Why are the costs for nursing care and long-term care beyond what is affordable?

CarolAnn, that sure is the truth. It is a racket and you don't get what you pay for. I can understand paying a lot for a NH where the patient gets round the clock care, turning them over, feeding and washing them, etc. But AL - I'm disillusioned. We were paying $2250 for Mom in IL and she had a small apt - kitchen, washer & dryer, living room and separate bedroom, very nice, very comfy. She got 20 meals a month also and monthly housekeeping and free activities and transportation. Now in AL, we pay $3600 a month plus $650 for level 2 care. She gets 3 meals a day (but she never goes down to breakfast so we buy things to eat in her room) She has a room half the size of the apt in IL and a bathroom, a sink, some cabinets and a microwave. For that amount of money the level 2 care, from what we can tell because they haven't been specific, consists of putting in and taking out her hearing aids, giving her a pill a day, and incontinence materials, and I assume keep track of her, and makes sure she goes to dinner and lunch. She won't let them help her with anything like showering, etc. She is mobile, dresses herself, makes her own bed, gets herself to the bathroom. Yeah, I feel there is some peace of mind that they monitor her a little bit more than they did in IL but I think its a ripoff for $2000 more. Laundry is included in the basic room rate so they wash her towels and change her sheets. But she throws her dirty clothes on the closet floor and they don't wash them so I'm still doing it. She puts her dirty dishes under the sink and doesn't wash them, they don't check, so we're still doing that. Because she is stubborn they mostly leave her alone. She's one of those people who puts on an act in front of them, acting normal and independent, and they accept it. She told me she fell and had rib and back pain. (They will take her to the doctor - for an extra fee) But she refuses to tell them and I know she will lie to them and the doctor if I do. My question is, is she walking different, or limping, are they observing her? I simply don't know if she is exaggerating to us and is ok or not because I can't get up there with my broken ankle. Yeah, paying $2400 a month more, to me, is a ripoff for what she is getting - the presence of people around but not actually doing much hands on. I could be wrong, but I simply don't know.

What you are describing is more the norm than exception. The staffing is low, paid little, respected little and this makes for a bad situation when caring for others. The staffing in most all of these corporate facilities have been cut to the bone and at times to dangerous levels (people fall and no one finds them for 2 days, etc) but the money goes right up to the top. I mentioned earlier The Green project which was featured recently on PBS, where a community got together and build a facility and ran it. The caregivers were trained, respected, and gave good care to the residents. The residents particiapted in all aspects of life they wanted, like helping w meals, etc. The costs were about 25% of what traditional care was. Yes, we do need to start grassroots initiates to do these things in our own communities. At this price point, they could accomodate Medicaid as well as private pay Very inspiring!

OTJenn, that is really a cool idea. I wish there were more people inspired and ambitious enough to lead a Green project in every community. Seniors shouldn't live in fear of losing everything they have, including the family home which has to be sold, not left to the children, just so they can get government help because the cost of AL and nursing homes is so high. Most of us children don't earn in a month what an AL or nursing home charges their parents and that is why so many of us baby boomers struggle with caregiving.

AmyGrace, I sympathize so much with what your mom is experiencing . I am.on verge of choosing an AL with my mom, who is frail and I would love for her to live in her own home, but she has such weakness and getting slightly confused. Over half her & dad's savings was spent on my dad's NH bills, plus his funeral (which he did not pre-plan and emotional spending by mom went overboard). Mom now has just her house,.Soc Sec and a dwindling savings. I struggle to provide all her transportation, food, shopping and entertainment needs. She has been a model citizen her whole life, and didn't squander anything, and I wish she could stay in her home --I would be happy to continue providing lots of help for her, if only we could find reasonable priced in-home helpers for about 2 × 4 hr shifts a day 7 days a week.. but our local caregivers want almost $30/hr plus mileage. It is still.affordable compared to AL which starts at $4,000 in our major metro area, plus the levels of service are all additonal.....figure starting cost $60,000 per year! When she runs out of money, they either don't accept welfare or they move them to basement dormitory style rooms. Yuck. It is so wrenching to know what to do, so mom can have helpers, but not end up in the Medicaid ward.

