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My grandsons had dreams of farming their great grandfather's farm. He told them it would someday be theirs. Now, the dream is going to a nursing home for great grandma. Thousands and thousands a month for a small empty room. Why does it cost so much? It doesn't seem to be going to the employees. They aren't paid that well. Can anyone justify the costs to me? Why does my father's hope that his grandsons will farm the same farm that his grandfather farmed have to be given up?

When health care become for profit...that's when this all went off the rails.

corporations believe that the only thing they need to produce is the largest possible profit for their owners. All health care in this country cost far more than any where else in the advanced western countries...yet have the worst out comes.

once for profit realized that draining the elderly was a GREAT source of more revenue...well..nursing homes and assisted living were taken over (trade on the NYSE). This amounts to a massive wealth transfer from not just is generation...but because it is sucking up all the lifetimes earnings of the elderly...it also ensures there is no opportunity for the next generation to get a leg up. Even reverse mortgages came into play....

this level of capitalism is just plain evil.
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cherokeegrrl54 Dec 4, 2019
Sooo agree!
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Yikes, major sticker shock.

To answer why is a nursing home is so expensive we need to realize how many costs are involved in running such a facility. I know it won't make your bill seen sweeter, but it will give you some idea why the cost...

First thing is the cost of the land, zoning changes, building designers, land development such as the footprint for the building, parking, water and sewer, road construction, etc. all need before the building is even built. Back and forth to the County/City for approvals. The cost of the new building itself, which can easily run into the multi-multi-millions. Imagine paying the mortgage and insurance on that !! Even an older facility would still have a mortgage, plus constant repairs.

The building needs to be Staffed, not only with 3 shifts of caregivers, nurses, Aides, but also with kitchen help, inside cleaning help daily, Administration, maintenance personal. Payroll is extremely expensive. Then add in payroll taxes, workman's comp, etc. Office computers, and telephone service. Alarm systems for fire and carbon monoxide. Constant laundry, washers and dryers going all day long. Don't forget the landscapers and winter plowing. Plus business licenses. And contracts with medical transporters, which are similar to ambulances, to take a patient to and from a medical appointment.

Now, lets look at the cost of the electric/gas bill, imagine what that would look like. Then the water bill must be over the top. Then there is furniture, hospital beds, special mattresses, cabinets for the rooms, hoya lifts, oxygen equipment, dining room furniture, nursing stations, WiFi. Then the cost of food for 3 meals per day with a lot of special diets. Let's not forget cost of bedding and towels. Oh, having meds and medical supplies on hand.

Here's a biggee, real estate tax on the building and land, and liability insurance. Plus malpractice insurance.

Some places have on-staff physical therapy with a small gym and all the equipment for the gym. Or a place has a contract with a sub-contractor for physical therapy which is done in a patient's room.

How old are your parents? Does your Dad still farm? If Dad is slowing down, could he rent out land to other farmers to grow crops or to have cattle graze? I don't know if that income would help with nursing home payments.
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Riverdale Dec 5, 2019
Such a very thorough helpful answer which is all so true. The only issue I have is that costs can vary by several thousands depending on the area but then parts of the country are simply more expensive. In NY the costs for my mother's AL were almost double to what we are paying in SC but then we are in a more expensive area in SC so costs here can be double to other parts of the state but that is not where we have chosen to relocate. At least here in SC they do not have an automatic annual 7% increase as they did in NY which almost seemed criminal. Nothing more was being offered for that increase and as my husband pointed out to the director there what other business has such an annual increase constantly for which she really did not have an adequate answer. I always recommend not for profit facilities if at all possible.
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Hopefully your parents consulted a good elder law attorney, there are ways to shelter property. Great grandpa should be able to keep his half.
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What is great grandma's quality of life? Does she have a DNR? Too many people have no idea what is involved in resuscitating a body that's 8-9 decades old. It is a terribly violent act that rarely ends in grandma knitting, gardening and reading the grandkids bedtime stories.

Her meds are probably doing a good job of keeping her alive? If so, perhaps it's time to wean her off and focus on her quality of life rather than quantity.

Her doctors and the nursing home have zero incentive to change her drug regimen. After all, Medicare is a cash cow and the milk runs dry once the patient dies.

And yes, I have grown very cynical about the medical system and doctors. After seeing what was done to my MIL, who had a neurodegenerative disease, I will never choose for quantity of life over quality. How does great grandma feel? How do her children feel?
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Isthisrealyreal Dec 3, 2019
Amen! Doctors are only interested in seeing how much a body can take and still survive.
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Teddy; Have you had a consultation with an Eldercare attorney in your state, one who understands Medicaid?

It is likely too late to do anything (Medicaid planning needs to be done 5 years in advance) but it is certainly worth it to get a free hour's consultation.

Some states have exemptions for family farms.

Also, I hope that great grandma's means are being used to fund her care, not your father's. Your post does not make that clear.
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Just affirming that you should spend the money to consult with an experienced, reputable Elder law/estate planning attorney sooner rather than later if you want to know if you can rescue the farm. Do you have financial PoA for your mom? You will probably need this if your mom is not able to make clear decisions.

Regarding the cost of care: employees are usually the biggest expense of any business. The more employees, the higher the organization's expenses. And insurances (yes, including for malpractice), business/liability, Workers Comp, benefits, medical and office supplies, personal care supplies provided to residents (toothpaste, shampoo, lotions, etc), upkeep/maintenance of large facilities, the food they serve to residents, the events, activities and field trips they sponsor (some charge a nominal amount), the buses they own to transport people plus gas/maintenance of those, the cost to heat and cool (utilities), landscaping, and other taxes state, local, federal, property, etc.

