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

My sympathies go out to you - murdered by modern medicine is the reason for your mother's untimely death. My mother, now 103 is suffering from the ravages of modern medical "cures" that have almost killed her. I am screening EVERY drug and treatment that is given her to "help" with anything. Last UTI treatment resulted in C Diff. I cured it in 3 days without hospitalization. The diarrhea had stopped by the time it was diagnosed and she was given antibiotics. She is weak, but recovering, no thanks to modern medicine. The UTIs are a different matter. I'm finally on top of them (hopefully) D-Manos, cranberry juice and changing underpants more regularly than she wishes. I pray that her body and mind don't go to the point that we must have 24 hour care. No nursing homes for us is my constant mantra.

Why not keep him in assisted living and hire sitters? Someone I know does that.

For the most part, long term care is a for-profit business. A large percentage of LTC facilities are privately owned, with the owner(s) & administrators collecting a huge salary. When the prospectus of the baby boomer generation declared that they'd all be aging & would need LTC, people started building these LTC places because they knew that once those baby boomers went in, they'd never get back out & they'd have a long term source of income from Medicare/Medicaid. It is a racket, and there are no financial regulations as long as they meet the minimum staffing requirements. It is a sad state of affairs.

We can move to a not for profit model vs for profit medical system! We are the ONLY country in the WORLD with a for profit medical system. While we do have problems with people living way beyond when life is meaningful, this is due in part to a for profit medical system that want to keep people alive as well as people not being responsible in communicating what they want their lives to be like, if they become unable to make those decisions. I have been lucky to live in NZ, Australia, and in Holland and practice as an OT and have seen a not for profit system in action. Much more human. People were not given services based on what they could pay for. Not perfect but much better. Nursing home were much more social environments and not a place were pills were pushed.

OTJenn:

"Much more human. People were not given services based on what they could pay for. Not perfect but much better"

You make some good points about profit vs. nonprofit systems, but there are other sometimes intractable issues as well in moving to a nonprofit system, presumably government funded.

Look at the outcry and hostility against the Affordable Care Act when Obama tried to institute a health care system that would be available to everyone. An egalitarian concept was met with intense hostility by some segments of the legislature.

Opponents are still sending out propaganda soliciting funds to battle against the concept. I've seen this solicitations; they're rhetorical and disgusting.

In addition, I would argue that people who are medically served based on what they can pay for is in itself harsh and cruel. Should a poor person be denied emergency service because he/she can't pay for it, while a wealthier person could in fact get such a service?

Think it over - health care based on ability to pay is draconian. There are already too many examples of people suffering because they lack the funds for treatment. Read some of the stores in AARP Bulletin to get an idea how people are still suffering because they can't afford treatment, especially for health conditions that are phenomenally expensive.

It's not my intent to criticize or provoke, or to take what you wrote out of context, but rather to raise specific questions about your conclusions.

TooYoungForThis--just a note that Medicare does not pay for Assisted living and only pays 20 days of very specific type of "nursing home".....just want to keep the info correct. Medicaid OTOH does pay nursing home (most NH do accept Mediciaid) but in my visits to about 2 dozen AL, not very many asst living accept Medicaid.

GardenArtist & OTJenn, I hear you both. People don't want to pay exorbitant price for an aspirin, or an outpatient surgery, or a hip replacement, or Alzheimer's care. Problem is there are too many people who think all of that should be "free." But in Truth, nothing is "Free." Someobody has to pay the aspirin maker, the aspirin bottle factory, the machines that pack them are in a million dollar factory, the truck driver who drives across the country in a $80,000 rig that eats diesel, the local CVS that's open 24 hrs and all their workers, plus the aspirin mfr has to have insurance and on and on. Health care doesn't come cheap enough for everyone to get it all, equally, for their whole life. I do feel it costs too much, when my family of 5 lays out about $20,000/year (we are a millimeter over the subsidy line) and that doesn't include eyeglasses or a bunch of other stuff. But I would never ever think that the government should just take over 100% of all health costs, cradle-to-grave, for every human being who is born in the US (plus a few million others). Do The MATH. I imagine a whole bunch of people are going to post very angry responses to my post here--but the FACTS are, there is not enough money in a country $20,000 TRILLION in debt, to pay for cradle-to-grave benefits. Add it up, sharpen the pencils, research it before going down that road. Other countries that offer this, have 75% tax rates. If you don't make an income then I suppose you don't mind that, but pretty soon everyone will become penniless, and the government will own everything --IOW, Communism. Who wants that?

