Friday, July 31, 2020

Socialist Standard No. 1392 August 2020

Child-Care and COVID-19

The pandemic upended child care plans for many parents in the United States, forcing them – particularly mothers – to grapple with tough choices that are only becoming more difficult as states push return-to-work policies to try to revive the battered economy. Do they hunt for expensive and hard-to-find child care that could expose their families to COVID-19, which is still raging across much of the country? Or do they scale back on work, or even quit, threatening their financial stability?

The barriers risk stalling or reversing the economic gains of recent years made by working women, who are more likely to take a career hit than men when they are unable to find child care, studies show. 

“If women don’t have child care, they can’t go back to work,” said Karen Schulman, Child Care and Early Learning Research Director for the National Women’s Law Center. If that doesn’t happen, “you end up creating a system that is going to result in vast gender inequities”.

“There’s this fragile, invisible thread holding the lives of our moms, holding the lives of our economy together,” said Chastity Lord, president and chief executive of the Jeremiah Program, a Minneapolis-based nonprofit organization that supports single mothers and their children.

Pressure looks certain to mount on families in the coming weeks, as various aid programs and protections that offered relief to jobless parents expire, including enhanced unemployment benefits, eviction moratoriums and a freeze on student loan payments. While child care places are hard to find for toddlers, they are even scarcer for school-age children and many summer programs for this age-group went online, leaving parents facing a quandary.

Child care was already scarce before the coronavirus led to the shuttering of thousands of centers. More than half of all Americans lived in a child care “desert” as of 2018, defined by the Center for American Progress, a liberal nonprofit group in Washington, as an area with no licensed child care providers or less than one slot for every three children under five. Now, in many states, care centers accept only limited numbers of children to prevent the virus from spreading. Additionally, families that relied on grandparents or other older relatives or neighbors must weigh up the risks of asking for their help again and perhaps exposing them to a disease that has proved especially deadly for the elderly. Under the CARES Act passed in late March, parents who lost access to child care because of the pandemic became eligible for unemployment benefits. But the process of qualifying for the program, which varies from state to state, became less clear cut as the school year ended and some day care centers began to re-open with limited capacity.

Bangladesh Floods and the Climate Emergency

Around a third of Bangladesh is underwater due to recent catastrophic flooding and the climate crisis has played a role in the devastation, according to experts.
The widespread flooding, which has displaced millions of vulnerable people and caused more than 100 deaths, follows the deadly super-cyclone Amphan which hit the region in May. Amphan tore through coastal areas of Bangladesh, a low-lying, heavily-populated country of 162 million people, along with neighbouring regions of India. The cyclone killed more than 100 people and impacted at least 1 million, according to the United Nations, wiping out villages and essential infrastructure with the cost of damage estimated at $11.5 billion.
Torrential monsoon rains this month have compounded the suffering, sending water rushing from hilly areas and causing dangerously high water levels in two of Bangladesh's major rivers, the Brahmaputra and the Meghna.

