alt Hacker News> housing and healthcare (the third is education.) For the first one we know roughly what we need to do but won’t. For the second we don’t even have that.
Healthcare costs increasing is of very little concern to nursing facility ownership. Almost none of that is borne by the facility itself. They'll often hire skeletal crews of CNAs and LPNs (I was a paramedic, rare was it to see a facility in our area that even had an RN, and if they were, they were the DON, Director of Nursing, and had no direct hand in patient care). The facilities would contract with a physician service who oftentimes would not even speak to the patient, let alone -see- them.
And every, every single interaction with actual care provision was fully billed to the patient/resident's insurance. Anything that is not a profit making center for facility ownership is ruthlessly subcontracted out. A solid portion of the SNFs in my county will openly call 911 for anything beyond the most absolute basic first aid, even when their employees are ostensibly better educated/trained than the EMTs who might be responding.
Healthcare costs in the US are an abomination, but that's not the issue here, or not directly.
It’s worse than that — not only are the subcontracted entities often affiliated with the owners, but when your EMTs transport a resident, the SNF “holds their spot” (ie invoices the government) for 30 days.
It’s in their interest to dump the resident on the hospital and get paid for services not rendered. Also, as residents decline they need more care, are often on Medicaid (lower reimbursement), each time they go to the hospital there is a probability they they won’t come back, and will be replaced by a Medicare patient (Medicare pays for ~90 days) at a higher rate, and perhaps higher margin services like PT/OT.
It’s an evil system. Most of the people who died in NYC during early phases of COVID did because of intense lobbying to send them back to the SNF.