I don't understand how people complain that the NH staff are underpaid and then complain that the cost of the care is too high? Or that there's not enough staff? Do you not understand that the 2 are completely connected? My MIL is in a faith-based non-profit NH and the private pay amount is still several thousands a month for basic care.

Also, scarcity forces prices up (Law of Supply and Demand). When all the baby boomers started to require NHs, there weren't enough in existence, and this drives up the prices. And there is an unskilled labor shortage right now, which also drives up the wages. Here in MN they are building NHs faster than can be believed. So, after the boomers pass, this should drive the prices down. But the labor/wage issue is its own thing.
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I see that too. My parents wanted us to have an inheritance partly because they had it from their parents. They worked hard also so that they could leave us something. There will be none. I suppose the cost of running a care facility is not just for the caregivers. I see the director of my mom's assisted living working on the books and schedules every day. I wouldn't know all that is involved. And I suppose the owners have to make some sort of profit in order to stay open. Taxes and insurance on the building. Upkeep of the property. I'm sure it goes on and on.
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pamzimmrrt Dec 3, 2019
Artist, I agree.. My FIL And mil thought they had enough to leave a big inheritance to their sons, not going to happen, due to some bad decisions and FIL worries about that. But it is what it is,, and we will deal when it happens.. Things these days are not what they used to be, and I am sad about that, because I also hoped to not burden my daughter. I pray I still wont.
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If you don't like the cost you do it yourself or find a cheaper alternative. That's what we have to do in many other aspects of life....yard maintenance, cleaning the roof, shoveling the snow, car repairs at the dealership, passing up the sitdown restaurant for a meal at home, child care, and on and on. We get upset at the really high cost of this type of service. We go through life without confronting this societal problem until it affects us personally, just like we do for many other issues....climate change, affordable and available public transportation, hungry homeless people in our streets of America. Yes there are reasons the cost of medical or custodial care is expensive but how many of us make an effort to effect societal change for all of our country? The world? Instead we react with shock when something bad happens close to us, whether it's crime, the fires and floods and climate refugees resulting from climate change, or a horrible health issue that we can't solve with some rest and chicken soup. In my job at a welfare office yesterday, among the people I saw were a blind man with a wife and children, a woman who had fled her husband who had been physically abusing her and she was now living in her car with two cats and whose quadriplegic son was not allowed to be in the home by this husband, a veteran dying of lung cancer, a grandmother aged refugee from the former Soviet Union, an undocumented alien from Central America (who does yard work) to get help for his citizen children, and a man living in his van who now has a physical problem that made it difficult to collect his cans for recycling, which is on top of his PTSD, bipolar, schizophrenia and anxiety disorders for which he's been hospitalized four times. And those just the ones I remember from yesterday who found there way in for food stamps. What are we doing to deal with societal problems before aspects of it smack us upside the head and crush our hearts? Can you do anything today? For me, I'm headed to work now. Who will I see today? And what will I do besides the job I get paid to do? How about you?
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KathyT124 15 hours ago
And how many of these clients will you have to say “no,” to because of the new cuts to food stamps that take effect April 1? Right now, the government is trying to limit access to the minimal safety net we have in this country.
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Who knows,, I know when my fil was in the hospital once he was worried about the cost,, his sons were worried about his health. I told him it was his money for his care, and we would all be OK. Then MIL ended up in MC,, more money going out. Life is expensive, and the end of life is currently more expensive. Is there any way the Grandsons and their dad can "buy" the farm, with the money going towards GGMs care? I know farming is not a great money maker these days, but it's a thought? I feel for you.
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We lost Dad five years ago. I continue to rent out the farm and that is the income we are using at this time for great-grandma's care. Even though we were assured of a certain price for her care, it has gone up 25% in just the two months she's been there! I may have to pay the farm taxes and expenses out of my savings, which will take it all. I find it hard to sleep at night, concentrate on things I need to do, and feel my health is being affected. I realize, there are many, many people in much greater dire need than I am. I know there are people right here in my location living under a bridge. I know poverty is horrible and there is much suffering in our world. I wish I could save everyone of them. I wish I could continue to try to educate the uneducated, to feed the hungry, stop all wars and make our planet healthy. Unfortunately, I can only do what I am able to do. Knowing this, doesn't make me feel very good. I wish I could be like Ghandi, Budda, or Jesus, but I can't. I just have to take care of what I am able. Right now, that is my husband with congestive hearth failure, my grandsons without their mother, my mother in memory care, and the farm, my home, and everyone that I can. I appreciate all the advice you all have given me. Your ideas are very helpful. I live in Iowa, so not sure of what laws are available to us to save the farm for the next family generation farmers. We have worked with a lawyer for many years. His advice to my father years ago, was to put the farm in a corporation. He told me that I will need to sell if my mother needs the money for the care.
I realize the expenses are great for these facilities, but I don't think the employees are being overpaid, that's for sure. But when you take the number of residents times the amount being paid, someone is making some bucks!
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mstrbill Dec 6, 2019
Yes, you are right Teddy. NHs are for profit organizations and just like most other for profit organizations in our society the folks at the top of the pyramid do very very well while the ones at the bottom might not get paid enough to make ends meet. The CNA's who bathe and clean and "bathroom" and otherwise do the bulk of the hands on care of our elders typically get paid close to minimum wage, maybe a few dollars/hr more, which is not enough to afford to live independently.
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