Developing countries like Bangladesh, which have historically contributed little to the pollution driving increased temperatures and rising sea levels, will suffer the greatest impacts. 10 per cent of the world’s most affluent people are responsible for between 25 and 43 per cent of environmental impact. In contrast, the world’s bottom 10 per cent income earners exert only around 3–5% of environmental impact.
Dr Saleemul Huq, director of the International Centre for Climate Change and Development (ICCCAD) in Bangladesh, told The Independent that the "fingerprint" of climate change could be seen in the magnitude of the recent disasters. I think that this is definitely linked to climate change," Dr Huq said. "This is a one in 20-year flood event that we are having now for the fifth time in the last 20 years. The events didn't happen because of climate change but they are definitely more intense because we've interfered with the climate system." Dr Huq pointed to the direct impacts that global heating had in intensifying Amphan into a super-cyclone in the Bay of Bengal. "Sea surface temperature aggravates the cyclone and makes it more intense," he said. Dr Huq wrote that “it is now apparent that the year 2020 is clearly the year in which the impact of climate change can be identified in both Cyclone Amphan that hit Bangladesh and India a few months ago, as well as the current flooding which is affecting millions of people as well as crops and property”.
A monsoon climate change assessment by the American Meteorological Society in June found that “continued global warming and urbanisation over the past century has already caused a significant rise in the intensity and frequency of extreme rainfall events in all monsoon regions”.
World Meteorological Organisation Secretary-General Petteri Taalas noted this week that “climate change is increasing the risk of extreme rainfall events, flooding and coastal inundation”.
The Bangladesh Directorate General of Health Services said this week that 129 people had died in the floods. Across India, Bangladesh and Nepal, some 550 people have died and millions more have been displaced from their homes, said the International Federation of Red Cross and Red Crescent Societies (IFRC). More than 100 Bangladeshis, mostly children, had drowned while other deaths were attributed to water-borne diseases. More than 3.3 million people had been impacted the flooding and a third of the total are children, according to UNICEF. Millions of Bangladeshis have little in the way of resources to fall back on, in a country where one in five people live below the poverty line and the average wage is less than $5 a day.
 Jagan Chapagain, secretary general of the IFRC, told AP that South Asia could face a humanitarian crisis.
“People in Bangladesh, India and Nepal are sandwiched in a triple disaster of flooding, the coronavirus and an associated socioeconomic crisis of loss of livelihoods and jobs,” he said. “Flooding of farmlands and destruction of crops can push millions of people, already badly impacted by Covid-19, further into poverty.”
Bangladesh is widely-recognised as one of the most climate-vulnerable countries on the planet with impacts expected to intensify in the coming decades. The number of Bangladeshis displaced by the climate crisis could reach 13.3 million by 2050, according to a 2018 World Bank report. The recent disasters bring into sharp focus the ongoing calls from developing countries to their wealthier counterparts to address the inequities, the so-called “loss and damage” of the climate crisis. Dr Huq said that “loss and damage” remained a deeply political issue and a “taboo” subject in the developed world.
"We are now seeing inevitable loss and damage that is no longer natural but is manmade," he said. "Under the framework, vulnerable developing countries have been demanding some financial mechanism or funding to be made available, to compensate the victims of climate change."

He who pays the piper...

New York governor Andrew Cuomo has stood firm against intensifying pressure to avert massive budget cuts by raising taxes on the many billionaires who live in his state.

Cuomo has insisted that he fears that the tax initiative will prompt the super-rich to leave the state. On Wednesday, he doubled down, warning that if the state tried to balance its budget through billionaire tax hikes “you’d have no billionaires left”. New York City alone is home to more billionaires than any other metropolitan area on the planet. It is an argument he has been making for years to justify opposition to tax increases on his state’s financial elite and there is little basis for it. Stanford University researchers’ 2016 study of IRS data found that so-called tax flight among the wealthy is negligible.

Cuomo is protecting a group of his most important financial donors. More than a third of New York’s billionaires have funneled cash to Cumo’s political machine.

 43 of New York’s 118 billionaire families have donated money to Cuomo’s campaigns and the state Democratic party committee he controls. In all, those billionaires and their family members have delivered more than $8m to Cuomo’s political apparatus since his first gubernatorial campaign. That includes large donations from billionaires in the last few weeks as Cuomo has fought to stop tax hikes on billionaires.

Eleven of Cuomo’s billionaire donors have delivered $100,000 or more to his campaign and the New York State Democratic party’s housekeeping fund. They include hedge fund titans James Simons ($3.6m), Stanley Druckenmiller ($1m) and Daniel Loeb ($114,000); real estate moguls Alexander Rovt ($321,000) and Stephen Ross ($80,000) and investor Ronald Perelman ($197,000). Ross, Simons and Simons’ wife delivered a total of $115,000 to Cuomo this month.

With Cuomo blocking billionaire tax hikes, his 43 billionaire donors have increased their net worth by $22bn during the pandemic. In all, New York’s 118 billionaires have seen their net worth increase by $77bn since coronavirus hit the United States. 

Those billionaire gains in just three months are more than five times the size of the state’s entire projected budget shortfall of $14bn.

