Very few things about the American economy are capable of astonishing me. But even I must admit to being shocked whenever I recall that some 70 percent of nursing homes or — to adopt the somehow even more inhuman-sounding term of art — “elder care facilities” have been established as money-making ventures. Depriving workers of their just wages, preying on the vulnerable with usurious loans, even just outright stealing: all of these are ghoulish, but they exist for me safely within the limits of human greed. The idea that any man or woman could wake up one day dreaming of the opportunities for making a profit from the gruesome fact of senescence is too horrifying to admit of merely terrestrial origins. It must literally be from hell.

This at any rate is what both my instincts tell me and what one gathers from reading about the conditions in which many of the more than one million Americans abandoned in nursing homes live. Outbreaks of influenza and scabies are depressingly common. Federal authorities are routinely overwhelmed by the number of institutions that require 15 months of special oversight due to repeated violations of basic sanitary and other regulations. According to The New York Times, of the 524 nursing homes ruled “special focus facilities” (bureaucratese for illness-ridden dens of misery and abuse), more than 50 percent continue harming patients after federal oversight is removed. Meanwhile, the persons who work in such facilities — for many years one of the fastest growing sectors of the American economy — are themselves paid miserable wages and asked to work indecent hours.