We have our concerns also. Mom is in AL, and is deteriorating mentally (and physically, but still having no "treatable" illness except old age). At 100 1/2 this is to be expected. She doesn't want anyone to help her in AL, she is a loner, stubborn and always unhappy. If she deteriorates further mentally she will go into a mental care unit or NH. Financially it will be devastating, paying a fortune to keep alive a 100 year old shell with no quality of life, sitting in a chair or lying in a bed. Mom is miserable now. I can't imagine how she will feel if she becomes helpless. I guess nursing homes provide more care, but many I have seen the patient spends more time alone, sitting or in bed - when no one is there, no one is comforting them or entertaining them, and for that they bilk the meager savings $10,000 a month. Its awful to say, but it would be much more merciful if Mom goes peacefully in her sleep rather than live on locked up in the prison of a helpless body and empty mind. It isn't what I would want for myself.

Mallory - I agree with you 100%. The sad but true fact is the people who need the help (veterans, seniors) are getting a pittance. Those are the people who contributed to the country. But the people who are getting cradle to grave, well, we know who they are and the majority of them get around the system and never work. They are getting the free medical, housing, food stamps, and education. A senior has worked all his/her life and has meager savings (because the cost of living and medical care is much more than ever planned for), a pittance of social security with insulting raises (because the govt spent all the money for 50 years instead of investing it). Then the government takes all that money away when the person is the most helpless and puts the senior on Medicaid, finally, when everything is gone. Yet there are able bodied people who never worked a day on Medicaid, cradle to grave. There is something inherently wrong with the way this country takes care of some and not others.

Just a quick note, my income tax in NZ, Australia and in Holland was about 4%-10% more than I paid in the US and we have just returned to the US 3 years ago to take care of my aging parents, so very recent numbers. However I never worried about bankruptcy due to healthcare costs, and what we did get was fair and equitable. The insurance companies and corporations make the money on our healthcare, which include pharmacuticals, and other vested interests If we did not have the insurance companies sitting inbetween us and our providers then the costs would not be so high. The Affordable Healthcare Act is a farce and is not an example of anything except business as usual.

Unfortunately, if the US did not waste money on frivolous things, did not dump billions into foreign aid, waste money on programs that duplicate programs that duplicate programs that do nothing, spend a fortune on things that are not needed but are merely pork for politicians there should be enough money for good free medical care. We need to go back to the basics, to the priorities but politics will never let that happen.

Dear Anoel - SNF's and LTC facilities are expensive, profit driven businesses because they offer cash pay 'services' that are not covered by insurance policies and can charge whatever they can get. I'm just surprised that there are so many people that can afford it. Several insurance companies that used to offer LTC policies are no longer doing so because the premium costs are so high - people have stopped buying them. They'd rather go on Medicaid instead. Now there is a shortage of Medicaid beds in the majority of facilities. This is starting to have a domino affect on the economics of the US. And as desperate people play 'bounce the patient' between hospitals and SNF's to have care provided under Medicare - it has impacted healthcare costs. We are in the midst of a perfect storm of poor economy, aging population and a lack of affordable options.

One of the reasons that the federal gov't is now starting to look into this is because it is affecting their income - taxes. One out of 4 people are caring for an aging relative when they could be employed and paying taxes. This is putting more people in poverty and the gov't is losing its tax base of payers.

It has taken years of poor bureaucratic decisions and a lack of foresight (denial?) to get us to this critical juncture. Joining AARP may help a bit as they provide people over 50 with lobbyists in Congress that could bring about changes to Medicare benefits. But any changes will take years to implement. This is going to get worse before it gets better.