Cuomo has previously championed a plan to eliminate New York’s bank tax and he reduced the state’s corporate tax rates to its lowest level in more than 50 years. He also cut tax rates on purchasers of luxury yachts and private jets – and now he has worked to stymie his party’s billionaire tax plan.

Cuomo has pushed for big spending cuts. In April, the legislature approved a plan to let Cumo’s budget director make $10bn of spending cuts. That plan also approved Cuomo’s push to cut $2.5bn from Medicaid, flatline education spending and impose tougher eligibility requirements on some long-term public benefits. New Yorkers may see increased mass transit fares and road tolls because “the money needs to come from somewhere.” Local governments could also see big cuts.

Shareholders First for the Lifeboats

Exxon Mobil Corp is preparing deep spending and job cuts to preserve an 8 percent shareholder dividend.

The latest cost cuts are needed to preserve the company's nearly $15bn annual payout to shareholders in the face of rising losses, the sources said. Exxon will not generate enough cash from production operations to cover this year's dividend, analysts have said. It borrowed $18bn earlier this year to bolster cash.

The latest cost cuts are needed to preserve the company's nearly $15bn annual payout to shareholders in the face of rising losses, the sources said. Exxon will not generate enough cash from production operations to cover this year's dividend, analysts have said. It borrowed $18bn earlier this year to bolster cash.

Woods has turned to spending and staff cuts, and a business restructuring to salvage the payout. The dividend, which yields about 8 percent at Wednesday's closing price of $44.03 a share, is sacrosanct at Exxon, which until this year raised the payout annually for 37 years.

Dirty England

More than 1,300 sites across England are breaching annual limits for harmful pollutant nitrogen dioxide, analysis by Friends of the Earth suggests. Friends of the Earth said 1,360 monitoring sites across the country exceeded the annual average air quality target of 40 micrograms per cubic metre of air for nitrogen dioxide in 2018, the most recent year for which data is available.

In some spots, the annual average was more than double the level set to protect health from long-term exposure to pollution, the analysis shows. Nitrogen dioxide is a pollutant which mostly comes from traffic fumes and, along with other pollution such as particulate matter, is linked to health issues such as lung and respiratory diseases and early deaths.

Simon Bowens, clean air campaigner at Friends of the Earth, said failing to fix air pollution costs lives and showed a failure to address the climate crisis.

The 10 sites with the highest annual average nitrogen dioxide levels according to the Friends of the Earth analysis are:
- Chideock Hill, West Dorset 97.7
- Station Taxi Rank, Sheffield 91.7
- North Street Clock Tower, Brighton 90.8
- Neville Street Tunnel, Leeds 88
- Strand, City of Westminster 88
- Walbrook Wharf, City of London 87
- Hickleton opp Fir Tree Close, Doncaster 86
- Marylebone Road, City of Westminster 85
- Euston Road, London Borough of Camden 82.3
- Hickleton, John O’Gaunts, Doncaster 82

