Unjust forms of Equity

[F]law School Episode 9: Profits Over Patients

Flaw School

January 4, 2025

Summary:

In this episode of [F]law School, hosts Molly Enloe and Gauri Sood sit down with third-year law student Charlotte Laurence to expose how private equity is infiltrating our healthcare system and, more specifically, how profit-driven investors are playing  shell games with nursing homes—trading care for cash flow, and leaving some of the most vulnerable residents in the wreckage. Charlotte unpacks the legal loopholes and financial sleight-of-hand that make it all possible, showing how the law isn’t just failing to stop the harm—it’s greasing the wheels.

Editors:

Very special thanks to Nandini Kalani for production and editing assistance.

Guest Bio:

Charlotte Laurence is a student at Harvard Law School in the Class of 2025. She is also a graduate of the University of California Berkeley and University of Cambridge. Before law school, Charlotte researched topics in History of Science and worked as a speech writer for the Shadow Minister of Women and Equalities in the British Parliament.

Music:

Our theme music is “I Been Waiting” by Crystal Squad, and you’ll also hear segments of “Palms Down” by Blue Dot Sessions.

[F]law Resources: 

Additional Resources: 

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Transcript 

 (This transcript was created by an automated process and contains errors.)

Flaw School – Private Equity – Charlotte Laurence Episode

Jon Hanson Introduction: Hi everyone! This is Jon Hanson from the Systemic Justice Project and The Flaw Magazine at Harvard Law School. In this episode of [F]law School, hosts Molly Enloe and Gauri Sood sit down with third-year law student Charlotte Laurence to expose how private equity is infiltrating our healthcare system and, more specifically, how profit-driven investors are playing  shell games with nursing homes—trading care for cash flow, and leaving some of the most vulnerable residents in the wreckage. Charlotte unpacks the legal loopholes and financial sleight-of-hand that make it all possible, showing how the law isn’t just failing to stop the harm—it’s greasing the wheels. Welcome to Flaw School; the podcast about the Flaws in the Law.

Molly Enloe Hey, welcome to Flaw School, a podcast that explores the flaws in our legal system. We’re today’s hosts, Molly Enloe. 

Gauri Sood  And Gauri Sood. 

Molly And we are so excited to be hosting Flaw School’s episode today. 

Gauri Every two weeks, we int erview law students to uncover the role of corporate actors in producing many of our most urgent social problems and the troubling tale of corporate actors shaping, bending, capturing, and breaking the law in their favor. In this episode, we’ll be discussing private equity and health care. 

Molly Today we’re joined by Charlotte Lawrence, who is a California native. She has her research masters in History and Philosophy of Science from the University of Cambridge and a strong legal interest in international law and health law, specifically regulations of privately owned nursing homes.  Thank you for being with us today, Charlotte. 

Charlotte Laurence Thank you. It’s such a pleasure to be here. 

Molly I would love if we could start by sort of hearing a little bit about your journey here to law school. 

Charlotte Sure. As you’ve mentioned, I had an interest in history and philosophy of science, and I was doing my own research in various topics, specifically relating to health ethics, organ donation, ethics. And from that, I was able to work in British politics for a member of Parliament who is now in the Labor government, who is a brilliant mentor for me. And through that work I was able to see how my interest in social ethics could be played out in a more legal realm. And that’s why I wanted to come to law school. And it’s been a really affirming journey for me so far. 

Gauri So what has been kind of the best part of law school for you so far? 

Charlotte I think the best part of law school it’s a bit cliche, but it would have to be the people. When I got here, I didn’t realize just how much of a learning curve going to law school would be. 

Charlotte And I t hink that I have never been around such generous, motivated, brilliant people who are willing to stay up all night to teach me something that that they’re going to be pitted against me to learn the very next day. And I think that I’ve made some incredibly genuine friendships here with with people that are just my heroes. So it’s the people, Definitely. 

Molly That’s amazing. I feel similarly. I would love to hear more about your plans for after law school. I know you have some things in the works. 