There is exactly ONE green nursing home in my area, is 40 minute drive not during Rush Hour.... It's full, and only has very limited availability for Medicaid recipient. It would be great if they could build one in every neighborhood. But at $15-$20 million each to buy the land and build the building, that is not going to happen. The country is much more worried about Putin, Iran, N.Korea, and Calif drought to be giving any notice to needs of seniors. I wish it were otherwise... I would go door to door to help, but I am pretty sure the party politics would mean I would refuse to be involved.

Well if you think three in a room is difficult, try a small one room apt with a kitchen or a one bedroom. Minimum of $3000 a month. Then add, the blood pressure takes and the pill dispensing and your up to 4000. The meals in these beautiful facilities are institutional foods and are salty and bad. People gain so much weight. NOT GOOD weight.

Oh, if they own nothing, and have nothing but their SS check...Its free

If the world were a perfect place, we would all eat a raw vegan diet, live to 120 and die in our sleep after having ecstatic sex with our wife/husband. Institutions are a mirror of the lives we live... too much pizza, too many hamburgers etc. We are seeing end of live conditions feeding our seniors much the same diets they chose themselves.
I would love to see a raw and living foods facility in which Natropathic doctors treated the elderly and kept them working outside in the organic gardens and harvesting the foods that they ate. It ain't gonna happen until people choose a healthy lifestyle whole they are independent.

Lol Sherry1Anne, it sounds so wonderful! There's a lot of good that could come from vegan life-long diets, naturopathic doctors and growing ones own foods. Probably not going to happen in enough mass to change to current situation, which is millions of seniors (or baby boomers becoming elderly ) who did eat tons of pizza beer hamburgers and had lousy sex despite billions spent on little blue pills. And hardly any of them saved $500,000 apiece to pay for a NH stint, they were too busy taking jets to France or Bermuda, buying smart phones big screen TV'S and indulging their kids (or pets or organizations ). Your idea holds much promise in that if we could legislate such a radical lifestyle change for all over age 80 they would probably die of massive panic attack and that would be the better solution (maybe not ). Everyone makes mistakes, including life-long mistakes that bring on early death or gruesome debilitating disease. It all costs somebody a lot of money. It should be each individual paying their own bills--that is the ONLY way for people to truly reap what they have sown.

Please continue this converstion! I need to watch the Green Project on PBS. Sounds like a solution.

My father has settled into a Long Term Care facility that was built by some Catholic Nuns, back in the day. But he has his own private room, dialysis is in-house and they accept medicaid, So far, so good.

Has anyone thought about the homeowners getting a reverse mortgage? My father did this. I was not happy when I realized what he had done. The money was not spent wisely. It could have been saved/used for health care expenses So when the s**t hit the fan and the doctor said he could no longer live alone anymore, we moved him into assisted living. His pension and SS was enough at the time to pay for the cost. We sold or donated everything in the house and used the cash to pay off some bills. I then called the company/bank he had the reverse mortgage with, and told them he no longer lived in the house and they took it over. In this economy, it may have taken forever to sell the house. Having a POA in place, helped tremendously. I was able to do things long-distance, as he lived in another state at the time.

I always say keep people i their own home as long as possible, even if it means round the clock care. In Alabama, depending on the area you should be able to get a night sitter for $8 - $10 per hour and a "companion" for about the same. Say $240 per day 30 days a month. That's $7200 assume family can take one shift, it reduces it to $4800. Add in taxes on their home, food, medicine etc and it is about the same for full time care as a nursing home. Under these conditions, the person has someone who gives him/her their undivided attention and they get what could be assumed the best of care.
I agree with OT Jenn, Obama care is a farce.