Pandemic - Protect the Workers

Up to 2 million extremely vulnerable people shielding in England must not be forced to return to their workplaces, the Trades Union Congress (TUC) said.
 It would be “heartless and reckless” for bosses to demand the immediate return of shielding workers on 1 August, when the government will no longer advise them to stay at home and will no longer pay them statutory sick pay.
Those classed as “clinically extremely vulnerable” – with serious illness such as blood cancers and severe asthma, as well as those on immunosuppressant medication – have been ordered to shield for more than four months since 23 March.
The TUC is asking employers not to force the return of their staff and instead to continue using the government’s job retention scheme for shielding workers, which runs until October. It is also calling for this to be extended for people who are told by their doctor that they should shield for longer.
Frances O’Grady, the TUC’s general secretary, told the Guardian: “It would be heartless and reckless for employers to demand the immediate return of shielding workers. After self-isolation for a number of months, requiring shielding workers to immediately travel to workplaces may cause anxiety and distress. The government must make clear to employers that they cannot give shielding workers unreasonable ultimatums to return to workplaces. The job retention scheme is in place until at least October, so employers must continue using it if home working is not an option. And the government should make clear that furlough will still be an option after October for shielding workers who cannot safely travel to workplaces or who may be subject to a local lockdown.”
The TUC’s demands include asking employers to publish full risk assessments for each workplace, conducted in consultation with staff unions and covering the needs of workers who are at higher risk. There should also be individual risk assessments in consultation with each shielding worker, or each worker who is a carer or a household member of someone shielding.
Prof Peter Openshaw, of Imperial College London, who sits on the government’s Sage group of Covid-19 advisers, said there was growing concern that transmission of the disease would increase in the next few weeks, just as those shielding may be returning to work.
“Many of us are concerned that we may be seeing an increase in transmission in the ensuing weeks,” he said. “We need to be alert to the possibility when people are on holiday in August that there may be increased transmission and we may need to bring in measures to protect people’s health.”
Dr Stephen Griffin, an associate professor at the University of Leeds school of medicine, said the government should provide the science behind their decision to end the shielding advice.
“What’s missing is a rationale,” he said. “They are just announcing that it’s safe for people to go back on 1 August, when there are still significant numbers of people infected every day and you’re talking about releasing 2 million or so highly, highly vulnerable individuals back out into society? In terms of the circulating amount of virus, it’s still there in appreciable numbers … We’ve become very desensitised to this. People are talking about pre-lockdown levels and, yes, it’s a comparison, but the reality is people are still dying from this.”
Fifteen charities, including Age UK and Macmillan Cancer Support, have written to Sunak raising concerns that unwinding the furlough scheme and ending shielding will put many “in an impossible position”.
They write: “If their occupation is one that they cannot carry out from home, and if it is extremely difficult to make their workplace safe for them, they may be forced to choose between putting their health on the line by returning, or staying safe by giving up their job.” The signatories say this is “desperately unfair” and call on the chancellor to take action and protect their jobs as well as supporting employers.
Gemma Peters, the charity Blood Cancer UK chief executive, said: “We are now getting calls from lots of people who are terrified about going back to a workplace that’s not safe, and the government needs to support them to make sure they don’t have to. After giving so much financial support to keep the economy going, it is inconceivable that Mr Sunak would cut people with blood cancer loose at their time of greatest need.”

The Lords Criticise Universal Credit

Universal Credit is "failing millions of people", especially the vulnerable, according to a new report from the Lords' Economic Affairs Committee.  It criticised its design, blaming Universal Credit for "soaring rent arrears and the use of food banks".
The Lords' report said cuts to social security budgets over the last 10 years had caused "widespread poverty and hardship". As a result, the committee said Universal Credit needed "urgent investment just to catch up and provide claimants with adequate income".
The committee also criticised the way payments were calculated, claiming the system could result in "large fluctuations in income month-to-month, making it extremely difficult for claimants to budget".
Tory peer Lord Forsyth, who chairs the committee, said the system "fails to provide a dependable safety net" for those in need.
"The mechanics of Universal Credit do not reflect the reality of people's lives," he added. "It is designed around an idealised claimant and rigid, inflexible features of the system are harming a range of claimant groups, including women, disabled people and the vulnerable."
He continued, "It needs rebalancing, with more carrot and less stick, particularly as large numbers of claimants will have ended up on it because of events completely out of their control. "

Mexico ignores women's rights

Mexican women’s groups have expressed deep disappointment after the supreme court dodged a ruling on a proposal which could have opened a legal path towards decriminalizing abortion. In a 4-1 decision, the court voted against the proposal for technical reasons – without addressing arguments that restrictions on abortion violated women’s rights and contravened international treaties to which Mexico is a signatory. 
The case centred on a court injunction in Veracruz, which ordered the legislature to rewrite its laws to remove penalties for abortion during the first 12 weeks of pregnancy. The case centred on a court injunction in Veracruz, which ordered the legislature to rewrite its laws to remove penalties for abortion during the first 12 weeks of pregnancy.
President Andrés Manuel López Obrador – a self-described leftist with social and fiscal conservative tendencies – has not made any moves towards reforming the country’s abortion laws, even though his party controls both chambers of congress and more than half the state legislatures. López Obrador said that he respected the court decision.
“Women’s rights are not a priority [for López Obrador’s government] even if he says they are,” said Maricruz Ocampo, who works with victims of sexual violence in Querétaro. “His actions demonstrate they are not.”

