Old age care

[accolay]

You're not understanding the argument.  When you are sharing those services amongst so many people, shouldn't your costs go down significantly? 1/6 of an aide at $7200 = $1200/month.

No, I get it:

That's why the cost is spread over 6-8 people.

I think you are failing to factor the true cost for all employees, and how difficult a job it is to provide quality care. $1200/aide/month is only the actual take home pay. The real cost to an employer for an aide is probably almost double that. One nurse for 50 people is a very poor ratio- That's a piss-smelling nursing home. Employer costs for a 24/7 nurse is probably closer to $50/hr. It all adds up to that $7-8k/month.

I guess it depends on what you would call significant savings though. I wonder if you actually could scrape it all together for $5-6k per month DIY. But usually a family care giver will break down by then. That's why we rely on nursing homes in the first place.

[SimpleCycle]

It's not 5-10 aides per 6-8 residents, they would make no money if it were that way!
1 aide:6-8
1 nurse for 20-50 im not even sure. They pretty much just dispense medications
1 doc for 100's
Therapists that don't count as it's a completely different service
1 janitor/housekeeper for perhaps 50
1 food service per perhaps 50.
Look. I've been there at home.  I'm constantly at the nursing home. The in home aide can do everything.  If 2 people could share 1 aide, perhaps paying slightly more, it would be a great savings. The housing is variable, but last time I checked,  a studio apartment is way cheaper than an entire house. Having roommates is cheaper yet. You can try to justify the costs for just about anything, but as a consumer, I want to see the value, and I don't.  Giving, the specific example I have in mind, and the price that is being extracted for it. I know what I was paying for everything for my mother, and I can easily extrapolate it to paying an aide 24-7. It was one on one care, catered to her, in an entire home, for significantly less money. It should not be.

This is unrealistic. Labor for 24-7 = 720 hours for 30 days at a generous $10/hr pay rate = $7200 not including what the employer pays. That's why the cost is spread over 6-8 people.

Until you find some free labor, you're not going to see the price go down.

Or have all the old people tend your weed plants.

Now your back's going to hurt 'cause you just pulled landscaping duty

Many states have minimum staffing requirements that are much higher than that.  Also, my CNA colleagues were paid $14/hr back in 2003, so by the time you pay taxes and benefits, you're looking at $30 per aide per hour.  The average nursing home provides 4 hours of nursing care per resident per day, which is split between RNs, LPNs, and CNAs.  Even if the average cost is around $35/hour ( probably lowballing ), that's $4200 in nursing care a month, before any other expenses.

[Cressida]

Unfortunately I know zero about this, but posting to follow anyway. Not so much for myself (I tend to agree with those who say to estimate an amount, add it to your stache calculation, and ¯\_(ツ)_/¯ if the actual bill is higher - you can't control everything), but I worry about my MIL.

[Milizard]

It's not 5-10 aides per 6-8 residents, they would make no money if it were that way!
1 aide:6-8
1 nurse for 20-50 im not even sure. They pretty much just dispense medications
1 doc for 100's
Therapists that don't count as it's a completely different service
1 janitor/housekeeper for perhaps 50
1 food service per perhaps 50.
Look. I've been there at home.  I'm constantly at the nursing home. The in home aide can do everything.  If 2 people could share 1 aide, perhaps paying slightly more, it would be a great savings. The housing is variable, but last time I checked,  a studio apartment is way cheaper than an entire house. Having roommates is cheaper yet. You can try to justify the costs for just about anything, but as a consumer, I want to see the value, and I don't.  Giving, the specific example I have in mind, and the price that is being extracted for it. I know what I was paying for everything for my mother, and I can easily extrapolate it to paying an aide 24-7. It was one on one care, catered to her, in an entire home, for significantly less money. It should not be.

This is unrealistic. Labor for 24-7 = 720 hours for 30 days at a generous $10/hr pay rate = $7200 not including what the employer pays. That's why the cost is spread over 6-8 people.

Until you find some free labor, you're not going to see the price go down.

Or have all the old people tend your weed plants.

Now your back's going to hurt 'cause you just pulled landscaping duty

Replied yesterday,  yet my post isn't here.

1/6 of $7200 is $1200.  Thats the majority of the service you're paying for.  My mother was charged over $11,000, including add ons for meds (@4-5x the normal price) and supplies(also at inflated prices, because I guarantee you,  I wasn't paying $175/month for adult diapers!).

Studio apartment + utilities, about $800, but you have a  roommate, so half of that.
Shall I go on?

[accolay]

1/6 of $7200 is $1200.  Thats the majority of the service you're paying for.  My mother was charged over $11,000, including add ons for meds (@4-5x the normal price) and supplies(also at inflated prices, because I guarantee you,  I wasn't paying $175/month for adult diapers!).

Studio apartment + utilities, about $800, but you have a  roommate, so half of that.
Shall I go on?

Go ahead, go on. I'm not sure what else I can do to convince you of what the true cost of this care is. $11k is on the high side of nursing home care but not unheard of. You've got this narrative that all these nursing homes are gouging you with their prices, but I assure you most of the price is legit. I'm out.

[Milizard]

1/6 of $7200 is $1200.  Thats the majority of the service you're paying for.  My mother was charged over $11,000, including add ons for meds (@4-5x the normal price) and supplies(also at inflated prices, because I guarantee you,  I wasn't paying $175/month for adult diapers!).

Studio apartment + utilities, about $800, but you have a  roommate, so half of that.
Shall I go on?

Go ahead, go on. I'm not sure what else I can do to convince you of what the true cost of this care is. $11k is on the high side of nursing home care but not unheard of. You've got this narrative that all these nursing homes are gouging you with their prices, but I assure you most of the price is legit. I'm out.

