bigjoey

I would think the “extra death count” over the most recent years would be an excellent way to figure out the Coronavirus death count.

Yes, it is a “feel good” story. We should celebrate when people do things right that save lives. As the story notes, hundreds of thousands of New Yorkers fled to Florida, so while not an international destination to the degree of New York, Florida is an destination within the US. Those New Yorkers seem to have brought the infection with them. While South America is sadly a new virus hot spot, I hope we are now smart enough to halt visitors from South America and Central America.

As I have written many times, we will have to wait for the pandemic to be over to know the full story. I have not seen exactly how they are allegedly manipulating the data. I assume the stories will eventually come out. Part of the problem of recording deaths as Covid19 deaths is there is no uniform standard at this moment. I am not sure how historians are ever going to get an accurate count but instead may give a range. For example, is the death a Covid19 death based on a test of the body? Was it doctor’s opinion? Was the virus one of several possibilities and only a contributing factor?

Interesting piece comparing the statistics and reopening in Florida and Tennessee and what they did right. While much media attention is focused on Cuomo and New York, a look should be seen at alternative actions taken by DeSantis and Florida. Florida is reopening and so far, things seem to be going well: https://www.city-journal.org/florida-evidence-based-reopening-working

What our offices and work behavior will look like: https://www.nytimes.com/2020/05/28/health/cdc-coronavirus-offices.amp.html Note that despite the physical changes, much will come down to personal behavioral compliance with the suggested new norms.

Food prices will rise (as will the prices of many other things) as stores and companies spend money on preventive measures against the virus. For example, stores and offices will go through more cleaning; companies will furnish hand sanitizer and wipes; etc. These extra costs will get passed along.

Send the model to my house. I’ll take a new picture of him and then post that picture. I’ll forward you a copy of the picture, too.??

I have a Journal subscription so I was able to read the article. A good fact-based article how “science” can be used in the name of political advancement. Unfortunately, “science” is often used for political ends and manipulated accordingly. Unfortunately, I do not know how to cut and paste it. While I have many skills, I am lacking in high tech abilities?.

WOW! Steven’s post #72 is a great example of one of his word dumps. A slight-of-hand trick buried in a word salad that shows his obsession with declaring the deaths of seniors like the Jewish Holocaust in Nazi Germany. The slight-of-hand trick is to attack @Epigonos in his post #69 and my agreement in post #70. Both short posts specifically were about nursing home deaths in NY caused by the NY mandate that placed people with Covid19 in nursing homes. I agreed with @Epigonos by pointing out very specifically that the nursing home death rate in NY was greater than states without such a mandate and that such a mandate was a huge blunder. Very clearly, both posts were about Covid19 nursing home death rates. Now while Steven is correct that the latest figures are hard to come by (and continually changing), he switches away from talking about the “death rate in nursing homes due to Covid19“ caused in a great part by the NY mandate. He switches to talking about the percentage of senior deaths to the total deaths as well as absolute numbers. He turns the discussion into one of nursing homes being like Nazi death camps. WHAT HE DOES NOT DO is talk about the NY mandate that placed people with Covid19 in nursing homes. WHAT HE DOES NOT DO is talk about the death rates of seniors living in nursing homes. In fact, the Covid19 death rate of seniors living in nursing homes in NY is more than twice that of Florida’s rate of Covid19 deaths of seniors living in nursing homes. While most reader’s eyes most likely glazed over due to the voluminous post that is repetitive from past posts, Steven’s personal attack at @Epigonos and my posts did not go unnoticed by me. The purposeful deception with his slight-of-hand change of subject was clear. Typical of his bullying others to make himself seem to be THE authority on a subject. He builds himself up by wrongly tearing others down. Neither @Epigonos nor I doubt that this virus is very deadly for seniors. Neither @Epigonos nor I are against test, trace and isolate (there really is no “treat” beyond supportive therapy). Our sin seems to be in believing that the NY mandate made things in nursing homes more deadly for seniors. The FACT is clear: the Covid19 death rate of seniors living in nursing homes is higher in NY with its mandate that placed people with Covid19 in nursing homes than in states like Florida without such a mandate. The exact death rates will not be known until historians write the history of the pandemic. NY has now dropped the mandate so the time period can be bracketed (allowing for a slight death lag) to compare Covid19 death rates.

The place I described where I was a volunteer was home to my parents for six years. I was there all the time at all hours. I have had other friends and family there as well over the years including a relative there this moment telling me about the lockdown from the inside. Hardly a newcomer to the field of senior care; I know so much because I was involved with the design of the current facility. As for a person searching for a new home, yes, a thorough search is best but often time is limited and a place needs to be found in a few days.

