University of North Carolina is moving to a bid model for their nursing shifts and they’re focusing on only hiring the lowest bidders

Late stage capitalism. Uhhhh

"Medicaid, which provides health insurance for those with low income and disabilities, also faces financial constraints. Due to hundreds of billions of dollars of federal Medicaid spending cuts by the One Big Beautiful Bill Act and the enforcement of work requirements, millions of Americans will be losing Medicaid coverage. The combined effects of ACA and Medicaid changes could result in 37 million Americans becoming uninsured in the next decade, according to The Commonwealth Fund."

"The Commonwealth Fund also noted that 50% of working-age adults did not receive needed healthcare because of costs. Reasons included not filling prescriptions, skipping recommended tests, avoiding doctors when sick and going without specialist care.

When people are uninsured or cannot afford care, individuals can put off preventive visits such as getting a mammogram or a colonoscopy. This can lead to delayed detection of cancers, diagnosis at an advanced stage and ultimately worse health outcomes."

Source : https://www.forbes.com/sites/omerawan/2026/10/23/new-poll-shows-americans-face-financial-strains-with-healthcare-amid-midterm-elections/

Submission Statement:

While many regular readers here at r/collapse are already familiar with the intersections between climate change and public health, this recent article piqued my curiosity due to its visual showmanship, its detailed descriptions, and in its particular "close to home" familiarity - starting in the emergency room of St. Paul’s Hospital, right in the heart of downtown Vancouver, B.C., during the midst of the 2021 PNW heat dome.

As it turns out, those who suffer from schizophrenia are particularly susceptible to becoming a mortality statistic during exceptional heatwave events. Of the 619 heat-related deaths resulting from the 2021 British Columbia heat dome, those living with schizophrenia (about 1 percent of the population) accounted for a remarkable 16~ percent of deaths during the event.

To quote the WIRED article, written by Hilary Beaumont:

For years, public health advisories warned that extreme heat was most dangerous to older adults, infants, and people with chronic illnesses like heart disease, respiratory disorders, and diabetes. But in 2023 a study revealed that schizophrenia was associated with a threefold increase in the odds of mortality during the heat dome. “That's when it became very clear that schizophrenia was the outstanding chronic condition in terms of risk,” says [Dr.] Sarah Henderson, scientific director of environmental health at the BC Center for Disease Control, who coauthored the report."

A flurry of studies followed, and in 2025 a group of interdisciplinary experts, including Henderson, published a review of the literature explaining the phenomenon. What they found were layers upon layers of risk factors.

These risk factors include (again, quoting the article):

(1) Dysfunctional Thermoregulation: “People with schizophrenia have wonky thermoregulation—their bodies are less able to cool themselves for a variety of reasons. They have a harder time regulating dopamine, which is associated with our body’s ability to manage its temperature, explains the study’s coauthor [Dr.] Nathalie Kirby, an applied climate and heat-health scientist.”

(2) Imbalanced Sympathetic and Parasympathetic Nervous Systems: “A related hallmark of schizophrenia, Kirby says, is an imbalance between the sympathetic and parasympathetic nervous systems, often called the “fight or flight” and “rest and digest” systems, respectively. Typically, these systems are in balance, but someone experiencing psychosis is caught up in a vicious cycle: They may experience hallucinations, tied to a dopamine imbalance in the brain, that make neutral experiences seem scary. This suppresses the parasympathetic nervous system, which in turn produces a fight-or-flight response and worsens the initial psychosis. Along the way, someone with increased fight-or-flight activity is predisposed to adverse cardiovascular events. It becomes harder for them to control the blood vessels and sweating that help with thermoregulation.”

(3) The Physical Side Effects of Antipsychotic Medication: "Another challenge that faces people with schizophrenia—one that [Dr. Jeff] Yoo was already aware of in the ER back in 2021—is that treatment for the disorder can include antipsychotic medications that prevent people from sweating, further depressing their ability to dissipate heat. “A lot of the antipsychotic medications have an anticholinergic effect,” Yoo says, describing physical side effects that include increased heart rate and decreased sweating. “That means they’re going to be at even higher risk of cooking their organs.”"

(4) Heat As A Trigger: “Heat can also cause schizophrenia symptoms to flare up, even for someone whose symptoms are well managed. They may feel increased anxiety, dread, and fear, which further aggravates the fight-or-flight system, Kirby says.”

(5) Insufficient Insight: “Beyond internal dysregulation, people with schizophrenia often show a lack of insight into their own health (though this can be improved with medication). In a heat wave, they may not be aware that their body is heating up, so they don’t drink water or attempt to cool themselves. They may do just the opposite—wearing multiple layers instead of shedding them.”

(6) Paranoid Thinking & Social Isolation: "Paranoia, another marker of schizophrenia, may also cause some people to avoid exposure to media, including news. “They are left in the dark, they don't know that a heat wave is coming,” says [Dr.] Liv Yoon, an assistant professor at the University of British Columbia’s School of Kinesiology. She led a study interviewing dozens of people with schizophrenia who survived the heat dome. “I cannot have news,” one woman told the authors. “News is triggering for me, impacting my mental health a lot. I don't own a radio, I don't watch TV, or the internet or anything.” When the heat dome arrived, the woman had no warning."

While the above is a summary of the article's contents, I still recommend that everyone give it a proper read - it's quite an interesting review of an emergent issue that will likely worsen for decades to come. Great work, Ms. Beaumont!

I’m not 100% sure what I’m seeking in posting this, but maybe just commiseration with other people who are in the same boat. I’ve been recommended to have a total thyroidectomy due to a large thyroid nodule that came back with a 95% risk of malignancy after molecular testing on the biopsy. While surgery recovery doesn’t sound fun I’m MUCH more terrified by living in a collapsing world with a condition where my body doesn’t produce the hormones it needs and I am dependent on synthetics or getting them somehow from other animals’ bodies once pharmacies are no longer functional. Wondering if anyone else here is dealing with a similar condition. I know there are plenty of you out there who are much more dependent on modern medicine / electricity / etc., so I know things could be a lot worse. I’m just currently in this place of wishing there were alternative treatment options to the good old Western medicine approach of “cut it out” and fearing that after I have the surgery it will either turn out not to be cancer or I will otherwise regret it somehow.

Removing the minimum wage and overtime protections for caregivers will contribute to collapse. It is already impossible to afford to live working full-time on minimum wage. Taking away these protections will turn caregivers into slaves or they will leave the field.

Caregivers were overwhelmed before Trump took office. Nursing home staff, state hospital staff, home health employees, and unpaid caregivers have been abandoning the people they care for at hospitals because providing care becomes more than they can handle. They see this as the better option over leaving them to die in bed.

Most of the time, these people do not have a medical reason to be admitted to the hospital, but there is nowhere else for them to go so they have to wait in the ER (and take up a bed) until a social worker can find a safe placement for them. Funding for these placements is running out (Medicaid). Also, if the hospital does admit them then it can disqualify them for services that would have been able to benefit from once they leave the hospital (this may vary by state).

Hospitals are not emergency shelters, but the existing emergency shelters cannot accommodate those who cannot perform their daily tasks of living. While taxpayers continue to pay the astronomically high price of caring for abandoned people in hospitals, it also takes resources away from patients who need emergency medical care.

Hospitals also cannot legally discharge a patient into an unsafe environment. When staff/family/ caregivers abandon people at hospitals, hospital staff will sometimes transport them back to where they came from by ambulance.

Reducing wages of home health employees and cutting Medicaid will make this exponentially worse. This will not make paying for a caregiver more affordable either.

The elderly and disabled are already vulnerable for abuse, especially when they rely on caregivers to continue living.