That's pretty weak. I'm citing specific examples, yet you provide a few "well, maybe"'s, and then try to make me out as the unreasonable one. Maybe, if we were paying the $7-8000 charge as citing in this specific LCOLA,  plus, not being gouged for things that should be more reasonable in price, and perhaps a private room like many other places provide, we'd feel like we were getting some value here. But we're not,  so I feel like I have a right to say that this is ridiculous.

[Bendigirl]

Here are some numbers from Canada, from personal experience with my late father.  Prices are less than two years old.
When he needed help with food he moved into a seniors residence, pretty nice one bedroom suite with kitchen.  Grandfathered in at a little,over $2000 a month ( a steal!, prices now well over $3000).
He had a stroke, spent weeks in therapy and went back to his room,  now with some aid.  We paid about $600 a month for the extra care....help to and from meals, meds, foot care.
Eventually he needed long term care, he could no longer do anything for himself.  A health assessment is necessary for admittance to funded long term care (province of BC) and I had that completeled.  The patient is then put on a waiting list for funded care...they look at tax returns and base the price on that.  They never bill you more than you make.  Problem is you have no choice of placement...whatever comes up first is what you get...if you want something different you go on another wat list.  I wanted dad near me so we opted for private care.  We got a room within a few months, at a cost of $7000 a month plus meds, adult diapers, hair cuts, foot care, phone, cable....
He did have a nice private room with a view and only ten minutes away.  As nice as this place was it was hell for him.  His mind still sharp, his body suffering from the effects of the stroke (could not speak well or walk)....he sadly lasted two moths and died of a heart attack.
Note:  as dad was medically accepted for long term care we just had to be patient for a funded room in the same facility.  It was about a six month wait....sadly he never made it.

[LaineyAZ]

A side note:
Whatever you believe about immigration into the U.S., your life will be touched by immigrants who are making up more and more of the caregivers for the elderly, disabled, and nursing home residents.

According to a recent article in our local paper, immigrants make up 24% of those workers in 2015 and the number is rising.  In a state like mine, Arizona, the number is higher.  One of the In-Home Services companies said that 60% of their workforce is now immigrants.  They only hire immigrants who are legally authorized to work, and they come from all over the world:  Africa, the Middle East, Mexico, China and the Philippines.  However, she notes that there is also a "gray market" for undocumented immigrants who work directly for individuals in private homes.

As she says, as Baby Boomers age there's a real critical shortage of caregivers because demand is outstripping supply.  Without immigrant labor, prices will go up.  That's the facts.

[Sibley]

A side note:
Whatever you believe about immigration into the U.S., your life will be touched by immigrants who are making up more and more of the caregivers for the elderly, disabled, and nursing home residents.

According to a recent article in our local paper, immigrants make up 24% of those workers in 2015 and the number is rising.  In a state like mine, Arizona, the number is higher.  One of the In-Home Services companies said that 60% of their workforce is now immigrants.  They only hire immigrants who are legally authorized to work, and they come from all over the world:  Africa, the Middle East, Mexico, China and the Philippines.  However, she notes that there is also a "gray market" for undocumented immigrants who work directly for individuals in private homes.

As she says, as Baby Boomers age there's a real critical shortage of caregivers because demand is outstripping supply.  Without immigrant labor, prices will go up.  That's the facts.

I don't think just prices will go up - I think there would be critical, and sometimes fatal, shortages in care. Quite frankly, for a number of people dying young is likely to be a much better option than growing very old simply because of the lack of quality care. Granted, we're probably going to see some of that regardless of immigration levels due to the sheer number of aging seniors and the low pay of the care fields.

[NorthernBlitz]

A side note:
Whatever you believe about immigration into the U.S., your life will be touched by immigrants who are making up more and more of the caregivers for the elderly, disabled, and nursing home residents.

According to a recent article in our local paper, immigrants make up 24% of those workers in 2015 and the number is rising.  In a state like mine, Arizona, the number is higher.  One of the In-Home Services companies said that 60% of their workforce is now immigrants.  They only hire immigrants who are legally authorized to work, and they come from all over the world:  Africa, the Middle East, Mexico, China and the Philippines.  However, she notes that there is also a "gray market" for undocumented immigrants who work directly for individuals in private homes.

As she says, as Baby Boomers age there's a real critical shortage of caregivers because demand is outstripping supply.  Without immigrant labor, prices will go up.  That's the facts.

I don't think just prices will go up - I think there would be critical, and sometimes fatal, shortages in care. Quite frankly, for a number of people dying young is likely to be a much better option than growing very old simply because of the lack of quality care. Granted, we're probably going to see some of that regardless of immigration levels due to the sheer number of aging seniors and the low pay of the care fields.

As of now, I'm on the save a bunch of money for old age care bandwagon.

But, I think that old age services will get significant automation over the next 20 years or so. That might significantly reduce costs.

I think that there are now robots that serve as companions (or at least offer rudimentary conversation) to those suffering from dementia. I remember hearing an interview with a researcher (from MIT?) who was designing these robots and testing their effect on patients...but I can't find the link now. Will post it if I find it.

[Mika M]

Uy... whenever I read about elder care problems it helps me feel a bit more zen about sticking with my lame job a few years longer...

[Acastus]

My father-in-law is 85 and lives in his house with no assistance. Most people do not need high cost care, except maybe for the last 1-2 years. Why can you not reasonably self insure for this? Why do you think you will need long term care?

[Bicycle_B]

Fwiw, my sister and I oversaw the care of our parent a couple years ago, during his Alzheimer's phase.  He spent a little over 2 years in assisted living, interspersed with a few weeks in a nursing home (a rehab center). 

