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Comment by giancarlostoro | Hacker News Reader

And I am sure the nurses are overworked and not receiving competitive pay to boot.

Speaking from experience, the only people who can afford to live as nursing home staff (typically LPNs) are the poor. In my metro area, only the presence of a large low-income high-crime area allows for a low enough cost of living for its residents to survive on nursing home pay. I think these folks can make more working at McDonalds. The quality of care is garbage... Less than 10% of nursing homes in my area provide the care I'd want for my relatives.

Oddly enough, even homes that advertise RNs and a high number of staff still don't provide the care I'd want for me relatives. The only homes I've been to where the staff are genuinely great are nursing homes out in the boonies, in rural areas at least an hour outside of my city.

I can echo this statement. My mother is in a nursing home facility for the last 8 years.

She is located in the facility she worked in as a poor laborer before becoming a resident. The facility is over an hour from the nearest metro area.

The care she receives there is pretty good. The staff are mostly locals in the rural town and are comfortable being poor and living that life.

We considered moving her into the city to be close to family who have to drive almost 3 hours to see her but the care is so bad in the city it isn’t worth it.

We have had family members in city nursing homes and they’re abysmal. Which to some level I get. The people there like you stated are underpaid and overworked. They live in bad neighborhoods because of systemic poverty. They bring all the stress of being poor in a metro city with them to work. Quality of care plummets but there’s nothing that can be done because no one is going to pay more than bare minimum to reach mandatory staff minimums.

> locals in the rural town and are comfortable being poor and living that life

> all the stress of being poor in a metro city

Is it generally accepted that people in similar economic circumstances have improved life satisfaction in rural areas? It is counterintuitive to me given any city typically has better low cost amenities like museums, libraries, and parks than rural areas that I have observed.

Think about how often you got to a museum, library, or park compared to how often you eat and pay the monthly bills. The more expensive the area, the higher the routine bills and wages don't always track that, especially at the low end.

Both have significant advantages, shared walls reducing energy costs and the ability to live without a car can make a huge difference at the bottom.

It’s really suburbs that end up the most expensive. You combine higher housing and labor costs vs rural areas without any of the cost savings of cities.

Some people prefer space, privacy, and nature over cultural amenities. It's possible to survive on fairly little income if you own some land and are able to hunt, fish, and grow a bit of your own food. Being poor is still tough anywhere but people get by.

> It is counterintuitive to me given any city typically has better low cost amenities like museums, libraries, and parks

Indeed, one can also add availability of theaters, operas, music festivals, multi-cuisine restaurants and sport complexes too.

And the situation will get worse due to aging population demographics. This type of work is among the hardest to automate.

There was an article here in HN how nurses and nursing home staff in a lot of US are basically using an "uber for Nursing" app where you get a request and you can accept it or not......but the company that built it has a "desperation" score on every nurse and the more desperate they are estimated to be, the less money they are offered for the job - the logic being that they are not in a position to refuse.

Honestly, the article literally made me want to vomit. I'm not religious but our society has sacrificed everything human in the worship of mammon.

This highlights the problem with privatizing things like healthcare and education, something libertarians don't understand. It works for the Koch's because they can pay for anything. It doesn't work if you're not rich.

I wouldn't say privatizing is the problem. It isn't. Private is often, or generally, good, as it gives you the freedom to pursue good ends without unnecessary involvement of state bureaucracy. It's bad and weird to have the state involved in everything. It's for-profit that is problematic in the mentioned cases.

Healthcare, insurance, banking, education, and so on should be not-for-profits or nonprofits (depending on the case).

I think nonprofits can be bent to something weird, too. But might be worth a try. The current situation is just crazy.

All nonprofit means is that you are not organized with profit as a primary goal. It doesn't mean you don't make money, and it doesn't mean that executives don't have outlandish compensation.

Main problem with non profits in my understanding is, that they are often created for tax evasion purposes, but the legit non profits still get the regulatory heat.

What is the incentive for a private entity to engage in non-profit business.. charity?

Nobody want's the state involved because they think they'll do a better job, they want the state involved because it's the last option available with incentives remotely aligned with the benefit of the polity.

Health of the population is in the public interest, therefore it should be run by the public. Same with education.

We can have nonprofit education, say, and people will still be left out.

Less education is bad for you, it's bad for me, and it's bad for the whole country. Therefore it must be public or we must suffer.

For-profit-of-outside-investors

Report: https://rooseveltinstitute.org/publications/uber-for-nursing...

HN discussion about a similar company exposing private information: https://news.ycombinator.com/item?id=43349115

The apps are ESHYFT, ShiftKey, ShiftMed, and CareRev. CareRev is a YC company (https://www.ycombinator.com/companies/carerev), so maybe the founders are around to explain the technical details of their desperation algorithm or why they allow employers to cancel shifts with 2 hours of notice.

Better profits and more efficient rent extraction is the why. Stick to the how and you might get an answer?

Or maybe the developers are on here and can explain why they agreed to implement such a thing?

But you know, free markets, invisible hand, everything else is Communism or something. Carry on.

Is this anything more than a scary way to describe a pricing algorithm?

Honest question - are you trying to downplay the absolute horror of our technofeudalistic society, where nurses(!!!) are paid in a gig economy betting on their hours, where (if you read the report) the hospitals are free to cancel their shifts with no or little penalty even during the shift, while nurses are heavily penalized on every side, and things like having a lot of debt means you will be offered less money for your shifts because the app determines you are desperate?

Yes sure, technically that's no different than Uber hiking up your price at 3am because really, what other choices do you have.

But I do hope you spend a minute to wonder what is it doing to our society as a whole, and how the relentless pursuit of profit means we treat people whose job is literally to look after others like disposable trash that can be priced the same way a taxi ride is.