That makes no sense. The goal is to maintain seniors functioning at the highest mental and physical level possible. That involves hard working staff and volunteers. The aim is to treat people with dignity and respect so they feel valued and that life is worthwhile. Sorry that does not meet with your approval. (The information was given to help you understand the answer to your question. People are given choices about such things as meals as well as how the Covid19 pandemic has affect the normal routine.)

In the assisted living part of the facility, there are three meals a day, seven days a week. There are 54 apartments with mostly singles but a few couples. There are three two bedroom units that have full size kitchens and the other units have a small kitchen area with a refrigerator, microwave and sink. Meal service is available in communal dining areas as well as room service on request. Choices include several options including Kosher plus (like McDonald’s), breakfast for any meal (a lot of seniors like eggs or oatmeal for dinner). The 54 units are in six “pods” of nine rooms. Each “pod” has a common sitting area with access to outdoor space. The people often come out of their apartment to sit in the common spaces in the pods as well as the larger spaces throughout the building including a library, chapel (all types of religious services), art gallery with changing exhibits, lobby area, outdoor areas, art and craft room, elder spa with indoor pool and exercise machines and classes, etc. Normally, there is a full set of activities (cut back because of Covid19 and people not coming into the building). Much of the social activities have been moved to the small common spaces in the pods so the groups are small. The activity director is limiting social activities to the small common spaces with several things each day to pull residents out of their rooms to socialize. Part of the building design was to cut down on infection transmitted by having these small groups. The skilled nursing area is similar in that the rooms in a small area are clustered around a common space in addition to a larger space for everyone on a floor. Right now, the larger common dining areas are closed. Meals are brought to the individual apartments or to the smaller common sitting areas for the nine apartments. The thinking is that IF someone becomes infected, they might be able to limit the infection to just one small area. This design was done for infections like the annual flu in mind but is serving the facility well during this pandemic. The state has a mandated lockdown on all senior facilities including but not limited to nursing homes. For people who are dying, it is hard on families as well as the resident not to have visitors; that is the current mandate in most states as I understand it. Very hard on all concerned.

As I recall from one of his books, GMHC in NYC was founded in his living room?. It is amazing to me that he was there at the very start of the AIDS pandemic and lived through its whole history. Anout the only other one who has chronicled that expanse of time who is still alive is Edmund White.

Yes, when a person is looking for themself or a family member, they should get all the input possible. Professionals like doctors, social workers and social service agencies as well as hospital discharge planners should be at the top of the list. If someone wants to do the legwork, the inspection reports are available to the public. They can be invaluable. Because staff is so important, I would concentrate on that aspect of research. One thing to notice during any tour is smell. A skilled nursing facility should not have a urine smell. The last thing on which I would rely would be the sales pitch and shiny brochures.

When the history of this pandemic is written, NY’s mandating nursing homes must take infected people will be seen as one of the great blunders. Just comparing the nursing home death rate in NY with Florida and other states that had no such mandate, the real scope of the blunder can be seen.

I have talked about building design taking fighting infection into account. One aspect of the skilled nursing facility where I volunteer is that almost all the rooms are private rooms. This was done for better outcomes for the residents: 1-less infection became everyone is separated with their own bathroom. Two (or more) people sharing a bathroom is a guarantee that if one has an infection the other(s) will get it as well. 2-less stress with no arguments over noise, TV, visitors, room temperature, personal possessions, etc. less stress means quicker recovery in rehab and less medical issues for long term residences. Private rooms give residents more control over their surroundings and residents are encouraged to decorate their rooms as they want (especially important with long term residents). We have a few double rooms which were constructed at the ends of the building so there was still some privacy and were not rectangle rooms but more like overlapping squares. These were designed for occupancy by two spouses, siblings, parent-child or two friends who chose to live together. Best part: no difference between those on Medicaid, Medicare and full private pay. Staff does not know who is there under which payment and there is no difference in services to any resident due to payment method. This was done so that dignity of the residents is preserved. No one needs to feel shamed at being poor and treated differently. When someone’s money runs out, they are not wheeled out of their private room into a shared room. Bottom line, the building design in this one aspect alone of having almost all private rooms made for better medical outcomes including infection control. Other design elements to cut infections included two special isolated rooms for residents who had an infection; the rooms had their own HVAC with negative air pressure to keep germs in the room and not out in the hallway.