We shopped for the best place available in a large low cost city.  The care wasn't perfect and we learned to visit frequently.  Build your support network - your care will be better if someone looks in on you, which they won't do unless they really care.  For most forum members, the social support will make more difference than whether you save yet another $100,000.

I think the cost in most cases will be less than is feared by the posters who have amounts like $1.4M for their living expenses but want to save more to account for long term care.  Remember, you're probably not going to be in a nursing home for 30 years, so you can have a higher withdrawal rate.  Even if you budget for 10 years, which is 4 or 5 times longer than the average stay, you can safely afford an 8% or more withdrawal rate plus any Social Security.

From what I can tell, the normal case is a couple years in assisted living, not nursing care; true nursing home stays are most often weeks or months, not years.  For example, my dad's care cost $3200 to $4500 per month  for assisted living (a little over 2 years, just a little over $100k total).  Nursing homes cost maybe twice as much, but his was paid for by Medicare because it's medical expense covered by Medicare.  If you pay for 4 years of assisted living at $5k/month, plus 2 years out of pocket for nursing home care at $10k/month even though Medicare could pay much or all if you're over 65 and nursing home stays are typically months, you'd be looking at $480k expenses total.  That's about 4 times as much as what we paid.

Again, we looked for the best care we could find.  I don't disbelieve the posters who actually spend more, but on a frugality forum, I have to say that care exists and doesn't have to cost millions.  Even the in home vs care facility discussion by the posters above shows that there options.  Usually when you get so sick you can't take care of yourself, the end is near.  Don't waste the good years of your life dreading an expense that will never come.

In my mind, your FIRE stash takes care of your expenses until you reach your final years.  Whenever your body enters its final years, you spend down the stash.  The amount sufficient for one is likely to be sufficient for the other.  I won't lie, I am getting a small modest long term care insurance policy to supplement the stash - and to reassure family members.  Its stated payout is only a fraction of my stash, which is about 450k.  I am highly likely to get decent care if my $ is reasonably well administrated.  There is still a 1% chance of compromises needing to be made but it's not worth several years of my best time to earn a 0.5% chance of improving the last year of my life. 

Again, I do take care to maintain friendships as well as family relationships so that more than one person cares about me enough to administrate the money and superintend to the care.  Live your life and build your relationships.  They make more difference than your second million.

[MayDay]

My concern, as the younger healthier spouse,is that my husband may need LTC, and that he'll wipe out our joint savings.

If he is in a home for 5 years at 10k a month that is 600k. Yes it is unlikely but still.that is a lot of money.

I know myself. I have no interest in doing elder Care no matter how much I love that person. I'd rather work more now,not wiping butts, and lower the chances I am wiping butts or eating cat food later.

[Sibley]

My father-in-law is 85 and lives in his house with no assistance. Most people do not need high cost care, except maybe for the last 1-2 years. Why can you not reasonably self insure for this? Why do you think you will need long term care?

The problem is that we don't know who will and who won't, and it's not a tiny percentage of people who do need help. In the US under current rules/programs, Medicaid will pay for long term care after you've spent down your assets. And your options may be much more limited under Medicaid than if you have the money to pay.

Also, are you sure that he doesn't need assistance? Is he able to cook, clean, manage finances, not get scammed, maintain the house and outdoors, drive, do necessary shopping - safely and without undue difficulty? Sorry, but I don't know many 85 year olds that are able to safely climb on a ladder to replace the lightbulb in the kitchen. Remember, there's a wide range of needing help. Some of it is pretty minor stuff.

[Sibley]

My concern, as the younger healthier spouse,is that my husband may need LTC, and that he'll wipe out our joint savings.

If he is in a home for 5 years at 10k a month that is 600k. Yes it is unlikely but still.that is a lot of money.

I know myself. I have no interest in doing elder Care no matter how much I love that person. I'd rather work more now,not wiping butts, and lower the chances I am wiping butts or eating cat food later.

You need to consult an elder care attorney, specifically about ways to structure your assets to protect you. The elder care attorney is most likely to know the ins and outs of those rules. Medicaid structuring is pretty specialized stuff - your run of the mill attorney won't know it.

[Bateaux]

The confidence that some have of Medicaid and Medicare being around decades from now is amazing.  As soon as immediately following the 2018 midterms elections those programs could change dramatically.   I simply don't trust my government that much.

[expatartist]

This is a great thread with more tangible debates than we usually get on this topic, thanks for starting OP.

A side note:
Whatever you believe about immigration into the U.S., your life will be touched by immigrants who are making up more and more of the caregivers for the elderly, disabled, and nursing home residents.

According to a recent article in our local paper, immigrants make up 24% of those workers in 2015 and the number is rising.  In a state like mine, Arizona, the number is higher.  One of the In-Home Services companies said that 60% of their workforce is now immigrants.  They only hire immigrants who are legally authorized to work, and they come from all over the world:  Africa, the Middle East, Mexico, China and the Philippines.  However, she notes that there is also a "gray market" for undocumented immigrants who work directly for individuals in private homes.

As she says, as Baby Boomers age there's a real critical shortage of caregivers because demand is outstripping supply.  Without immigrant labor, prices will go up.  That's the facts.

Good point. Many places in the world are similar. If I retire where I live now (Hong Kong), I would probably have one then eventually two full-time helpers who typically come from Indonesia or the Philippines. Currently the salary is around US$800/month including plane tickets/holiday/insurance pay, etc. for 6 days/week, ~12 hours/day, and they typically live with you. Many are now being trained in elder care. Ideally I would share care costs with another neighboring person/people who need care. As a very last resort, there's one old folks home for foreigners in HK....I tried to volunteer there but they never responded to my offer of free arts workshops.

Build your support network - your care will be better if someone looks in on you, which they won't do unless they really care.  For most forum members, the social support will make more difference than whether you save yet another $100,000.
....
Again, I do take care to maintain friendships as well as family relationships so that more than one person cares about me enough to administrate the money and superintend to the care.  Live your life and build your relationships.  They make more difference than your second million.

