Do you feel it is proper, ethical, and/or moral to put the care of a LO on the local/federal government?

When my mother became demented and disabled I put her in a memory care home. Then later to a nursing home. My father who had been caring for her had a neurological disease and was failing fast. I managed to keep him with me until he died at home. My mother was not kind to me and I could never live with her. Having dementia just made her more mean. Fortunately they died soon before they used all their money thanks to my father's frugality so guess I was not tested. Don't care who I have to go to, Mother was not living with me.

If the question is "why put someone's care on the government?", then why not "why put someone's care on a random family member, to the possible detriment to their physical, psychological, and/or financial well-being?" That doesn't seem fair, but different cultures will say differently.

"Should the government be the solution for poor planning"? Turn it around: "should my parents' poor planning or inability to pay for extremely expensive care mean that I am now responsible for it?" That doesn't seem fair, either, but again, different cultures will say differently.

It also tends to be a matter of degree - some flippantly say that families should do X in Y situation, but the reality means a great deal of sacrifice, and the more sacrifice, the more those people start backing off, because it starts to, again, seem unfair. Yes, of course, I would be willing to pay for my parents care to be wonderful if I had the money, but in reality VERY VERY FEW people have that kind of money. So how much will others demand I sacrifice rather than asking the government to help? Will they demand I use up all my savings? Sell my belongings? Will they demand I live in actual, literal poverty because I cannot work and also care for my parents? Will they demand I give up my career and only source of income to care for my parents myself (putting myself and them in poverty, because they and me would then have no income?) Put myself, then, on the mercy of the government for my own future care because I've spent all my money and given up my career caring for my parents? Give up my job's health care and open myself up to higher medical costs and/or worse outcomes because I have to make do with whatever someone who doesn't work can get for free? ...how much sacrifice is fair to ask of me? Yet these are all things that would happen, right now, if I, an only child, HAD to care for my parents. Insta-poverty. This is the reality. Others might have it better. Others might have spouses who could support them, or jobs that give them enough to support a parent's care, but MANY DO NOT.

The "families take care of their elders" model only seems to be even remotely possible on a large scale when either a large portion of the population doesn't need to have a job to survive (like marriages where one partner doesn't "need" to work because the other makes so much money) OR where an average job makes so much that someone can pay for parental care. This is not the situation today for the vast majority of people, and that shifts the equation.

"But my family took care of Nana when she needed it!" Great. But look clear-eyed at what it cost your family, monetarily, or in labor, or in lost opportunities, to do that. These are often invisible costs, because someone (often a woman) is providing their labor for free, but that is STILL A COST.

Also, everyone who has paid taxes has supported Medicaid for just this reason. Saying "why should it be put on the government" is, to me, like asking why we should expect the government to pay for health care for the elderly (via Medicare) - because that is the deal American citizens get. We pay X taxes in exchange for Y services. That's the point. It helps spread the weight so that an individual is not forced to shoulder the hardship alone simply because they are the only family member left. And the government stepping in makes sense: it allows families to break the cycle of poverty where younger family members cannot work or cannot build wealth because they must be willing to take on an unpaid job for however many years are needed.

I understand what you are saying and have less than definite feelings. My own situation is that around the time of the beginning of the pandemic, I turned retirement age ( but had originally planned to work to 70+ ), job had become very toxic, and adult daughter and I lived together and brought Mom to live with us a few years earlier. But Mom required more care, companion-ish, meal preparation, etc. and I wound up making my retirement permanent.

Now I am 68, single (with no life anyway :) and Mom is almost 97. We get along well now ( after having butt heads a lot during the first 2 years ), and I have this "invisible barrier" that " if things get too hard or overwhelming ( i.e. dementia and / or her becoming bed bound or "something" ), that then I would think about the nursing home route. But as long as I can, I want to keep her at home where her QOL is the best it can be.

And I am grateful that in our society, it would be "acceptable" to go the nursing home route. And I think you are right about the "nuclear family" being the beginning point for that viewpoint.

Being 68, I remember much more of "the way things used to be" before that. Through conversation, reminiscence, reading, history, shows ( think The Waltons ) and movies, I realize that our beginnings of life in the U.S. came from those family-valued traditions from European, Native American, Latin, Asian, etc. cultures. It used to be that families took care of one another... it just was.