As GardenArtist noted, many elder's health problems are beyond what can be managed at home, especially if the adult children are still working full time and the elderly person cannot be left alone at home safely even for 5 minutes. Also, what pushes most people to put their elder in a NH is incontinence. They can deal with confusion, etc. - but once a person starts peeing & pooping themselves, that's often the "last straw" for many adult children.

I disagree with the comment of "If you do not take good care of yourself before you get older, then you will probably need services." Cancer, Alzheimer's and CHF are no respecter of lifestyle. The bottom line is that if you live LONG ENOUGH, your body will fail and you will need services - no matter how much self-care you had as a younger adult.

In fact, I have an acquaintance who is a sharp-minded 100-year-old. But she just had to move herself into a nursing home because her growing frailty required a constant army of help in her apartment just to accomplish her ADLs. When one is no longer able to "do" for themselves, then others must do it for them.

I am grateful that we live in a time when nursing homes are available. Many elders were left to die alone in early centuries because (1) they had no living relatives to assist them and (2) there were no long-term care facilities. It is a myth that everyone in centuries past had all of these family members that took care of them.

Sherry1anne wrote: "I always say keep people i their own home as long as possible, even if it means round the clock care."

But who will organize and supervise this "care" when the elder has no friends or relatives in the area willing to provide the oversight? Who will see to it that the utilities are paid, property & school taxes paid, etc. when the elder no longer has the mental wherewithal to take care of it themselves?

Not all adult children have an interest in helping to care for their elderly parent - or the ability. Some adult children can barely function themselves, let alone care for an 82-year-old with Alzheimer's disease.

BTW....I recently went to an estate sale at a house in which an elderly woman had lived - obviously, with dementia. The house was in disarray with dirty dishes all over the place, water damage on the kitchen floor where the sink had overflowed, etc. By the state of things, she had dementia for quite some time before somebody realized the state of the place. The estate sale people just held the sale "as is" - just to unload as much of the junk as possible.

After the furnishings were sold, the place had to be partially gutted and fixed up in order to make it live-able. This is not an isolated situation, unfortunately.

Last post on this topic....then I'll get off my rant.

I have several friends who 'swore' they would never put their elderly parent in a nursing home. However, once that parent declined to the point of (1) being incontinent, (2) not being able to dress themselves properly - suddenly they put their parent in a NH.

A lot of it was denial. They just could not believe that their parent would "get to that point" even though I had warned them about the predictable stages of Alzheimer's disease.

people are living longer due to medical advancements?! We like that, but the end result many times is an unhealthy person unable to care for themselves that medicine has created. yes, they are alive, but are they really. hard question to answer. my 96 yr old mother is in assisted living paying 3,000 a month with additional care, showers, taking down to dinner, dressing, assistance brushing teeth. who knew all this would be needed. she was in a nursing home after a fall and I was happy I could get her back into her AL. I would also try to pay for private extra help if needed and would be cheaper than nursing home.(her money) someone mentioned hospice and maybe assisted living did not know. they do know, in many states, if a person cannot get up on their own, they cannot remain, but if hospice can be called in, they can stay. unfortunately with obama care, hospice qualifications have changed also. sooooo much we do not know

I will say why it costs so much to care for all of us: young or old is Overpopulation in the Nation! My own mother was very lucky to have my help to stay so stubbornly independent at our CA home until she was 93 years old and required a NH after several falls and failing health at our place because she could no longer care for herself. She was put in a private room up in OR because it was too expensive for myself and our family to pay in CA.

