setting for the care you need, then move up to more care as needed.
This is directly from a friend, so I don’t know the facts behind it, but also the claim that it makes in-home care much cheaper. You not only have appropriate settings for the care you need but there’s a lot of them in one spot, and of course it’s Florida so the caregivers are probably exploited to hell and back, so it’s all cheaply available.
While there’s a lot of negativity to that specific retirement area, I really think they have something by doing it at scale
There are many places across the country with staged levels of care offered. I'm in the Chicago suburbs, where based on the facility it can cost $3500-5000/mo per person for independent living (essentially your own apartment/townhome space where support services are available very quickly) $4000-10,000/mo for assisted living (someone is checking on you multiple times a day and potentially delivering meals/helping with meds) or $9000-16,000+/mo for nursing care (full care.)
The devil is in the details though. I know many facilities have different practices, but it's not uncommon for a facility to require proof that you already have 2 years worth of payments on hand before letting you move in. Also some will just let you sign over your property/home as security.
I knew a man a few years ago that had moved with his mother to an independent living where he cared for her. He was there over 30 years, having "purchased" the unit for $275,000 and paid around $3000 mo in maintenance fees. She had passed away at some point, he continued to live there. When he sustained a fall and hit his head, they moved him into the nursing unit as it appeared he would pass soon. They cleaned out his home and sold it, "securing" the proceeds to pay for his care. He ended up recovering more than anyone expected, at which point he was told he only had enough money for about 18 months of care, then he would be moved to a Medicaid room where he would have to share his room. A friend helped him find a less expensive place, but with his belongings sold he had to buy furniture. He passed alone a couple years later. Through all of this he never questioned whether or not any of this was right or wrong, just shrugged it off and accepted that this is the way things happen.
Well, let’s look at the math briefly.
First, what should a nurse make?
Add 20% cut to this for your risk and management.
Then, how many people should the nurse care for?
(Nurse pay * 1.20)/patients=cost per patient
(22*1.20)/5=5.28 per hour 24 hours per day So 126.72 a day Roughly 3,8000 a month per patient just for nurse care. Not including housing, utilities, food, or medication.
Alternatives could be mandatory civic or military duty at 18 for a few years and nursing duty could be in there?
Another alternative could be inmate care, paying minimum wage in municipal bonds, as a way to work off a sentence?
Pay nurses less, requiring less certification?
Outsource nursing to countries where wage arbitrage can be leveraged?
Obviously this was fast and dirty but illustrates the expense.
"Sorry, we can't afford $3,800/month for nurses; this year, we only made $100 billion more than last year. Sorry, it just isn't in the budget. You know times are hard, we all have to be a team player and buckle down here if we're all gonna get through this together."
That's what you sound like.
Why the actual fuck would anyone think admin fees per employee would be percentage of salary?
That makes no sense.
It's roughly 17k/year, regardless of if you pay $5/hr or 5k/hr.
I was thinking more like 20 percent markup as a profit margin. Other fees not included yet
None of that makes any sort of sense, it just sounds like you heard some "business words" and are saying them without knowing what they mean...
Edit:
You're just copy/pasting a chatbot, right?
That would be plain this. If that's what you do, you should be upfront about it or at least admit when asked.
It's essentially tricking everyone into interacting with a chatbot, and people are going to get frustrated at you thinking it's your words, eventually realize what it is, then get even more upset at the human doing the copy/paste because you're wasting everyone's time and burning our planet down.
I assure you that you will get better answers and more effort from others if you think and type for yourself.
Using the chatbot means no one is helping you, just training a chat or for free
Chatbots speak in coherent sentences and don't mess up the number formatting. I think they are using their own words.
No that would not be plain this!
;-)
https://imgur.com/a/3LDP7VW
My grade in business, just a few weeks ago...
My post is supposed to illustrate some baseline. I used just an off-the-cuff, arbitrary yet heuristic figure from my experience working in, of all things, elderly care. I was a nurses aide and certified as a one-on-one for Alzheimer’s and dementia patients, helping the nurses feed and bathe, keeping the patients occupied…. Walking walking walking… and not falling out of bed etc.
I did this for 5 years.
So if you are running a business, and you have nurse employees, there are expenses, overhead, risks, and profit to take for your efforts. What should that number be? I picked 20% in the hopes someone would give perhaps a more realistic figure. Instead I get cut down.
And no, Im not copy and pasting anything.
What strikes me is, who can pay 3000 a month to watch granny? and that was just nurse salary, not meds, housing, etc. My numbers are made up, I chose 22 per hour for nurse pay, I have no idea what it really is, just wanted to get to get something going and im looking for others to post more data, though the conclusion will probably be the same… its a no win situation unless you’re extremely wealthy, granny dies.
At least we found some common ground
"we can't pay for basic services because we started another war that's costing us trillions"
While better pay for care workers could end up being a problem resulting in higher costs, when people like you bring up this topic it is without addressing the potential cost savings to be had by clawing back "administrative" costs.
Yes, there is absolutely some level of administration needed, and no one is arguing that we should make some aspect of care worse to enable better pay for nurses and other care staff.
The argument generally is that there is more than significant overpay happening at high levels (executive and levels close to them) which could be drawn from at little to no noticable difference to the executives and overpaid themselves while significantly improving things for the levels below them.
Oh no, one of them made 3m in a year instead of 4m? That's 5 whole six-figure positions even with your 20% overhead.
Until such time as these sorts of hypothetical talks about the impact of raising pay begin to also including the hypothetical that this additional pay could come by redirecting money that already exists and already goes into these systems, examining executive compensation packages and the like, you aren't going to make any ground on the "costs" argument.
Because there's currently a lot more than 20% of expenses going to "overhead". Maybe 20% to administrative overhead, plus 50% to executive compensation packages.
And look, I get that not every exec is Musk, and the margins can be smaller than people may assume. I have family that run a small family business who have to make those sorts of decisions and costs absolutely do add up fucking quick.
But that's all the more reason to be open and honest about this shit instead of trying to frame this with only one side.
There probably are some hospitals out in podunk nowhere where there isn't anything left to cut from the execs and administration, but there are plenty of places (at least in the US) that are explicitly for profit.
So just as I have family running a small family business where things are fair for their grand total of... four employees I think, my wife's family used to be close with the elder care magnate in their area. Wife's family matriarch was close friends with the lady who married the elder care magnate.
We had to sit and watch this entitled bitch have a puff-piece novel ghost-written about the trauma of having a dedicated live in care team for her own mother while she declined, dedicated driver and multiple handlers so they could go on beach days still... while her former supposed best friend (my wife's mother) suffered in one of her husband's facilities. Had the audacity to message asking if there was anything she could do, but couldn't even get off her ass and visit. To even risk seeing the true mess of elder care as her husband ran it.
So yeah, all that shit to say: Yes, the money has to come from somewhere, but there's a whole bunch of fucking money right fucking there that keeps going into hoards instead of actually being put to use for the betterment of the company/workers/etc.