The insane cost of elder care

[Anonymous]

Anonymous wrote:

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.

PP you replied to. They know exactly what the market is like, PP. This is a community of war refugees. The people that made it here are not stupid, but some of them lack diplomas. The aides are paid a living wage, we know their husbands and children. The family paid to repatriate a husband who had fallen gravely ill abroad, and similar things beyond their wages. The aides understand exactly how much they can ask for beyond which the family could not afford to pay them.

You don't understand because perhaps you've never experienced this type of community before. These people all look after each other. There is no advantage taken. Also, and I don't mean to be rude or presume, but perhaps you prefer to think this way because you have not found such a system within the majority white community in which you live.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:My parents thought they had planned carefully but had no comprehension of elder care costs in the 21st century (neither did us kids). They were an accountant and administrative assistant with modest pensions and <$1 million in other savings. It's all gone after years of those $10k/month bills. My Dad passed at 86 and my 88-year old Mom is moving to a Medicaid facility this summer.

Sometimes that's how it goes when you get old. I have no better suggestion other than to not be sick for very long at the end.

Precisely what happened to us. My dad went to level 4 LTC at Hebrew Home in Rockville at 15K/month. Previously he'd had 24-hour private nurses at his home at ca. 30k/month. We burned through his savings, and his house sale proceeds, like a match through dry grass.

Now that he has passed, I'm wondering what to do in my own old age. "Not being sick for very long at the end" is the only solution in the US, unless you are very wealthy indeed.

+1. Unless you/your family has recenlty had to deal with elder care, you just don't get it. Unless you are independently wealthy, you can never save enough. And this is why more and more parents are moving in with their children - the money starts to run out.

Nope. There are plenty of places that are $3-5k a month.

That is a lot of money.

$4000x12=$48000 for just one year

Where are these places? I’m looking now in nova and I’m finding $7500-$12k for assisted living.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:My parents thought they had planned carefully but had no comprehension of elder care costs in the 21st century (neither did us kids). They were an accountant and administrative assistant with modest pensions and <$1 million in other savings. It's all gone after years of those $10k/month bills. My Dad passed at 86 and my 88-year old Mom is moving to a Medicaid facility this summer.

Sometimes that's how it goes when you get old. I have no better suggestion other than to not be sick for very long at the end.

Precisely what happened to us. My dad went to level 4 LTC at Hebrew Home in Rockville at 15K/month. Previously he'd had 24-hour private nurses at his home at ca. 30k/month. We burned through his savings, and his house sale proceeds, like a match through dry grass.

Now that he has passed, I'm wondering what to do in my own old age. "Not being sick for very long at the end" is the only solution in the US, unless you are very wealthy indeed.

+1. Unless you/your family has recenlty had to deal with elder care, you just don't get it. Unless you are independently wealthy, you can never save enough. And this is why more and more parents are moving in with their children - the money starts to run out.

Nope. There are plenty of places that are $3-5k a month.

They may start you out at that rate... but 6 mos later, that place is bought out by XXX company, and the price goes up to $6500/mo. Then another 6 mos later, they do an assessment and decide the needs have increased (although it's mostly the same as it was in the beginning) and the price goes up to $8000/mo. By this point, your parent is familiar with the routines/people at this place, so you don't want to move him/her b/c it will likely cause agitation and even more confusion.... and besides that, there are waiting lists for the other places (that are cheaper). So, you figure it can't be THAT long before they don't need any care at all. And time goes on...

The "retirement savings" of $250,000 are dwindling down month by month (after using all the parent's SS and military pension first, and then drawing the remaining balance from the retirement savings). The parent who is fully healthy stays in the marital home, but honestly, is going to be a lot better off financially when the dementia parent dies b/c she will get the use of the spousal portion of the military pension and the widow portion of the SS. For people in the midwest who stopped working 20+ yrs ago (now in their 80's) -- whose salaries were never comparable to what people earn today (and on the coasts), $250k was a very respectable retirement nestegg. But, when you start drawing down several thousand per month, and that goes on for years... it shows you where the gaps are in our care system.

I don't think it's correct to suggest that there are places for people with dementia at $3-5k/mo. That's more of a way to get people into the facility... and it assumes they are low-needs/high-functioning. That's just not the case for most people who are progressing through dementia -- they need full care.

We did not experience this. There was a small increase the second year.

Yes, there absolutely are places that are $3-5k per month for dementia.

Please provide a link to this place!

Here is one company

https://www.avalonresidentialliving.com/

There are companies like this all over the US. Numerous ones in the dmv. Half the price as larger places like Atria. You certainly don’t need to spend $10-12k per month.

These look awful. Are these Medicaid homes?

[Anonymous]

Anonymous wrote:

PP you replied to. They know exactly what the market is like, PP. This is a community of war refugees. The people that made it here are not stupid, but some of them lack diplomas. The aides are paid a living wage, we know their husbands and children. The family paid to repatriate a husband who had fallen gravely ill abroad, and similar things beyond their wages. The aides understand exactly how much they can ask for beyond which the family could not afford to pay them.

You don't understand because perhaps you've never experienced this type of community before. These people all look after each other. There is no advantage taken. Also, and I don't mean to be rude or presume, but perhaps you prefer to think this way because you have not found such a system within the majority white community in which you live.

I'm not white, nice try. $7.40/hour is not a living wage and yes, we are immigrants as well.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Lifelong planning and savings. Also LTC insurance.