Charlotte Uh, At the moment I am going to be starting out working for a firm in litigation. I’m hoping to do international arbitration, do a little bit of public international work as well, and hopefully further explore some of the other legal interests that I have. I think one of the great things about Harvard is that they really encourage you to be a generalist and take on subjects in different areas of interest. So I’ve discovered an interest in bankruptcy and corporate restructuring, but also in health law and policy as as we’re here to discuss. And so I’m hoping to keep exploring that as I start my more formal work at my firm. 

Gauri That’s super amazing to hear and very affirming as an undergrad who has a million interests. But yeah, let’s shift a little bit and talk about the topic today. So how did you get interested in private equity and health care? 

CharlotteI have been interested in health care policy for a while. My boss, as I previously mentioned, the woman that I’d worked for before coming to law school, was a pharmacist before becoming a politician. And she has an interest in health policy, which I was able to explore alongside her. And I was working in the UK during the pandemic where I was exposed to a lot of issues systemically with nursing home care, of course, in a very different system and a different country. And when I came here, I have a friend who is in my year who I have really enjoyed discussing these issues with, who was working at the time in New York before I wrote this article that that I’ll be discussing with you who heard about the lawsuit that was happening in New York that is pretty central to my article. And just discussing that lawsuit with him, learning more about it was how I first got engaged with the facts. So I guess just really just talking around the water cooler with other law students. 

Molly Yeah, that is a great sort of segway into your article, which does center in part around this case happening with the New York Attorney General’s office. Could you give us a brief overview of the circumstances of the case where we are now? 

CharlotteI’d be happy to. So this case I’ll start out by saying that the New York Attorney General, Letitia James, has made it a focal point of her policy to make fraud and negligence to to go after that in the context of nursing homes. So it’s been ongoing. This is one of many lawsuits that her office has put forth. This lawsuit in particular was with four nursing homes that. Attorney General James, on behalf of the state of New York, was making this It’s Centers for Care LLC is a privately owned fund that owns four that we know of, four nursing homes in the state of New York. And her petition was aiming to halt what was described in the claim as a pattern of repeated fraud, illegality in the operation of the nursing homes that was resulting in serious harm and even death to many of the residents. In terms of where I think you asked about where the lawsuit is at right now, it’s ongoing. The attorney general’s office is seeking restitution, different forms of relief, including injunctive relief. So basically having them halt the harmful behavior and halting the profit-motive of taking practices that the office is alleging is causing these harms. 

Gauri So you mentioned some of the broader typical legal loopholes that are insulated from public scrutiny. Could you briefly touch on how some of those work and what they are? And then I think also of interest might be some numbers and statistics of how the private equity form ownership has sort of grown in this space. 