I think it's so expensive because of the medical and nursing care and hopefully the quality of that care. It seems like most elders need care like a child does, yet the costs are so much higher than having a child to raise. And unlike a child who usually is going to independence a elder is going in the reverse, away from independence. And the costs is so high whether it's in $$$'s, emotion, or the body for all those around that elder. That said I have read through the other comments and just wanted to add ... my family of myself, husband, and 2 children at no point could afford the premiums of long-term care. Never. My husband was in the military for most of his career and had a modest job after leaving the military. I did not work enough to get SS points, partly because of the cost of child care, partly because of the frequent moves, also his long deployments, and a child who had many health problems. Then the added health problems of my own. We did not take vacations, did not have extra money to spend on homes, cars, or anything else. We stayed out of debt. And I consider us lucky, so many bad things could have happened. So I am disappointed when I see a comment that we are in this place of worrying about not have enough funds to pay for such care. You can't really buy if you don't have it start with. And there are so many people who have worked hard their entire lives only to find that they are overwhelmed by the costs of LTC. I could not purchase LTC even if I had the money because of a medical problem. Not having the money for LTC whether it's out of the pocket or via a policy does not mean someone has been lazy or neglectful with their finances. Just said to support all those who feel like they are overwhelmed by forces and situations beyond them. This comment won't help solve their problem or ours. And unfortunately I don't see any nearby fix. I wish you all luck and a better fortune in finding a solution that will work for you and yours.

My mom and I worked and saved together for over 30 years, and we bought our CA condo together. Mom passed away at age 95 last November, leaving the entire condo to me. Today, I am an unemployed age 59 single person with a genetic disability who has no children. Since I am the youngest in our family who lives mostly out-of-state, I am alone with some wonderful friends in CA except for one sibling who lives in the Bay Area. He had no children, either. One sibling who lives in TX has two out of three surviving grown children but no grandchildren. I have very little relationships with my niece and nephew. When I become elderly, I wonder what assisted living I will end up in and who will take care of me?? My own money/investments may run out when it comes time to pay for my own hopefully decent elder care. It is probably too early to worry yet, so things will be taken one day and year at time.

nurses make 85K a year? wow should have switched majors...

Independent Living and dependent living are two different things. The most beautiful place is right down the highway from us. But, it is horrible when you get past the lobby. The Director is a Dictator who is there to make money for the company...If you move in there as Independent, they are working on you day in and day out to become dependent. We know this as we lived there while our home was being rebuilt after a fire. (our dustbuster started the fire) (the insurance company is suing dust buster.) Anyway after being there for a few months, we both HATED it. JUST HATE is not enough. It was like a prison. I was the youngest person there and I got into it with the Director a couple of times. The place was beautiful, but that is the cover....the food was horrible...and the help was so inexperienced and some did not even speak English. I don't think that was legal, but if you asked one of them a question, they just shook their head and kept walking. We were out of there as soon as our home was finished. My partner would rather die than move in there. $3800 a month and it goes up from there if you have a "little pill" delivered. They eat you alive and you are forced to clear out your savings and sell your home.. We would destroy any possible inheritance to our children. NO we will never move into one of those. EVER!

All these places are for-profit places. You want a gov't run nursing home? Cost will be whatever you get from Medicaid/Pension & you will sit in a wheelchair all day & wait for meals with nothing to do in between.

We don't treat our elderly with the respect they deserve unless they have tons of money and they can pay someone to pretend to respect them. It is disgusting!!

We were lucky enough to be able to put a small addition on our house so my Mom could come live with us. God only knows what we'll do if/when(?) she needs more/daily care. Space not big enough for an aide to live-in. Our space is only 2 bedrooms (under 900 usable square feet-we have an attic with pull-down type of stairs-can't live up there).

It is so sad how we treat the elderly and sick in this country. Unless you have tons (meaning MILLIONS) of money and can afford to stay in your home with live-in nurses/aides, what is to become of any of us? And as a gay married woman, will I even be allowed to stay with my wife in any of these independent &/or assisted living places?? Sad and scary!!!

