It Takes A Potemkin Village

Josh Planos describes an innovative nursing-home alternative in the Netherlands:

Today, the isolated village of Hogewey lies on the outskirts of Amsterdam in the small town of Wheesp. Dubbed “Dementia Village” by CNN, Hogewey is a cutting-edge elderly-care facility—roughly the size of 10 football fields—where residents are given the chance to live seemingly normal lives. With only 152 inhabitants, it’s run like a more benevolent version of The Truman Show, if The Truman Show were about dementia and Alzheimer’s patients. Like most small villages, it has its own town square, theater, garden, and post office. Unlike typical villages, however, this one has cameras monitoring residents every hour of every day, caretakers posing in street clothes, and only one door in and out of town, all part of a security system designed to keep the community safe. Friends and family are encouraged to visit. Some come every day. Last year, CNN reported that residents at Hogewey require fewer medications, eat better, live longer, and appear more joyful than those in standard elderly-care facilities.

There are no wards, long hallways, or corridors at the facility. Residents live in groups of six or seven to a house, with one or two caretakers. Perhaps the most unique element of the facility—apart from the stealthy “gardener” caretakers—is its approach toward housing.

Hogeway features 23 uniquely stylized homes, furnished around the time period when residents’ short-term memories stopped properly functioning. There are homes resembling the 1950s, 1970s, and 2000s, accurate down to the tablecloths, because it helps residents feel as if they’re home. Residents are cared for by 250 full- and part-time geriatric nurses and specialists, who wander the town and hold a myriad of occupations in the village, like cashiers, grocery-store attendees, and post-office clerks. Finances are often one of the trickier life skills for dementia or Alzheimer’s patients to retain, which is why Hogewey takes it out of the equation; everything is included with the family’s payment plan, and there is no currency exchanged within the confines of the village. …

In the years since Hogewey’s founding, dementia experts from the United States, United Kingdom, Ireland, Germany, Japan, Norway, Switzerland, and Australia have all flocked to the unassuming Dutch town in the hopes of finding a blueprint for handling the global problem. While dementia-only living facilities have been created outside the Netherlands, none of them have offered the amenities or level of care per patient that Hogeway provides. Last year, inspired by Hogewey, a nursing home in Fartown, England, built a 1950s village for its residents; a similar project is underway in Wiedlisbach, Switzerland. But because cost is one of the greatest barriers to making self-contained villages the standard in dementia care, it would be extremely difficult to implement in a non-socialized healthcare system—meaning that in the U.S., a facility like Hogewey might be impossible for the forseeable future.

What Is The Surgeon General Good For?

Part of the liberal line in the political battle over Ebola is that we’d be much better placed to respond to the crisis if only Congressional Republicans would stop stonewalling the confirmation of Obama’s nominee Dr. Vivek Murthy to the post of surgeon general, which has been empty for over a year. But Mike Stobbe doubts this would really make much difference, considering how the role of the surgeon general has changed over time from front-lines crusader against disease to mere public health advocate:

[I]t was in the 1960s, during the Democratic presidencies of John F. Kennedy and Lyndon B. Johnson, that things really started to go downhill for the surgeon general. Administration officials were pushing to enact Great Society programs, and increasingly viewed the surgeon general and his troops as foot-draggers reluctant to take on the new initiatives—especially Medicare and Medicaid. … Dr. Luther Terry became renowned in 1964 for releasing a report that finally convinced many Americans of the deadliness of cigarette smoking, but he was shown the door a year later, after only one term. By 1968, the HEW Secretary had stripped away the surgeon general’s administrative powers and redistributed them to others.

Since then, the surgeon general has been little more than a health educator—“a pathetic shadow of authority who traveled around the country lecturing high school students on the hazards of smoking,” as the political scientist Eric Redman once wrote.

McArdle takes a broader view, noting that “this is not your grandfather’s public health system”:

Public health experts were, in a way, too successful;

they beat back our infectious disease load to the point where most of us have never had anything more serious than Human papillomavirus or a bad case of the flu. This left them without that much to do. So they reinvented themselves as the overseers of everything that might make us unhealthy, from French Fries to work stress. As with the steel mills, these problems are not necessarily amenable to the organizational tools used to tackle tuberculosis. The more the public and private health system are focused on these problems, the less optimized they will be for fighting the war against infectious disease. It is less surprising to find that they didn’t know how to respond to a novel infectious disease than it would have been to discover that they botched a new campaign against texting and driving.

Don’t get me wrong: Fighting infection is still one of the things that the public health infrastructure does, and though I hope it doesn’t come to that, I expect that our system will do a much better job next time. But the CDC did not botch the job because there’s something wrong with Barack Obama, or government, or the state of Texas, or private hospitals. They dropped the ball because the public health system no longer needs to work so many miracles, and consequently hasn’t had much practice.

The way Steven Malanga sees it, CDC Director Thomas Frieden’s embrace of that new role as nanny-in-chief is part of why he’s not really that good at his job:

As New York City’s health commissioner, Frieden engineered a law requiring food chains to post calorie counts on menus, though there was no evidence that the availability of such information has any effect on eating habits. Frieden also led a campaign to cut salt consumption despite studies that had shown, in fact, that some individuals fared poorly on a salt-restricted diet. Frieden’s campaign led one world-renown hypertension expert to proclaim that New York was attempting to engineer a giant uncontrolled experiment.

As time passed, Frieden’s practice of recommending sometimes outrageous solutions to health problems based on few facts grew more disconcerting. In 2007, he even proposed a campaign to persuade uncircumcised adult men in New York to get circumcised to reduce their risk to HIV; a study in Africa had concluded that the practice helped lower infections there. But Frieden’s proposal was widely derided and quickly dismissed because of the vast differences between the two populations and the preliminary nature of the research.

Ugh. Back to the issue at hand, Byron York blames the surgeon general vacancy on Democrats rather than Republicans:

[H]ere is the basic fact about charges that Republicans are blocking the surgeon general nominee: There are 55 Democrats in the Senate. Since Majority Leader Harry Reid changed the rules to kill filibusters for nominations, it would take just 51 votes to confirm Murthy. Democrats could do it all by themselves, even if every Republican opposed. But Democrats have not confirmed Murthy.

The reason has more to do with Murthy himself than anything else. As doctors go, he is a very political man, so it’s no surprise his politics have created political problems.

York notes that the NRA “took a strong stand against Murthy, a position that caught the attention not only of Republicans but of red-state Democrats seeking re-election.” Weigel adds context:

The NRA actually promised to score votes for Murthy – anyone who backed him would see a drop in his grade from the gun lobby. Among the horribles that made Murthy unacceptable were tweets like this (as York cites):

You can see why the NRA wanted to prevent such a doctor from becoming surgeon general. And you can sort of see why red state Democrats begged Harry Reid to prevent a vote on him.