Charlotte Sure. And please stop me and ask me questions if if I’m if I’m getting too into the jargon, I promise I’m I’m relatively new to this as well. My background is very much in history and not in finance, but I will do my best. So the way that I understand it and it is a private equity ownership and the loopholes that enable it to flourish in this industry. The ownership structure is, as I understand it, pretty complicated. And that’s part of the issue: it’s very difficult to understand or to just kind of figure out just as a regular person who owns what if it’s owned ultimately by a private equity fund. But the way that this works in terms of legal loopholes. Is that funds take advantage of the fact that at the heart of their profit making process, they do two things. They take on debt, and they divert the money that they have to operating expenses pre profit. Now, what all of this does is it creates an incentive for them to limit reinvestment into the nursing homes that they own because they’re trying to pay back the debt, cut costs and extract as much value as possible to, as I said, pay back that debt interest and generate profits that they’ve promised to investors. So in terms of the loopholes, there’s four main ones that I’ve outlined and I’ll go as quickly as possible, but please stop if you have any questions. The first loophole is a process called sale leasebacks. And this is for me a really difficult one because I don’t see any regulation aimed currently at stopping this within this sphere, even though there has been ongoing policy pushes for for maybe some of the other loopholes. The way that it works is that a fund, a private equity fund, will initially own the nursing home and the real estate and the buildings, and they’ll sell the real estate to an investor, typically something called a real estate investment trust or REIT. And if anyone who’s listening chooses to Google this issue, you’re going to see REIT everywhere. So after selling the property, the nursing home owner, the fund, will lease back the real estate, and the lease agreement will usually be for long term like 10 to 20 years, and that will provide the investor with a stable, predictable income stream. And then that initial sale to the fund’s investor, let’s say they sell it for $10 million — the land, the building — injects immediate capital back into the nursing home business, which the firm can use for a facility improvements. But that leads me to the second loophole because — I just call it “fees,” because it’s easier for me to remember. If you have got a situation where you have $10 million and you have to you have a state regulation saying that you can’t profit for more than X amount, more than 10%. What you’re going to do as a fund is you’re going to own a cleaning service. You’re going to own a nurse training program. You’re going to own a catering service, and you are going to use that money, that capital, to pay all of those different actors that you own, as the over arching fund. So you are technically reinvesting it into the nursing home, but you’re paying for services that you own. So you are going to minimize the quality of those services and maximize the amount of money that you keep. But this is all pre-profit because you’re maintaining that money before you see any profit. It’s it’s all technically being reinvested. So that’s fees and sale leaseback sets too. The third is called dividend recapitalization. Basically how this works is that a fund and these are all legal loopholes, they’re all allowed under current regulations. A private equity owned nursing home will take on a substantial loan. And this may and is often from an entity that the fund also owns. So from itself, essentially, and once the loan is in place, the nursing home will use the loan to process a special dividend, quote unquote, paid back to them. And if you’ve heard the word dividend before, it’s usually in the context of a company giving itself payments from its regular earnings. But a fund will give itself payments funded by the newly acquired debt. And so. This. This is a you know, this is this is essentially a big chunk of money that they get to keep off of the of this. And it’s it’s it’s a essentially a benefit financially without having to improve care quality. And the last thing is roll ups and to me is the simplest thing to understand for me personally, which is where a company, a fund, will buy up a ton of different nursing homes in a geographic area so that there’s no competition. Raises prices, reduces incentive to enhance quality of care, and complements these other mechanisms quite nicely. So that’s those are the four. Those are the four legal mechanisms. 

Molly Yeah. I mean, wow, They’re doing. They’re doing the things. So now that we sort of have that background on the state of play, I know that this has become a bit of a hot button issue under the Biden Administration? And he came out with a number of public statements and initiatives. I also know that Trump has touched on this in the past. I’d love it if you could give us some insight on what the governmental response has been between those two different presidents. 

Charlotte Sure. And just to give you some context. For that question, because I think that governments, you know, have been trying to respond to this issue in one way or another for decades. But, and I outlined this in my article, there are, I think, very different approaches that have been tried, and I think that has to do with misunderstandings of how this money is being allocated. There was a series of concerted studies published quite recently, I say quite recently post-pandemic, that seemed to outline the issues that I’ve been outlining for you and outlined more extensively in my paper about how transparency is one of the key facilitators for this type of harm. And so admirably, the Biden administration has–in citing, for example, a paper from the well, Cornell School of Medicine, Public Health–has taken a page from that and has established through executive order minimum staffing standards which are raised from what they had previously been set in, I believe, 1987, the last time it was set. Improving transparency: So homes are required to disclose ownership and management information and various mechanisms to incentivize supporting family caregivers. So all of this will be phased in over the next five years. I will say this. This executive order was announced last spring. It’s already just a few weeks ago faced some legal challenges. 20 Republican state attorney generals have filed a lawsuit against the Biden administration arguing that these new staffing requirements could financially strain nursing homes, potentially leading to closures. So we’ll see where those lawsuit, where those lawsuits head, especially in the wake of a new administration. So it’s an interesting time to be having this discussion. President Trump has, as you kind of alluded to, mentioned, reforms that he would make in this space, which I definitely think are worth looking into. He announced a proposal to introduce I don’t know how serious this proposal was, but it was something he announced to introduce a tax credit for family members caring for elderly relatives at home. So I don’t know. I’ m sure that there are many benefits to a tax credit for at home caregivers in conjunction with other systemic changes. But I don’t know if you guys can can see some of the drawbacks. I certainly have an idea of what they might be. 

