nursing homes

Nursing homes across nations

This is all from Michael A. Alcorn, from my email, no further indentation offered:

“Just to keep hammering on this nursing home point… I saw your Tweet about Eastern vs. Western Europe and decided to explore the nursing home angle there too. The WHO has data on the number of nursing and elderly home beds for different countries here. Unfortunately, the data only goes up to 2013-ish for many countries, but it’s suggestive nonetheless.

Italy and France were clearly trending up seven years ago in its number of beds… would be interesting to see if Italy had a similar jump to Spain at some point. The number of beds gives us a proxy for the number of people who are highly vulnerable to COVID-19. Obviously, these countries have different total populations, but I don’t think that should matter too much because I suspect nursing homes tend to be highly concentrated within countries (e.g., how many of France’s nursing homes are in the Paris metro?). Based on what I’ve read about nursing home staff often being low paid and so perhaps coming to work when sick and working at multiple facilities, I suspect nursing home density is nonlinearly related to the number of COVID-19 deaths in a country (especially when you account for some of the truly horrifying government decisions regarding nursing homes).

Here are those Nordic countries everyone likes to compare:

You can get exact numbers on the website, but Sweden had twice as many nursing home beds as Finland and three times as many as Norway. The ship might have sailed on what we can do to protect these vulnerable populations, but I would love to see a Fast Grant go towards investigating the COVID-19/nursing home tragedy.”

Claims about nursing homes

From Neil Emery:

 Nursing homes are chronically understaffed in times of economic prosperity. But, when the job market tightens, a one percent increase in unemployment sees full time employment in nursing facilities rise three times as fast. After a recession, when the economy picks back up and jobs become available again, low skilled workers abandon nursing homes jobs’ low pay and even fewer accolades for better prospects. The shift of workers in and out of nursing jobs drives the swings in the national death rate and underscores the importance of these under-appreciated jobs.

A look at the relationship between economic downturns and health outcomes in the United States reveals a complex picture: harm from lost insurance and increased anxiety but better care for the elderly. These two trends coexist because, while harm concentrates in working age people, retirees reap the majority of the benefit.

I do not know if these claims are true, but see the post for a discussion of the evidence.

Nursing home estimates of the day

Database of 1,100 superspreading events

It is about time someone put this together, here are some summary conclusions:

  • Nearly all SSEs in the database — more than 97% — took place indoors
  • The great majority of SSEs happened during flu season in that location
  • The vast majority took place in settings where people were essentially confined together, indoors, for a prolonged period (for example, nursing homes, prisons, cruise ships, worker housing)
  • Processing plants where temperatures are kept very low (especially meat processing plants) seem particularly vulnerable to SSEs

Here is the full material by Koen Swinkels, via Balaji.

Just how weird are things now?

That is the topic of my latest Bloomberg column, here is the opener:

If I have learned one thing over the last few weeks, it is that the psychology of the American public is weirder — and perhaps more flexible — than I ever would have thought.

Consider, as just one example among many, the issue of nursing homes. According to some estimates, about 40% of the deaths associated with Covid-19 have occurred in nursing homes, with more almost certain to come.

You might think that those 40,000-plus deaths would be a major national scandal. But so far the response has been subdued. Yes, there has been ample news coverage, but there are no riots in response, no social movement to “clean up the nursing homes,” no Ralph Nader-like crusader who has made this his or her political cause.

Nor has there been much resulting vilification. There are plenty of condemnations of technology billionaires, but very few of nursing-home CEOs. Many of the state and local politicians who oversee public-sector nursing homes have been rewarded with higher approval ratings.

As if all this weren’t bad enough, of those 40,000 deaths, surely a considerable number are African-American (data by race is hard to come by). This could be an issue for Black Lives Matter, but somehow it isn’t.

There is indeed much more at the link.

Stockholm City’s Elderly Care and Covid19

Upwards of 70 percent of the Covid19 death toll in Sweden has been people in elderly care services (as of mid-May 2020). We summarize the Covid19 tragedy in elderly care in Sweden, particularly in the City of Stockholm. We explain the institutional structure of elderly care administration and service provision. Those who died of Covid19 in Stockholm’s nursing homes had a life-remaining median somewhere in the range of 5 to 9 months. Having contextualized the Covid19 problem in City of Stockholm, we present an interview of Barbro Karlsson, who works at the administrative heart of the Stockholm elderly care system. Her institutional knowledge and sentiment offer great insight into the concrete problems and challenges. There are really two sides the elderly care Covid19 challenge: The vulnerability and frailty of those in nursing homes and the problem of nosocomial infection—that is, infection caused by contact with others involved in the elderly care experience. The problem calls for targeted solutions by those close to the vulnerable individuals.

That is the abstract of a new paper by Charlotta Stern and Daniel B. Klein.

Small steps toward a much better world

After mounting criticism and thousands of deaths in New York nursing homes—including several individual facilities that have lost more than 50 residents—the state on Sunday reversed the mandate, which said nursing homes couldn’t refuse to accept patients from hospitals who had been diagnosed with Covid-19. New York now says hospitals can send patients to nursing homes only if they have tested negative for the virus.

Here is the WSJ article, via John F.

