I would seem to me, there’s a market for opening a daycare that pays livable wages, and another where you could both undercut nursing facilities and pay the staff living wages.
I’m not a fan of capitalism by any means, but it does seem that this should market correct no? What’s stopping that from happening?
insurance, frivolous lawsuits, lack of cooperation from regulating authorities, take your pick
For a daycare, it’s because setting up a new one is expensive and risky. You need property, insurance, and licensing. You need employees you’ve vetted and trained. It takes months to do all this and during these months you aren’t making any income.
Nursing homes are even worse because they have a lot of legal requirements (that should exist!) which raises the barrier even further.
It’s hard to get the loans needed for these new businesses if you aren’t already wealthy.
The people that are wealthy enough to do this are instead investing in PE firms which buy up daycares and run them into the ground for profit. You are looking at “I could invest here for 10 or 20% return and I don’t have to do any of the management work” or “I can invest here for 3 to 5% return and it’s a full time job running the place”.
With regards to nursing homes there’s a second level. I’m going to borrow from my own past writing here :
Due to the way that insurance pays these days and that they can take up to 18 months to review and deny a claim at which point you have to pay them back, it’s becoming harder and rarer for single practitioners or small groups to have the ability to have a practice (unless cash based, which is difficult and excludes a lot of people from care which I have FEELINGS about). Corporations have the administrative ability to have a dedicated coder, dedicated team for denial challenges etc. However corporations are predictably exploitative.
I really don’t see any way to run anything medial based without a dedicated admin team ensuring cashflow. Which sucks. It also costs a ton of money up front.
Interesting info, thank you!
What’s stopping that from happening?
Capitalism, actually. The purpose of a system is what it does.
Thats the billionaires squeezing profits out of every transaction, not just the enrollment fees, the rent on the property, the Healthcare and insurance premiums for the staff and the operation.
Everything they do is being optimized to squeeze wealth Into the mouths of billionaires.
Tax wealth not work.
This is tangential, but I recently learned quite a bit about hospice care in Oregon. I was dating someone who worked in the industry. She said that private equity was buying up the industry, intending to bill Medicare for as much as possible. I asked why she and her hard-working co-workers didn’t start up their own hospice. Don’t quote me on the specifics, but 1) a new hospice here has to generate no profit for the first X years and 2) you have to have something like half a million in reserves in order to be allowed the license to start one.
The laws were well-intentioned, but they end up being a way for the wealthy to continue generating income on the backs of everyone else. If you have the industry knowledge and funding to start a hospice, you can do it, then sell it off to private equity after a few years. Rinse and repeat. The rich get richer and we all pay for it, largely via Medicare.
Yeah, if you are looking for waste, fraud, and abuse it’s this right here. It’s endemic in all things health related. Very few individual patients are wasting social welfare money, instead it’s almost entirely the providers who are milking the government.
Yet for some reason (hmmm) basically all the laws to “stop fraud” focus around the patients and not the providers. May have something to do with the fact that senators like Rick Scott being one of the biggest medicare fraudsters in the US.
Waste in government happens when private businesses get involved. There’s very little real waste (beyond, ironically, laws which create waste to try and stop waste or means test recipients).
Healthcare should be nationalized. We’d save huge amounts of money by eliminating all these private company hucksters stealing public funds.
Jesus Christ. Hospice and private equity do not belong in the same universe together. The fact that this isn’t swiftly and easily prevented by the courts is an incredibly basic failure of society. We cannot have a civilization while something like that exists.
My dad went into hospice a year ago and died less than a week later. We keep getting letters from Medicare indicating that his hospice program keeps submitting bills for services to them.
Report them for Medicare fraud
I don’t think it’s fraud per se. The dates for the services are all from when he was still alive.
I think someone wrote a manifesto about this once.
Something something government is bad something something private industry.
Well, let’s look at the math briefly.
First, what should a nurse make?
Add 20% cut to this for your risk and management.
Then, how many people should the nurse care for?
(Nurse pay * 1.20)/patients=cost per patient
(22*1.20)/5=5.28 per hour 24 hours per day So 126.72 a day Roughly 3,8000 a month per patient just for nurse care. Not including housing, utilities, food, or medication.
Alternatives could be mandatory civic or military duty at 18 for a few years and nursing duty could be in there?
