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

Assisted Living does not provide nearly as high a level of care as a Nursing Home. The NH will have RN's on 24/7, more aides and an actual MD on staff. You can get a private room only in a private pay nursing home.

I was fortunate and able to keep my Mom in AL for the entire duration of her final 18 months. And yes, it was half the cost of the nursing homes. But as part of my research, I did find that different AL's offered different services. You've offered no info on your Dad's issues/age but my first thought is for you to check a variety of ALs that may provide what is needed at less cost. Having said that, if he truly needs skilled nursing, then that is where he should be. After his funds run out, he can apply for medicaid.

Yes it is about the nursing care, doors are open and there are checks done rregularly for patient safety. However, after working in both as a healthcare professional, I agree the cost is not worth it. I agree that you need to determine what your dad actually needs and see if it can be provided at a lower costs at an AL that can provide that service. This might mean that your dad does use a call light for help. It might mean that if you have particular times he needs help, you pay private duty. good luck! My father was falling and hallucinating and we could not get his AL to continue with him and my father went through nearly all his savings in skilled care. We did find one with private room for $350 day!!!

As long as we continue to believe, as a country, that it's okay to make a profit off the sick and the elderly, the costs will be exorbitant.

Is your father a veteran ? If so aid & assistance may be available.

My Mom is 87 and just recently in the past couple of months has needed someone to stay with her at all times. She uses a walker now and is a higher risk for falls since she has issues with iron deficency anemia that we are trying to stablize. Her red blood levels were so low she passed out. (She may need Procrit shots or iron infusions.) She has also been having memory issues-most likeky onset of dementia. She has partial seizure disorder that is under control, CHF, CKD, neuropathy, osteoarthritis, COPD (on oxygen), GERD, High Blood Pressure, gout and high Cholesterol. Fortunately she is not diabetic or incontinent. She no longer cooks, cleans or pays her own bills. I do that for her. The scary part is she could never afford any assisted living or nursing home costs. It's all outrageously priced. Who can really afford the costs?! My husband and sister take turns caring for her each day while I am working a full time job. There is someone here 24/7 with her. I am fortunate to have this help for her and especially hearing about some of the conditions and problems with room sharing in NH and the costs of AL. If I had to quit my job and care for her I would. My pay is less than the costs to place her somewhere, so she could afford at least to cover my debts while caring for her at home. I hloe it does not come to this, but I have thought about it. I just pray we can continue caring for our Mom in her last years at home.

We do not value the elderly. We, as a country, have our priorities all screwed up. Yes, I agree there is a better level of care (I hope) in a nursing facility. I know the care back in the day was horrid - hence these Independent & Assisted Living places cropped up to fill in with different levels of care. But once it a person goes into a nursing home, unless you pay privately, it is like a hospital but for much of the time they put the person in a wheelchair & leave them in it all day. I hope you can find someplace that is worthy of your father. This inevitability scares me for my Mother, my spouse, my friends and quite frankly for myself.

Good luck, stay strong. Reach out to friends for comfort. Best of luck. Keep us posted.

The costs are probably related to the overall healthcare costs in the US which, as everyone knows, are very high--so high that travel advisories issued by other countries make a point of warning about medical costs if traveling to the US.

I thought it would be interesting to look at childcare rates, thinking that care for an infant would have some similarities to care for an elderly person. I found that childcare rates are from about $100 to $200 per week (depending upon area, of course). This would mean ca. $5K to $10K per year. From what I can determine, typically there is no nursing staff. However, this is generally for weekday daytime hours and not 24/7, so AL rates of ca. $30K per year don't seem so unreasonable. Nursing homes, because of their additional costs, can be expected to cost much more, but whether $70K or more per year is "reasonable" for a nursing home is difficult to answer without taking into account all the additional regulations and requirements.