Molly Yeah, I think not this legislation or sort of regulatory scheme specifically, but I know that within Medicaid there’s this idea that it is now or it should be reimbursable. And now it is in Georgia. This is something that the legislators did maybe two sessions ago, but to have kinship care be reimbursable so that people can help their relatives with intellectual and developmental disabilities. I think a lot of the pushback in that legislation was around sort of concerns of Medicaid fraud and this narrative that is largely unfounded and pretty costly to administer in terms of Medicaid fraud control units. So I, I know that on a state based level, that’s sort of what that looks like, but.

Charlotte I absolutely back that assessment. I think in addition to that, I see an avenue where a tax credit, while I’m sure well-intentioned and will have a positive impact, will be handled in a way that is unequal and inaccessible to many, benefits, only those who have taxable income. So you mentioned Medicaid. You know, I can discuss this just that the statistics for for  nursing home residents, but the majority of it, especially in private equity context, is being paid on Medicaid. And so, you know, how much taxable income can a person have? It’s a delayed financial benefit. You know, that happens at a certain time of year, and it may create a disincentive for institutional reforms if you’ve got this kind of Band-Aid issue that some are benefiting from. So I worry if that is the only mechanism to relieve the institutional, as I see it, issues in private equity owned nursing homes and privately owned nursing homes in general. 

Molly Yeah, it’s almost reminiscent of school vouchers. 

Charlotte I couldn’t agree more. Yeah. 

Gauri It’s super interesting to think about how the administration transition will affect this issue amongst all the others we’re thinking about Let’s shift gears a little bit and talk about the industry broadly. So I’m curious, what makes health care as an industry appealing to private equity groups? 

Charlotte Health care is an industry is appealing to private equity groups. If I can speculate in this in a speculation, make it a little ungenerous. So everyone should take what I’m saying with a grain of salt. But I think one reason that I think it’s a good target for private equity investment is that you have Medicaid.And the need is fairly steady. And in fact, when I say steady, the need has only increased substantially from, you know, over the last century. It’s increased a lot. I’d have to find the statistic, but I know that the curve looks for those. I’m making a sort of asymptotic motion with my hand. The you’ve got a steady stream of funding. It’s government funding. The need is only ever going to increase. Populations are getting older. We know that. People are starting to get they’re taking on more of a degree of education, which means that they’re working later, which means that they can’t support their relatives as directly as soon. You know, people are going to be retiring largely when they’re 50. That’s not a standard thing that you think about anymore. And so. And the more cynical person in me worries about how private equity particularly in health care is one of those need based areas in regards to nursing homes that have a population that is both growing but also increasingly less able to actualize their own systemic change. You’ve got a group of people who are I mean, it’s 70% of nursing home residents are women, most of whom are likely to have a spouse that is not alive. Over 50% have some form of cognitive impairment. There are mobility and self-care limitations. And so the reality is that you have a group of people with a steady supply of funds who  who are less able to push back against the tension between profit maximization and patient care. 

Molly Yeah, definitely. Thank you for sharing your speculation. I think it was helpful. And I think that we talked about earlier in the episode some of the legal loopholes that exist in this space. But could you maybe speak to the broader relationship between regulatory agencies and private equity groups?  Specifically, maybe we can just start with who’s in charge of that regulation. What does that look like? 

Charlotte Yeah, I’d be happy to. I mean, there’s there’s really two layers of regulation, as I’m sure most of us well, certainly most of us in law school are aware of. There’s federal and state regulation. And most regulation for nursing home care, because these are going to be regulations governing nursing home care, are at the state level. That’s where you’ve got dense codes with the nitty gritty discussion of how much you’re allowed to profit. And they they seem to be broadly, from what I’ve seen, like fairly aligned with a bit of variation but fairly aligned. And then you have federal regulations as well through either executive order, Health and Human Services broadly, it comes under that remit. And that has been taking a backseat in terms of hands on regulation. As I was writing this paper, the Biden administration came out of that executive order. And I remember the day before the order was announced it was writing Federal regulation has not made any leaps since the 1980s. And then this happened and I was like, “oh wow! ok,” and it was a massive shock. I mean, not so much of a shock because it was announced for the State of the Union. But you know, you never be 100% sure that something announced the State of the Union is going to manifest. But largely speaking, state regulatory health agencies very similar, I’m sure, to the ones that you had worked with when you were working in Georgia. 

