I wonder if the average condition of a patient in a for profit facility might be considerably worse than a patient in a non profit facility. In other words maybe the for profit homes are keeping patients alive that would have otherwise died in non profit facilities. Hard to judge something like this without knowing all the factors involved.
There’s no reason at all to think private homes have more frail clients than the public run homes. DMC’s link above suggested that private homes are often in older, less up to standards buildings.
The research showed that there were potentially issues surrounding for-profit care, such as inadequate staffing levels, but as CarnalK noted, the COVID-19 death variance appears to mainly be driven by differences in layout, such as shared washrooms, more people per room, etc.
In other words, it costs money to upgrade the facilities to a better standard that leads to better health outcomes. And the for-profit care homes are understandably more interested in the bottom line financial return.
In my (limited) experience with elders in my life at both public and for-profit care homes in BC, I have found that they are fairly similar, but the for-profit homes have more “bells and whistles” and show dressing to make them appeal to those elders who value appearances and “cachet”.
That is what your unpublshed paper suggests, yes. I doubt it’s the whole story. Regardless, the point is clear that protecting nursing home residents better is not some impossibility in this pandemic.
Not my paper, but okay.
Absolutely agree.
Agreed, but not sure the reason for the point you are making. Has anyone claimed otherwise?
Manda Jo asked the question. That’s why I brought it up in the first place, dude.
You did leave out the sticking point in her question, which definitely makes the answer less clear.
Her quote (my bolding):
I think the answer is still yes, but in a more limited fashion than would be the case if Sweden hadn’t fucked up.
For a guy who agrees, you sure seem like you want to argue about it.
It’s important to understand the business model of for profit nursing homes in the US. In particular, two things need to be appreciated:
- The vast majority of patients are having their nursing home fees paid by Medicaid
- Absent special health treatments, Medicaid’s daily fees are fixed regardless of quality or level of service.
The result of these two factors is that the way the game is played in nursing homes is cutting costs. You can’t make it in the business by offering a high end product because you won’t get reimbursed for it. Upping the quality has very little return.
Within reason, of course. Cut things too much and you’ll get in trouble from the inspectors. Or possibly you’ll get bad press and people won’t show up at your place. But as long as things are within reason, there’s a constant pressure to cut costs, since that’s the only way you can increase your profits.
Add in that these Care Home companies are often chains that run a number of facilities and have to borrow money and pay shareholders out and you can see they face pressures that the Public care system does not have - seems to me its a given that the service will tend toward more costly in the private sector - you can argue that it means they must work harder to keep and attract their clientele if you like.
I am dubious about that latter though - always believed that care should be something we all contribute directly as responsible citizens and that profit should not be made out of caring for our social duties
I agree with your response to a straw man.
Funny that writing something big does not change the validity or lack thereof of what is being said. Nor does misrepresenting what is being said help make anyone’s case. No, your title fails to impress, and I respect those with plungers who have critical thinking skills much more than who try to claim expertise with a title.
Denmark also had a high of a fraction of deaths in nursing homes, like Sweden much worse of a share than the United States. Okay. And?
Let me try to spell this out in terms that even a head of data science might understand.
Here’s the hypothesis in several parts (note not stating if it or its assumptions are correct, just stating the hypothesis):
Assume that suppressing rates long term are doomed to fail and most countries will end up getting their number of cases at some point over some time period. Long term therefore it is better to, and possible to, have infections at a rate below a level that overwhelms the system during a sooner period of time when capacity is not stressed by influenza as it will be in winter, without rigid orders regarding shut downs, within the context of Swedish society. Deaths overall over the entire course will be reduced if the highest risk populations can be relatively spared from being among those cases and such is possible to do even as lower risk populations experience the disease. If you recall that was the basic idea when the messaging was all about flattening the curve - same total number of cases but timed to not be concentrated in a peak that overwhelmed capacity.
Now let’s look at what has occurred so far and use critical thinking to evaluate it without any attachment to desired conclusions.
Clear fail to prove that it is possible to protect the highest risk populations. My belief remains that it is possible but so far I must admit that I have no large scale examples of success. Maybe publicly run nursing homes in Canada but no complete region or system to point to. Not falsified but not supported yet either.
