Tag Archives: neglect

No Ice Floes Handy?

According to legend, when their elderly became burdensome, Eskimos put them on ice floes and let them drift out to sea.

If I thought that Trump and his “best people” could read, I’d suspect they were emulating the Eskimos.

A week or so ago, a friend who no longer lives in Indianapolis was in town, and met my husband and me for breakfast. During the “catching up” talk that takes place when old friends haven’t seen each other for a while, we asked him what his wife was doing. He said she’d been working part-time as an advocate for nursing home patients–a position required as a condition of federal grants for nursing home care–but that the Trump Administration had eliminated the requirement, along with a number of other regulations intended to protect the sick and elderly residents of such institutions. So she was looking for another job.

I was pretty incredulous; why would even this benighted administration refuse to protect helpless old folks against the well-documented abuses encountered in numerous substandard nursing homes?

Turned out, however, our friend was right. I saw this article from The Hill not long after our conversation:

The Trump administration is reportedly rolling back the use of fines against nursing homes that have been cited for violations such as neglect or mistreatment.

The move comes after the nursing home industry requested the change in the Medicare program’s penalty protocols, The New York Times reported over the holiday weekend.

The American Health Care Association had argued that inspectors were too focused on finding wrongdoings at nursing homes instead of assisting the facilities.

A 2001 Congressional investigation uncovered reports of serious, physical, sexual and verbal abuse in a third of the nation’s nursing homes. That led to more monitoring and additional regulation. Since 2013, nearly 6,500 nursing homes have been cited  for one or more serious violations. Approximately two-thirds of those were fined by Medicare.

Nevertheless, the personnel installed by Trump at the Center for Medicare and Medicaid Services argued that the regulations and fines were counterproductive.

“Rather than spending quality time with their patients, the providers are spending time complying with regulations that get in the way of caring for their patients and doesn’t increase the quality of care they provide.”

A lawyer from the Center for Medicare Advocacy disagreed, observing that the revised regulations and diminished penalties have “pretty much emasculated enforcement, which was already weak.”

So let’s see….this administration wants tough penalties for street crime and drug use and illegal immigration, because Trump and Sessions say punishment is a deterrent to socially undesirable behaviors. But we don’t need to fine or otherwise punish the owners of nursing homes that mistreat their vulnerable inhabitants. (Sorry–I know the word “vulnerable” has been banned.) We can  gently suggest they desist, and maybe those bedsores will go away by themselves….

The regulations no longer being enforced weren’t imposed by some abstract, rule-happy big government bureaucrat; they were put in place because of evidence that far too many nursing homes were abusing and neglecting their elderly, incapacitated patients, and doing so with impunity.

Someone needs to explain to me just how forbidding elder abuse “gets in the way of quality care.”

Actually, ice floes might be more humane….


Our Third-World Country

It has come to this: the Mexican government has issued a statement to its citizens planning to travel in the United States, warning them to avoid drinking tap water.

I think it was Eric Hoffer who said the measure of a civilization is not what it builds, but what it maintains. We look back at the Romans with considerable awe, not just because they built roads and aqueducts, but because they kept those elements of their infrastructure operational for such a long period of time.

America could take some pointers.

In the wake of Flint’s water crisis, there has been a renewed attention to the country’s scandalous neglect of our aging infrastructure. A recent article from the Brookings Institution points to the magnitude of the problem:

A combination of factors, of course, have contributed to Flint’s crisis—including lapses in state monitoring—but the aging and deteriorating condition of the city’s water infrastructure plays an enormous role.

Similar to many older industrial cities in the Midwest, Flint has struggled to pay for needed maintenance on pipes and other facilities, which not only buckle under time and pressure in the form of widespread leaks, but also result in higher costs and declining water quality. Typically out of sight and out of mind, many pipes are more than a century old and are expected to need $1 trillion in repairs nationally over the next 25 years alone. With more than 51,000 community water systems scattered across the country and the federal government responsible for under one-quarter of all public spending on water infrastructure, states and localities must coordinate and cover most of these costs.

Infrastructure isn’t sexy. But it is essential; when you cannot flush your toilet, when clean, safe drinking water doesn’t come out of your tap, the effects on the economy and the quality of life are immediate and dire.