+1. For mental health as well as a safe and healthy optimised old age, maintaining relationships with family and friends in different generations is really important.


ETA: Four siblings and I just took care of my dad last month as he quickly declined then died of two very sudden, aggressive cancers. He was given a month to live once diagnosed in January. My brother and I flew in to dedicate our time. Hundreds of people emailed, visited, flew in from around the country to see him and celebrate mass by his bedside. It was wonderful to see the outpouring of support, and that we were all there to assist during his final weeks. The nature of his cancers (swift, painless, fast decline) made the urgency sharp and I suppose expenses were very low. Luckily, one of his former students was the daughter of a hospice nurse and had started a religious community of nuns, they were so helpful to us preparing meals, helping with medication, etc. (they wouldn't accept a dime but we'll be donating some of Dad's victorian era furniture and religious paintings to their community so they can furnish their new space and remember him). So he was able to die at home with visits from hospice nurses. The nuns and his children did the rest. Due to his work he had incredible social connections though he was quite a private and fundamentally lonely guy.

Anyway, +1 for social capital being a huge asset for your final days/years.

[NorthernBlitz]

My concern, as the younger healthier spouse,is that my husband may need LTC, and that he'll wipe out our joint savings.

If he is in a home for 5 years at 10k a month that is 600k. Yes it is unlikely but still.that is a lot of money.

I know myself. I have no interest in doing elder Care no matter how much I love that person. I'd rather work more now,not wiping butts, and lower the chances I am wiping butts or eating cat food later.

It's sad, but there is probably a reasonable argument for paper divorces as we get older. My understanding is that this would protect assets in cases like this. I think I remember hearing that there were advantages when claiming social security benefits as well.

[Sibley]

My concern, as the younger healthier spouse,is that my husband may need LTC, and that he'll wipe out our joint savings.

If he is in a home for 5 years at 10k a month that is 600k. Yes it is unlikely but still.that is a lot of money.

I know myself. I have no interest in doing elder Care no matter how much I love that person. I'd rather work more now,not wiping butts, and lower the chances I am wiping butts or eating cat food later.

It's sad, but there is probably a reasonable argument for paper divorces as we get older. My understanding is that this would protect assets in cases like this. I think I remember hearing that there were advantages when claiming social security benefits as well.

Some states, like Calif, have spousal impoverishment protection laws so that the spouse who doesn't need care can keep the family home, vehicle, a large hunk of shared assets and all their personal separate assets and income and investments. This allows the spouse who goes into a nursing home to qualify for Medicaid much sooner since they don't need to spend down the spouses assets, and protects the well spouse as well.  Maybe a good reason to keep some financial assets separate rather than joint.

There may also be things you can do with trusts, etc. Depends on where you are, and you need a knowledgeable, experience elder law attorney to figure out the best plan.

[EnjoyIt]

In my mind, your FIRE stash takes care of your expenses until you reach your final years.  Whenever your body enters its final years, you spend down the stash.  The amount sufficient for one is likely to be sufficient for the other.  I won't lie, I am getting a small modest long term care insurance policy to supplement the stash - and to reassure family members.  Its stated payout is only a fraction of my stash, which is about 450k.  I am highly likely to get decent care if my $ is reasonably well administrated.  There is still a 1% chance of compromises needing to be made but it's not worth several years of my best time to earn a 0.5% chance of improving the last year of my life. 

Again, I do take care to maintain friendships as well as family relationships so that more than one person cares about me enough to administrate the money and superintend to the care.  Live your life and build your relationships.  They make more difference than your second million.

+1

I completely and fully agree.  Between SS, your stash, your home and any social support you may build,  the odds are extremely small that you will be in a NH to a point of spending down all of your assets. Add in that at 4% withdrawal rate, historically most people had much more money then they started with.  Fine, if you are really nervous then save up 1 more years expenses and let that grow for the next 20+ years before you need end of life care.  By then it should be plenty.

Those that think medicare/medicaid won't exist in the future, although they may be right, the reality is that once the government gives the people something, it is very hard and very rare for it to later take it away.  More than likely it will change some.  Maybe Medicare will start at 66 or 67, maybe cost a little more, but it is extremely unlikely it will ever go away.

[Pigeon]

My concern, as the younger healthier spouse,is that my husband may need LTC, and that he'll wipe out our joint savings.

If he is in a home for 5 years at 10k a month that is 600k. Yes it is unlikely but still.that is a lot of money.

I know myself. I have no interest in doing elder Care no matter how much I love that person. I'd rather work more now,not wiping butts, and lower the chances I am wiping butts or eating cat food later.

This terrifies me as well.  I've been through watching my parents and my ILs get old and require care.  The mediocre nursing home my father was in was $12K/month.  At the same time, the surviving spouse may also need some kind of help. Even if they aren't in a nursing home, they might need senior housing with services, home health aids, help with cleaning, etc., or assisted living.  It's frightening how little money the remaining spouse is allowed to keep--even though they are able to keep the family home, they can't keep enough assets to maintain it.

I also think there's a certain unrealistic tilt to the "well I'll just end it myself" train of thought.  My FIL was very healthy (with mild cognitive impairment) right up until the day he tripped in his house and broke his back, which paralyzed him from the waist down.  At that point, all sorts of complications arose and his mental state took a nosedive.  He went into a nursing home.  He was in constant agony and begged for anyone to put him out of his misery.  That  wasn't happening in the nursing home, and I sincerely doubt it could even in states with assisted suicide laws because of his mental state.

I think a lot of people overestimate one's willingness to kill oneself when you are still relatively able and with it, and when you are willing the window of opportunity is gone.

