Yesterday I got a call from my sister . Our Aunt Lena was in the hospital after an episode of alimentary distress, that need not be graphically described here. She's doing well, but I can't reach her to ask permission, but I'm pretty sure she would give me the O.K. for this diary if I explained the reason for it, that telling her story might possibly help others. She would say that I could use her as an example, even giving away her secret. In fact I'm going to take the liberty of allowing you to meet her via YouTube, which I will link at the end of the diary.

It may be time for her to be in a different residential setting, where she would have more care, and more importantly, a chance for companionship that is not available in her apartment. Aunt Lena is lucky, as she has access to nursing homes, or assisted living as it is now called, in her city that are supported by Philanthropic Organizations, and may get a subsidized price that is affordable. Others, who are dependent on private nursing homes, and haven't visited one in a while are in for a surprise.

The new conservatism, the core ideology of the Republican party, has now infected this area of activity. Nursing homes have never been anyone's idea of a delightful setting. It's for people who can no longer take care of themselves, or have lost their sense of identity and are often close to their end days. It is the very vulnerability of these people that makes the provision of care special. These people generally do not have the ability to complain, to defend themselves or to insist on a decent level of treatment. Somehow the model of free market competition doesn't quite apply here.

This is the problem with ideologues of any stripe. The current crop of Bush Conservatives learn their various truisms, what is bad-Government, and what is good-Free Enterprise; and that is where their thinking ends. Of course, the other side can have the same simplistic mentality. But now, in this country, we have a new example of free enterprise that doesn't even deserve the name, as it has a character that was never anticipated by theorists such as Adam Smith. He, and others of his era could not have conceived of this economic principle being distorted to obviate the morality, the norms of decency that they expected would always temper excesses.

The New York Times had a major article a few weeks ago that begins:

Habana Health Care Center, a 150-bed nursing home in Tampa, Fla., was struggling when a group of large private investment firms purchased it and 48 other nursing homes in 2002.

The facility's managers quickly cut costs. Within months, the number of clinical registered nurses at the home was half what it had been a year earlier, records collected by the Centers for Medicare and Medicaid Services indicate. Budgets for nursing supplies, resident activities and other services also fell, according to Florida's Agency for Health Care Administration.

The investors and operators were soon earning millions of dollars a year from their 49 homes.

Residents fared less well. Over three years, 15 at Habana died from what their families contend was negligent care in lawsuits filed in state court. Regulators repeatedly warned the home that staff levels were below mandatory minimums. When regulators visited, they found malfunctioning fire doors, unhygienic kitchens and a resident using a leg brace that was broken.

No effective government oversight, and the CEO of the Habana Health Care never has to visit the facility. He just reads the P&L statement and gives the order, “cut expenses.” And his stockholders are happy with the result, as profits, that is income minus the reduced expenses, soar. And nursing homes are only part of the reign of terror of conservative ideology. There is are recent reports, also in the NY Times, that shows that even those who have long term health insurance are facing difficulties actually collecting. And Medicare Plan D, the humanitarian program of this administration, is being negated by the process of the insurance companies not answering the phone calls from providers, among other ploys.

I see it like this:

In a country that is transitioning to an economic libertarian conservative ideology, there are vast sums to be made by those who identify the unwritten moral obligations that infuse a society's economic relationships, and simply eliminate them from their enterprises. The savings to be realized are astronomical.

Privatized hospitals that had been providing educational service to new professionals, simply eliminate this, which increases short term profit. The owners ignore that this deprives new professionals of sufficient hands on training. The indigent, a certain amount who were previously cared for, are simply turned away. The key to all of these depredations is to keep your eye on the bottom line, and on nothing else. All the harm that is not prohibited by law becomes acceptable; as any cultural expectation that is not mandated, is eliminated.

But what about my Aunt Lena. And your aunts, uncles, mothers and fathers, not to mention, many years from now, ourselves. Now that the asset level of Habana Health Care is based on the reduced cost of inadequate care, who will deprive them of their enhanced cash flow. Will all of the owners of this stock, or of mutual funds that have similar equities, now become defenders of this way of doing business. Will those investors, whether Warren Buffet or a guy with a five figure 401K, who depend on the value and cash flow of their assets, accept the Democrats mandating a level of care that the “free enterprise” party is willing to ignore.

Once the standards of decency have been lowered, once the word "unconscionable” has left our national vocabulary, just how do we bring it back? Letting old people in nursing homes suffer during their last months is now priced into the value of this stock, and who knows how many others with a similar business model.

Aunt Lena's secret is her age, 104. She doesn't like to make a big deal about it, and simply soldiers on. All of her friends are long gone, and having no children, it is her nieces and nephews who look out for her. Somehow as a little girl she learned that she was a Democrat, just like she learned that she was Jewish. I don't think she could ever have articulated her reasons, any more profoundly than when my Dad explained to me a long time ago that, “Republicans are for the Rich, so we are Democrats.”

What is missing from that simple explanation, is that the problem is not that the Republicans support the rich, but the policies they foster to allow them to get rich. Perhaps there was a time when virtue and wealth were intrinsically connected, but as we see here, this no longer is the case in this country. Greed is certainly a legitimate motivator, but like all things taken in excess, it can be harmful to one's health, whether an individual or a country.

Policy, those laws that we debate based on exalted principles, translate into effects on individuals. So, this is a little video of my Aunt Lena , in her very own apartment where she enjoyed cooking her meals and up to recently walking a mile to the grocery store. But, she may now have to give that up, and spend her remaining years in a nursing home. Will the focus there be helping her enjoy life, maybe even finding a bridge game to join. Or will services be cut to the bone for the benefit of the owners, the stockholders, and those venture capitalists who see a quick buck to be made out of human suffering.

My Aunt Lena-- and your loved ones are not going to have the energy to make their lives tolerable in these settings. If anyone is going to do it, it is us.