It seems that the puzzle of why death rates rise in good economic times is nearly solved. There’s an effect of increased driving deaths from increased driving, but the main effect is that in good times nursing homes have to compete more for minimum wage nursing assistants. Apparently a one percentage point cut in the unemployment rate leads to three percent fewer nursing assistants, which increases the national death rate by a half percent (which cuts about three weeks of life per person):
>Might this be due to a fixed government price that refuses to adapt to the business cycle?
Might this be due to small furry creatures from alpha centauri kidnapping our nursing home staff when the party lights during boom times allow then to hide their space-ships?
i.e. do we have any particular reason to think the fixed government price is to blame?
How many cycles were followed? Less respiratory deaths could have been due to confounding variables such as milder flu season one year or the previous season might have killed off the weaklings so next year the stats looked better. Why the sex difference? Nursing home workers anecdotally say old men go fast but women just gradually get weaker, so any increased stress that happens to come along might accelerate deaths.
As usual, the explanations for the facts needs to be refined,using hypotheses derived from new data before announcing a demanding for an obvious sounding solution. For example one could experimentally raise the salary of a group of nurse's aids to see if this helps.
The frustrating thing about these tantalizing studies is how they seldom seem to go to the next level. In other medical studies, promising leads usually flop when pursued, but there is always hope that some increment of progress will be made.
QALY seems relevant. The differential deaths are occurring primarily among, essentially, permanently hospitalized people. Now I am amused by the rationalist orthodoxy that living forever for the individual must be a Good Thing (tm). But is it really? And is it as good a thing as living when you are not in a nursing home?
Economic theory would suggest these aides who are taken to other occupations during a good economy are indeed doing something mroe valuable in that economy. Maybe extra weeks in a wheelchair or a bed is not the highest and best return on low wage work.
I suspect that this is a case of quality, not quantity being the problem. I suspect that the number of and the wages of nursing assistants is fairly stable in good times and in bad. In bad economic times there are relatively higher skilled nursing assistants available because they have few options. In good times those relatively higher skilled nursing assistants are able to leverage their higher ability for better paying jobs in other industries.
Simply paying more may not be a solution to this issue. If the problem is in fact quality not quantity, then higher pay would only be helpful if it was possible to accurately identify the higher quality assistants
The future of medical care seems likely to consist chiefly of two things: morphine and hospice care.Medical care for the elderly is bankrupting the country (and the world). What can't go on forever, won't.Pain meds are cheap. I see large amounts of morphine in the future.
I should make clear the other sides of the equation: raising the welfare of the old nearly senile person also has with it keeping the welfare of the young healthy person tolerable, while raising the welfare of the young healthy person to decent has the old senile person dead, which is not unpleasant at all.
Seems like there are mixed incentives here. It might be better to let those people in nursing homes die, and focus more on increasing the welfare of others. It sounds heartless but think seriously about it: many times this might be exchanging raising some old nearly senile person's existence from miserable to slightly less miserable, vs raising a young and healthy person's existence from tolerable to decent.
Thanks to lemmy caution for sharing some actual facts.
Unfortunately I don't have time at the moment: is there enough data in there to (at least roughly) calculate the cost per life year of raising the hourly medicare reimbursement rates for nursing assistants?
Moving from deaths, or persons lost, to person-years of life lost changes things by a factor of, say, 30.
Moving to quality-adjusted life years could change things by many, many orders of magnitude, depending on how low we rate the quality of life of those who might die a year early from sub-optimal nursing care. That quality could be close to zero or even negative — especially when we take into account the tendency to show that we care, rather than to let people go.
And if everyone in nursing homes were to be given a speedy and painless death, how much would we save? Isn't that, perhaps, at the back of the government's limp-wristed approach to "mercy-killing" in recent years?
This might be a matter of signaling. It might be more important to signal that you are saving money (e.g., by keeping wages stable) than to spend it wisely.
>Might this be due to a fixed government price that refuses to adapt to the business cycle?