[expatartist]

I think a lot of people overestimate one's willingness to kill oneself when you are still relatively able and with it, and when you are willing the window of opportunity is gone.

+1 Or if you're completely convinced that's what you'd want, you'd want to get friendly with the right people before you're incapacitated, rather than after.

[DreamFIRE]

If Medicare and Medicaid don't exist in the long term, then I think it will be because we will end up with universal healthcare as a replacement that we hear more and more people advocating.

[expatartist]

I think a lot of people overestimate one's willingness to kill oneself when you are still relatively able and with it, and when you are willing the window of opportunity is gone.

+1 Or if you're completely convinced that's what you'd want, you'd want to get friendly with the right people before you're incapacitated, rather than after.

Who would be the right people? Do you mean a medical facility in a state or country that allows euthanasia? Or friend or family willing to pull the plug (or the trigger) and hope they don't get charged with murder? I have an Advanced Directive that lists my wishes if I'm incapacitated on file with the VA (and you know they'll be happy to off me ;-)) otherwise I think we have to handle it ourselves if were capable. If not capable than an Advance Directive ( no feeding tube, no medical intervention, palliative care only, etc) is probably all we can do. My understanding is that even in states and countries where euthanasia is legal, you still have to be functional enough to both consent and physically take the drugs yourself.

Yes to all the above. Research, get to know what the options are where you live, etc. This is a worldwide forum so there are many different scenarios based on where one lives. I will most likely die in a socialist-leaning country so there should be no problems from my end if that's what I decide ;) Though in the past couple of generations in my family we tend to get cancer and die at a relatively young age without needing a lot of long-term care, so there's that...

[wageslave23]

To the person complaining that nursing homes are gouging their residents - start your own nursing home and make millions then.

For the people having a legitimate discussion about saving for LTC.  The thing to remember is that the average amount of time spent in a nursing home is 2 yrs.   Can you tough out 2 years in a less than optimal nursing home when you are 90?  I can.  And if thats the case, then whether Medicare, medicaid is still around you are fine.  And guess what, there is never going to be a scenario where the government just allows old people who can't take care of themselves to just lay out in the streets shitting themselves and starving to death.  They will always have to provide for people who don't have the means to provide for themselves, unless we have regressed to a 3rd world country by that point.  In which case, your stock portfolio and LTC insurance provider aren't going to help you either.

[jim555]

They almost gutted traditional Medicaid in the latest OCare repeal efforts.  One vote away from a complete destruction of how Medicaid is funded.  I am not so sure they are not fine with leaving grandma out in skid row to die.

[Cassie]

The problem with divorce is that if the person has a pension you give up your right to it forever. While if you stay married once that person dies you get a spousal benefit if they offer one and you signed up for it. Lots to think about. I also believe they just aren't going to leave old people dying in the streets.  It's a small percentage of people that end up in nursing homes anyways.

[wenchsenior]

They almost gutted traditional Medicaid in the latest OCare repeal efforts.  One vote away from a complete destruction of how Medicaid is funded.  I am not so sure they are not fine with leaving grandma out in skid row to die.

I have no doubt a lot of GOP politicians are absolutely fine with that, but I'm not entirely sure their voters would agree once it started happening.

[doggyfizzle]

To the person complaining that nursing homes are gouging their residents - start your own nursing home and make millions then.

I have personal experience with this - not running my own nursing home, but seeing my Grandma and Great Aunt/Uncle (surrogate grandparents) live out their dementia-addled days in single family homes turned into nursing homes cared for by extremely devoted first-generation immigrant families.  In both cases, my Grandma et al were removed from the "factory-style" care facilities due to price gouging, poor care, and mistreatment (in some instances).  The care homes they ended up in were amazing, and exactly the type of place I hope I'm able to find to live out my days.  The aversion to "institutional" care of old folks by the Romanian and Ukrainian families who ran the care homes was impressive, and at a reasonable cost of $4000-$6000 per month per patient for a shared room with 24-hour care (always with at least one RN on duty), home cooked meals EVERY meal, and therapy pets (dogs) present at all times.  When factoring in the 4-5 bedrooms in each care home at 2 people per room, those families did VERY well for themselves.  I can't tell you how many times I went to visit my Grandma and got pumped full of all sorts of Romanian food that I still can't pronounce, but really, really enjoyed.  In CA State, there is a Ombudsman service that will help find homes like these for old folks (probably in other states as well).  OP (and others) should look into services like this too, and not just limit one's focus to the Soylent Green type places that just focus on grinding up the old folks ASAP to maximize profits with minimally-skilled care.

[DreamFIRE]

This terrifies me as well.  I've been through watching my parents and my ILs get old and require care.  The mediocre nursing home my father was in was $12K/month.

That's a lot higher than I've heard about from my family.  I had a family member who was in a nursing home last Spring, a shared room, and it was in a section were residents required more care/surveillance, so the cost was higher, and it was about $6000/mo.  I thought that was unbelievably costly, let alone $12K!

[Sibley]

For everyone comparing prices - location, location, location. Regulations are different. COL is different. Many times it's apples and oranges. $6k might be reasonable in one location, but it's $10k somewhere else.

[tipster350]

My mother's one month stay in a horrible nursing home was $11k.

I've seen a number of people say that they will just tough it out in a lousy care facility if that's what it comes to, rather than work more for more old age care options. Maybe the 35 year old you could tough it out but will the 90 year old you feel the same? Think about sitting in your own poo and pee for hours, think about being served food that your medical condition, if you ate it, it would kill you? These are just two examples of things I've seen and my family members personally experienced - I can give a list of many similar issues they faced on a daily basis. It is horrible, degrading, cruel...and will only get worse with all of the funding cuts coming.

