John Oliver explores problems with U.S. nursing homes and long-term care, suggests you pay attention

"Nursing homes, and long-term care in general, are something that we tend to try to avoid thinking about, but the truth is, whether due to old age or disability, many of us do — or will — require help with daily living," John Oliver said on Sunday's Last Week Tonight. "For the rich, there are plenty of options," but "the vast majority of people receive long-term care at home," not retirement palaces with $200 Versace plates.

About 80 percent of home care is provided by unpaid caregivers, typically family members trying to keep their loved ones out of institutional care. But "taking care of someone at home can be an incredibly complicated full-time job that is almost always unpaid," Oliver said. "In fact, in terms of lost wages, the labor of family caregivers totals about $67 billion annually," or roughly the GDP of Bulgaria.

There are more than 2 million people in long-term care facilities, though, and that 0.63 percent of the U.S. population accounts for about 33 percent of COVID-19 deaths, Oliver noted. "The truth is, COVID just exposed what we've basically known for years: that the way the elderly and disabled are treated in far too many of these facilities is with, at best, indifference, and at worst abuse and neglect. So tonight let's talk about long-term care: how the industry is structured, how that structure creates bad incentives, and what we can do going forward."

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There are different issues depending on whether you are underserved on Medicaid or inappropriately over-treated on Medicare — for the short period Medicare covers nursing home care, at least, Oliver said. But partly because of the myriad problems at both kinds of facilities, 90 percent of people 65 and older want to stay in their homes for as long as possible, something Medicaid generally doesn't cover. There are bills to fix that, and President Biden's infrastructure plan would help a lot, he said, "but we do need to do something, and it all starts with showing we give a sh-t about what happens to the elderly and people with disabilities in this country. Because right now, evidence points to the fact that we absolutely don't, and all the other problems are stemming from that." There is some off-color language, disturbing tales, and one Andrew Cuomo joke. Peter Weber