Another alternative could be inmate care, paying minimum wage in municipal bonds, as a way to work off a sentence?
Pay nurses less, requiring less certification?
Outsource nursing to countries where wage arbitrage can be leveraged?
Obviously this was fast and dirty but illustrates the expense.
“Sorry, we can’t afford $3,800/month for nurses; this year, we only made $100 billion more than last year. Sorry, it just isn’t in the budget. You know times are hard, we all have to be a team player and buckle down here if we’re all gonna get through this together.”
That’s what you sound like.
“we can’t pay for basic services because we started another war that’s costing us trillions”
While better pay for care workers could end up being a problem resulting in higher costs, when people like you bring up this topic it is without addressing the potential cost savings to be had by clawing back “administrative” costs.
Yes, there is absolutely some level of administration needed, and no one is arguing that we should make some aspect of care worse to enable better pay for nurses and other care staff.
The argument generally is that there is more than significant overpay happening at high levels (executive and levels close to them) which could be drawn from at little to no noticable difference to the executives and overpaid themselves while significantly improving things for the levels below them.
Oh no, one of them made 3m in a year instead of 4m? That’s 5 whole six-figure positions even with your 20% overhead.
Until such time as these sorts of hypothetical talks about the impact of raising pay begin to also including the hypothetical that this additional pay could come by redirecting money that already exists and already goes into these systems, examining executive compensation packages and the like, you aren’t going to make any ground on the “costs” argument.
Because there’s currently a lot more than 20% of expenses going to “overhead”. Maybe 20% to administrative overhead, plus 50% to executive compensation packages.
And look, I get that not every exec is Musk, and the margins can be smaller than people may assume. I have family that run a small family business who have to make those sorts of decisions and costs absolutely do add up fucking quick.
But that’s all the more reason to be open and honest about this shit instead of trying to frame this with only one side.
There probably are some hospitals out in podunk nowhere where there isn’t anything left to cut from the execs and administration, but there are plenty of places (at least in the US) that are explicitly for profit.
So just as I have family running a small family business where things are fair for their grand total of… four employees I think, my wife’s family used to be close with the elder care magnate in their area. Wife’s family matriarch was close friends with the lady who married the elder care magnate.
We had to sit and watch this entitled bitch have a puff-piece novel ghost-written about the trauma of having a dedicated live in care team for her own mother while she declined, dedicated driver and multiple handlers so they could go on beach days still… while her former supposed best friend (my wife’s mother) suffered in one of her husband’s facilities. Had the audacity to message asking if there was anything she could do, but couldn’t even get off her ass and visit. To even risk seeing the true mess of elder care as her husband ran it.
So yeah, all that shit to say: Yes, the money has to come from somewhere, but there’s a whole bunch of fucking money right fucking there that keeps going into hoards instead of actually being put to use for the betterment of the company/workers/etc.
Why the actual fuck would anyone think admin fees per employee would be percentage of salary?
That makes no sense.
It’s roughly 17k/year, regardless of if you pay $5/hr or 5k/hr.
I was thinking more like 20 percent markup as a profit margin. Other fees not included yet
None of that makes any sort of sense, it just sounds like you heard some “business words” and are saying them without knowing what they mean…
Edit:
You’re just copy/pasting a chatbot, right?
That would be plain this. If that’s what you do, you should be upfront about it or at least admit when asked.
It’s essentially tricking everyone into interacting with a chatbot, and people are going to get frustrated at you thinking it’s your words, eventually realize what it is, then get even more upset at the human doing the copy/paste because you’re wasting everyone’s time and burning our planet down.
I assure you that you will get better answers and more effort from others if you think and type for yourself.
Using the chatbot means no one is helping you, just training a chat or for free
That would be plain this.
No that would not be plain this!
;-)
Chatbots speak in coherent sentences and don’t mess up the number formatting. I think they are using their own words.
My grade in business, just a few weeks ago…
My post is supposed to illustrate some baseline. I used just an off-the-cuff, arbitrary yet heuristic figure from my experience working in, of all things, elderly care. I was a nurses aide and certified as a one-on-one for Alzheimer’s and dementia patients, helping the nurses feed and bathe, keeping the patients occupied…. Walking walking walking… and not falling out of bed etc.
