site banner
PaperclipPerfector  6mo ago (text post)   24897 thread views

Culture War Roundup for the week of October 30, 2023

This weekly roundup thread is intended for all culture war posts. 'Culture war' is vaguely defined, but it basically means controversial issues that fall along set tribal lines. Arguments over culture war issues generate a lot of heat and little light, and few deeply entrenched people ever change their minds. This thread is for voicing opinions and analyzing the state of the discussion while trying to optimize for light over heat.

Optimistically, we think that engaging with people you disagree with is worth your time, and so is being nice! Pessimistically, there are many dynamics that can lead discussions on Culture War topics to become unproductive. There's a human tendency to divide along tribal lines, praising your ingroup and vilifying your outgroup - and if you think you find it easy to criticize your ingroup, then it may be that your outgroup is not who you think it is. Extremists with opposing positions can feed off each other, highlighting each other's worst points to justify their own angry rhetoric, which becomes in turn a new example of bad behavior for the other side to highlight.

We would like to avoid these negative dynamics. Accordingly, we ask that you do not use this thread for waging the Culture War. Examples of waging the Culture War:

  • Shaming.

  • Attempting to 'build consensus' or enforce ideological conformity.

  • Making sweeping generalizations to vilify a group you dislike.

  • Recruiting for a cause.

  • Posting links that could be summarized as 'Boo outgroup!' Basically, if your content is 'Can you believe what Those People did this week?' then you should either refrain from posting, or do some very patient work to contextualize and/or steel-man the relevant viewpoint.

In general, you should argue to understand, not to win. This thread is not territory to be claimed by one group or another; indeed, the aim is to have many different viewpoints represented here. Thus, we also ask that you follow some guidelines:

  • Speak plainly. Avoid sarcasm and mockery. When disagreeing with someone, state your objections explicitly.

  • Be as precise and charitable as you can. Don't paraphrase unflatteringly.

  • Don't imply that someone said something they did not say, even if you think it follows from what they said.

  • Write like everyone is reading and you want them to be included in the discussion.

On an ad hoc basis, the mods will try to compile a list of the best posts/comments from the previous week, posted in Quality Contribution threads and archived at /r/TheThread. You may nominate a comment for this list by clicking on 'report' at the bottom of the post and typing 'Actually a quality contribution' as the report reason.

8
Top Bottom Old Controversial Comments
Jump in the discussion.

No email address required.

Staffing Shortages in Nursing Homes

Recently the House Energy and Commerce Health Subcommittee held a hearing about two new Biden Administration rules impacting staffing in nursing homes.

The lay of the land is that everyone in both parties agrees that we have a critical lack of workers in nursing homes. There have been more than 500 long term facility closures in 2020, and we would need to fill 150,000 jobs just to reach pre-pandemic levels. One of the witnesses mentioned that most nursing homes do not have anywhere near the minimum number of staff that the Center for Medicare and Medicaid Services considers a requirement to be safe. Higher numbers of staffing are also associated with higher quality patient care and lower deaths. Some witnesses related horror stories of nurses not being able to wash patients who had soiled themselves because they were dealing with more urgent medical situations for other patients.

This is especially urgent because by 2030 all 75 million of the boomers will be over 65 and the demand for care will only continue to rise. So the Biden Administration has proposed two rules to address the situation.

1 - The Proposed Minimum Staffing Rule would require there to be a registered nurse on-site 24 hours a day (up from 8 hours currently), and a ratio of one nurse for every 44 residents and one nurse aid for every ten residents.

• Republicans objected that the Kaiser Family Foundation found as many as 80% of nursing homes would not be able to meet the minimum staffing requirements, and compliance costs alone would be tens of millions per state. This would be especially difficult for rural nursing homes where trained staff are rare.

• Democrats responded by pointing out that the rule phases in over three years, gives rural facilities five years, and makes full exceptions for nursing homes that are trying to find staff but can’t.

• Republicans also claimed there simply aren’t enough trained staff out there to be hired, which makes the requirement impossible. It’s unclear if this is true; the witnesses were pretty evenly divided.

• (Related tidbit from outside this particular hearing: Senator Bill Cassidy, Bernie Sanders’ Republican counterpart on the Senate HELP Committee, has complained that we have a shortage of trained nurses partially because many states require nursing colleges to be taught by nurses with masters degrees, who are few in number and already mostly working as practitioners. I can buy this because in my experience looking into other healthcare issues, state level regulations often do make federal laws go much less far. For example pricing transparency rules don’t really matter when states allow hospitals to be monopolies.)