I suspect a big part of the issue is that some elderly people require some assistance for daily living but aren't quite competent enough to take their medications--that is, a nursing home may be "overkill" (no pun intended!) for some elderly who need slightly more than AL provides. Is it possible for someone to be admitted into AL with the understanding that a family member or other person will visit make certain the resident takes his/her medication?

I suspect a huge part of the cost has to do with preventing and insuring against medical liability issues in the American "land of lawsuits"!

It is ridiculous the cost of NH's but it is because of all the staff (in my opinion too many doing to much specialty/limited care, etc). My dad was in 2 different NH (now in AL) and the staff - OMG you have one person to do one thing, the health care system is in terrible trouble and unfortunately the sick/elderly are paying the high cost. Living out your remaining days/months/years wasting away in a NH is NO way to go out of this life. There are limited options, in my case there is no way on earth I would tolerate my dad living in my home, when he runs out of money and still alive he'll just have to be a ward of the state. No love loss with between my dad and me. Watch out for pill pushing doctors in these facilities also.

I did quit my job to care for family members. I paid off my home in 2005, I'm 58, and do commissioned artwork from home (which is not nearly enough to pay for anything.) I'm full time with Mom here, 92, multiple medical concerns, but still a sharp lady. All utilities and auto costs are approx. $900 a month. Prior excursion to care for younger sister (bone marrow transplant) out of state cost me the 401K to keep my house and leave the state. For now we are ok. Mom's SS of $1300 pays her seven doctors, meds, and personal needs. She has no assets, qualifies for NADA. I own the house (all 1100 sq ft) so I'm out as well. We can drive to docs, we have groceries and electric. I consider that quite an accomplishment considering the circumstances. Since the beginning of time, people age, become infirm, die. Family members in a group took turns taking care of them. Only in this our MODERN ADVANCED society do we have unimaginable financial burdens to continue our lifestyle of 'privilege'. I say that with a smirk, because it's been five years of full-time no-real-income, no
'respite' and no-projected-future-for-me-lifestyle. I just CANNOT consider delegating my Mom to government-paid stressed-out strangers in a warehouse-style facility ! What if she's thirsty but can't find the word? She's embarrassed to no end if the poops her pants- and it's just us here ! Every time I get frustrated, every time I want to pull out my hair over an old story about my ex-husband that goes on repeatedly EVERY day...(at breakfast !!!) and how much she hates him, and how much she hates her father, and blah, blah, blah...I envision her alone and afraid with (maybe even kind) strangers, with (like you described) several people in a room (when she is afraid of anyone coming into this house...) I put on my big-girl pants, suck it up and move on to another day. ALL 63 million of us here in the US of A need to start emailing our congressmen. (Not just me, thank you.) Generations of folks who have not paid into the system get more 'assistance' than those of us who pay taxes. I will leave this adventure (fourth family member cared for) with the hope that these years have galvanized experiences in me that will somehow benefit my ENTRY BACK INTO THE WORKPLACE IN MY SIXTIES.

While no one wants to broach this subject, I have with my children as I look to the future. At age 75, I want no further treatments to extend my life. I want palliative care only. I work with the elderly and have for 30 years and I was caregiver for both my parents who have passed away. I have seen what chronic illness does for people and their families. My children cannot care for me, and and we have no means of paying for corporate medical costs of AL or NH. In fact we would be lucky to pay to co-pays etc of Medicare that are being proposed for baby boomers. This is a quality of life issue coupled with financial one. Not easy and my view does not mean true for others. However, we cannot continue down this path.