Iran's falling birth rate

 Back in the 1980s, Iran's birth rate was one of the highest in the world, with the population growing at an explosive rate. But now, Iran's spiritual leaders are worried about their country's low birth rate. Political measures aimed at helping people juggle work and family life haven't made much of a difference.

"I don't want a child," said Sarah, a woman who's been happily married for eight years. "Having a child is a lot of responsibility that I don't want, perhaps because I haven't yet recovered from the constant competition in my own life," the 38-year-old, who lives in Tehran and works for a food company, told DW. For Sarah, money isn't a problem. She counts herself among Iran's "baby boomer" generation, born after the 1979 revolution. 
In 1979, the country had 37 million inhabitants. Family planning was the rule — the population even dipped slightly in the previous decade. But religious revolutionaries at the time rejected family planning as un-Islamic — they envisioned a powerful, populous, Shiite-dominated country in the Middle East. During the long bloody war against Iraq in the 1980s, Iranian authorities actively encouraged women to have babies. 
Iran's population has more than doubled in the last 41 years, from 37 million to 84 million people. With that growth came a realization among politicians that the country's education and health systems were overtaxed, and that sorely needed investments had been lacking during the war with Iraq. In December 1988, the Supreme Court paved the way for a modern program to promote family planning when it declared the practice was perfectly compatible with Islam.
The new program foresaw families with an average of three children. The government promoted the distribution of modern contraceptives, and made counseling and education available across Iran. The plan worked: By 2010, the average number of births per woman had dropped from 5.1 to 1.7, a figure that has essentially remained stable to this day. According to the Tehran Times, however, the number of annual births has been steadily dropping in recent years. About 1.48 million births were recorded between March 2016 and March 2017, 1.36 million the year after, and 1.2 million the year after that — a steady decline of around 100,000 births every year.
Supreme Leader Ayatollah Ali Khamenei has long criticized the low birth rate in the Islamic Republic. The spiritual leader wants the population to grow to 150 million, and in 2012 he enforced a turnaround in the country's family policies that cut off funding for family planning education and contraceptive services. Two years later, Khamenei declared the increase of the country's birth rate to be a strategic goal. Since then, a number of family-friendly measures have been introduced, including an extended maternity leave of nine months. Pregnant women are free to take sick leave whenever necessary, with a simple medical certificate, and access to loans and jobs has also been facilitated for families with children.  The measures have been accompanied by a massive propaganda effort in state media and institutions, including universities. 
However, they haven't been enough to convince young people to change their minds, in a country where the average age is almost 31. Many young people just can't see having a large family with several children. Many Iranians are struggling economically and they simply can't imagine bringing children into the world under such circumstances.

'Everything is burning'

Raging fires described as “completely out of control” is threatening the Paraná delta grasslands, one of South America’s major wetland ecosystems. The fires have been burning for months now.

The Paraná is South America’s second largest river after the Amazon and the eighth longest river in the world. Its floodplain, known by Rosarinos as “la isla”, is not actually an island, but a vast delta covering some 15,000km2 , through which the Paraná drains towards the Atlantic Ocean 300km away. The giant delta is clearly visible in satellite imagery as a dark green wedge on the northern margin of the Paraná from Rosario to Buenos Aires. Giant plumes of smoke from the fires raging since February have at times covered the streets of Rosario and other places along the Paraná with a layer of ash from scorched plants and animals. The air in Rosario has been unbreathable for weeks at a time. 