I was told that one of the reasons Alzheimer’s residents live so long is they have no stress once they get to a certain point. They are certainly there for a very long time. Where I volunteer, there is a separate building for “memory care” with three levels of functioning with the lowest being skilled nursing. Those who are there under a year are really in two groups: 1-often there until rehabilitation gets them well enough to leave to assisted living or even back home for full independent living. 2-they are pretty well gone and really getting hospice care (where I volunteer there are dedicated hospice beds for “end-of-life care”). The third group who might be there more than a year requires more care than one can normally get in assisted living. The ideal model senior facility is a full continuum of care from fully independent living to end of life care with heavy medical needs (but short of hospitalization/ICU). Interestingly enough, in a continuum of care model, residents move back and forth across the units. For example, a resident in full independent living falls and breaks a hip which sends her for a short hospital stay; she is then discharged to the skilled nursing section where she gets rehab and then if not back to full independent living, there may be a short stay in assisted living while still accessing rehab; then back to full independent living.

While flu deaths in the entire United States go from about 30,000 to 40,000 per year, the 380,000 per year nursing home deaths from infections cover other infections besides just flu. These deaths get little publicity.

Most moves into “senior facilities” are not moves of choice but moves of necessity. We had to use a bulldozer to get my mother and stepfather to sell the home they loved and move into the independent living section of the “senior facility” where I volunteer. The home was designed specifically for senior living; after six months of living there, my mother told me: “I should have moved here years earlier because life is so much easier.” The good“senior facilities” are physically designed to make senior living easier and programing and services add to making life better. Sorry, but the well run places are far from a “sad” place. The good places add life into those final years. Yes, there are some places that are “sad” but no need to condemn all because of the bad ones. No different than any other aspects of life.

I think one thing that may come out of this is an understanding of the importance of infection control. I have talked about the senior facility where I volunteer and how seriously they have always taken infection control to the point of incorporating that into the design of the building as well as the staffing and management. No one seems to notice the 380,000 infection deaths a year from seniors in nursing homes. That number dwarfs the Covid19 number without the hysteria we see in the media. This silent pandemic of nursing home deaths might begin to gain some of the publicity it deserves. If infection control becomes a primary concern, then some of the best practices that I have seen might become part of new regulations. With those new regulations and inspections to enforce them will the infection pandemic end.

When I moved a few years ago, I had a collection of matchbooks like yours. I started collecting them about 1960. Before they went into my “moving sale”, it was like a trip down memory lane. In addition, I had a few ashtrays. Some restaurants would have a perk ashtray as part of each table setting. From The Four Seasons in NYC, I had three of the four seasons and always wanted the missing season.

According to the story in the Wall Street Journal, at Spring break students were given the choice to finish online or return to campus. 1,200 students chose to return to campus. In addition to the 1,200 students attending live classes, there were the staff which included professors, food service, etc.

To be clear: the good LTCF did not just start fighting Covid19. The facilities with good management and practices have been on the battlefront of fighting infections for decades. The Covid19 fight is just the newest one in this long fight; a very contagious infection and a very deadly one but fighting infections is not new. As I posted, two decades ago we considered fighting infections in the design of the building. However, our main weapon against infections has always been staff. Where I volunteer always put priority on hiring good people, training them and treating them well (which includes pay). When I became involved fifty years ago, the emphasis was on having good, caring staff and that has been the hallmark of the institution. That is why we are so far successful in fighting Covid19. Years of fighting infections and the annual flu have prepared the better facilities for this moment. The Talmud has a very famous quote about starting something you know you will not finish. Even the knowledge that you will not be successful is not an excuse not to begin. Even if the task of not fighting Covid19 will not be a winning one, no reason we should not try. The better LTCF are at least engaged in the fight. The nay sayers just may be wrong as they were when Falwell opened Liberty University; in that case they attacked Falwell in that his actions will cause people to die. Falwell may not believe in evolution but not one student or staff that was on campus got infected. From the Talmud: https://www.voices-visions.org/content/poster/collection-poster-rabbi-tarfon-pirke-avot-221-bob-gill A defeatist attitude runs against the positive Jewish attitude expressed in an old Jewish story: A rabbi was widely believed to have wondrous powers to do miracles and cure the sick. His reputation reached the Czar who summoned the rabbi to appear. The Czar thought he would have fun and he would expose this “miracle” making rabbi as a fraud. The Czar demanded the rabbi teach his dog to talk or the rabbi would be put to death. The rabbi thought about his bad choices and said that if given three years, he would teach the dog to talk. On leaving with the dog in tow, the rabbi’s companion looked at him and said: “Are you crazy? Youcan not teach that dog to talk.” The rabbi responded: “In three years, I could be dead. In three years, the dog could be dead. Who knows, in three years, the dog could talk.” I prefer to have a positive outlook and concentrate on fighting the virus to prevent seniors from dying. So far, thousands of facilities in Florida are successful. So far, almost all facilities in Johnson County are successful. This can all be happening while modified lockdowns are happening and test, trace and isolate is implemented. These things are not mutually exclusive. Besides, when all this is over, “the dog could talk.”