It has nothing to do with the physical building, and little to do with the number of patients in a room, and everything to do with paying all the workers. If you have 60 patients in a facility that must be staffed with 2 or 3 RN'S 24/7 (not just on call but actually working there, awake) all of a sudden you don't just have 3 x $85,000/yearly salary PLUS health ins, pensions, union benefits, paid time off which must be covered by another nurse, etc. Their actual reimbursement takes up what is paid by about 5-6 residents. Then there's all the LPN's, health aides, maintenance staff, laundry staff, professional chef & kitchen staff, marketing staff & office helpers, just add up all those workers' paychecks and you start to realize how it costs $90,000 a year. Plus they have to have insurance, keep the roof from leaking, and maybe update their furnace & air conditioning every so often. My wish is not that the government would pay for a billion people's bills every year, but that every single teenager was taught every single year in school, to Save Save Save and get their financial Priorities straight. It IS possible to get your education and buy a modest home AND do ALL of that without ONE PENNY of government handouts. I've done it and my kids are doing it. It's called WORK and Living Within Your Means. No one needs a $10,000 vacation every year, two Big Screen TV'S and a 3-car garage. Your kids want an I-phone? Let them work for it. They want to drive your car? Let them pay for it. You want to retire at 65 with another 40 years of luxury? I hope you planned & saved for that Priviledge, because No One has a Right to steal MY hard-earned & SAVED money which I have crimped and saved for my own "retirement" (which won't come until 70 and won't be anything fancy). Buy LTC insurance and buy the inflation riders. Keep yourself healthy. Don't waste money on frivolous crap you can't live without. If everyone did this, we would still have a few that by reason of being extremely disabled, or severe disease would require government help. But by far, there are too many mooches living off gov't who are setting a huge bad example and the cycle just continues.

Well welcome to the healthcare industry. If you do not take good care of yourself before you get older, then you will probably need services. No one wants to pay at the end of their lives, but leave him where he is since funds are low. It is expensive because you have to pay all the professional people who went to school to get an education and probably are still paying for their student loans (like me).

My husband had Alzheimer's. I put him in memory unit of an assisted living facility. When he couldn't walk any more and other issues, it was suggested to have his doctor call in hospice. As long as my husband was under hospice care, they said he could stay at the assisted living until he passed. Not sure if alf 'knew' his health was going down hill quickly or not, but hospice was there for his last 3 months. alf did not want to lose him as a resident of course, so that's why they suggested hospice. So very glad I didn't have to move him, and pay twice as much as we already were.

Brand-new facilities will eat $130,000 to $145,000 per room in start-up costs–or about $11 million for an average-sized location with 80 units... all-in costs include buying the land, design, construction, furniture and equipment, sales and marketing [as of 2007 article in Forbes Magazine].

As Mallory had mentioned above the cost of running a nursing home, especially employees... sales to liability insurance, property taxes and utility bills. Accountants and lawyers. Security and maintenance [interior and exterior], housekeeping and laundry service, and transportation services.

The nursing home my mother was in charged $410 per day. The AL she was going to be in charged $12, 600 per month and yes, the space was no bigger than a bedroom.

While I don't disagree with other comments, I think StarGazer summed it up very succinctly. Mallory also makes some very good points about consumerism and the lack of money for old age care.

People are living longer and developing more health problems, some of which are beyond the ability of caregivers to manage at home. Commercial providers see a need, move in, and establish a foothold. Some attorneys have focused on asset management specifically designed to open up Medicaid qualification for people, enlarging the pool of potential facility residents. Elderly folks bring in dollars for commercial enterprises.

But it's not just the elderly who are becoming profit centers. As individuals, we are as well. Think about all the data being collected on us, whether we're caregivers or not. If you read privacy policies and terms of service for websites, you'll find references to data gathering, third party use, etc., etc.

People and our data are the hot commodities now. Marketers want that data, and they get it.

Look into board and care and steer clear of "nursing homes" . You can get a privite room in some board and cares for a little more money. You much better care in a family like setting in a board and care 6 bed facility. You just have to look around and find the right one. At most nursing homes the cost is astronomical and the care is not good. They don't have the staff to care for all of the residents in a timely manner in my experience and they should be avoided. It takes a little time and research no matter what you choose but don't let the "Nurse" fool you.

"malloryg8r" here's a clue for you, nobody is interested in your rant about your retirement years and how much you deserve them.