• Democrats responded that the rule provides $75 million in grants to train nurse aids, and also pointed out that Democrats repeatedly have tried to boost federal spending to help with this kind of training and hiring but Republicans were opposed soooo.

2 - The proposed Medicaid Access Rule would require home health agencies to pass through a minimum of 80% of funds to direct health care work force.

• Republicans objected that this only leaves 20% of funds to handle everything else: administrative costs, facilities, training, supervision.

• Democrats countered by demonstrating that non-profit nursing homes were spending on average 43 more minutes per patient each day than for-profit nursing homes, and this held consistent across urban vs rural areas as well as rich vs poor areas. Meanwhile, for-profit orgs are also, obviously, walking away with more profit. Thus, the 80% rule is just a way of ensuring that the federal funds goes to our most critical problem: staffing and patient care, since clearly you can’t rely on businesses choosing to do this on their own.

It's a crappy situation. Basically everyone agrees that the current status quo is unacceptable, but also nursing homes genuinely don't seem to be the funds to hire the desperately needed more nurses, even though they were able to (at least moreso) only a few years ago? The only solution seems to be raising federal funding for nursing homes to hire more people, but this is unlikely to happen any time soon. It would probably be easier to get everyone to agree on stuff like lifting the supply restrictions on nursing colleges, but of course that happens on the state level and is much more complicated to address from the federal side.

Prior to her death last month, my grandmother spent about two years in a retirement home. They struggled with staffing constantly. I’m not even talking about technical employees giving care, though I’m sure they were hard to find too. I’m talking about cooks, cleaners, and receptionists.

Quality of service fluctuated noticeably. Each time someone quit, the remainder of the staff were more stressed, and the inhabitants were more cranky.

The overall impression was that wages weren’t keeping up. I think the management might have cut them mid-pandemic? Either way, they could not or would not afford to crank up wages. There were rent hikes, but old people are a strange customer base. While they have lots of sunk costs keeping them from moving, they are particularly inclined to raise hell when something goes poorly. Or to just ignore a rent increase—what are you going to do, sue them? I could easily see this become a death spiral if morale got low enough to push out new clients.

Thing is, I don’t know why this would be limited to elder care. Was there a particular reason—COVID restrictions, or some regulatory regime—pushing staff to other industries? Or does every service job in Dallas have a similar level of churn? Is this post going to start another fight about inflation and lived experience?

Since she passed, I haven’t spent much time at her apartment. I doubt that they’ve reached a happy equilibrium. There’s a complex web of rents and reputation pulling against wages and property taxes and material costs. In better days, maybe a vacancy in the kitchen was easy to fill. Today, if frictions really are higher, maybe that gap pulls everything else down with it.

I'm sorry to hear about your grandmother's passing.

Or does every service job in Dallas have a similar level of churn?

Yes. Dallas has a strong labor market coupled with high housing costs relative to low skill wages; the guy you find to drive in from waxahatchie or royse city to earn $14/hr instead of $12/hr will either find a better job or get arrested for driving in on a suspended license every day, and the local low skill laborers are getting squeezed out.

Was there a particular reason—COVID restrictions, or some regulatory regime—pushing staff to other industries?

Anecdotes are not data, but what I was hearing during the lockdown in Ireland was that a lot of the hospitality industry laid off staff and didn't guarantee that they would have jobs to come back to. So people got jobs elsewhere, then when the lockdown was lifted and the pubs, etc. were looking for staff back, people said "why would I work unsociable hours in crappy conditions for bad pay, when I have a better job now?"

Unless unemployment levels hit that point where any kind of a job is better than none, low-paying/poor conditions jobs are going to remain open since people can find work elsewhere. The retirement homes may not be able to pay more, or they may just not want to. Either way, if they can't make it worth people's while to work there, then staffing levels will be hit.

a lot of the hospitality industry laid off staff

But why would they do that? Genuine question.

Money saving measures. Understandable, if you're a pub or restaurant that now can't have more than X number of people inside and they have to be Y feet apart, and on top of that the public is being cautioned to stay at home and not go out in public. The custom isn't there, so the work isn't there and the money to keep people paid isn't there.