This 1000%

Also selecting to live in a CCRC well before you need any of these services. With a CCRC you pay a high entrance fee and your monthly rent in independent living is not cheap, but is reasonable for the meals included and the services you get. That entrance fee basically covers the extra costs for when you need to be anywhere except independent living---one spouse can still be in independent living in your 2 bedroom place and the other can be in assisted living/medical care living/memory care/etc. Most of the CCRC guarantee that you can continue living there even if you "run out of money" as they won't let you in unless you have enough saved. Typically it is the women who live past 95 that this happens to---and they won't touch your Social security.

This way, you only continue to pay say $7000/month that you were paying in independent living even if you now require memory care. No increases to $12K/month for that (That's why you paid a high 6 figure fee upfront)

NP. Everyone glossed over this post, but it's exactly right. Locally I know of Collington in Bowie and Riderwood in Silver Spring. My mother is in Collington and loves it. It almost seems too good to be true.

[Anonymous]

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.

By the time you decide to euthanize, you are too far gone to do it.

I have an end-of-life plan that I will communicate clearly to my kids as they get older (I’m in my thirties).

[Anonymous]

Anonymous wrote: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.

Sincere question: how can the system be improved, in your view?

[Anonymous]

Both of my DH's parents, who are divorced and 93 years old, are in an assisted living facility in Anne Arundel County that costs $4,000/month. The facility has only 12 beds, is privately run, and hasn't increased in price for 3 years. Each of his parents has a separate small bedroom with attached bathroom (with shower), and there are a couple of common areas and nice back yards (with fencing). The best thing is the meals are made family-style, in house, from real food - no Sysco sort of prepurchased junk.

Both his parents have dementia and are mostly incontinent, and both are wheelchair-bound. There is live-in staff 24/7 with nursing care and doctor visits. They're responsive and wonderful.

The only extra cost we pay is to a local pharmacy who provides supplies - this tends to be about $40-$50/month.

Having said that, both his parents are about to run out of money. I know their current place will accept Medicaid, so that might be what happens next.

For DH and myself, who are in our late fifties/early sixties, we can no longer qualify for LTC insurance because of cancer diagnoses. We'll be running through our own funds if necessary, but thankfully our grown kids are doing well on their own and don't need to rely on inheritance.

[Anonymous]

PP here - to clarify, each of DH's parents pays $4,000/month.

[Anonymous]

My best friend's ILs didn't plan well for their elderly years. They thought their modest savings would carry them through. Her FIL had some health issues and they burned through so much of their savings in only a few short years. They either had to pick between buying $$$ private insurance that covered more or cheaper private insurance and then paying more when the bills came in that the insurance didn't cover.

Her FIL then had a mini-stroke and left the state where they lived on a wild road trip. My friend's husband and his other siblings spent 3 weeks tracking him all over the US. They spent a lot of their own money doing that, flying/driving from one state to another and hiring PIs, etc. He was finally caught about 2500 miles from home after getting caught shoplifting. After that incident, they put him in LTC. He got kicked out of all the private ones in their area because he became very combative after his stroke. All the siblings were pooling money to afford those facilities, too. I think my friend said the cheapest one was $4500/month.

[Anonymous]

Anonymous wrote:

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.

Your comment is about as ridiculous someone in India telling you that every American walks around with a gun and shoots others on sight! What you say happened. Similar things also happened in the US during covid, or have you forgotten? Remember the ventilator fiasco? The public healthcare system in India is swamped and underfunded. It is the most populous country in the world and is an emerging economy, so what do you expect? However, the private healthcare system there is very robust. In most cities (which is where these folks are from) you can see a specialist in any domain, the same day or within a day or two. The best you can do here is a nurse at CVS or Urgent care/emergency care at an exorbitant premium. As another poster noted, you can get full-time in-home care for a fraction of what it costs here without depending on the government or a cartel.

I posted recently on another thread - I got a prescription, had comprehensive blood work, abdominal scans and cervical MRIs done, had them reviewed by a doctor, purchased some prescribed medication all over the span of 3 days. Total cost about $250!. I'm trying to get an appointment with a specialist here for my DC who needs to see one before heading out of the country next month, and the earliest appointments I'm getting are for end of June!

I do agree on your last point. The eldercare experience in India is not a luxury experience, simply because it's not an organized corporate experience but is mostly in-house. There is no medicaid equivalent for the poor, but that's not what I'm talking about (nor care about in this context).

[Anonymous]

Anonymous wrote:

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.

Your ignorance is showing.. please come back when you have learned the difference between between tax planning and tax fraud.

[Anonymous]

Anonymous wrote:

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.

While all of your observations about India may be valid, none of them are relevant nor refute the points made by the PP you are responding to. It matters not where a nurse lives once she's done with her shift. Do you care for the restaurant worker in Vienna that closes the store at midnight and has to drive to Winchester because that's where they can afford to live? PP was not talking about 'most Indians', just lucky not-so-many that can afford such services.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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.

Your ignorance is showing.. please come back when you have learned the difference between between tax planning and tax fraud.

Estate planning attorney here. “Medicaid planning” is impoverishing yourself on paper to qualify for gov’t benefits that are intended for the poor. Plain and simple. I agree the cost of long-term care is a terrible shame. But it doesn’t follow that I shouldn’t have to pay it because damnit I worked hard and I want my kids to get my money.

[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.

By the time you decide to euthanize, you are too far gone to do it.

I have an end-of-life plan that I will communicate clearly to my kids as they get older (I’m in my thirties).

Estate planning attorney here. Unfortunately you can’t authorize your healthcare agent to pursue aid in dying. It is quite difficult to qualify under most states’ laws, at this time.