Despite that however Sweden still managed to have rates below levels that overwhelmed their system. Proving minimally that a less draconian approach could keep rates below that threshold even when coupled with doing horribly at preventing infections in the most vulnerable.
Do case numbers being higher than Denmark’s or their other Nordic neighbors falsify the
first part of the hypothesis? Obviously no.
The hypothesis can be falsified by seeing what happens over winter and not before. There are very few epidemiologists who would not agree that everything else being equal beginning a new wave with at least 20 to 30% highly probably with some significant degree of protection would result in a smaller new wave spreading less quickly than starting at 1%.
The alternate hypothesis is that rates can be suppressed now and be maintained as suppressed for however long it takes until a vaccine is safe, effective, widely available, and widely used. This approach is in a very real way a huge gamble, betting on that unproven ability to suppress long term in hopes of the brass ring of few cases over the complete course. If wrong and a significant surge occurs timed with influenza with virtually no one in the resolved bucket (and apparently no ability to protect the elder population) then the loss is huge, overwhelming systems. Big bet. The risk is that the cases are being pushed from a curve that is relatively flat into a peak during winter instead. Maybe won’t happen. That’s the gamble.
Is that hypothesis yet strongly supported or falsified? No. Won’t be until we see what happens over winter and not before.
Any head of data science who makes confident conclusions before the data is in really is poorly suited for the job. I don’t assume the toilet is unclogged until I flush it and see whether after the flush shit has gone down or flooded on the floor.
To be precise you stated that assuming that it was possible to get herd immunity was a “less than forgivable error”. I don’t think I misunderstood that as it was written pretty clearly.
And yet that “less than forgivable error” is the assumption that girds the plan to develop a vaccine.
No we do not know much about immunity and this specific virus. There are educated guesses based on the ranges seen in other human coronaviruses and there are guesses made based off of influenza pandemics (which may be viewed with some doubt as this germ has already proven that in many ways it does not behave like influenza). There is evidence that there is at least some protection to it from past infections with other human coronaviruses but no clear evidence to what degree that immunity is or is not clinically significant, and who has that protection the most. Most of the experts conclude that the odds are good that infection will give reasonable levels of protection that last for reasonable periods of time, like two to three years or more. But not known.
From here on I’m going to try really hard to not make this same point again and again, because it is getting boring. It is unknowable if Sweden overall fucked up or saved lives until we get to the other side of the winter. I am less optimistic than many are here that those with extremely low rates now have not just pushed their bigger surge into the worst possible time in the future instead of backfilling the summer. I very much hope to have my pessimism proven to be wrong.
So, Norway is opening the borders to Finland and Denmark with more nations to follow. Not Sweden. And what strikes me is that Sweden, or the Swedish authorities are acting as though the really do not get why. Its like they are surprised and hurt by this. I don’t understand them.
There are several reasons for it. One is that the Swedish side of Öresundsbron, where Malmö is, has significantly lower rates of coronavirus infection than the Danish side. Another is that the Norwegian government wants tourists from Norway to be able to visit Gotland, but not the other way around. And the authorities on Gotland aren’t overly keen on being bombarded by tourists this year since they have a very low contagion rate so far and not an overly large hospital capacity for visitors. The problem with treating countries as monolithic entities is that is misses a great deal of nuance.
Riiiiiiiiiight.
Pretty much any country could nuance and minimize their failures in this way. Sweden isn’t special.
A good resource is the OurWorldinData website, which has a section on COVID.
If you compare Sweden to its European neighbors, it’s clear that Sweden’s response has failed. One good base of comparison is the Netherlands, which had daily growth rates that were similar to Sweden’s – worse actually. But whereas the Netherlands brought the pandemic under control, Sweden did not. FWIW, the UK’s numbers were actually worse than Sweden, but that’s only because the UK’s response was just as negligent and atrocious as Sweden’s.
What is that supposed to mean?
He doesnt understand nuance?
Let’s just say I’m skeptical of “It’s just a bad flu. It’s not really that bad. Sweden’s smart - you’ll see in the end” propaganda.
Accept facts, mate. Sweden’s response has failed spectacularly. The only reason it doesn’t have a spectacularly high number of coffins stacked one on top of the other is because it’s a sparsely populated country.