OTJenn, that is interesting info, have you read that article in the Atlantic? About the Dutch - built dementia "city" of Hogewey? The Dutch gov't built it at a cost of about $25 Million. About 130 dementia patients live there in group homes. About 250 staff take care of them. The cost is about $8,000 /month. The gov't DOES have each patient PAY $3,600/month. So, even in Netherlands, people will be paying an enormous amount out of their own pockets. I've also read about similar situations in both Germany and Japan-- the gov't there had promises of providing senior care facilities, but ran into immense financial trouble.....in the end the gov't only provides a small stipend (something like 25% of the cost, don't quote me but look it up, and its always changing). There is just no way government will ever be able to provide so much care for so many seniors. Yes, it is going to get much worse before it gets better.

Mallory who has 10,000 sq foot homes and $2,000 month mortgages! geesh! I've worked since I've been 16. NJ is very very expensive. I live in a relatively "not so nice area" and still pay $1,500 for 1 bedroom apt without a washer & dryer (yes trek to the Laundromat). If I want to pay less than I have to move to a high crime neighborhood. I did this to be near my parents who need me closer by. THEY are the ones living in a rich area n a big house with an expensive car etc but they earned it. I do not leach off of them. My salary basically covers my expenses--nothing fancy. I couldn't afford to put much into retirement. I just didn't make enough. So who are you moralizing to?

Mallory - AL can be paid for by Medicaid. For all issues Medicaid, there is no one single answer as EACH state administers it's Medicaid program uniquely. Medicaid is a joint federal & state funded program in which each state manages and administers its funds but within an overall federal guideline. For AL, states can use diversionary funding aspect of Medicaid to pay for AL. Many states do this routinely with a clear payment stream so there is a lot of participation by AL's throughout a state. Other states are more about using diversionary for other programs, which right now are focused on PACE and IHHS type of programs (CA is big on doing IHHS, while LA is moving into PACE to totally replace any AL payments). AL can be paid by Medicaid - depends on your state.

NJCinderalla - brings up a very important point…location, location, location. Making 100K & living in Mississippi puts one in the 5%, but in NYC that is poverty level to afford to live in Manhattan. For Medicaid, some states have the house value limit (to qualify) significantly higher @ 750K/850K to take into account property values on the coasts; while most states have the value set at 500K to qualify. In many areas, a mortgage of 3K - 4K a month is standard. Where I am in New Orleans, it's a sellers market as there just flat is no real inventory in the desired neighborhoods. Prices are high, homes that would have sold in 2009 for 300K are now 1M and that's about $ 3,700 a mo mortgage. Our lot sizes are going to be maybe 2K sq ft house on 4000 sq ft lot size/3,700 sq ft on 7000 sq ft lot size.
A 10,000 sq ft home with 2K mortgage would be a huge, very low-grade cheap home out in some remote area for where I'm at. Location makes a difference.

dragonflower - "what will we do with all the old people", well personally I like the Sol Roth approach (Soylent Green). The public policy issues the oncoming tsunami of baby boomers needing a facility will present is going to be not pretty in the US.
I'd put a case of Prosecco that: - the look back will be extended to 10 years & all states will outsource Medicaid applications (much like what states are doing for MERP with having HMS & PCG be the outside contractor), so it's going to be even harder & more documentation driven by the applicant to qualify. Current law allows for a 10 year look-back span but it's too unwieldily for state workers to do but not for the big data mining companies to do this; - Medicaid income limit will be really held back, so that for those boomers who are getting a nice SS & retirement check will never, ever qualify for Medicaid as they -even if a couple- make just too much retirement. For my mom, who died in her 90's, she got about 800 in SS as when dad worked it was in the 1950's- 1960's when wages were low, many at mom's NH that were her age got SS of only $ 500 a month; now a huge # of retirees get the 3K max allowed by SS as they worked in the 1980's - 2000's when wages were so much higher & they aren't going to qualify for Medicaid without doing a QIT or long term planning; if there isn't a real safety net for the aged available and once folks start realizing this, there will be no incentive to save if you going to end up in a shared room at a NH.