Molly Yeah. Yes. A lot of that regulation is done on a state level in Georgia as well. A lot of the push back similarly is lobbying at a state level. Big health care systems, nursing home systems have a lot of power in that space to work with local state governments. 

Gauri What are some of the reasons why this hasn’t been addressed yet in legislation or why it has taken a backseat? 

Charlotte That’s a tough question because I don’t mean to. What is the phrase in law school? I don’t mean to fight the hypo, but I. I do see it as having been addressed. I don’t think it’s been addressed effectively. I mean, I think that there have been attempts. I think what happened during the pandemic is a really good example. During the pandemic, you know, we saw a lot of studies come out talking about the state of nursing home residents. And from that, members of Congress at the national level were introducing bills. For example, one bill, the Covid 19 Nursing Home Protection Act, proposed $750 million in federal funding that could go directly into nursing homes, and another one proposed. It’s called the Quality Care for Nursing Home Residents and Workers during Covid 19 and Beyond Act. So really easy, it rolls off the tongue, and it proposed heightened minimum standards for nursing, which has now come to fruition through the executive order. Neither bill passed, but especially looking at that first bill, it’s not uncommon for, in times of crisis and when a story like this is broken, for politicians, well-meaning legislature, legislators, to say, hey, we should give them more money, these places are decrepit. They don’t have staff, they don’t have food, they don’t have equipment. We should give them money. And I, I think that that’s an incredibly well-intentioned proposal. My issue with that is that through these loopholes, when you got, I think at last check, 11% of nursing homes in the U.S. were owned by private equity companies. The last statistic that I have, 70% are over 70% are privately owned, but 11% total owned by private equity. And if you’ve got these types of models where people can take that money and reinvest it into their fund to generate profit for their investors, pre pre profit of the nursing home, when you look at the balance sheet, that money, it’s not an issue of having money. These these funds have money it’s more so an issue of incentivizing them to spend it on something other than themselves. And by incentivizing I mean regulating. This is a it’s a harsh word. So, yeah, I think that I think you’ve got a lot of well-intentioned, you know, let’s let’s give more Medicaid funding like these are all and I would never say the government should invest less in health care. Having said that. It’s tricky to know, and only only since these studies have started to come out and people have started to talk about it more and you have more political will from attorney generals like the New York AG to prosecute, to sue this type of harm, have we been understanding that the transparency issue is is a big part of why we don’t know where the money is going and we don’t really know who owns these nursing homes. So we don’t know how they’re spending it or how they’re incentivized to spend it. So I absolutely think there have been have been things in the works to help mitigate the harm. I just don’t know how effective it’s been in light of how opaque this area is. 

Molly Yeah, I agree. And I think a lot of at least what I saw at the state level was the creation of a real interest in data and transparency and whether or not data driven policy is a buzz word or actually sort of comes to fruition, I think is up for debate sometimes. But I do think that that is an area that is has ripened, I would say, maybe over the past decade or so. 

Charlotte I totally agree. And the sort of, on the other hand, to that, though, that really nags at me is that, you know, we’re seeing a situation where people are now going to have access if this executive order manifests over the next five years to more transparent information on the ownership structure of the nursing home that they might be looking at. But are we then basically telling I mean, depending on where it’s posted, depending on how easy this information is to access, the burden is now shifting onto families with elderly, the vast majority elderly people,  going into these nursing homes, dealing with a lot of no doubt stress, a lot of turbulence, and the burden is now on them to do their research to find out, okay, is that one of these profit maximizing owners or is it a public owner or is it something in between? And are we are we going to help them now that we’ve like, quote unquote, turned them into, I don’t know, some ideal of a discerning consumer now that they have the tools, so to speak. And I worry that that that that it will a, transparency is no doubt important, but I worry that it will stop there. And I would hope that that’s not the case because the burden is then almost entirely on the people who are both victims and the most in need. 

Gauri Yeah, that’s super interesting. I think the narrative of opaqueness in private equity is I can understand follows you know, institutions and spaces beyond health care as well, and to businesses and business models. And I guess I’m curious about your opinion on private equity investments as maybe a positive for some people and what they believe. So I guess a critique of this argument might be listeners who feel private equity investments might help support businesses that would otherwise fail and help these businesses develop efficient, innovative business models. And I’d love to hear your thoughts on that. 