Buster, you are so right. I will add that those people who deserve it the least, those who have contributed nothing are the ones getting the most. And our seniors, our injured military get little or nothing. Social security, which I paid into for 50 years - well, I will have to live to be 110 before I get back what I paid in because the government spent it on other things instead of investing it for us as promised. And yet its a law you have to pay 7.5% of your income into it, and your employer has to match it. Seniors are only addressed during election years with promises that are never kept. Now there are signs we will receive less in the way of medical care in coming years...............I'm scared too.

AmyGrace: YOU are so right on all points.

Anyone out there have any suggestions to help those of us who 1) served in the military & get squat, 2) worked all our lives and paid into SS for years & years & will get nothing when we retire & 3) were told by our gov't that Affordable Care Act will cure all our ills.

Would love to hear how we are supposed to live in our "golden" years without having to spend down all our assets (which for most of us is just a small house & a small pension) in order to get Medicaid.

Thank you all for your insignhful answers. I do know this, the more you visit your loved one, the better they are treated. I am gathering names, phone numbers etc.I am marking clothing, but keeping the nicer things at home. I have blessed his room and pray in the chapel almost every visit. (He is in a Catholic nursing home). I still will go to doctor appointments with him. As for myself, I hope the Lord takes me before I reach this stage in my life. This is not a quality of life.

Buster, I wish I knew what to do next, except vote, and make our voices heard loud and clear, but we are so outnumbered now - and helpless older seniors can't speak for themselves. We worked hard on campaigns to stop the ACA. It was obvious seniors were being courted for votes and handed a bill of goods with the turncoat help of AARP (which makes a bundle off the program). It was obvious the program was unaffordable, and funding would be taken from medicare and put in medicaid (which, as you say, seniors don't get until we have spent down until there is nothing left to show (or leave for children) for 50-60 years of hard work and savings) Once they start denying care for certain conditions after age 76, savings will disappear more quickly and so will we.

Costs are high because in a free market, prices are set on "what the market will bear". Unfortunately the government pays these high prices and so do those who still have any money left because of extreme need. Government and insurance companies propping up prices is the main reason that hospitals, nursing homes, etc are able to keep charging like this. Obviously this is beyond the resources of the normal working class person. I am lucky that I am able to keep my mother home and spend about $1500 out of her VA money and SS for her care. We are about to sell her home and reinvest the proceeds in rental property for more income to give us a larger caregiving budget. I understand that many people have loved ones who are beyond the capacity to be able to live at home. If there is any way possible, I strongly recommend the route of keeping your loved one at home. It may cost more in the long run, but at least the family is in control of what happens with the patient.

Sherry, I totally agree. Having a person in a Retirement home or Long term care facility will wipe out an estate. We had to stay in one for about 6 months after we had a fire. They rent out a couple of the nice units. Ours was 2 BR. Of course they are trying to get you to love it and sell your house and move in there. After about 4 months my partner and I were so sick of the rigid schedule and what appeared to be death around every corner, we moved back home as soon as our home was completed. It told both of us, we want nothing to do with that sort of living in our last years. BUT, some people are socialable and love people around them all the time. They might be comfortable in a place like that. It is VERY expensive. I could care less about having people around me at all times. It is SO expensive. Ours was about 3800 a month.

Buster and Amy, it is scary. We paid in both sides as we were self employed. We only GET ONE SIDE in SS. They were not to touch the SS fund in fact it was supposed to bear interest to us. The goal was to increase the amount that we would get someday. But, instead our pay goes down and the secondary insurance keeps going up. People who are used to be on the government for everything are feeling like they are in heaven having all this medical care for free. The retirement homes are required to keep a percentage of their beautiful room available for Medical or State pay. As far as VA, don't get me started. When my husband died, my spousal payment stopped due to a doctors mistake on a death certificate. Once the VA got their hands on that diagnosis, they said I was not eligible for my monthly pay. Even after our private Dr wrote a letter stating he died from an injury he sustained onboard ship during a battle. I am living now on Social security and the savings that we accumulated. And, now after the death I have to file taxes and PAY the government more. It is a way to keep the people down It is so unfair.