Assisted living facilities: U.S. eldercare

As people live longer, we need to think harder about end-of-life and late-in-life care of all sorts.

 The Guardian has the story (much of which focuses on a particular difficult situation):

In the US, not even $11,000 a month can buy you dignity at the end of your life  by Laura Fraser

"how much longer will we accept a future where most of us lose our sense of human worth in old age?"

...

"Currently, about 65% of US elders are cared for by their families at home. For 13% of those who aren’t living with family, the gap is partially filled by assisted living establishments.

...

"Nursing homes, assisted living and memory care (special units for people with dementia) are interchangeable in many people’s minds. But there are big differences. Nursing homes, funded by Medicare and Medicaid, are federally regulated. Assisted living and memory care are state-regulated, and mostly paid for out of pocket; some states have subsidies for certain conditions, so about 20% of all assisted living costs are paid for by Medicaid. The median cost of care in the US is $5,900 a month, but ancillary services provided on top of that base rate, including extra skilled nursing care, and can bring that cost up to $20,000 a month.

...

"Assisted living and memory care communities are covered by a range of 350 licensing regulations that vary widely from state to state – but with little oversight or enforcement of what few regulations exist. Most regulations don’t require minimum staffing ratios, or are worded as “sufficient” to meet residents’ needs. While this standard is vague, some advocates say that being more prescriptive would be problematic given staffing availability, costs and residents’ needs. Caregivers are typically required to have only a few hours’ training; only about half of communities employ a nurse, usually voluntarily. State and regional long-term care ombudsmen have the right to enter and investigate and informally mediate complaints at these residences, but they have no ability to enforce regulations, other than making a complaint to the state licensing agency.

Where burial societies go to die

The NY Times has a story on burial societies, cooperatives set up by immigrants in the 1800s and early 1900s to buy and maintain cemeteries. Membership came with burial rights. But the members of the remaining burial societies are aging, and as the society administrators die, it is hard to find replacements: With Demise of Jewish Burial Societies, Resting Places Are in Turmoil .

Various public agencies have gotten involved, e.g. in NY, the New York State Division of Cemeteries exercises general supervision over cemeteries, while the New York State Insurance Department supervises insurance companies. A burial society is both. The Insurance Department's Liquidation Bureau protects consumers who hold policies with failed insurance companies, and its office of Miscellaneous Estates has taken over the administration of some of the burial societies, until their last members are buried.

"Mark G. Peters, who heads the quasi-public Liquidation Bureau...said the government viewed burial societies as a type of insurer. “They may be a historically anachronistic insurance product,” he said, “but we are essentially the only safety net for people still depending on these societies.” "

At a time when the appropriate role of regulators for a variety of markets, including insurance markets, is under new scrutiny, it's reassuring to hear of a fairly unobtrusive regulator stepping up to do the job for which it was designed.

Pirate ransom: counterparty risk in the endgame

The NY Times reports that Hijacked Arms Ship Limps Into Port (this is the Ukranian ship full of Russian tanks and other heavy weapons that I blogged about earlier).

An earlier report, Somali Pirates Said to Be Leaving Ship , sheds some light on the negotiations:
"Somali pirates freed a Ukrainian ship carrying tanks and other heavy weapons Thursday after receiving a $3.2 million ransom. The U.S. Navy watched the pirates go but didn't act because the pirates still hold almost 150 people from other crews hostage." ...
"U.S. seamen were inspecting the pirates' departing boats to make sure they weren't taking weapons from the Faina's cargo, Mikhail Voitenko, a spokesman for the ship's owners, said Thursday.
But the Navy was not taking action against the pirates because it did not want members of other crews still in captivity to be harmed, said Cmdr. Jane Campbell, a spokeswoman for the 5th Fleet in Bahrain.
''Even when you release Faina, there are still 147 mariners held hostage by armed pirates,'' Campbell told The Associated Press. ''We're concerned for their well-being.''"

This is the same U.S. Navy one of whose first missions was to fight the Barbary Pirates , an earlier African/Islamic manifestation of piracy. (Do you say a Navy won its wings? spurs? water wings?). So it is very plausible that the pirates worry that, when they release their last hostages, they will face military retaliation against their bases in Somalia.

This will make the endgame tricky.