Charlotte I know. I would love to to discuss this. I think a couple of a couple of thoughts are coming to mind. In terms of how this might develop, like an interesting or business model, if you’re to respond to that. If your goal is to create an interesting, effective business model in theory, in the abstract, then on paper, yes, they’ve proven their point. You take this private equity model with the existing regulations in this nursing home industry and you can generate huge profits using this business model. So as an academic exercise, it’s been proven. I would push back on the premise that they are supporting businesses that might otherwise fail. I think these are, first of all, in terms of, say, like the catering or the cleaning or the these other businesses that are taking the fees. These are businesses by surely by the making of the fund, by the by design of the fund as a mechanism for the fund to take money. And so these businesses are in my head, I think of them as almost pop up and they have a purpose and that is to siphon and provide minimal support. But also private equity owned nursing homes are, my understanding is, slightly on the decline because again, all of this is being brought to light. But at last count, 11% of all nursing homes. So, you know, it’s not as if the majority of the lion’s share of this landscape is owned by private equity. And no doubt the country would survive if, you know, in the short term, that smaller percent wound down. But as you pointed out, I mean, there are critiques that these private owners will face that that they’re doing harm. Am I correct in understanding that that is kind of the main criticism that you would you would say they might push back against that they’re doing harm? 

Gauri Yes, I would agree. 

Charlotte So, I mean, they might I would see them as having a few responses to those allegations. First, they would say that their duty of care is to their investors. They’re a company, not a charity. And their duty of care to the people who invest in them. And I believe that that’s the first thing they would say. And second, they would probably say that it benefits their investors and their clients or patients, whatever you want to call them, so to speak, to have a robust business with a lot of money so that they can reinvest in them so that they can open up more venues, that they can help people by opening up more nursing homes. But the bottom line is that you can’t have two primary motivations. You can’t be primarily motivated to maximize profit for yourself and your investors and primarily motivated to help patients. And if at any point — and I say “if” when I really mean “when” — at every point the profit maximizing motivation is at odds with the patient-care-help motivation, I don’t see a world in which of their own volition they are going to choose patient care over maximizing profit. Because of what’s been discussed and because it’s allowed. So to their response to my hypothetical critique and my rejoinder of that hypothetical response, I think increased regulation needs to happen to sort of navigate these what I see as competing tensions at the core. 

Molly Definitely. I think it would be interesting to discuss with you if you are up for it, the Stewart Health sort of scandal in Boston. Do you know about that? 

CharlotteI am probably less familiar with it than you are. Do you mind giving a quick . . .? 

Molly Yeah, a synopsis. So from my understanding, we’ll start generally, the Northeast has been very anti private health care historically.Specifically very anti, I think, large private health care. And there was a Catholic chain of hospitals in Boston that was in trouble. And I believe it was the state government. 

Molly They allowed Stuart Health to come in and buy those hospitals and there was some private equity shenanigans. The private equity group there, I do believe they executed a sale back and leaseback a leaseback agreement. Yes. Which is something that happens in Georgia as well. 

Charlotte Get to know what’s happening everywhere. 

Molly Tangent aside,  they came in, long story short, private equity leaves; hospital is failing. I think the sort of debate is whether or not to bail out that hospital system under sort of the competing narratives that A, it will encourage bad behavior or B it is a they have extensive service provision lines. And even though, as we know, private equity closes a lot of service provision lines, they are providing care to a lot of people. So it’s it’s an interesting sort of dilemma. 