Although cattle ranchers, illegal hunters and property developers have encroached on its rich habitat, the Paraná delta still teems with diverse wildlife, all facing a dire challenge to their survival. There’s the carpincho [capybara], the world’s largest rodent, a relative to the guinea pig, but the size of a farm pig, weighing over 60 kilos, aquatic and highly gregarious. Then the gato montés [wildcat], a solitary hunter at the top of the delta food chain despite being only the size of a domestic cat, either spotted like a leopard or entirely black like a panther. Then there’s an endless variety of birds, invertebrates, mollusks, rare insects, amphibians, reptiles … which must be suffering an incredible mortality rate.”

Far from abating, the number of fires has been rising. Liotta works at the Scasso Natural Science Museum in San Nicolás, where he has been monitoring the delta fires via Nasa satellites. “We’ve identified 8,024 likely fires so far this year, almost half of them this month of July.” Liotta worked backwards and found the scale of the
calamity was unprecedented. “The average number of yearly satellite-detected hotspots was only 1,800 in 2012–2019. We’re already at over 8,000 and barely halfway through the year.”

The unregulated expansion of cattle ranching is the main culprit for the expanding fires says Laura Prol, an ecologist from the Rosario-based environmental NGO Taller Ecologista. Cattle ranchers ship their livestock to the islands on barcos jaula [cage boats], sometimes two storeys high, that carry around 60 heads of cattle each. 

“The delta has always been used by livestock farmers to graze their cattle, but the number of cattle grew 500% between between 2000 and 2010,” Prol told the Guardian. “Although that number has dropped some in the last decade, ranchers continue burning the dead winter grass as if they were still in the 19th century, the idea being for the new grass beneath to sprout stronger.”

“But the real problem is that 2020 has been one of the driest of recent years, which causes two problems. First, without proper humidity the dead grass becomes highly flammable, and second, the low level of the river dries out the canals that usually act as buffers that stop the fire from expanding beyond individual islands,” says Prol.

“Legal action won’t stop the fires. What is needed is a long-term environmental policy to deal with the drop in the level of the river caused by the changing climate and by the El Niño weather phenomenon,” says Prol. “This year’s dry spell might also be an effect of the fires in the Amazon last year, in which a large amount of vapour-producing vegetation that then turned to rain perished. Finding the culprits for this year’s fires is of course important, but we need real environmental protection.”

 Leonel Mingo, a spokesperson for Greenpeaceagrees: 
“We have been lobbying for years for a comprehensive wetlands law. The reason these fires are raging is because there is no legislation. We need to ban cattle farming in the delta. Because right now, with this dry weather, with the drying up of the Paraná river and without a campaign to change the traditional use of fire by cattle ranchers to clear land for pasture, you have the perfect storm.”

The Care-Home Scandals

The cycle of buying and selling care homes has led to shortcuts, closures, even fraud – and imperiled vulnerable residents’ health. In an already fraught industry embattled by a variety of problems – particularly those that directly affect residents’ care, like eviction of Medicaid patients, lack of regulation, chronic understaffing, and poor infection control – massive fraud cases are as shocking as they are common.

In 2015 New Jersey-based Skyline Healthcare LLC, owned by Joseph Schwartz, began gobbling up nursing homes, amassing enough facilities to provide them with an estimated several hundred million dollars a year of taxpayer money in the form of Medicare and Medicaid reimbursements. Just two years later, they were managing at least 100.

Then Skyline effectively disappeared overnight, leaving staff to wonder why food vendors were no longer being paid, why their paychecks were bouncing, why the lights weren’t on. Nine facilities in Pennsylvania were similarly abandoned, along with dozens more in other states including South Dakota, Kansas and Massachusetts.

On average, nursing home workers make $19,000 a year, and many rely on second jobs or food stamps to get by. “The thing that is still sad is these people are low-paid to begin with,” Chris Sloat, an administrative organizer with SEIU Healthcare of Pennsylvania, the largest healthcare union in the state, said about staffers cheated out of pay and benefits by Skyline. “And now the debt that they have, people coming after them for bills, is just mind-blowing. And they don’t have the money. There’s still this residual effect from everything Schwartz has done.”

The collapsing of Skyline was a foreboding of disasters to come – a sign of how a cycle of buying and selling had opened the precarious industry up to fraudsters who could amass a string of facilities, suck the money out of them, and then run off, leaving residents and staff without much recourse. The case was an unheeded warning that the industry was insufficiently regulated and absolutely unprepared to withstand any new crisis that might come along.