I did this for 5 years.
So if you are running a business, and you have nurse employees, there are expenses, overhead, risks, and profit to take for your efforts. What should that number be? I picked 20% in the hopes someone would give perhaps a more realistic figure. Instead I get cut down.
And no, Im not copy and pasting anything.
What strikes me is, who can pay 3000 a month to watch granny? and that was just nurse salary, not meds, housing, etc. My numbers are made up, I chose 22 per hour for nurse pay, I have no idea what it really is, just wanted to get to get something going and im looking for others to post more data, though the conclusion will probably be the same… its a no win situation unless you’re extremely wealthy, granny dies.
My numbers are made up,
At least we found some common ground
It adds up when you consider the parasites.
Sadly this math adds up. In my country those are public services. So no corporate greed is involved and no significat ammount goes to corruption or overpaid management.
Sadly this formula for example in daycare is true:
(“Huge payment from us” x “number of kids”) / " number of people getting paid" = “low number”
We usually just do not account for cooks, cleaners, janitors, administration in our intuition.
Yet somehow a struggling mom can take on babysitting as a gig and watch four kids a day by herself, for like $50 each. That includes cooking, cleaning, changing, and a smile on your kiddos face when they come home.
My sister does this. Shes the cook, cleaner, janitor, and administration.
I think part of the problem is also the fact that entrepreneurial types have convinced us that the necessary architecture for a successful business also happens to be the architecture which makes us give up most of our proceeds.
You are capable and can make a difference by yourself. You don’t need them.
Concerning you did not list educator in her tasks, and instead focused on the least important aspects of “childcare”.
Children shouldn’t be a business model, but proper ECE is vital at that age where they learn more than any other time in their life.
I work for a non-profit, and assuming your $50 is American we would charge about $75 and with that comes along with a team of professionals who have studied how to do all this and can support each other and the children’s development while minimising risks.
Sure, I’m not saying that it meets every need prescribed to kids in our modern enlightened era. $25 extra a day (or rather, $500 extra a month) doesn’t sound like much for the professionalism, the standardized and trusted procedures, and the army of workers available to meet your kids needs.
Most daycare centers in my area don’t have a curriculum, they’re for profit, and the online reviews are utter trash. My sister worked for one and has plenty of stories about staff members cursing around children, being rude to them, … the whole “I just work here” treatment.
My sister isn’t a licensed educator, so I won’t be saying she educates the kids. She does play with them, though. They are learning more than they otherwise would; probably would be cooped up in a grandparents house with their tablet or something. Who knows? But she wouldn’t have customers if there wasn’t a problem.
True facts. The “missing” money in the equation is all the boring expensive stuff, and those who benefit from those expenses love how obscure they are. Rent, utilities, property upkeep, property taxes, legal, administration (bookkeeping, compliance), insurance (child safety/liability is a convenient excuse for sky-high premiums).
We need to make it far easier for people to operate businesses out of their homes. So many of these costs disappear if you can use the structure you already have to pay for.
My state has a framework for at-home daycare operations, but good luck finding one that’s not already at capacity. I’ve heard of other states scrapping their programs or not creating one to begin with, citing imagined “potential for abuse”.
It’s always easier to just sit on your hands instead of improving things, and “think of the children” does an insane amount of heavy lifting while managing to hurt the very children and families it claims to protect.
Yeah people fall for it. Hell, look at the mass downvoting of my comment here.
I’m a leftist myself, but folks on the left are just as vulnerable to knee jerk reactionary thinking as conservatives. They see someone saying that regulations can be bad, and their mind immediately jumps to the conclusion, “THIS PERSON MUST BE A REPUBLICAN!!!” and all thought ceases.
Regulations can just as easily be a tool of big business as they are a tool to protect the public. And the easiest way for governments to take away people’s rights or for big business to stifle competition via regulation is “think of the children.”
We had those for child care. Then government added additional regulations for safety after some incidents, and a lot of them quit because the additional costs made it not worth it anymore. Now the government complains about a shortage of child care places.
