The insane cost of elder care

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:My husband and his brothers pay for non-licensed aides to take care of their mother round the clock in her own apartment. She has always said she did not wish to go to a nursing home. They looked for aides from her own community, speaking her own language and cooking her cuisine. They are cheaper than
"official" senior aides because they have practically no education (not sure they even graduated high school), but after a decade of shopping for my MIL, cooking, cleaning, giving massages, and helping with very complex medication needs and increasing toileting needs, they have proved themselves very caring and trustworthy people. They are supervised, of course, by the son who lives nearby.

So in the end it comes to less than 5K a month, for an advanced Parkinson's patient owning her own apartment and with one child able to physically visit once every two days.

$5k/month for round-the clock caregivers would mean less than $7.50/hour. Licensed or not, this doesn't add up.

Round-the-clock care means 168 hrs/week. If you're only paying $5k/month, that's less than $7.50 per hour.

My FIL's round-the-clock caregivers cost $30/hour. Entry level. For one caregiver on duty 24/7, that's $5,000 per WEEK.

PP you replied to. No, the price for night time is much cheaper than the cost for daytime, where shopping/cleaning/cooking/conversation is involved. At night the caregiver has their own room and sleeps, basically, only to be rung if ever my MIL needs help, which she doesn't right now, except the occasional bathroom visit. As I explained, there is no entry level, none of this follows standards, the people hired do not have any degrees. The aides are happy to get the work. Since they're all from my MIL's native country and speak the same language, it's hard to explain, but there is a sense of loyalty and there is a bond. They know my MIL will never fire them until she dies, because she knows they depend on the income. And they know they will be recommended to her friends and relatives if they are trustworthy. So it works out.

It's really nice. There are situations where it's best to do that rather than hire formally trained expensive nurses that have no particular loyalty to the patient.

Sorry, but the more you write, the more it sounds as though your family is taking advantage of these untrained aides. Please think about this and treat these people better.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I plan to self-euthanize once I can no longer live independently. I’m not going to enrich some crooked private industry because I’ve kept myself in good health. I’d rather leave money and assets to my kids at age eighty than spend $100k a year for an additinal 10-15 years to gaze out of a window being fed cafeteria food and missing my old life.

+1

So many say this, so few do it. Your life feels different at every age.

Very true. Hedonic adaptation.

[Anonymous]

Anonymous wrote:
Sorry, but the more you write, the more it sounds as though your family is taking advantage of these untrained aides. Please think about this and treat these people better.

+1

yup, sadly it seems they don't know they are being taken advantage of. They are grossly underpaid.

[Anonymous]

I’ve been working in hospice care for the last 7 years and have seen the gamut from Medicaid/Medicare funded to wealthy self funded in home care and facility care. Definitely things can be easier if you’re wealthy, but the whole process is stressful and agonizing apart from money so even if you can afford all those insane costs you can still end up quite miserable.

I’ve determined to set myself adrift on an ice floe when I hit a certain age.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Are there any countries out there that provide an equivalent level/amount of care for the elderly as one would expect at one of these expensive facilities but for a much more reasonable cost? Or is this a US thing?

My neighbor is of Indian descent and her father still lives in India. Apparently, the gov. provides 24 hr care for him (he's 90+). He can't come to the US anymore b/c they can no longer buy temporary health ins. for him. And he gets better care in India.

I have family that got their parents green cards and they eventually became citizens. Now in their 80s, they qualify for Medicaid but the quality of care and services is terrible! Doctors appointments take forever. One of the parents needs extensive care - can't walk properly, needs someone to walk him to the bathroom (may fall and has fallen down several times if no one is watching, etc.) - but according to medicaid doctors not at a point, not enough to be recommended for a care facility. They complain about awesome things would have been in India - 24/7 care, same day access doctors/specialists and hospitals, etc. but can't return because all kids are here and no one in India to take care of them.