Typical Steven post which twists and distorts what I have said to produce a misleading post.? When I said I did not know the protocols, that was clearly referring to what they were going to be using in the future when they opened up. I do not know that the protocols have even been finalized. I do know they will be hard work going forward just as the ones that have been in place during the lockdown have been hard work. You have specifically taken something out-of-context and twisted it to then hold it up to ridicule, a Steven argument trick. Nice.? I have never said a single death or even a few means that best practices are not followed. Nothing is 100% certain. In referring to the statistics in Johnson County, Kansas, 7 out of about 150 facilities had one or a few Covid19 deaths but one facility had 17 that is more that all the others combined! That single nursing home is the one I referred to has having poor management that lead to the deaths; I never referred to the other LTCF as being poorly run or not following best practices. You distort what I said to claim that I would condemn the 183 Florida LTCF that had at least one death. I would certainly question the management and if they followed best practices at the 14 LTCF that had 10 or more deaths. Those 14 facilities are .0036% of the 3,800 total Florida facilities. Distortions and making false claims are Steven hallmarks. No where do I say a single death means best practices were not followed but yet you claim that is what I believe. More typical Steven distortion and lies. I have clearly said that I am in favor of testing, tracing and isolation and that can be done while LTCF continue their own work. A community with no Covid19 makes that work easier; I agree. But until that happens, the hard work goes on. Just as the facts of what is being done in Johnson County, Kansas (or Liberty University did last semester with a university) shows there can be success in fighting the virus until it is conquered. Somehow, thousands of Florida LTCF have been successful, too. Maybe those thousands of Florida facilities were just lucky or maybe they had good management and followed best practices? As for the places that you continually hold up as success stories, China, South Korea and Singapore have all had virus flare ups. This shows that until there is artificial or natural herd immunity, the virus will be a continued threat. NOTE: that is not “promoting” herd immunity but just recognizing reality. I note you have failed to comment on the 380,000 seniors who die each year from infections in LTCF. Ever since I became involved as a volunteer in a nursing home over 50 years ago, infections have been an issue. The protocols that have been developed over the years are the basis for the current Covid19 protocols which are more extensive. Do you not consider that 380,000 deaths per year of seniors in LTCF is an important issue? I consider that a major issue. I was involved over 20 years ago in the design of the current LTCF building that had features in the building design to fight infections. (That 20 year old building is currently under renovation to incorporate the newest ideas in excellence of care). The facilities with better management and practices did not just happen with the appearance of Covid19. That helps explain the success in Johnson County and why thousands of Florida facilities have been successful Please stop misrepresenting what I have posted, distorting my views and posting outright lies. To quote you: “Give me a fucking break.”

An update on Covid19 and nursing home deaths in Johnson County, Kansas. To refresh memories, there are over 600,000 people in Johnson Country with 150 senior long term care facilities. Those facilities house about 20,000 seniors. The newest dashboard: https://public.tableau.com/profile/mapper.of.the.day.mod.#!/vizhome/shared/558GFDZKM The one poorly managed nursing home now has had 17 dead but the rest of the nursing homes in the county have had no additional deaths and their total remains at 14 deaths. Bottom line, 143 of 150 nursing homes figured out best practices to where there were no deaths. One poorly managed nursing home is now responsible from more than half the deaths. The first lawsuit has already been filed! Poor management will shortly put Brighton Gardens out of business as the lawyers descend. Personally, this virus hot spot is eight blocks from my home; a little frightening. Best practices have kept deaths away from our seniors. In a few days, the nursing homes will be opening up; I do not know the protocols they will be using but my guess they will be strict. However, while this has been hard and difficult work, it can be done. The same goes with keeping down infections everyday which kill about 380,000 seniors each year in nursing homes. The better run nursing homes have figured out this difficult task while poorly managed places have everyday infections killing seniors. Same principle: good protocols and good management save lives. We just go not throw up our hands and say the task is too hard. Yes, it would be an easier job to protect seniors if there was no Covid19 virus in the general community. In the same vein, my father use to say: “I would rather be young, rich and healthy than old, poor and sick.” By all means, eradicating the virus in the community should be our goal BUT that does not mean we can not protect seniors in nursing homes as the facts presented in the dashboard show. Both goals can be done at the same time. I posted earlier about Falwell’s Liberty University bringing back students to campus. The media hysteria was that students would die BUT just like the Johnson Country nursing homes, best practices executed with good management can produce good results. Liberty had no on-campus infections of students or faculty. Yet, other university campuses are undecided on what to do. Apparently, what Liberty University did last Spring, other universities feel is too difficult for their management to execute this Fall. Yes, it was hard work but Liberty showed it could be done. Be it a senior campus or university campus, people know what proper protocols need to be done. In both cases, the hard work would be a lot easier if the virus was crushed and not in the community. We should be able to multi-task and do both goals.