What I think the smarter $ is going to do is move out of the US to age but be someplace where its a plane ride back to Medicare paid for hospitals & health care. I see it every day where I live in New Orleans with the long existing program that Oschner Hospital (Brent House) has with Latin America. Houston & San Antonio health science centers have similar systems for those going back & forth from living in Mexico but come back for health care needs. Banks totally know how to deal with moving funds via swift/bic so there's little glitches with US income. Cost of living is so much lower in so many places that it can make total sense to live outside the US for those who can be multicultural even on a modest retirement. The undercurrent now in the US, to me, is that we are on the cusp of another "gilded age" where you are either truly wealthy (have $ whether or not you work) or you are poor & a tiny band of well educated upper middle class. It is not going to be pretty.

Dear Anoel - Maybe I misread your question. Are you asking Why costs are so high, or are you asking for Affordable options to those costs? I assume you aren't asking for a resolution to the problem of sky-rocketing LTC costs as that would take years and won't help your immediate situation.

I see parallels with other massive population shifts and issues in our nation's history, especially recent history. These shifts and phenomena occur before private and public sectors are prepared to deal with them on a broad basis - the private sector steps in with remedies that don't always benefit all parties involved. It's as if we're behind the curve on some changing phenomena that drastically impact citizens, business and the government.

Think of the returning Vets after the Vietnam war, and now from the "conflicts" - 2 major banks began to offer assistance and developed programs to integrate them into the work force; more attention is being given that aspect now. The VA is stepping up its efforts to identify at risk Vets. But there are still mental and physical health issues as well as employment issues. There are problems that are going to require participation and support from a lot of sectors.

In perspective, I think there have been so many changes in our society since the Civil War, through the Industrial Revolution and periodic wars and conflicts that the problems created by change exist before adequate solutions can be instituted. This is a broad stroke conclusion, but I think that might be what's happening with the growing older population and extended longevity.

We're still trying to figure out solutions that work for the families and caregivers and battle through the myriad problems that arise. I sometimes view it as wading through mud, sometimes finding a dry, solid spot, and other times wondering when we will, if ever, find solid ground on which new solutions can be created that are in fact cost effective and preserve the dignity, sanity, health and other aspects of all involved.

SamathaW:I want to know why the costs are so high. It does not make sense to me that people can been hard workers all of their lives, contributing to society and cannot afford to pay for their care as they age. All of us will end up on medicaid, I think this is a well kept secret in our government. I have not heard any politican, on either side, addressing this issue. I believe their is more money to be made on the sick and elderly, and so it goes. Mty father is a dialysis patient. The costs for dialysis are beyond belief, but the government pays for this. So, way isn't long-term care regulated. I know I do not want to have to share a room with someone I do not know, in my old age. College is one thing. Old and sick, is another. Sharing bathrooms, closets, noises, visitors, smells...etc think about it! Maybe AARP needs to have a lobby to address the growing need for standards in long-term care/nursing care.

Igloo572: I caught the Soylent Green reference and laughed out loud!!!!! A GREAT movie. My husband hand never seen it and was shocked at what really happens to the old people. I pray it never comes to that.

I feel like I opened up a bad wound. We are all having issues with this reality.I have not been able to read all of the responses yet, as my father has now moved to LTC and their is a lot of paperwork and people to consult with. He has a private room, but must go on medicaid. He is a WWII vet, has never been on assistance his entire life. It is in a much older building, built by a group of Catholic Sisters back in the 50's or 60's. It was a non-profit, but was recently bought out by a for profit company. I will keep you abreast of how things are going. I hope we continue this conversation. Hopefully, God willing, something positive will come out of it, that will benefit us all in the future.

Anoel - let us know how it goes. We all learn from each other.

For me, whether for-profit or nonprofit, did not seem to make a difference as the staffing costs are just there whatever way the facility is legally. How a building looks or its age does not seem to make a difference in quality of care. My mom's NH #2 was the least visually nice building but the level of care and continuity of staff was great. The DON (director of nursing and the goddess & ruler of all) and her two assistants had been there a decade plus as most of the other staff was too and there was maybe 1/3 of the RN were male (former military medics) - staff seemed to like working there.