It's expensive no matter where you go. ALF is less expensive than a nursing home. Nursing homes have nurses on duty 24/7 which is just a part of the cost. If your dad doesn't have the funds to pay for a nursing home, then he may qualify for long term care Medicaid. If he qualifies then Medicaid will pay the majority of the cost. Check with your local area agency on aging for more info on nursing homes and 'waiver' or home and community based programs. If your dad is in the nursing home for a certain length of time and has Medicaid, then he may be able to move back into an assisted living facility and the waiver would help pay for it. I see a lot of facilities that are 'chains', only for profit and even the non profit facilities charge as much or more than other facilities. There isn't an easy solution, but the AAA may be able to answer some of your questions. Good Luck, your dad is lucky to have you to help him.

I do not know the state you are in but in several state there are adult foster care homes where up to 6 people stay, have their own room and is very reasonable. This is what Terryjack 1 is referring to. As an OT, I can tell you these are, for the most part, are very good. My mother hospiced in one, when we could no longer take care of her at home. It does really depend on what your father needs, which is going to be things like medication management, toileting, (incontinence ?) feeding, bed mobility, bathing and dressing and what level of support he needs for these activities . Most places require people to be assist of one. While I am not a big fan of AARP, they can be a source of great information.

Cleverdish, you are so right and I wish that WE could make a difference in a hurry. Unfortunately, not enough of us (Americans) have had these experiences to even care. Everyone on this website cares and understand. I support you in thought and prayer. You are a rock! Good job!

Another thing regarding costs, how much competition is there for nursing homes? I read on this forum how hard it is just to find a good nursing home, so of course the cost will be high because the nursing home isn't competing for business with other nursing homes.

Once all of us early baby boomers are on very long waiting list to get into retirement villages, assisted living facilities, memory care facilities, nursing homes, etc. I hope we will see a fury of new construction of such places.

I know in my area, they can't build 55+ communities fast enough. Those 55+ residents [55 to 90] will need to go to another layer of care within the next 10-20 years. There are many of us who never were blessed with children, so we will need to pay our way for hands on care.

Hey, koufax, I sincerely hope you have seen that my comment is primarily a lot of helpful information that is relevant to the original question. There is also another question behind the OP question-- a huge ripple effect with everyone's decisions affecting everyone else. Unfortunately the sheer numbers of people living irresponsibly, threaten the honestly earned homes & security of the dwindling numbers who are responsible. When it comes to older age, or unfortunate early disability, those who have been responsible will fare much better, due to their own efforts. I believe that 5-year lookback for Medicaid should be 40 or 50 years. The huge costs of NH could easily be paid by those who have $2,000/month mortgages, $1,000/mo car payments, and other luxuries, for 40-50 yrs when they could have lived more exonomically, and bought LTC ins. I have that same sticker shock over NH costs, as expressed by the OP. Nobody who has worked like crazy all their lives seems to know that 30-40 years of senior life could cost so much. Yet NH are flourishing, they have waiting lists and are full to the gills. Their "product" is flying off the shelves so fast--if it were too expensive we would see empty rooms wouldnt we? So the problem is not the nursing homes, they are priced correctly &competitively. It is the same problem as hospitals--there are too many people there who are using the product who don't pay full price (Medicaid), and the self-paying folks pay the difference. Its either that situation, or the NH does not accept Medicaid, they only take private pay (and these places have wait lists a mile long). Nobody in WashDC can seem to do anything to control the costs. There are not enough rich people to tax, to pay all these bills. So it is just up to us common folks to save more & more for our own needs, and the pain we feel is not that I am "ranting," it is that all of us realize we can't be living it up, we gotta be saving an incredible amount of money for those senior years--and if you're not going to be responsible & work & save, you're costing everyone else. Just like the bad drivers on the road who increase the costs for the good drivers.