Might this be due to small furry creatures from alpha centauri kidnapping our nursing home staff when the party lights during boom times allow then to hide their space-ships?
i.e. do we have any particular reason to think the fixed government price is to blame?
Right, but who pays the $1 and who gets the 3 weeks?
$1 for 3 weeks is on par with the best interventions in the developing world, though the QALYs probably aren't as good.
$1 for 3 weeks of life, even in a nursing home? sounds like a bargain to me.
How many cycles were followed? Less respiratory deaths could have been due to confounding variables such as milder flu season one year or the previous season might have killed off the weaklings so next year the stats looked better. Why the sex difference? Nursing home workers anecdotally say old men go fast but women just gradually get weaker, so any increased stress that happens to come along might accelerate deaths.
As usual, the explanations for the facts needs to be refined,using hypotheses derived from new data before announcing a demanding for an obvious sounding solution. For example one could experimentally raise the salary of a group of nurse's aids to see if this helps.
The frustrating thing about these tantalizing studies is how they seldom seem to go to the next level. In other medical studies, promising leads usually flop when pursued, but there is always hope that some increment of progress will be made.
QALY seems relevant. The differential deaths are occurring primarily among, essentially, permanently hospitalized people. Now I am amused by the rationalist orthodoxy that living forever for the individual must be a Good Thing (tm). But is it really? And is it as good a thing as living when you are not in a nursing home?
Economic theory would suggest these aides who are taken to other occupations during a good economy are indeed doing something mroe valuable in that economy. Maybe extra weeks in a wheelchair or a bed is not the highest and best return on low wage work.
I suspect that this is a case of quality, not quantity being the problem. I suspect that the number of and the wages of nursing assistants is fairly stable in good times and in bad. In bad economic times there are relatively higher skilled nursing assistants available because they have few options. In good times those relatively higher skilled nursing assistants are able to leverage their higher ability for better paying jobs in other industries.
Simply paying more may not be a solution to this issue. If the problem is in fact quality not quantity, then higher pay would only be helpful if it was possible to accurately identify the higher quality assistants
The future of medical care seems likely to consist chiefly of two things: morphine and hospice care.Medical care for the elderly is bankrupting the country (and the world). What can't go on forever, won't.Pain meds are cheap. I see large amounts of morphine in the future.
I think it's a productivity problem. There's just no way for them to be very productive in this kind of work.
I like the Japanese solution: robots!
I should make clear the other sides of the equation: raising the welfare of the old nearly senile person also has with it keeping the welfare of the young healthy person tolerable, while raising the welfare of the young healthy person to decent has the old senile person dead, which is not unpleasant at all.
Seems like there are mixed incentives here. It might be better to let those people in nursing homes die, and focus more on increasing the welfare of others. It sounds heartless but think seriously about it: many times this might be exchanging raising some old nearly senile person's existence from miserable to slightly less miserable, vs raising a young and healthy person's existence from tolerable to decent.
Thanks to lemmy caution for sharing some actual facts.
Unfortunately I don't have time at the moment: is there enough data in there to (at least roughly) calculate the cost per life year of raising the hourly medicare reimbursement rates for nursing assistants?
It seems like a continuation of a pattern that's reasonably common in Robin's arguments:
1. Here's a dubious-looking argument I just invented that A implies not B.2. Therefore, everyone who believes A and B is a hypocrite.
Moving from deaths, or persons lost, to person-years of life lost changes things by a factor of, say, 30.
Moving to quality-adjusted life years could change things by many, many orders of magnitude, depending on how low we rate the quality of life of those who might die a year early from sub-optimal nursing care. That quality could be close to zero or even negative — especially when we take into account the tendency to show that we care, rather than to let people go.
And if everyone in nursing homes were to be given a speedy and painless death, how much would we save? Isn't that, perhaps, at the back of the government's limp-wristed approach to "mercy-killing" in recent years?
This might be a matter of signaling. It might be more important to signal that you are saving money (e.g., by keeping wages stable) than to spend it wisely.