But some places instead of telling people "it's a temporary shut-down, there's a job for you when we re-open", just got rid of people (presumably expecting they could just hire new staff back when re-opening) in preference to temporary lay-off, then had trouble recruiting back post-pandemic. Because some workers had gone abroad, and some had gone into better jobs:

“It is estimated that around 20pc of the workforce in the travel and tourism industry left the sector permanently during the pandemic. Some left the country as they were laid off, and many sought employment in other sectors like construction which resumed trade earlier and some cases offered better remuneration.

“The sizeable gap in staffing has already caused substantial disruption for some businesses who have been forced to adjust their operating models and this could delay their recovery,” he said.

This has resulted in situations such as:

-Rooms in most hotels are only cleaned when requested by the customer
-Some hotels had to close down some bedrooms or lost on revenue because room could not be serviced
-Bars and restaurants reviewing their opening/closing times as allowed by staffing levels
-Reduced menu items

“In order to retain/maintain or secure new staff many hospitality businesses have resorted to increasing remuneration, which may have a longer-term impact on the sector unless businesses are able to pass the increased cost of business to their customers. The increase may also have to reflect the impact of inflation on food and beverage costs and utility expenses among others.

The hospitality industry is a long time situation of long and unsociable hours, low pay, being expected to do extra work, etc. Most places are good, but there are always the smaller, owner-run ones which do exploit staff (there's one such hotel in my home town which is notorious for this). This leads to constant turnover, poor service, etc. (hilariously, years back when one of my siblings got a summer job in a local hotel, they arrived in to work one morning to find the manager cooking the breakfast for guests because the chef had walked out).

It's a misunderstanding on my part then. I thought the original comment was about retirement home employees and hospital staff in general.

I think the way titles are used is also confusing; there's nursing staff and registered nurses and practical nurses, and different countries describe the jobs differently:

There are five levels of nursing: Certified Nursing Assistant (CNA), Licensed Practical Nurse (LPN), Registered Nurse (RN), Advanced Practice Registered Nurse (APRN), and Doctor of Nursing Practice (DNP). Each level has different requirements, educational qualifications, and salary rates.

So a speech or a newspaper article about "we need more nurses" could mean RNs or they could mean CNAs. Pretty much you are going to need more of everyone, but the ones helping patients bathe etc. aren't the RNs:

CERTIFIED NURSING ASSISTANT (CNA) Position description: Although a CNA is not an actual nurse, they’re the main line of communication between the patients and the nurses. CNAs typically take care of the patients’ hygiene, feeding, and mobility needs. With the help of CNAs, patients can bathe, eat, transfer from beds to wheelchairs, and perform other necessary daily activities.

Requirements: To become a CNA, the first thing you need is a high school diploma. Next, you’ll have to undergo a state-approved education program that lasts up to 8 weeks, with specific numbers of hours in the classroom or clinical practice. Last but not least, you’ll need to pass a CNA exam that tests all that you’ve learned and gives you the opportunity to start your life as a nurse.

Over here that would be a healthcare assistant or the likes, not a nurse, but Americans like fancy titles and steps up the salary ladder in an orderly progression 😁

What’s the Difference Between a Nurse and a Healthcare Assistant? While Nurses and Healthcare Assistants both care for patients, there are important differences in their roles. A Nurse is responsible for a patient’s medical care and has greater freedom when it comes to assessing and observing their health and condition. A Healthcare Assistant is involved in a patient’s basic, daily and personal care.

In Ireland, Nursing is a graduate career so involves extensive study. You don’t need to earn a degree to be a Healthcare Assistant – a QQI Level 5 qualification allows you to work in the role.

People still have the old-fashioned image of nurses in mind when they did change bedsheets and the rest of it, but now it's a much more technical role.

But why would they do that?

Because it was illegal for the vast majority of hospitality businesses to operate in anything resembling their normal form?

Can you elaborate please?

As you undoubtedly recall, operation of the vast majority of hospitality businesses was outright prohibited over the 2 years weeks to flatten the curve.

That means that those businesses no longer required the services of their staff. So they were (temporarily to permanently) fired without cause, which is what "laid off" means.

Thing is, I don’t know why this would be limited to elder care. Was there a particular reason—COVID restrictions, or some regulatory regime—pushing staff to other industries? Or does every service job in Dallas have a similar level of churn? Is this post going to start another fight about inflation and lived experience?