To continue this question about nursing home prices correctly. I just saw an amazing show on PBS about Green Nursing homes, built not for profit and supported by the community. Normal nursing homes make 1-3 Million profit /year dependent upon their case mix (Part A vs private/Medicaid). They many times have their own pharmacy that make money etc. In this for profit model, which is very medical model, not social model, they are cutting corners every where and the patient suffers with reduced staff, cheap food, etc, etc. This Green Home Model, was open to anyone. The cost was private pay or medicaid so very low. All had private rooms, all staff were trained and given a real part in care and valued, the kitchen was open for residents to help if they wanted. There were real activities, house pets, etc. I nearly cried at the case examples. This is a clear example of what you can do with money, IF you don't send it to the top for the owners/share holders (the 99%). Washington wont do it. This is a grass root effort. The show visited the place 3 years later and things were ticking right along. Look it up on the internet! Makes me feel hopeful for the future!

Jenn, thanks for that helpful information. I did some checking and will do more later.

This reminds me of a movement I discovered a little over 10 years ago. At that time it was called the Eden Alternative, or it might have been the Eden Initiative.

I did check out one facility practicing this and was very, very disappointed. Although the principles of integrating pet activity and other helpful practices were in existence, it was county run (by a wealthy county) and was desperately depressing. I couldn't wait to get out of there.

Perhaps the movements have changed; it's worth investigating.

OTJenn, you and I are in agreement regarding palliative care and you're right it is a decision based on quality of life and financial concerns. More of us need to discuss this with our families. We're great about our Advanced Directives etc. but there can be a long time between the time when we can no longer live on our own and our deaths. It's our responsibility to let our families know what we want done!
What is the point in taking routine medications that may prolong our lives just so we can live in a care facility or be a burden to our families. It makes no sense. When I can no longer live on my own, it's time for me to go and the sooner the better. I would like to leave this earth knowing that I had a good life and was not a burden on my family or society. Until modern medicine can guarantee me a quality of life to match the quantity of life it can give me palliative care sounds like a very reasonable choice for me.

Everyone needs to check out VA survivor benefits. It helps us keep our heads above water. It takes almost all of Mothers VA & SS to pay for her care here at home and I am with her nights and weekends when I'm off work. I tried to work from home and care for her myself, but I could not focus on my job (magazine publisher/editor) and be available for her 24/7 at home. I've gone back to the office a few days a week. It helps my sanity and VA pays for it. We have a lovely lady who lives in our home and works 40 hours +/- each week I do the rest. It's easier and less expensive than a nursing home. Mother survived C-Diff last month. She is legally blind, has hyperthyroid disorder, congestive heart failure, iron deficiency anemia and is very unsteady on her feet. She had multiple UTIs over the past year and was out of her mind, but we worked it out and kept her home. She's 103 and is having a good day today. She still eats well, enjoys the sun porch and the infrequent visits from the grand-kids. Our overall cash out of pocket is about $400 per week + gasoline for doctor's visits and her meds (unless there's an illness they cost about $50 - $60 per month. I am an only child and she never deserted me. I can't desert her. She moved a hospital bed into my old bedroom at home and brought her mother to live with us and had a second hospital bed in the second bedroom for my father's mother while she worked in her beauty shop that my dad built for her in our garage. She hired a woman to come in nights, but she and her sisters cared for them during the day. She set the example of doing what needs to be done.