 On Easter weekend, the pandemic struck a remaining Skyline facility in New Jersey, as if to prove a point. An anonymous tip brought police to Andover Subacute and Rehabilitation Center where they discovered the bodies of 17 residents piled into the facility’s tiny four-person morgue. The grim Easter Sunday discovery at Andover Subacute in New Jersey, the state’s largest licensed facility, was not the end of unnecessary deaths there. By mid-June, at least 70 residents and staff members had died in the facility, where nearly 550 residents lived. Local news reported that Louis Schwartz, the son of Joseph Schwartz and the vice-president of mergers and acquisitions for Skyline, was a 50% owner of the facility. According to Skilled Nursing News, as of July, 2019 Skyline still retained an ownership stake in “more than 50 nursing homes”. 
Flipping, or the buying and selling of nursing homes with the purpose of turning a quick profit, is exceedingly common. Once dominated by individual, family-owned non-profits, over the past few decades the industry has experienced the penetration of for-profit corporate ownership leading to an increase in facility sales and contributing to the overall uptick in closures across the US – more than 550 nursing homes (out of a total of 15,600) have closed since June 2015.
In Pennsylvania, nursing homes inhabit an “extremely volatile market”, according to Zach Schamberg, the president and CEO of the Pennsylvania Health Care Association, which represents the nursing home industry. There are a total of 700 facilities in the state. In just the past three years, there have been 100 nursing home sales, changes of ownership, or reorganizations, he told me, a rate that has doubled between 2007 and 2017.
According to industry advocates like Schamberg, the increased number of sales is due to the costs of care rising about 2.5% a year while Medicaid reimbursements do not. “So do the math,” Shamberg said. But patient advocates, who acknowledge the stagnation of reimbursement rates, strongly deny that increasing those rates alone will solve the industry’s problems. Rather, studies have shown, when Medicare and Medicaid rates increase, care quality often doesn’t.
Philip Esformes, whose string of nursing homes stretched from Illinois to Florida, was sentenced to 20 years in prison last September for paying doctors to refer patients to his facilities and for taking taxpayer money that he never applied to residents’ care. His indictment included money laundering, receiving healthcare kickbacks, bribery conspiracy and obstruction of justice. Esformes, who owned multiple homes and drove around Miami Beach in a Ferrari, amassed $1.3bn in Medicare and Medicaid money. The case reached court several years after reporting by dogged journalists at the Chicago Tribune, David Jackson and Mario Ariza. In a 2016 documentary about the case, Jackson states, “the scope of the schemes is staggering”.
HCR ManorCare, a national chain of facilities, collapsed after investment from private-equity firm the Carlyle Group. Within four years, ManorCare sold most of the buildings its facilities operated in for $6.1bn, funneling the profit to shareholders. ManorCare continued operation of the facilities but became strapped with monthly rent payments they couldn’t make. With $7.1bn in debt, the company filed for Chapter 11 bankruptcy in 2018.
The elusive multimillionaire Joseph Schwartz, owner of Skyline, has become, to thousands of elders, their families and their caregivers, the face of all that is wrong with the American nursing home industry. When Schwartz abandoned dozens of facilities, starting in 2017, residents were left sitting in their own feces, unfed and unbathed. Whatever staff remained, like Shelly Robinson, were left to buy food for elders and to pay the facility’s utility bills. “Sometimes, as employees, we purchased snacks for our residents so they had snacks,” Robinson said.