For me personally, our family had strong family values which instilled in me the "I can do it myself" attitude. We had a very good but small ( 2 parents, 2 children ) and supportive family who loved one another. My Mom was a stay-at-home mother which is all I ever wanted to be. But parents insisted I go to nursing school before my engagement turned to married status. I was very lucky coming from this up-bringing and I treasure it.

Not everyone has had this experience; and I would never subject them with a condescending or negative attitude for placing their LO's in a nursing home. I think it is fortunate we have such a resource for those who need it. And it is not my place to say who should or should not go to one.

And knowing how expensive nursing homes are ( i.e. $8k-10k monthly ), it is necessary for the government to help. No one could ever pre-plan for the sky-rocketing costs of nursing homes. Does your friend realize that everything is taken from the LO before Medicaid kicks in ? Does your friend think you should give up your salary toward that amount ? That is not reasonable.

When my parents run out of their assets, it would be a tremendous burden for me and my spouse to pay for their care. They have not planned for this period in their life and have made very poor financial and investment decisions that have left them basically with only SS. I dont want to do this to my own children, so when their assets are gone, I plan to apply for Medi-Cal for them.

Depends on the situation and every situation is different. Gone are the days of huge families who all lived within a couple of miles of each other and could depend on each other to help with grandma so that no single person was burdened with it all. One person CANNOT possibly handle an invalid or violent dementia patient for very long without total mental and physical burnout.

I found this to be interesting googled from https://www.sciencedirect.com/science/article/pii/S1976131713000212
It is from prior to 2018, so a few years older.

" The proportion of the elderly people in Korea is rapidly increasing. About 11.0% of the population is currently over 65 years of age, a percentage that is expected rise to 14.3% by 2018 (Statistics Korea, 2011). " and this .....

" For these reasons, the Korean government has provided a Long-Term Care Insurance System (LTCIS) since July 2008. As a result, the number of nursing homes and nursing home residents has increased rapidly. In 2001, 7,864 elderly people resided in 128 nursing homes throughout the whole of Korea. In 2012, following the launch of LTCIS in 2008, 103,973 elderly Korean people resided in 4,079 nursing homes (Ministry of Health & Welfare, 2012). This number is expected to grow steadily in the future due to the increase in the elderly population and financial support from the Korean government. "

*************
So, "new values" are also seen in Korea. Not sure your or your friend's age is, but
family vs. nursing home is around the world, short of a handful of countries. While it would be lovely to envision multi-generational families in lovely homes, everyone taking care of one another, it just isn't possible.

Individual and social morality is subjective but legal is objective. While one can argue that shouldn't be or needs changed, for now, as long as a decision is within the law, I can't fathom choosing a moral high ground or a cultural comparison between a kelidescope country like the U.S. and a more homogenous one like Korea.

My husband and I were both raised with a family first belief. It was thought that with enough advanced planning we would keep our parents in our care to the very end. Fate had a different plan. With just us now, the LBD, Capgras syndrome, hallucinations, paranoia and delusional outbursts has become unbearable to think our LO's must suffer more because we aren't trained to help -- especially with my mom as my sibling's education was in part for THAT EXACT purpose until sib died young-ish.

I won't morally speculate on anyone else's circumstances as to why they are needing government LTC assistance and hopefully they will return the favor and only legally judge mine.

Sighopinion: Oftentimes the elder must resort to a Medicaid application as they don't have the funds for facility care. Also, it is not the family of the elder's duty to finance their care at all.

We are the government: it's not them vs us..........it is us.

There's only one scenario in which it's completely unethical to make the government pay. People who aren't the spouse shouldn't be allowed to live in the house once Mom is placed into a Medicaid home until she dies and until they decide to sell. The lien option should be done away with, or at best replaced with a foreclosure option in six months. Sell by then, pay Medicaid their bit and go back to private care until Mom truly has no money. It is not ethical to use Medicaid to pay when one owns a house beyond the six months it'd reasonably take to sell it so that Medicaid will get paid off and the person will go back to spending down their assets.

A family who insists Medicaid pay while staying in the home is also limiting Mom's options. The places that take Medicaid immediately are typically more limited and less nice. Nice homes that take both often prioritize private pay residents for private rooms, and prioritize those who have been on private pay over those needing Medicaid right away. When mom gets placed, the priority should be to make her existence as tolerable as possible in a nice place--of which the majority require private pay going in.

Sighopinion - I saw this sign above a cemetery's gate (in a movie I think): "We were like you and you will be like us"

That message is very true applying to the dead and the living.