I call BS on this comment. I’ve seen very recent documentaries about the healthcare system in India where family has to come to the hospital to care for covid patients or they don’t get cared for. Overrun and swamped and underfunded. India is going into the cesspool under Modi, it wouldn’t be a luxury elder care experience over there either.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:My husband and his brothers pay for non-licensed aides to take care of their mother round the clock in her own apartment. She has always said she did not wish to go to a nursing home. They looked for aides from her own community, speaking her own language and cooking her cuisine. They are cheaper than
"official" senior aides because they have practically no education (not sure they even graduated high school), but after a decade of shopping for my MIL, cooking, cleaning, giving massages, and helping with very complex medication needs and increasing toileting needs, they have proved themselves very caring and trustworthy people. They are supervised, of course, by the son who lives nearby.

So in the end it comes to less than 5K a month, for an advanced Parkinson's patient owning her own apartment and with one child able to physically visit once every two days.

$5k/month for round-the clock caregivers would mean less than $7.50/hour. Licensed or not, this doesn't add up.

Round-the-clock care means 168 hrs/week. If you're only paying $5k/month, that's less than $7.50 per hour.

My FIL's round-the-clock caregivers cost $30/hour. Entry level. For one caregiver on duty 24/7, that's $5,000 per WEEK.

PP you replied to. No, the price for night time is much cheaper than the cost for daytime, where shopping/cleaning/cooking/conversation is involved. At night the caregiver has their own room and sleeps, basically, only to be rung if ever my MIL needs help, which she doesn't right now, except the occasional bathroom visit. As I explained, there is no entry level, none of this follows standards, the people hired do not have any degrees. The aides are happy to get the work. Since they're all from my MIL's native country and speak the same language, it's hard to explain, but there is a sense of loyalty and there is a bond. They know my MIL will never fire them until she dies, because she knows they depend on the income. And they know they will be recommended to her friends and relatives if they are trustworthy. So it works out.

It's really nice. There are situations where it's best to do that rather than hire formally trained expensive nurses that have no particular loyalty to the patient.

Caregiver here for the last 7 years and just want to confirm that it is common practice for live-in caregivers to not get paid for the 8 hours overnight that they are sleeping and on call for emergency only. If they are required to wake up and provide care during the night, then they get paid and sometimes that is a reduced rate it just depends on the contract.

On the other hand, if the patient/client advances to a point where they are fall risk, delusional from dementia, wandering at night etc. then they get a full overnight caregiver who stays awake and that means full wages on the overnight shift.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Unless you're wealthy, it's LTC insurance or Medicaid. Get your assets out of your name 5 years before you need Medicaid LTC or the state will take it all!

What if your assets are already in a trust

Only works if your assets are in an irrevocable trust, which is not normally the case. Most people have a revocable trust.

[Anonymous]

Anonymous wrote:[twitter]

Anonymous wrote:

Anonymous wrote:Unless you're wealthy, it's LTC insurance or Medicaid. Get your assets out of your name 5 years before you need Medicaid LTC or the state will take it all!

Well, no. That would be unethical. Why do you think others should pay for your health care? Are you a welfare queen, too? Do you like the dole?

These two posts are perfect examples of harmful misinformation that gets spread around:

Medicaid planning involves far more than attempting to “get your assets out of your name, years before the unknown date at which the need will arise. This is precisely the amateur thinking that gets people into a jam.

Taking advantage of a public benefit program in accordance with its structure and regulations is not “having others pay for your health care,” or “the dole” any more than driving on public roads, using police and fire services, accepting appropriate tax breaks, and the like are unjustifiably shifting a person’s obligations to someone else. The claim to the contrary is nasty, selfish, insecure and quite frankly ignorant. Very wealthy people can afford private care that typically is much better than that provided by Medicaid. The unsuccessful, but also the irresponsible, self-indulgent and spendthrift, have nothing to spend away. Medicare planning is a tool for the hard working, responsible middle class person who has slaved and deprived themselves all their life, only to become (absent planning) a fat chicken to be plucked at the end of their life. That is an injustice and a scandal.

We aren’t talking about Medicare (which doesn’t pay for nursing homes). We are talking about Medicaid (which does). PP was basically advocating freeloading. But if you need nursing care under Medicaid, you absolutely should have to surrender everything you own to get it. Why should you be able to shift your assets elsewhere and freeload? That is disgusting.

[Anonymous]

Anonymous wrote:Unless you're wealthy, it's LTC insurance or Medicaid. Get your assets out of your name 5 years before you need Medicaid LTC or the state will take it all!