My Mom was born in 1914. She died April 29, 2014 - a week before my 76th birthday. Mom was an avid reader; an educated, active lady interested in the world around her. However, she had become legally blind, due to Macular Degeneration, and had become more and more hard of hearing. Self-supporting, I was still working, so she had taken up residence at an AL facility near me. She was on very little medication (aspirin etc. for high blood pressure) and danced and socialized with a wonderful group called "Day Out for the Blind" every Friday.
When flu was identified "on-site" @ the AL, as their R.N. told me, they requested Mom's doctor authorize an antibiotic ("Z-Pack")for her. Two days later, they requested (and received) authorization for Tamiflu. My mother has a history of serious adverse reactions to meds - and the pharmacist warned me to watch her closely for "any neurological disturbances", which should be "immediately reported" to her doctor. Sure enough, 2 days later she was complaining that "there's something wrong with my head!". The Dr. ordered "D/C the Tamiflu". In response, the nursing staff FAX'd the Dr. "Why?" - but the Dr. had left for a 3-day wk-end! Therefore, the Tamiflu was continued!? By the Dr's. return, Mother was absolutely incoherent and disoriented, "out-of-touch"!! Only gibberish came out of her mouth. It was horrible, absolutely gut-wrenching. (For your own information, just look up the side-effects, and LIMITED VALUE of Tamiflu! I looked it up and brought it to the R.N.'s attention. She said she was previously unaware of the data!).
While the AL facility, the Dr., and even the hospital tried to justify other causes for Mother's condition, I kept encouraging her not to give up when she said "I just want to die". I'd seen her reactions and recovery from being over-medicated before, and so kept encouraging her with, "You'll feel better, Mom, when you get these meds out of your system." A retired R.N. friend helped me console and comfort her, as well as feed her so she could regain some strength. As the meds wore off, she DID feel better and became Mom again! Again, she was as spunky and sharp as always - astonishing everyone she encountered - except me. I was just relieved, and ever so grateful she'd made it through once again. Hallelujah!
With the help of 2 attorneys, we got her out of there! I gave up the last of my Substitute Teaching and took her home with me, where I became her 24-hour CareGiver. My only sibling died long ago, and my family is grown and gone, so it was just Mom and me. We had many enlightening, provocative, funny conversations; a 99th birthday party with her church friends; Bible study, church on Sunday; shopping trips; meals out - and memories (and pictures!) to fill my heart. When, after a heart attack, she became bed-ridden - friends came to visit, and Hospice became part of our life. All were amazed @ her interesting, meaningful conversation. I slept in a recliner by her bed to respond to the necessary commode assistance she required or her calls with "I'm thirsty.". I was finally using just an eye-dropper of water to ease her thirst.
Yes, I was short on sleep at times, constantly on call with the bell I gave her to summon me, and pretty much house-bound. But I do not regret any of it. I am grateful that I had her here with me until the day she died. She was again on her own turf, among her "old" friends, and in the care and company of someone who really knew and loved her.
I hope readers will join me in advocating for funding for Caregiver Assistance Programs through Area Agency on Aging. This was a big help to me by providing several hours a week of Caregiving Assistants. Support for In-Home care will be far less costly than the for-profit corporations that Assisted-Living facilities have become. Veterans' funding has now become one of their primary targets for getting Veteran residents. And, yes, they even use their own related pharmacies to boost profits for all the medications they provide residents. These pharmacies charge as much as 10 times the price Costco or Wal-Mart charges for these same meds! These facilities should not be so-connected, since it incentivizes excessive use of meds for their residents!
Please contact your Legislators on these important issues, and INFORM YOUR FRIENDS and FAMILY!
This has been a time-consuming lengthy response, but contains heartfelt messages I hope readers will sincerely think about, consider, share, and hopefully - even act upon!

Unless something takes you out of this life prematurely, we will ALL age to the point where our bodies and minds fail, and we need some type of assisted living and/or skilled nursing care.

The whole system is a mess - and I don't know what the solution is. In general, however, nursing homes are much better than they were 50 years ago because they are highly regulated. I've visited several in recent years and they are so "nice" compared to the ones I saw when I was a youth and visiting relatives there. I think sometimes we have unrealistic expectations of what a "nursing home" is supposed to be like. In many ways, a NH is a bit like a long-term care hospital with semi-private rooms and different staff members performing different functions.

In the past, it was not the rosy situation people like to believe. Not everyone was taken in my relatives and cared for. Some were left to die in their own excrement - because they had no living relatives, or none that cared. Some wandered off into the woods and died of exposure or dehydration.

We all criticize the current system.....but I have yet to see any real solutions offered to the problem. Things will only get worse as people continue to outlive their own life expectancy due to advances in medical science. What will we do with all of these very old people?