It’s a hard problem. It’s also what prevents meaningful criminal justice reform. Some people just have a very hard time accepting that bad things are going to happen. If you make the justice system less punitive, yes, you’re going to get some number of extra crimes, as some people who should have stayed locked up will be freed. People have a very hard time grasping the concept that you need to do a cost benefit analysis for any policy. Sure, criminal justice reform will result in some small number of additional crime victims, but it will prevent orders of magnitude more people from being victimized by overly punitive laws and extreme jail sentences.
Assuming a 9hr work day to cover another persons workday… Likely closer to 10hr due to commute… but I wouldn’t know.
200/9hr=22/hr
BSing utils at 300/mo is a mere 0.40/hr
BSing rent/mortgage at 1200/MO is 1.64/hr
So basically she’s getting $20/hr assuming she does all 3 jobs just within that 9hr.
Not terrible but it does raise more questions and definitely doesn’t scale well. Like presumably these are older kids that can be ignored while cooking and cleaning or that 9hr estimate is low… And prob isn’t carrying insurance for this? Doesn’t include additional supplies - anything from extra paper towels to defibs. And utils, rent/mortgage is quite possibly off considerably…
Comparing someone doing it out their house vs an actual business is always going to be silly.
E: Oof… Lunch and snack… each kid prob consumes $4 in food… 16/9… pushing down to 18/hr.
There’s absolutely tradeoffs. Yet, the parents that take their kids to my sister have a different kind of tradeoff: don’t go to work, or find affordable childcare. My sister winds up in this halfway point, servicing those people.
It’s true she doesn’t stock a defib. She watches those kids well enough, though, and has a cell phone to call 911 in case of emergency.
It’s not the picture perfect setup. It is making sure plenty of families can continue putting food on their table, though. Sometimes that’s what’s important (imo).
It doesn’t scale. But, you could have a lot of nonscalable businesses — a “gig economy” as they call it. A gig economy can scale even if the independent pieces don’t.
As counterpoint, I know at least a couple home daycares, which were more convenient and less expensive for their customers but:
- my aunt had an unhealthy basement rec room after multiple floods, and was not very mobile
- an old college friend had gone conservative and refused to either get Covid vaccinations or to require any vaccinations of their customers. Can you imagine if you found out you were sending your kids to a germ factory where any kid could have anything? Or could you imagine something happening and then to find that out?
I’m more confident that a larger daycare at least has someone actively watching and comply with health mandates
Yeah, I don’t really disagree.
We could have nice things, but logistically it’s not feasible at an affordable cost. So a gig economy steps up to fill those gaps. Yes, that comes with risks. You will find horror stories, they’re valid. Nonetheless, this is closer to how childcare had been done for centuries. It’s a regression from the modern liberal way, but it certainly isn’t unfamiliar.
In a sense, you can say trust has replaced expense. Pay less, require more trust. In fairness, my sister knows her clients pretty well. She’s not running ads or anything like that.
What would be more ideal is if the state could partner with gig workers to ensure adequate resources. Perhaps there’s a way to redraw the lines here, so that we don’t find ourselves in a situation where you work to afford childcare and are otherwise broke. That’s also not a way to live.
So true. When we had our second kid, we found the cost of daycare for two younger ones was approaching her salary as a teacher. That’s ridiculous. Luckily I made enough to support us and she always said she didn’t mind staying home to care for them, but most people probably can’t afford that
Yes there are tradeoffs.
Your “yet somehow a struggling mother can take on babysitting” is wholly because of these tradeoffs… and depending on specifics, may be getting paid less than minimum wage.
She effectively is operating in the gig economy. That’s a whole can of worms itself.
I think a lot more people would be willing to swallow the cost of a nursing home, if the loved one was guaranteed proper care and respect.
And let me tell you, I’ve worked in a lot of nursing homes (not in a medical position), and it doesnt matter how high end the nursing home is, the treatment is the same across the board.
There are ways you can try to tip the system in your favor to increase the chances of getting better care for your loved one.
-
Visit Frequently. Every Day is best (but if you had that kind of free time you’d probably have your loved one at home instead of a facility). Residents who get frequent, regular visits tend to get better taken care of.
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Try not to have a visitation pattern, To avoid staff taking care of your loved one in preparation for that day. If you do have a schedule to visit every saturday, then atleast a few times a month try to pop in on different day at random (and don’t make it a pattern)
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If your loved one can not advocate for themselves, put a granny cam in the room. You can decide if you want an overt one or a hidden one. Preferably one you can log into from home/where ever and monitor live, though this may require some kind of subscription.