Limiting liability for a resumption of business activity

I have a short Mercatus policy brief on that topic, co-authored with Trace Mitchell.  Excerpt:

Risk from reopening cannot fall to zero, but investments in safety by employers can bring real gains in many cases. Ideally, a plan should both minimize risk and encourage employers’ safety investments. In essence, policymakers should (1) limit liability in the short term to cases of recklessness, (2) use direct regulation to prohibit some obviously risky options, and (3) create and fund a COVID-19 compensation program while capping liability for covered entities.

To understand how this combination of options might work in practice, consider the simple example of the restaurant. Many states are allowing partial reopenings of restaurants, albeit with social distancing, which might comprise outdoor seating, limited seating within the restaurant, or both. Yet some practices that would be very dangerous in the current situation, such as open buffets, have been made illegal per se. This arrangement takes some of the highest-risk problems off the table, and for the better. It is also appropriate for regulation to mandate soap-and-water washing facilities for workers in all restaurants, to provide another example of a sensible regulation.

It is still necessary, however, for these businesses to have stronger liability protection, so that restaurants may proceed with greater certainty, and also solvency. While the number of future COVID-19 transmissions in restaurants is unlikely to be zero, restaurants can only do so much to limit risk, vulnerable individuals still can opt to stay away and indeed are likely to do so, and tracing particular cases to particular restaurants is very difficult. For all of those reasons, we do not expect the traditional liability system to perform well in the case of restaurants, and we wish to limit its applicability, while of course keeping other safeguards in place. In essence, our proposal takes that commonsense approach to restaurants and applies it to the economy more broadly.

I would stress that nursing homes require a fully separate treatment.  Here is a related Marc Thiessen piece.  Here is Ross Marchand on state-level experimentation with liability.

Model this, coronavirus stupidity edition

A [NY] state guideline says nursing homes cannot refuse to take patients from hospitals solely because they have the coronavirus.

Here is the NYT article, with much more detail.  Here is a previous MR post Claims About Nursing Homes.  Via Megan McArdle.

And from a formal study:

Twenty-three days after the first positive test result in a resident at this skilled nursing facility, 57 of 89 residents (64%) tested positive for SARS-CoV-2.

Lockdown socialism will collapse

Under Lockdown Socialism:

–you can stay in your residence, but paying rent or paying your mortgage is optional.

–you can obtain groceries and shop on line, but having a job is optional.

–other people work at farms, factories, and distribution services to make sure that you have food on the table, but you can sit at home waiting for a vaccine.

–people still work in nursing homes that have lost so many patients that they no longer have enough revenue to make payroll.

–professors and teachers are paid even though schools are shut down.

–police protect your property even though they are at risk for catching the virus and criminals are being set free.

–state and local governments will continue paying employees even though sales tax revenue has collapsed.

–if you own a small business, you don’t need revenue, because the government will keep sending checks.

–if you own shares in an airline, a bank, or other fragile corporations, don’t worry, the Treasury will work something out.

This might not be sustainable.

That is from Arnold Kling.  Too many of our elites are a little shy about pushing this message out there.

Swedish expert against lockdowns

Here is Johan Giesecke, Swedish epidemiologist, interviewed by Freddie Sayers for a little over half an hour, one of the most interesting set pieces I have heard this year.  “I’m going to tell you what I really think.  I don’t usually do that.”  He also gives his account of what Sweden did right and wrong, and he argues that more Swedes than Norwegians have died because a) Sweden has much larger nursing homes, and b) Swedish immigrants.  How he puts matters is of great interest as well.

It is a good exercise to figure out exactly where and why his claims might be wrong.  For a start, I don’t think his extreme claims about fatality and infection rates can be true, even if you agree with much of what he says.

Via Adam.

And from the excellent Samir Varma here is a new Bloomberg article about the Swedes claiming success.

The three ideas you all are writing me the most about

1. Segregating old people, and letting others go about their regular business.  Given how many older people now work (and vote), and how many employees in nursing homes are young, I’ve yet to see a good version of this plan, but if you favor it please do try to write one up.  One of you suggested taking everyone over the age of 65 and encasing them in bubble wrap, or something.

2. Tracking and surveillance by smart phones.  Here is one story, here is another.  Here is an Oxford project.  Singapore is using related ideas, China has too.

3. Testing as many Americans as possible, or at least a representative sample, to get data.

I hope to analyze these more in the future.

Those old service sector jobs (Ansichten eines Clowns)

At first they came for the clowns, and I said nothing:

Then McDonald’s terminated its regional Ronald McDonald program at the end of last year, though it’s vague about the reasons for the move…

One former Ronald, who believes their number was as high as 300 nationally, said he earned $64,000 in 2016, plus a $2,000 expense account, a car, and health and dental insurance, a fortune in clowning.

Now, that sort of income and security may be disappearing.

“Young people have not been excited by clowns,” says Richard “Junior” Snowberg, a World Clown Association founder and a retired professor [sic]. “They’re more excited by entertainment on screens.”

The World Clown Association has 2,400 members, about half its peak membership in the 1990s.

I believe roboclowns are not to blame, nor is it trade with China:

“I’ve been told that ‘you can’t come to the hospital. You’ll scare people.’ That was really heartbreaking,” says veteran Tricia “Pricilla Mooseburger” Manuel, 56, of Maple Lake, Minn. “It’s diminished my income. The damage is done in so many respects. There’s a whole generation that, when they think of a clown, they think of something scary.”

Though, Manuel adds, “people still love us in nursing homes.”

That is from Karen Heller at The Washington Post, via Michael Rosenwald and Mark Thorson.

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