Charlotte That is a toughie. And, you know, I think when we’re in like this, this podcast is about lawsuits and legal issues. And I think one of the things about law school that I find particularly interesting and also frustrating is that we’re always thinking about, “okay, if we do something, what is it going to encourage or discourage?” And while I think that’s extremely important in this case, because you might be encouraging, you know, what we consider to be in hindsight, bad behavior, you know, blurring those lines between public and private, where you have a mandate to maintain public. We really not knowing as much about the needs and the issues as you do, the way that I would start by thinking about it is what are the needs of I mean, if this is primarily happening in Boston, the primarily the harm is happening in Boston, what are the needs of Bostonians? Are they being met by the existing infrastructure? And if not, is this a vital locus for meeting their needs? And if so, how can we (A) buttress regulations such that this type of loophole, this type of sale leaseback that can happen under the table because you can have a firm come in and swoop in. I mean, you have this concept in like international law when a hedge fund is affectionately called a vulture fund, when they’ll take a country at its weakest and they’ll they’ll swoop in with massive interest rates. And it’s it’s it’s a rock and a hard place. Countries take it, Argentina quite famously. But but in this context, how do we create an incentive such that that is not a decision that a public hospital has to make? And in the short term, how do we ensure that they are armed against making that decision again now if we do bail them out.? I sincerely hope that an infrastructure that supports no doubt well-meaning nurses and physicians is able to remain afloat. But I completely agree that we need to be mindful of not doing so in a way that  just injects money, no holds barred and and creates a status quo where this type of behavior is acceptable, especially in a sanctuary, almost like, I would say, like like the state of Massachusetts for for health care that people traditionally know that they can trust the providence of. 

Molly Charlotte I’d love if we could touch on some of the things that everyday people could do about this, get involved with. If people are listening to this and they really just have a passion to get things done, what would you recommend? 

Charlotte Well, first of all, please, please reach out to me if you have a passion to get things done and you’re listening to this podcast episode. But a couple of really basic things I would start out by I know I just railed against the burden being on the patient to inform themselves, but I would make an effort to inform yourself, try and become a little bit more familiar with some of the information right now out about private equity ownership. Use my article as a starting point and kind of inform yourself about just broadly speaking, what your local government is doing or state government in addition to keeping an ear to the ground for what the federal government is doing. And I plan on continuing to work and publishing on this. So, you know, I will do my best to make that available. I think in terms of what you can do to help get involved, it’s a cliche, but, you know, your vote is your voice. And I know that’s a particularly strong statement to make right now shortly after a national election. And I don’t want to imply that care home residents. I don’t want to infantilize them and say, they’re not capable of of of of moving the dial on their own because that’s not the case at all. They’re very much their own advocates. But I think that they’re advocates in a different way. I think for advocating for themselves by fighting every day, by choosing to try and make the most of disastrous, oftentimes living conditions. They’re their own advocates, by courageously speaking, to people who will take their very sensitive stories and use them, hopefully to raise the narrative profile of what’s happening to them. But when you’re in a situation where you can’t get someone to close your window, you’re worried about getting hypothermia or you can’t get someone to change your bedpan so you don’t get an ulcer. It’s very difficult for that group of people to get someone to take them to a polling station or to help them fill out an online ballot when they can’t get those most basic material needs. So the best that we can do is look for interventions and make this a sticking point with our vote telling our representatives, this is important to me. I strongly believe that that will make the strongest difference. 

Gauri Thank you so much, Charlotte, for that call to action. I am surely excited. That is all we have time for today. Charlotte, thank you so much for joining us and flaw school. We are happy to talk private equity in health care with you any day. 

Charlotte Thank you. I’ve had such a pleasure speaking with you both and I look forward to chatting more off camera off off recorder, whatever it’s called, later on. Yeah. I also just want to say thank you for such a wonderful conversation. I found it lovely to pick your brain this evening. 

Gauri And thank you, Molly, for being a great co-host. It’s been wonderful to chat with you. 

Molly Of course. Right back at you, Gauri. If you’re interested in reading Charlotte Lawrence’s full article or learning more about the flaws in our legal system, check out The Flaw magazine at theflaw.org. And Charlotte, would you like to tell listeners where they can find you. 

Charlotte On any given day? No. You can find me. You can You can use my email address. My school email address. It’s claurence@jd25.law.harvard.edu. And I will try and make sure that it’s uploaded next to my articles so that anyone who wants to chat this subject can reach out. I’d love it. 

Gauri Thank you. And if you enjoyed this episode, please first make sure to check out the show notes. There’ll be some awesome links and references there and make sure to subscribe to our podcast wherever you listen to your podcasts. You can also check out flawschool.org for more content. Thank you all so much for listening and we’re looking forward to talking at you in the future. Class is dismissed. 

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