[Padonak]

My mother's one month stay in a horrible nursing home was $11k.

I've seen a number of people say that they will just tough it out in a lousy care facility if that's what it comes to, rather than work more for more old age care options. Maybe the 35 year old you could tough it out but will the 90 year old you feel the same? Think about sitting in your own poo and pee for hours, think about being served food that your medical condition, if you ate it, it would kill you? These are just two examples of things I've seen and my family members personally experienced - I can give a list of many similar issues they faced on a daily basis. It is horrible, degrading, cruel...and will only get worse with all of the funding cuts coming.

If I sit in my own poo and regular food can kill me, maybe it's time for me to die?

[mm1970]

My mother's one month stay in a horrible nursing home was $11k.

I've seen a number of people say that they will just tough it out in a lousy care facility if that's what it comes to, rather than work more for more old age care options. Maybe the 35 year old you could tough it out but will the 90 year old you feel the same? Think about sitting in your own poo and pee for hours, think about being served food that your medical condition, if you ate it, it would kill you? These are just two examples of things I've seen and my family members personally experienced - I can give a list of many similar issues they faced on a daily basis. It is horrible, degrading, cruel...and will only get worse with all of the funding cuts coming.

If I sit in my own poo and regular food can kill me, maybe it's time for me to die?

Right, but where are you allowed to do that?  With dignity?  Oregon?

[mm1970]

To the person complaining that nursing homes are gouging their residents - start your own nursing home and make millions then.

I have personal experience with this - not running my own nursing home, but seeing my Grandma and Great Aunt/Uncle (surrogate grandparents) live out their dementia-addled days in single family homes turned into nursing homes cared for by extremely devoted first-generation immigrant families.  In both cases, my Grandma et al were removed from the "factory-style" care facilities due to price gouging, poor care, and mistreatment (in some instances).  The care homes they ended up in were amazing, and exactly the type of place I hope I'm able to find to live out my days.  The aversion to "institutional" care of old folks by the Romanian and Ukrainian families who ran the care homes was impressive, and at a reasonable cost of $4000-$6000 per month per patient for a shared room with 24-hour care (always with at least one RN on duty), home cooked meals EVERY meal, and therapy pets (dogs) present at all times.  When factoring in the 4-5 bedrooms in each care home at 2 people per room, those families did VERY well for themselves.  I can't tell you how many times I went to visit my Grandma and got pumped full of all sorts of Romanian food that I still can't pronounce, but really, really enjoyed.  In CA State, there is a Ombudsman service that will help find homes like these for old folks (probably in other states as well).  OP (and others) should look into services like this too, and not just limit one's focus to the Soylent Green type places that just focus on grinding up the old folks ASAP to maximize profits with minimally-skilled care.

This sounds quite lovely.

[wenchsenior]

My mother's one month stay in a horrible nursing home was $11k.

I've seen a number of people say that they will just tough it out in a lousy care facility if that's what it comes to, rather than work more for more old age care options. Maybe the 35 year old you could tough it out but will the 90 year old you feel the same? Think about sitting in your own poo and pee for hours, think about being served food that your medical condition, if you ate it, it would kill you? These are just two examples of things I've seen and my family members personally experienced - I can give a list of many similar issues they faced on a daily basis. It is horrible, degrading, cruel...and will only get worse with all of the funding cuts coming.

If I sit in my own poo and regular food can kill me, maybe it's time for me to die?

What does that have to do with it? Humans used to regularly die in their 50s (or younger if they were women, usually in childbirth).  We don't now, because medical advances allow us to live longer.  We all live longer than we 'should' in that regard.  What are you suggesting should be done to you when you reach that point? Leave you in your shit and let you starve to death?

[tipster350]

My mother's one month stay in a horrible nursing home was $11k.

I've seen a number of people say that they will just tough it out in a lousy care facility if that's what it comes to, rather than work more for more old age care options. Maybe the 35 year old you could tough it out but will the 90 year old you feel the same? Think about sitting in your own poo and pee for hours, think about being served food that your medical condition, if you ate it, it would kill you? These are just two examples of things I've seen and my family members personally experienced - I can give a list of many similar issues they faced on a daily basis. It is horrible, degrading, cruel...and will only get worse with all of the funding cuts coming.

By that logic, anyone with an injury who needs help getting to the bathroom and anyone with a peanut allergy should just be allowed to die. No help, no special diet. Out you go!

If I sit in my own poo and regular food can kill me, maybe it's time for me to die?

[Hula Hoop]

To the person complaining that nursing homes are gouging their residents - start your own nursing home and make millions then.

I have personal experience with this - not running my own nursing home, but seeing my Grandma and Great Aunt/Uncle (surrogate grandparents) live out their dementia-addled days in single family homes turned into nursing homes cared for by extremely devoted first-generation immigrant families.  In both cases, my Grandma et al were removed from the "factory-style" care facilities due to price gouging, poor care, and mistreatment (in some instances).  The care homes they ended up in were amazing, and exactly the type of place I hope I'm able to find to live out my days.  The aversion to "institutional" care of old folks by the Romanian and Ukrainian families who ran the care homes was impressive, and at a reasonable cost of $4000-$6000 per month per patient for a shared room with 24-hour care (always with at least one RN on duty), home cooked meals EVERY meal, and therapy pets (dogs) present at all times.  When factoring in the 4-5 bedrooms in each care home at 2 people per room, those families did VERY well for themselves.  I can't tell you how many times I went to visit my Grandma and got pumped full of all sorts of Romanian food that I still can't pronounce, but really, really enjoyed.  In CA State, there is a Ombudsman service that will help find homes like these for old folks (probably in other states as well).  OP (and others) should look into services like this too, and not just limit one's focus to the Soylent Green type places that just focus on grinding up the old folks ASAP to maximize profits with minimally-skilled care.