Sure, it's "just a scary way to describe it" - and I hope it's really scary.

What you described is nothing new. Staffing firms for nurses have existed for a long time. These apps are automating the process and making it easier for both sides. I'm open to the idea that it's worse for workers but I haven't seen it. People seem to flock to these apps. To me that means they prefer the arbitrary and capricious nature of an algorithm over the arbitrary and capricious nature of human managers.

>>Staffing firms for nurses have existed for a long time.

Do those staffing firms for nurses also pull information on your credit card debt and offer nurses less money if they have a lot of debt?

That doesn't really address my point.

I'm sorry, what is your point then. Because I thought it was that the apps and hiring houses for nurses are effectively the same - which is why I'm asking if they also pay less if you have more debt.

That in practice the arbitrary nature of the algorithm is superior to the arbitrary nature of human hiring.

For the company the algorithm works for? Yeah, no doubt about it. For the nurses? No, I don't believe that - unless like I asked earlier, the employment agencies also reduce their pay if they think they are desperate. In which case I'm happy to concede this point.

> The quality of care is garbage... Less than 10% of nursing homes in my area provide the care I'd want for my relatives.

As a paramedic who delivered probably thousands of patients to (and picked up patients from) nursing homes, I'd unfortunately absolutely agree. Not always to the point of filing complaints, but not great.

> Oddly enough, even homes that advertise RNs and a high number of staff still don't provide the care I'd want for me relatives.

As that same paramedic, absolutely, you know why?

Many of those homes have ONE RN as the supervisor for a bunch of LPNs and CNAs. And they have policies/insurance/whatever that say "anything larger than a bandaid, call 911 and have them deal with it", which leads to ridiculous situations where you have two nurses standing around while my partner and I bandage a straightforward laceration.

Those are usually the ones advertising out front "Round the clock nursing care" (and absolutely charging for it).

Anecdotally, my friend's mom was is a nurse at a hospital that got bought up a while ago. During COVID, her pay and the hours were awful. She left shortly after. It blows my mind how little some hospitals can pay a nurse, while others are paying much more, all for the same core work. I believe she has since found a new hospital to work at and is making significantly more.

As the son of a nurse, the lack of hazard pay for putting up with doctors’ egos is also unconscionable. Doctors make mistakes all the time but you wouldn’t know it by looking at them.

And to extend your statement, and not to imply this was what you were saying: overwork in Nursing doesn't just happen either, the scheduling and staffing is very intentional and very much a management decision

Is anyone else here also see the insane schedules nurses often work as unsustainable? 12 hour shifts seem incredibly common. I get there's risks in patient handoffs, but there are risks in understaffing and overworking people as well.

I personally know of several people who ended up having to leave acute nursing because they just couldn't continue with the schedules while trying to have any kind of sane family life. It seems to me hospitals need to change up schedules to have better options for work.

But I'm a lay person tech bro looking at an industry I only have a small window in. What are the other arguments for and against these kind of long schedules?

nurse to patient ratios and the type/level of care needed in the patient mix factor higher in overwork imho

These are the hospitals that are essentially all travel nurses.

Worked to death, but well paid. Don't actually have to care anything more than the bare minimum because at the end of the day, there's an end of the day (contract).

I can anecdotally confirm this, based on my father's experience in a private-equity owned facility in California. It was astonishing how under-staffed they were for the amount of care the patients needed. (I'm sure they were at least nominally in compliance with whatever the regulations said, but that doesn't mean they were adequately staffed.)

Thing is, I loved those nurses. I watched them walk in with the look I remember from my restaurant days when you knew you'd be in the weeds all shift - call it a hundred-yard stare, if you like. They were all completely burnt out, and openly and cheerfully cynical and contemptuous towards the owners and administrators, but for the sake of the patients they just got on with it, as best they could. I don't think I ever saw the head nurse sit down.

There weren't enough supplies, because the laundry service was late, so I went back to my dad's house and brought him an extra blanket. The next day I got another for his neighbor.

There weren't really any rules, because nobody had time for that. The blanket thing? Shouldn't have been allowed, especially giving one to someone else. I asked about visiting hours, and just got a raised eyebrow, and "just put 8pm on the signout sheet". I said "well, then, I'll come back with a six-pack and stay until midnight!" She laughed at me, because I was (half) joking, but I'm pretty sure that would have been fine.

More substantively, when my dad needed the heavy-duty painkillers - prescribed by his doctor, mind - the administration (reached by phone) wouldn't allow them to be dispensed - supposedly because of the liability of having that kind of controlled substance on site; we sorted it out, but it took a couple of of days - when that happened, I said I'd bring in the bottle he had at home and give them to him myself. The nurse said pretty much "we can't do that - but if I didn't see it, it didn't happen," so I did. Then she made sure to give him his other medications herself, so she could check on how much I'd given him, and that it wouldn't cause a problem with the other pain-killers he was on.

I'm sure all of those things were wildly "wrong", from someone's point of view - ethically, or legally, or fiscally, or something. But I viewed the whole situation as so morally appalling - people live there for months, waiting to die - that I can't view those nurses' ethical commitment to whatever it takes to make their patients' lives more tolerable as anything but admirable.

Thing is, we're eating our societal seed-corn. The more awful those jobs are made, the more quickly people burn out of them, and the worse the care provided will become. Those folks were dying on their feet, and there was no help coming, and I don't know how much longer that facility - let alone the whole medical system - can stay afloat on those admirable people's dwindling store of compassion.

But hey, some folks got a little richer by owning that place. All the rest of it's a small price to pay for living in such a land of glorious opportunity, right?

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