Anecdotally, many service jobs I encounter on a regular basis have gone downhill in the past few years post-Covid. I'm thinking particularly servers and cafe clerks, but also public transport drivers. It's not that their individual performance has gotten worse - AFAICT, that's remained the same - but they're constantly understaffed, leading to just inevitably terrible service due to the long wait times. This also causes extra stress on the staff, which sometimes results in less-than-ideal performance that would have been better but for the extra pressure put on them due to the reduced staff.

My pet theory is that the Covid lockdowns made a lot of people in the service industries realize that these jobs generally weren't worth the pay in comparison to other ways they could be spending their time, whether that be staying at home or pursuing some other venue to make money, resulting in a shortage relative to what the economy was used to before. Perhaps it's a bit of a market correction, where these workers, for whatever reason, were priced below their market price, and suddenly a lot of the workers realized this at once and, in an uncoordinated fashion, simultaneously decided to quit the industry.

I'd add that the 2021-22 period was also one of uncertainty for many service sector workers because governments promised that restrictions will be eased soon, but nobody knew if this'll last, or there'll be a policy reversal due to a new panic once the data arrives about supposedly growing COVID rates and whatnot. I'd assume many people decided that they can't just sit around waiting for times to get better sometime in the future, and left the sector.

My impression is that Covid was a signal for Boomers to retire. Now all those service jobs which used to be filled with Boomers are staffed by nobody, so labor is hard to find and more expensive. As a concrete example, an aquaintence was a nursing assistant and dropped from full-time to retired in May of 2020. They have since returned to work, but only around 4 hrs/wk, and only in 1-1 care for clients they like, rather than the more economically efficient (but more demanding) group care. Social security is paying about what they used to make; why would they subject themselves to the stressful job?

Might be even worse than that, if retirees freed up a whole cascade of jobs via promotion. There was absolutely a hiring flurry in my industry and I wonder if it attracted some lower-skill employees who’d otherwise have been finishing their vocational training.

This is exactly what happened with our local healthcare. Nurse past retirement age finally "retired," then took up private practice to fill the gaps left by the completely incompetent hospital district, now "retiring for real except for helping friends/whoever asks because she can't say no."

Competent boomers were absolutely doing all the actual work, and losing them is destroying the institutional knowledge of every industry.

We're seeing a similar thing in Seattle with jails and mental facilities. No one wants to work at these places, and for good reason.

As the ratio of invalids to capable adult sincreases, this problem seems like it will only get worse. As usual, the socialist solution accelerates the decline. We need to think about ways to reduce the cost of institutionalization, not increase it.

On a positive note, generative AI could be a boon for the elderly. The desperate loneliness felt by the old and infirm will soon be alleviated by convincing AI-generated video chats.

COVID sky money plus COVID restrictions meant it was often better to just stay at home and collect skybucks rather than go to work at a shitty job and lose said skybucks.

What is this place?

This website is a place for people who want to move past shady thinking and test their ideas in a court of people who don't all share the same biases. Our goal is to optimize for light, not heat; this is a group effort, and all commentators are asked to do their part.

The weekly Culture War threads host the most controversial topics and are the most visible aspect of The Motte. However, many other topics are appropriate here. We encourage people to post anything related to science, politics, or philosophy; if in doubt, post!

Check out The Vault for an archive of old quality posts. You are encouraged to crosspost these elsewhere.


Why are you called The Motte?

A motte is a stone keep on a raised earthwork common in early medieval fortifications. More pertinently, it's an element in a rhetorical move called a "Motte-and-Bailey", originally identified by philosopher Nicholas Shackel. It describes the tendency in discourse for people to move from a controversial but high value claim to a defensible but less exciting one upon any resistance to the former. He likens this to the medieval fortification, where a desirable land (the bailey) is abandoned when in danger for the more easily defended motte. In Shackel's words, "The Motte represents the defensible but undesired propositions to which one retreats when hard pressed."

On The Motte, always attempt to remain inside your defensible territory, even if you are not being pressed.


New post guidelines

If you're posting something that isn't related to the culture war, we encourage you to post a thread for it. A submission statement is highly appreciated, but isn't necessary for text posts or links to largely-text posts such as blogs or news articles; if we're unsure of the value of your post, we might remove it until you add a submission statement. A submission statement is required for non-text sources (videos, podcasts, images).

Culture war posts go in the culture war thread; all links must either include a submission statement or significant commentary. Bare links without those will be removed.

If in doubt, please post it!


Rules


Recommended Posts And Communities

Recommended Realtime Chats