3a) If you’re loved one can advocate for themselves, make sure they feel safe and secure to tell you any mistreatment/bad things/unacceptable response times they may be suffering. You’d be surprised how hard it can be to get an at risk relative to confess any mistreatment to you.
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Be respectful to the staff until they prove otherwise. Sometimes sucking up, and little gifts, and just generally getting to know the staff involved in your loved one will get your loved one better treatment.
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Do not hesitate to take issues up with the building administrator. The administrator is the highest authority in the building, and doubly do not hesitate to escalate things to your state oversight agency if the administrator fails to satisfy the issue.
4&5 TLDR) Be sweet and kind to staff, but don’t hesitate to be a roaring asshole when needed.
and I want to be clear, none of this will guarantee good/better treatment for your loved one. It just increases the chances of good/better treatment. Some people are just too lazy, cruel, and lack a single ounce of give-a-fuck to care. and some facilities try to cut costs by hiring only people that have all but been blackballed from other facilities, at low wages, because the choice for worker is either continue to use the education and experience they have or start over at even lower wage in a whole new job they know nothing about, which means they are typically at the end of their give-a-fuck. But sometimes you can have a facility run by absolute goddamn angels… and its too random to be able to predict.
Why pay $80,000 per year in an expensive country for mediocre care when I could spend $10,000 for my parents in our cheaper home country for exceptional care. There’s like almost 200 countries in the world and life can be very very nice in honestly most of them with a bit of money.
because not everyone can fucking afford to uproot their entire lives to move their entire family to another country at the drop of a hat, on the hope and prayer that they can get any residency/citizenship papers fast tracked and not take a year+ of waiting on it, which will most assuredly be denied since normal people wont be rich enough to fund it and show they wont be a burden to the state.
Jesus fucking christ, the absofuckinglute stupid entitlement of this comment.
So fucking tired of rich fuckwits and know nothing fucking idiots chiming in with the same tired trope of “Oh well, dont like muricuh? then move to another country! heuh heuh heuh” as if its such an easy, affordable fucking thing to do. Trust me, I wager a LOT of people would like to get out of this fucking cesspit if they could.
Can you just go there? Don’t you need a visa?
Hi, I would like to immigrate so I can take advantage of your free health care now that I am the most expensive patient to care for. Also, I cannot work or contribute to the economy. Is there a hospice visa?
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The rent is super expensive, that’s the answer
We were paying double daycare until recently. While it was never inexpensive, it was more manageable when our daycare center was locally owned. Then Kindercare came in and bought 80% of daycares in my major city. When we tried changing daycares we found that many daycares not explicitly named Kindercare were still under the Kindercare umbrella but retained their old name. I guess they caught on.
As SOON as the corporate takeover was complete they started increasing rates 8% per year BEFORE we had high inflation, instituted mandatory annual fees just to enroll, and mandatory fees for supplies that we use to be able to bring but now they charged us MORE than the supplies cost and they were super shitty quality items. So if you wanted to bring in supplies for your kid, you still got to pay the fee for supplies but then also had to buy the non shitty quality ones and bring them in.
To the point of the topic though, what pissed me off the most was that even though we paid 3k/month for two our center started bleeding employees because they simply wouldn’t pay them anything. So what this meant is veteran teachers left for more pay and new ones were only there long enough to get experience.
It’s rent, and advertising. Shit costs so much and yet the landlord’s and advertising industry makes ya think it’s the cost of labour. I know alot of restaurant owners who work 5 days a week(alot close two days a week) and only vacation once a year just to visit family. they have steady business but still struggle due to costs. Only places I know are doing well are ones who own their building.
Long-term direct care for humans at any stage of life in the US (that aren’t of extreme wealth) is both obscenely expensive and yet woefully inadequate. I work in brain and spinal rehab AFCs and we’re far worse than most average nursing homes.
I’ve said for years that daycares and nursing homes are extremely expensive, and they’re probably not charging enough. The profit margins for both of these businesses are extremely thin.
I think posts like this are narrow-minded because they don’t take into consideration the cost of operating these kinds of facilities.