You are going to have your work cut out to do the Medicaid paperwork. You also can do the VA for your dad - now since he is in a NH he can't get VA's Aid & Attendance (that only for when at home, IL or AL) but he can get the extra VA personal care stipend. I think it's $ 100. So he will have that and then whatever your state has set for it's PNA (personal needs allowance) from his income paid to the NH as his "spending money". One decision is whether you want these to go into a personal trust account at the NH (so the NH gets his monthly checks) OR that you have his income go into his bank account and you pay the facility his required copay (the SOC - share of cost) and therefore his bank account increases each month by the PNA and the VA stipend. Once you do this either way, it's hard to change back so think carefully about what system works best for you all. For me, I paid the facility as I live out of state and when I would come in the business office would likely be closed so it would be had to do withdrawals from mom's NH trust account, plus I'd rather be able to build up her PNA so I could do a bigger spending trip every 3 mos or so to replace clothing and lotions. Do what works best for you.

GardenArtist said it beautifully well, "I sometimes view it as wading through mud, sometimes finding a dry, solid spot, and other times wondering when we will, if ever, find solid ground on which new solutions can be created that are in fact cost effective...." There is a lot of mis-information out there (such as, Medicare pays for AL, no it does not), and many people confuse Medicare with Medicaid. The fact that some states pay AL and others do not is also confusing.

But the biggest "confuzzlement" seems to be the OP "why are the costs beyond what is affordable?" If I had it my way, a senior could simply move into this nice 1 BR asst living place in their same neighborhood, get 3 homecooked meals a day, and all the assistance they would ever need, until the day they died, AND it would cost exactly what they were paying before entering the asst living. But it just isn't that way.

Along with the sticker shock, and because of the immense fear associated with not having enough money to pay one's bills (some people do care about this, even these days) the natural routes to deal with this emotion is to get mad, get depressed, or get "smart" and call a lawyer to "make it" so that you somehow escape having to pay.

And then there are people who spent all their money, didn't save, and expect the government to put them next door to them in the nice AL, and there is quite a LOT of righteous indignation, among the middle classed, that your next door neighbor is getting that nice AL for free, when you sacrificed & scrimped to "do the right thing"?

Disagree, some people have to work in stressful situations that take a toll on their health. That's not something they can change even if they do "take good care of themselves before they get older."

My husband was a BSRN for 35 years. He now has Parkinsons. Should he be punished because he "didn't take good care of himself before he got sick and old?"

We are receiving nothing and looks like we never will. Savings are gone and I'm still working for the time being. Will quit if he needs me full-time.

No easy answers.

AmyGrace: Nothing is free, really. Those people who have taken advantage of the system, have given up their freedom. They also have given a bad name to the system that is theew to help the less fortunate. The scriptures say that "the poor will always be with us." But, their are scammers on every level of our society. For me, the scammers are the drug companies and for-profit businesses that make it unaffordable for the rest of us, who would pay, but at $8,000 a month,,,,who can?

malloryg8r: I know of one AL that accepts medicaid, only after you have lived there a year or more and paid the cash and are now out of cash. Seems like the right thing to do in that case.

I am still reading through all of your responses. Here's a thought. When the Presidential election rolls around, we should all go to the town halls or campaign meetings in our local communities and ask the question: What are you going to do about the high cost of Long-Term Care? If someone could phrase this better, please do. Who knows, with so many people asking this, in so many places all over the country, we might have an impact. My husband and I do not have any children, so we will be in the system, eventually. But, not every child takes care of the needs of their elderly parents. I have seen that in the eyes of the seniors who hardly ever get a visit from a family member, and look forward to seeing me, when I come to see about my father. I did not say "visit," I see my father everyday and everyone knows me and my husband. I applaud you all for being caring children for parents who can sometimes be difficult. God Bless You!