This kind of nursing home sounds great but, apart from an ombudsman, how would I find something like this outside California?  How would I do a google search, for example?  Is there something to look for in the description that would indicate this kind of environment?  Maybe the size of the nursing home?

[chouchouu]

I've been thinking about aged care quite a bit recently.  My aunt passed away last month and her nursing home was quite nice. The system in Australia is that you give the facility a deposit and they also receive money from the government.  For my aunt her deposit was 500k and the facility was very nice. My sister told me that the Dr caring for my aunt mentioned the same facility recently opened a "luxury" wing where the deposits are more than a million but the care is the same, you just get fresh flowers in your room and stuff like that.  The nursing facility uses income from the deposit to care for you but the principal is returned to your estate. It is a big relief that such a nice facility is affordable but I'm concerned my mum won't be able to afford it since she blows through money. Her house is worth about 2 million but now she is planning to sell it. She said she is going to give us the proceeds but she has never really given any of us financial support other than my eldest brother. So I fear the money will be spent and she won't be able to afford decent care. I know she has no intention of going to a nursing home but none of us will want her living with us, she's not easy to live with at all.

My bil is American and his parents have decided their retirement planning is to move to Australia and have Australia take care of them. Brother in law's father is Aussie but moved to the US as soon as he finished his education.  He has never paid taxes here but moved here when he was eligible for the state pension, he also receives social security payments from the US so has a very comfortable income. He is divorced from his wife but she has decided she is moving here too since she can't afford to retire in the US.  I don't know if that's possible, she doesn't have citizenship and it seems mighty unfair that aussies should be lumped with the care of people who have never paid taxes here. They would have had more than enough to retire on if they hadn't decided to send their kids to some of the most expensive schools on earth. Bil and his twin brother both went to Harrow, a top school on England, i believe Winston Churchill went there, they then went to English universities.  To top it all off his father complains bitterly about how backward and socialist Australia is despite having his hand out and living off this country he despises yet has never contributed to.

[Scandium]

Look. I've been there at home.  I'm constantly at the nursing home. The in home aide can do everything.  If 2 people could share 1 aide, perhaps paying slightly more, it would be a great savings.

How do you get 24/7 care for two people with one aide? Does this person never sleep? Never have time off? Even if you have two aides working 12 hr shifts constantly, each would probably cost $100k/year including taxes etc. That's $8k/month per old person. So pretty much same as the facility costs. And that's without housing, food etc. Adding RNs, MDs etc would cost even more. 

[honeybbq]

I think a lot of the younger people on this board discount health care/LTC costs somewhat in their plans.  That's natural...I didn't grapple with it until my 40s, when I began experiencing increasing health problems at the same time as several grandparents/my families were struggling with LTC.

Agreed. My MIL needed round the clock care at the end, and when I posted the costs of the in-home care I was accused of lying/exaggerating/not standard (ie fancy-pants care). Yes, if you call injecting morphine and changing diapers, yes, it was fancy pants care.

The truth is if you have assets (as most of us do) you don't get to get taken care of for free. People should think about this long and hard and consider it when they want to FIRE what their end of life for themselves and their spouses is going to look like.

[honeybbq]

My father-in-law is 85 and lives in his house with no assistance. Most people do not need high cost care, except maybe for the last 1-2 years. Why can you not reasonably self insure for this? Why do you think you will need long term care?

My MIL was 88 and living in her own home, driving, etc until she fell and hit her head. You never know when the shit will hit the fan.

[Milizard]

Look. I've been there at home.  I'm constantly at the nursing home. The in home aide can do everything.  If 2 people could share 1 aide, perhaps paying slightly more, it would be a great savings.

How do you get 24/7 care for two people with one aide? Does this person never sleep? Never have time off? Even if you have two aides working 12 hr shifts constantly, each would probably cost $100k/year including taxes etc. That's $8k/month per old person. So pretty much same as the facility costs. And that's without housing, food etc. Adding RNs, MDs etc would cost even more.

It's really not that hard to understand.  One aide at a time.  Just do the math.  I'm talking LCOLA here.  Generous $15/hr*24hours/day*30 days a month / 2 people sharing = $5,400.  Add a very generous grand a month for room and food, it's still way less than $9,600 for a shared shitty room in a facility.  Meds are on top of the cost no matter what.  Most people don't need RN's at their beck and call 24/7.  Visiting nurses are covered by insurance.  I have no medical training whatsoever and was perfectly capable of giving my parent her pills.  It's not that hard.

[wageslave23]

Look. I've been there at home.  I'm constantly at the nursing home. The in home aide can do everything.  If 2 people could share 1 aide, perhaps paying slightly more, it would be a great savings.

How do you get 24/7 care for two people with one aide? Does this person never sleep? Never have time off? Even if you have two aides working 12 hr shifts constantly, each would probably cost $100k/year including taxes etc. That's $8k/month per old person. So pretty much same as the facility costs. And that's without housing, food etc. Adding RNs, MDs etc would cost even more.

It's really not that hard to understand.  One aide at a time.  Just do the math.  I'm talking LCOLA here.  Generous $15/hr*24hours/day*30 days a month / 2 people sharing = $5,400.  Add a very generous grand a month for room and food, it's still way less than $9,600 for a shared shitty room in a facility.  Meds are on top of the cost no matter what.  Most people don't need RN's at their beck and call 24/7.  Visiting nurses are covered by insurance.  I have no medical training whatsoever and was perfectly capable of giving my parent her pills.  It's not that hard.

I think the logistics of coordinating 3 full time people 24/7 would be difficult.  If one of the workers gets sick, goes on vacation, flakes out, etc.  You have to have it covered.  Plus if one of the two old people need to be driven somewhere or grocery shopping, you need another person.  It might turn out to be cheaper, but definitely more hassle for the person coordinating all this.