One of the great missed opportunities of the past decade was Congressional refusal to address the Great Recession with a program to repair America’s infrastructure. As the President pointed out at the time, such an initiative would not only have put millions of people to work, the depressed interest rates would have allowed us to do the work at a considerable savings.

Evidently, opposing anything and everything Obama proposed was more important than safe water and bridges.

The rest of the world has noticed.


Urban Life and Political Strife

Every couple of weeks, I get an email from Citiwire.net, a brainchild (I think) of Neil Pierce, the longtime observer of urban life and policy. Each email has two columns, one from Pierce and a second that “rotates” among a variety of writers. (Those of you interested in–or passionate about–cities should sign up. It’s free.)

Last Friday’s edition included a piece from Curtis Johnson, identified as the President of Citistates Group, commenting on a very prominent article from the previous week’s New York Times headlined “Republicans to Cities: Drop Dead.”

Johnson–who noted that he had worked many years for a Republican governor–said he cringed “to see the way sensible economics has been chained up, locked out and hooted over by the reigning ideology of today’s Republicans. Not that the Democrats are much better. A dear colleague of mine says ruefully that the Democrats don’t have very good answers, but Republicans don’t even understand the questions (and he’s Republican).”

Johnson goes on to report what most people who follow urban policy already know: as baby-boomers age, a huge number of them are abandoning suburbia and moving back into the cities, while the “millennials” already prefer urban life. (He shares a ‘factoid’ of which I was unaware–millennials are the first modern generation showing a decline in automobile ownership.)

Despite the increasing move to the cities–a move amply documented by demographers–those cities are struggling. Infrastructure is crumbling. Mass transit is lagging (or, as in Indianapolis, virtually non-existent). “Things that metro regions used to be able to build in a decade now take 30 to 40 years.” Yet policymakers of both parties give short shrift to these problems.

Johnson ends by pointing out something I’ve known ever since I got married, because it is my husband’s most persistent gripe: We rely upon our cities to generate the profits that pay the nation’s bills. Here in Indiana, certainly,  tax revenues generated in Indianapolis don’t stay here–along with the other cities in Indiana–South Bend, Ft. Wayne, Evansville–we pay the lion’s share of the state’s bills. We fund the priorities of Indiana policymakers–priorities that rarely include us.

It behooves us to take better care of the goose that is laying that golden egg.

Another Reason to Retire Ballard

My husband and I ate dinner last night at the Left Bank, a nice bistro at water’s level on the Indianapolis canal, then walked a couple of blocks along the canal to a program at the Center for Inquiry.While I often walk or bike along the water in nice weather, it was the first time I’d been on the canal this spring, and I was shocked and dismayed by the deterioration of the concrete walks and the pedestrian bridges, and the peeling paint beneath those bridges. The concrete at the edge of the water is crumbling into the water at several places. The concrete in the steps down from street to canal level was so eaten away that the rebar showed.

This is absolutely inexcusable.

The canal not only represents a huge investment by prior administrations, it is an extremely important amenity in a city without mountains, oceans or other natural draws. It has triggered significant private investment, and it is very heavily used. Whenever I am there, I see large numbers of people walking, biking, paddle-boating and enjoying themselves. It is a beautiful urban space, a huge asset to Indianapolis and it absolutely must be maintained. Its current condition is criminal.

I’ve been watching the slapdash way in which the much-touted street and sidewalk “infrastructure improvements” are being made with some dismay. I’ve yet to see an inspector, and to my (admittedly non-expert) eyes, it looks as if the administration is doing superficial paving that will look good through the Superbowl (assuming that happens), but falls far short of what would be involved in genuine long-term repairs. I hope I’m wrong about that. But Ballard and his administration haven’t even made that minimal level of effort at the canal–and we are at risk of losing one of the rare jewels of this city.

Eric Hoffer once wrote that the measure of a civilization is its ability to maintain what it has built.

I suppose I shouldn’t be surprised that an administration unable to manage its own parking meters is too inept to maintain its own infrastructure, but Indianapolis really cannot afford four more years of this.