I think it's also true applying to the culture differences between the US and Korea when it comes to elder care.

Generations ago, the US was like Korea, but soon, Korea will be like the US.

Do not think it is the kind or compassionate thing to put a loved one in a nursing home. Out here in NY, when a loved one is put in a nursing home, it is like putting him or her in jail, especially now with covid. Before covid, people were expected to live about 18 months in a nursing home on average. They are horrible places. I was medically prohibited from taking my dad home and practically lived at the nursing home. It was literally traumatic to witness and I was there to regularly advocate for him, trying to get him well enough to come home. When you ask yourself whether it is ethical or moral, ask yourself this question: “What would YOU want if you were in that position? Would you prefer to be cared for at home or in a nursing home?” You see, being a caregiver of an elderly person is challenging, time consuming and sacrificial and most people in this society would prefer to walk down the easy road and not do anything to help but rather let the government do it. I paid out of pocket when my dad was in the nursing home/ rehab and kept him on temporary status so he got better treatment, while all the time trying to bring him home. My dad was always there for me in times of trouble and he deserved me being there for him in his dire time of need and discomfort.

"True it is subjective and I agree it is unfair to make a judgment on such things.

Though one aspect is objective that the cost is not something we can readily sustain with our current system. Something has to change to meet the rising the cost and demand of elder care.

For example my LO does not need the medical need of SNF but since medicaid does not cover AL or MC in our state SNF is where they have to be. This is an unfortunate waste of resources but is a very common tale in our country."

@sighopinion,
I'm neither going to agree or disagree right now.

Just as conversations, like the one you had with your games partner and this one that you've started here, organically expand/grow/change, I posit that your answers have expanded/grown/changed the conversation from subjective ethics/morality to objective legal/politics/money.

That conversion creates a different debatable subject. And as much as I'd really, really like to join in on that, I have neither the time or the energy to attack that soap box of mine today. :-)

A slightly morbid thought, but maybe after the LO's are out of their suffering.?. ;-)

I think the system is broken. We pay more for care than any other country in the world for similar or worse results. This includes elder care where there are few affordable options for people who need care that can't be provided by their family (if they have one). There are also a significant number of people who don't plan for their future financially or take care of their health to ensure they can live independently.
My mother is in a care home, although she self-pays, because she is totally immobile and we are not capable of caring for her. It is likely she will run out of money and have no option but Medicaid. We currently can't pay for her care due to the cost so I personally have no issue with her having to use Medicaid if she outlives her money. Even if that means she has to move to another facility. We have no option as she needs 24-hour care.
I don't know the answer, but I think there needs to be more affordable options coupled with people taking responsibility for their future.

I assume you mean the financial burden on taxpayers, because no government is doing the care.

I think your control group wasn't diverse enough to say not taking care of a loved one is a western culture thing. Many, many western families care for their own, no matter what. That's what this forum is about.

I have contributed financially to both my parents because their bad choices left them in dire straights. Doesn't mean I am capable or willing to bring them into my home. But that doesn't mean I am not caring for them as an advocate, taxi services, entertainment director, appointment setter and a hundred other things.

I, honestly, think that other cultures consider boundaries, as not taking care. They expect blind obedience from adult children and that is a big difference that makes "western" culture seem wrong to many. Even though they have left their countries to come to the USA, Great Britian or other western cultural countries.

I do see the 35 and younger crowd not having any respect for their elders, across all cultures though and I find that very sad.

My hubs is Asian. I can tell you from first hand experience that his parents, one 92, the other 86 refuse to even discuss the possibility of nursing home, assisted living etc. Actually neither of them would qualify for AL at this point. His mom says " We are East Indian. We don't go to nursing homes" She says this as if it's a fact. When discussing the possibility of her husband dying she says oh, A (hub's sister) will move in and take care of me. Never considering that maybe A has other plans. A, the dutiful daughter will probably cave in.

So, it's not always so black and white. I don't believe all Asian cultures etc. are just sacrificing out of the goodness of their hearts. Sometimes, it's just the pure bull headedness of the parents that dictates what happens in the future and the kids are just sacrificial lambs in the big scheme of things.

Your question is a bit black and white and I don't mean that in any racial form. What happens when an elderly likely parent might become immobile and is compromised with other health issues?This happened with one of my grandmothers in her mid 90's. My mother is immobile and requires alot of skilled nursing. If she were in my home I would need nursing staff to come in daily. My 3 children live in other states. What would I do when I visit them and our grandchildren? That is the only traveling we do. I would have to hope that everything would go smoothly with those coming into my house when I would be away.