[former player]

Look. I've been there at home.  I'm constantly at the nursing home. The in home aide can do everything.  If 2 people could share 1 aide, perhaps paying slightly more, it would be a great savings.

How do you get 24/7 care for two people with one aide? Does this person never sleep? Never have time off? Even if you have two aides working 12 hr shifts constantly, each would probably cost $100k/year including taxes etc. That's $8k/month per old person. So pretty much same as the facility costs. And that's without housing, food etc. Adding RNs, MDs etc would cost even more.

It's really not that hard to understand.  One aide at a time.  Just do the math.  I'm talking LCOLA here.  Generous $15/hr*24hours/day*30 days a month / 2 people sharing = $5,400.  Add a very generous grand a month for room and food, it's still way less than $9,600 for a shared shitty room in a facility.  Meds are on top of the cost no matter what.  Most people don't need RN's at their beck and call 24/7.  Visiting nurses are covered by insurance.  I have no medical training whatsoever and was perfectly capable of giving my parent her pills.  It's not that hard.

I think the logistics of coordinating 3 full time people 24/7 would be difficult.  If one of the workers gets sick, goes on vacation, flakes out, etc.  You have to have it covered.  Plus if one of the two old people need to be driven somewhere or grocery shopping, you need another person.  It might turn out to be cheaper, but definitely more hassle for the person coordinating all this.

This is the third page of trying to convince Milizard that 24/7/52 care takes more than one person and it hasn't happened yet.  It's probably time to give up.

[Scandium]

Look. I've been there at home.  I'm constantly at the nursing home. The in home aide can do everything.  If 2 people could share 1 aide, perhaps paying slightly more, it would be a great savings.

How do you get 24/7 care for two people with one aide? Does this person never sleep? Never have time off? Even if you have two aides working 12 hr shifts constantly, each would probably cost $100k/year including taxes etc. That's $8k/month per old person. So pretty much same as the facility costs. And that's without housing, food etc. Adding RNs, MDs etc would cost even more.

It's really not that hard to understand.  One aide at a time.  Just do the math.  I'm talking LCOLA here.  Generous $15/hr*24hours/day*30 days a month / 2 people sharing = $5,400.  Add a very generous grand a month for room and food, it's still way less than $9,600 for a shared shitty room in a facility.  Meds are on top of the cost no matter what.  Most people don't need RN's at their beck and call 24/7.  Visiting nurses are covered by insurance.  I have no medical training whatsoever and was perfectly capable of giving my parent her pills.  It's not that hard.

But even with "generous" salary it won't cost just $15/hr for the employer. The costs is usually double the salary, for insurance, taxes, licensing etc etc. Not to mention having others on standby or backup. I don't think you can get a qualified person to do this job (in 12 hr shifts) for minimum wage.. At least not anyone I would want to take care of my grandma.

You seems to assume the only cost is a bare minimum salary per hour. That's too simplistic

[Scandium]

Look. I've been there at home.  I'm constantly at the nursing home. The in home aide can do everything.  If 2 people could share 1 aide, perhaps paying slightly more, it would be a great savings.

How do you get 24/7 care for two people with one aide? Does this person never sleep? Never have time off? Even if you have two aides working 12 hr shifts constantly, each would probably cost $100k/year including taxes etc. That's $8k/month per old person. So pretty much same as the facility costs. And that's without housing, food etc. Adding RNs, MDs etc would cost even more.

It's really not that hard to understand.  One aide at a time.  Just do the math.  I'm talking LCOLA here.  Generous $15/hr*24hours/day*30 days a month / 2 people sharing = $5,400.  Add a very generous grand a month for room and food, it's still way less than $9,600 for a shared shitty room in a facility.  Meds are on top of the cost no matter what.  Most people don't need RN's at their beck and call 24/7.  Visiting nurses are covered by insurance.  I have no medical training whatsoever and was perfectly capable of giving my parent her pills.  It's not that hard.

I think the logistics of coordinating 3 full time people 24/7 would be difficult.  If one of the workers gets sick, goes on vacation, flakes out, etc.  You have to have it covered.  Plus if one of the two old people need to be driven somewhere or grocery shopping, you need another person.  It might turn out to be cheaper, but definitely more hassle for the person coordinating all this.

This is the third page of trying to convince Milizard that 24/7/52 care takes more than one person and it hasn't happened yet.  It's probably time to give up.

Probably right. And it's really quite simple. If he/she thinks the facilities charge too much just don't go there. Instead get your elderly care from one person at $15/hr. Let me know how that is

[NewPerspective]

My biggest issue with in home care is the issue of managing it.  I don't have children and if I live to be very elderly I don't think I could manage the administrative needs (either dealing with a company or individuals).  I base this off of my grandmother who was 98 when she died in August.  She was not senile and was "healthy" (she became bed ridden the last 3 or 4 months).  There is no way she could have handled administrative tasks or scheduling people.

Someone else mentioned they are building a strong support network.  What does that mean exactly?  All of my friends are either older than me or around my age.  So I think we will all be in the same boat when the time comes.  I can see this making sense if you are involved in a church maybe? 

[Cassie]

I am 63 and I can tell you that people do not want to care for their friends in their old age. We had some friends where both people in the couple got sick and most of  their friends disappeared.  They both had cancer and she had Alzheimer's. We helped them stay in their home a extra year by going over about 3x's/day. This gets old. Finally when we had a 3 week vacation planned she had to go to a home and he went to live with his son until he died.   I have had a few other friends become disabled and their friends also disappeared.  I did not put her in  a family care home because I think that in a facility it is harder to abuse people then it would be in a private home. The costs were expensive no matter what.