Fundamentally, the reason daycares and nursing homes are so expensive is because the overhead is insane, much like in the American healthcare industry. A portable X-ray machine at a hospital can cost over $100,000, and even the metal slab they slide under you can cost around $10,000.
These machines don’t cost nearly that much to produce. The manufacturers are milking the system.
My gas company charges a minimum monthly fee. I’ve never paid less than $70, no matter how little gas I use.
If you want to make these kinds of services cheaper, especially in America, you have to start with the fundamentals and bring down the cost of the things these businesses are forced to buy and pay for.
It’s almost like capital aggregates over time, slowly absorbing or driving out competition, and eventually crystallizing into a single monopolized sector.
If only we had, like, tomes of philosophy predicting this over the last century, and maybe just a smidge of foresight, we could have stopped it before it became a problem. I propose that once a company monopolizes like this and makes itself a threat to the general public, we just absorb it into another branch of government services. This has happened before, usually under wartime laws, but rules and precedent don’t seem to matter nowadays…
The world could be fixed overnight with the right cooperation and motivation.
Well, no, it can’t.
But I don’t disagree with you. We let things get totally out of control.
What we need is sweeping legislation, and it needs to start with the legislators themselves: term limits, harsher penalties for abuse of power, and reforms to executive authority, especially the use of executive orders.
Lobbying should be outlawed entirely. It should be illegal for elected officials to trade, own, or even discuss individual stocks.
There also need to be much stricter limits on what corporations can do and how much market power they can accumulate.
Did you know the U.S. has some of the weakest antitrust enforcement among developed countries? You know why? Lobbying by corporations that want to become monopolies. It’s complete insanity.
And the worst part is they’ve figured out ways to limit the American people’s ability to speak out against it. Most major media is owned by large corporations. People are drowning in debt and diabetes. Sports are on around the clock across multiple channels. We’re distracted. We’re unhealthy, and we’re uneducated.
To add insult to injury, a small minority of people have somehow been convinced that their race is more important than others’ in a country made up of people from every race and background.
A daycare around here is literally a full wage, you can’t tell me that’s not enough. Ever.
I actually can.
The daycare my kid goes to is considered a cheap one. It’s $1,000 a month for my son because he’s three, and it’s even less for older children.
They have about 15 kids enrolled, including two or three babies they care for.
I’m guessing they bring in around $15,000 a month in revenue. They have four employees. Three of them are probably making around $20 an hour, and one manager is likely making a little more than that. Four employees working 40 hours a week is already consuming most of the revenue they bring in each month.
Maybe I’m missing a lot of variables here, but when you add in rent, utilities, insurance, food, supplies, licensing, maintenance, and everything else it takes to keep the business running, it doesn’t seem like there’s much left. Aside from payroll, they’re probably making very little, maybe only a couple thousand dollars a month in profit.
Businesses like daycares and nursing homes, anything that provides quasi-medical care, generally make very little profit. They’re there to fill an essential need, not necessarily to generate massive profits like you see with many internet businesses.
I’d even argue that if you doubled tuition to $2,000 a month, it wouldn’t dramatically increase how much money they actually make. Higher wages, insurance, regulatory compliance, facilities, food, equipment, and other operating costs would still consume a significant portion of that additional revenue.
They take care of kids man… It’s a hard job and they’re already getting paid bullshit for it.
Like I said in my original comment, if you want to change this, we need to change it from the fundamentals, not the business model itself.
Kids are put there out of necessity for a second wage and then that entire second wage gets gobbled up, see the irony there. It’s not working.
What? Nothing you said was ironic… Or made any sense.
I’ll explain it slowly, parents need a second wage to pay the bills as a result of this their kid gets put in daycare which they rather didn’t.
But then that daycare eats up that entire wage, leaving the parents in the same spot financially but now without time or energy.
If you’re trying to say that parents need a second job or supplemental income to pay for daycare you might be correct. Maybe, probably. I don’t know. But that has nothing to do with what I was saying.
No they need a second wage to pay the bills.
As a result of that the need for daycare arises, then that daycare gobbled up that ENTIRE wage in my country.
It does not work. It costs too much. No matter how much you justify the cost from the business point of view.
Services are expensive. Where I’m from daycare is socialized but still considered expensive. I imagine a full price in for profit daycare must be brutal.