A Noel is totally right on-- there are always going to be poor/disabled/ hard luck cases who will merit the care of society's bounty, meaning each of us (ALL of us including the 60% who pay only 2% of taxes) ALL of us are morally obligated to provide for these unfortunate cases. The problem is there are too MANY who claim they're in these unfortunate circumstances. 35 yrs of RN salary is very good pay-- But If widely recommended financial planning (saving & LTC ins) was not done, the problem is not the cost of care, or society (which is too stretched thin providing for those who really could not have saved), or who could not qualify for LTC because of genetic anomaly. It's unfortunate to get Parkinson but everyone knows about that possibility, that's a terrible disease but that's why we all save and buy LTC. It is not "punishment" it is only what all of Life is like--we all have to pay our own way. If you do truly burn thru all your savings, there is Medicaid (and as CS you do get to keep your house car, and about $114,000 so you're not destitute). $500,000 or more of care (5-7 yrs of NH) can be affordable, with 35 years of saving on average $10,000 year and a modest LTC policy. But society having to pay that for a million Parkinson patients in NH for 5-7 years, is completely unaffordable.

Anoel, yes some states Medicaid will pay for AL, does anyone know if there was a list of which? That would be helpful. What we have is called Elderly Waiver in my state (it's welfare ) but for about 24 AL's I have visited, only 3 or 4 accepted it, and they required a complete (invasive) Financial Statement showing 3 yrs self-pay, before you would be accepted. That's about $180,000 or about the average cost of a home in US so that is not too much. Unless there is CS, who might want to stay in that home, but feel (like Daffodilgal ) immense pressure to sell that home just to pay spouse's bills. Yes this is a tough situation. But the general bad economy is a huge part of the problem--my parents bought a home in 1960's for maybe $20,000? And sold it 30 yrs later for over $200,000, and it covered dad's NH stay 6 yrs. OTOH, my home bought in 1995 for $140,000 is not going to be worth 1.4 million in 2025 (ROFL!). But even if it were, the cost of NH in 2025, five yr stay, is going to be beyond 1.4 million, at the current rate of increase. I'm no mathematician and have no crystal ball, but predict that whatever pain people feel in 2015, is going to be much worse in another 10 or 20 yrs. I totally expect the gov't will just start euthanizing the elderly, which will be the majority morality of the younger voters at that time. I hope I am wrong! But again, no crystal ball.

They are corporations for profit!They know there is BIG money in it or they wouldn't be in it. There will be a 70% increase in elder care in the next 10 years.There are other ways our goverment can help and subsidize care and costs but don't! Just like big Pharma why do Rx 's cost $2700 a month here but in Mexico or Europe $200 a month from the same company???It is what the market will bear. Until enough people complain and write your Congressman, President, Senators who all have great plans already set up ..it won't change and with technology/research we will keep living longer and longer and pad someone's pockets in the process...not ours....we need private small settings not big corporations. Think Habitat for Humanity.....they are able to fund housing at very reasonable prices for low income families, we could do the same with our senior population but it is all profit driven unless you are lucky enough to get into a church non profit NH center which most have several year wait lists because the families put their names on years ago. Agreed, something must change and become more efficent in the process! Our goverment has not had a good history of being a "thrifty shopper" or catching fraud that constitutes incredible losses.....why ?Not enough people...hire more.. plenty of people need jobs it's a vicious cycle. Best bet I hate to say is to live in another country where they care for their elders....we should model Denmark or Sweden but the US is too money driven."Denmark has taken the top spot on the United Nation's first ever World Happiness Report, followed by Finland, Norway and the Netherlands.
Published by Columbia University explains personal and national variations in happiness.The rankings in the report were based on a number called the "life evaluation score," a measurement which takes into account a variety of factors including people's health care, aging, family and job security,education, housing as well as social factors like political freedom and government corruption." It can be done, just not here apparently!

Denmark has extremely high taxes of 50 to 70% plus 25% sales tax.

AL and NH have become such a racket. My dad is 90 with mid-stage alzheimers. I'm 60, retired and have diabetes & hyperactive thyroid. My wonderful husband is soon 63 with his own health problems.

We are exhausted. We looked into moving dad and quickly realized that most want $1900-3500 per month with a roommate. Insurance usually won't cover cost. Dad has money, but not for long if he moves into one of these homes.