At the SN facility my mother is in it is very hard to imagine residents there living in a private home. Of course they could but it would require alot of outside help.

My next door neighbor has a wife who was severely injured in a car crash. The cars coming and going there go on all day. In this case it is his wife and I understand wanting to be with her. I feel that differs from a parent.

There may come a point when there is no money left. My mother has outlived her LTC policy which was significant. She is now going through a trust left to her by her mother. This will not last forever. I find little quality to her life and she keeps asking me when she will be better which is never. Her monthly costs are significant made more so by a mistake on the part of the SN facility yet they are dealing with it. It absolutely requires the daily care of a nurse. Once her money runs out if she lives that long should my husband and I have to pay for her. We are retired. Both of us worked for many years. We live a simple life. Should we not be allowed that life? We would have to move into different housing to support her.

I understand certain cultures thinking differently but do they consider worse case scenarios? I know I never want to be a burden to my children. Some people go on and on. I witness this on every visit to the SN facility my mother is in. I live a much more healthy life than my mother did. I hope I do not go on way past an expiration date which may sound crass which I don't mean it to be but sadly is greatly the reality for many.

In China when the 1-child policy was forced upon the people, it was still a mostly aggrarian society. The rural Chinese tradition was to have many children because they needed the farm labor and the males would be the ones to provide the financial support for their parents in their old age (and the wives would provide the hands-on daily care). With the 1-child policy, parents began abandoning and aborting their female babies and today China is suffering with the imbalance of this unplanned outcome. Also, now there are many generations of male only children to care for 2 parents because in China there are no nursing homes or provision for the elderly. If the only gets married, they have 4 aging parents, and maybe none of them live in the same area. We don't hear about it because China controls information, or maybe doesn't care enough to even measure this phenomenon.

Even in Japan, which currently has one of the lowest birthrates in the world, is having trouble dealing with their aging population because their people tend to live a long time. A few years ago I read in the NYT about how Japanese elders are dying by themselves in pension apartments and aren't found for quite a while. It doesn't help that their culture supports stoicism.

Our elder care here may be expensive and imperfect but at least we have some options.

Sigh, you response below by saying you will swallow a bullet before you get to the point of having someone else wipe your azz.

Well, you obviously don't have much life experience to believe that is always an option.

Some people have accidents and everything changes in an instant, some have strokes and they are literally gone with a living body that someone else needs to take care of.

So, wishful thinking aside, you should really consider your options based on reality. Because I don't know one person that wouldn't feel the same way, had they been able to see it coming but, then you get old and dying is more real then it is in your 20s or 30s, so perspectives change.

Care goes beyond monetary expense, you have to take into account the other factors; time, stress, freedom, peace of mind just to name a few. It is far from reasonable to expect a family take on such a task by choice.

Many of the times the reason a family does not place someone it largely boils down to; inheritance, false sense of obligation, misinformation, fear, housing, etc… in my personal opinion rarely is it out of the goodness in ones heart.

Medicaid related services do provide a safety net for many families, without I do feel elder abuse would sky rocket. Give people limited options, they will create their own.

I do wonder how long the coffers can remain solvent with the increase spending across the board, and longer life expectancies and declining birth rates. I know it is a running meme long before now, but younger millennials and older zoomers may really be the ones that face the realities of no more money in the system.

my mom is close to running out of money. My dad, refused to take out the pension that would have taken care of both of them… he was busy smoking and drinking that cash away. They paid their taxes.. There is only me here….I worked hard all my life since I was 15 . I paid my taxes. I worked, I have always been self sufficient. My mom will go on Medicaid. I did not work all these years to retire and become a caregiver. It was a hard No with my in laws and it’s a hard no with my mom…

Babies and the elderly require additional support; as a moral society, their care is our obligation: Medicaid is the societal method of providing care.

Before we spend money on citizens of other countries, we must take care of our own.

P.S. Free diapers for both!

During our game night I did ask who did the caring and I was correct it was the mother, but he also told me the community did help also. Their neighbors would come over and watch while his parents went out on special occasions be it work functions, anniversaries things of that nature. He mentioned his community often helped others greatly. They use to pool funds together to send kids to camp as one example. People would offer their services for free to neighbors.

So their view is clearly far from the norm. I said I would ask so I did, thanks for the different views and opinions it was a fun discussion.