In some cases, state governments stepped in to care for the abandoned residents, overseeing operations until a buyer could be found for the facility. Families were shocked by not just the neglect but the blatant lack of communication about their loved ones’ status.
“It seems like they had a plan to go in there for two or three years, bleed the nursing homes and then just bail out,” Thomas Pasternack, the owner of Walsh Pharmacy in Fall River, Massachusetts, told after three Skyline facilities left him with $200,000 of unpaid bills.
When they left Lancaster Care and Rehabilitation, Skyline refused to pay staff for any of the time off they had accrued. “Skyline said they weren’t paying us for our sick time or vacation time,” Robinson explained. “It was actually our time that we accrued through working, but they said they weren’t going to pay us.” Pennsylvania does not require that staff and residents of a facility be notified of a change of ownership for the first 30 days. When staff are finally informed of the sale, they must scramble to negotiate livable salaries and benefits with the new owner. The incremental erosion of wages and benefits increases the precarity of staff and their families but it also jeopardizes the health of residents who suffer from short staffing and staff members who can hardly pay their own bills.
The Covid-19 pandemic has escalated the repercussions of mismanagement, fraud and the lack of regulations.  States all across the country, like New York, are moving to provide immunity from Covid-19 litigation to nursing homes. Last month, 250 patient advocacy organizations wrote a letter asking legislators to not provide immunity to the nation’s facilities. 
The letter states: “Essentially, the only mechanism available for a nursing home resident to hold facilities responsible for substandard care is judicial recourse. By removing this safety net, nursing homes will have little to no oversight.”
When asked what needs to be done to correct course, Robinson, a veteran of the industry – she’s worked in nursing facilities for more than 30 years and joined SEIU in 1993 – says: “Stop making money the bottom line and care for our elders. They are people and they have lives and families and you can’t just put a dollar sign on their head.”

Floods to come

The combined impacts of human-caused sea level rise, storm surges and high tides could expose an extra 23 million people to coastal flooding within the next 30 years, even with relatively ambitious cuts to greenhouse gas emissions, a new global study has found. According to the study, about 148 million people globally are exposed to flooding events today.

Rising sea levels caused by global heating that expands the oceans and melts land-based ice could mean that one-in-100-year floods occurring now would become one-in-10-year floods by the end of the century. As much as 4% of the world’s population could be affected by flooding.

The study, published in the journal Scientific Reports, identified “hotspot” regions at risk of extensive flooding. South-eastern China, Australia’s north, Bangladesh, West Bengal and Gujarat in India were especially at risk. In the United States, North Carolina, Virginia and Maryland were considered to be most exposed, as were the UK, northern France and northern Germany.

In a worst-case scenario where emissions continue to rise and no efforts are made to adapt to the rising sea levels, coastal assets worth US$14.2tn – about 20% of global GDP – could be at risk by the end of the century. But the study also shows how the risk of damage from rising sea levels and storm surges will continue to rise even if emissions are kept to a level that would keep the global temperature rise to well below 2C by the end of this century. If greenhouse gas emissions rise moderately – the equivalent of 1.8C of global warming by the end of the century – a further 54 million people will be exposed. But if emissions are allowed to spiral in a worst-case scenario, then this number rises to 77 million. About US$10.2tn of coastal assets are exposed to coastal flooding in 2100, even with emissions kept at moderate level, according to the study.

Prof Ian Young, a co-author of the study at the University of Melbourne, said: “We certainly need to mitigate our greenhouse gases but that won’t solve this problem.

“The sea level rise is already baked in – even if we reduce emissions today the sea level will continue to rise because the glaciers will continue to melt for hundreds of years.” Young said: “When most people think of sea level rise they think about 3 or 4mm per year, but when flooding occurs it happens it’s when you also have a storm. That happens today and we have seen that on the coast of New South Wales last week. Sea level rise exacerbates the magnitude – and increases the frequency – of these flooding events. There are significantly larger areas of land flooded and that will have significant economic impacts on infrastructure.

He explained, “Even if we mitigate greenhouse gases it does not make much effect. We have to adapt to this – it is going to happen so we have to look at either hard engineering solutions, or do we look at planned retreat and move populations and that’s incredibly difficult, or there are nature-based coastal defence systems.”

Ebru Kirezci, the lead researcher, also of the University of Melbourne, said: “We need to adapt to sea level rise and climate change. Adaptation is the only way out and we need to adopt some risk mitigation strategies like sea walls and dykes and develop forecasting and warning systems, or coastal retreat, which means the relocation of coastal communities to safer places.”