I know that's common practice to shield assets, but it's also garbage. Why should the state pick up the tab for your care when you could have otherwise afforded it?

[Anonymous]

Anonymous wrote:

Anonymous wrote:
Sorry, but the more you write, the more it sounds as though your family is taking advantage of these untrained aides. Please think about this and treat these people better.

+1

yup, sadly it seems they don't know they are being taken advantage of. They are grossly underpaid.

Wouldn't be surprised if they get paid under the table so no taxes to pay. I'm sure they know exactly what they're doing. IT works for them and the family. Quit being judgmental because it's only making you look selfish and bad.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Unless you're wealthy, it's LTC insurance or Medicaid. Get your assets out of your name 5 years before you need Medicaid LTC or the state will take it all!

Well, no. That would be unethical. Why do you think others should pay for your health care? Are you a welfare queen, too? Do you like the dole?

DP. I know you are looking for a 'discussion' but why do you think a person, few years away from death, would really care about ethics or if society foots the bill? I wouldn't? We have enough money (and hopefully a lot more in 30 years when we hit our 80s) but I think it's society's job to take care of the elderly. Shame on you for not voting out every bast*rd that is trying to move the country in the opposite direction.

Society DOES take care of the elderly. What you are suggesting is that the elderly should be able to keep all their assets at the same time. That’s fine, if you raise the money for their care elsewhere (ie tax the rich or a consumption tax or whatever) but we don’t do that. Advocating FRAUD and sheltering assets to duck the cost of care under the current system is disgusting and unethical. Freeloaders suck.

[Anonymous]

Anonymous wrote:Are there any countries out there that provide an equivalent level/amount of care for the elderly as one would expect at one of these expensive facilities but for a much more reasonable cost? Or is this a US thing?

I’m from a culture where we have very few if any elder care safety nets. Our elders live with extended family. I’m also from a culture where the life expectancy is higher than the US.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I know I shouldn’t be shocked but the cost of care for the elderly is insane. I’m researching assisted living places. In addition to the rent, which is significant, there are extra costs for medication administration and “level 1-4 care” which is from $400-$2500 extra per month on top of rent. There are special programs for people who suffer from memory issues (not a memory care facility but a group), and other types of extra group programs. These range from $1000-$1500 more a month.

Seriously looking at $9k-$11k per month. How do people afford that??

LTC is for the rich. The rich afford it because they have a lot of money. The rest of the population doesn't afford it. They either die or they have strong family bonds and live with family members who care for them.

My LMC parents purchased LTC because they didn't want to be a burden for the kids. They never made more than $40K total as a family. But they made it a priority. You do not have to be rich....in fact the rich dont' need it. It's the MC/LMC who need it.

How are they affording long term care on 40k?

Or do you mean to say they had insurance?

[Anonymous]

Anonymous wrote:

Anonymous wrote:Unless you're wealthy, it's LTC insurance or Medicaid. Get your assets out of your name 5 years before you need Medicaid LTC or the state will take it all!

I know that's common practice to shield assets, but it's also garbage. Why should the state pick up the tab for your care when you could have otherwise afforded it?

Why work and earn money if better to just let Medicaid pay?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Are there any countries out there that provide an equivalent level/amount of care for the elderly as one would expect at one of these expensive facilities but for a much more reasonable cost? Or is this a US thing?

My neighbor is of Indian descent and her father still lives in India. Apparently, the gov. provides 24 hr care for him (he's 90+). He can't come to the US anymore b/c they can no longer buy temporary health ins. for him. And he gets better care in India.

He was likely a govt worker to get that. But it doesn't matter really because in India you can spend the equivalent of ~$500 USD/month and have excellent round the clock nursing care--typically 2 nurses that work opposing shifts. That would cost $20K+/month in US, likely closer to $30K and no guarantee that the nurses don't just not show up---nursing care is hard to get consistency for only $25/hour.

I am Indian and you are painting a really rosy picture here. The poverty in India is shocking to me when I go back. The reason why things are so cheap is because the average Indian lives on a few dollars a day and the entire country has rampant slavery and extreme labor abuses. Most likely said nurse heads home to a slum at night.

Most Indians are taken care of by extended family not just out of necessity, but out of tradition.