Escape From the Nursing Home (Only Federal Government Can Afford NH Care)

New York Times ^ | 17 January 2007 | IRA ROSOFSKY

[shrinkermd]

...Seventy-five thousand dollars is the average yearly cost of living in a nursing home, whether you pay out of pocket, whether you have long-term-care insurance, or whether you’re on welfare and your stay is paid for by Medicaid. (In 2005, Medicaid paid an estimated $54 billion of the $122 billion national expenditure on nursing homes.)

Few elderly people or their families make a deliberate, considered decision to move to a nursing home. More often, institutionalization follows an accident or sudden illness. The broken hip is a typical trigger. First the patient goes to the hospital, and then to the nursing home for rehab. A nursing home works well for short-term recovery. But for long-term care, couldn’t we imagine a better way to spend that $75,000?

What about simply staying home and paying for the needed medical services à la carte? That would be expensive. The average charge for a health aide is $19 per hour. So to keep someone with you around the clock for a year would cost at least $166,000, more than double your $75,000.

But three frail elderly people could share an apartment and a 24-hour aide and, by pooling the cost, have more than $58,000 left over among them for food, clothing, shelter, physical therapy and even fun and frolic.

In many cases, a nursing home offers services far beyond what a patient needs. Many people need only a little help — someone to dispense their medicines, prepare their meals and help them get in and out of bed. Others might need 24-hour care, but not a nursing home.

[shrinkermd]

This is a problem exacerbated by people living longer, deterioratin of the extended family and the lack of alternative resources other than the government.

What to do is not a matter of one line slogans or one line thinking.

[dawn53]

My MIL lived with us until she couldn't be left alone (at this point she was in her late 80's.)

Then we opted for an assisted living facility...but they are pricey.

When her health failed dramatically, she was hospitalized and then transferred to a nursing home/rehab center. But because she could not be "rehabilitated," medicare would not pay, so we ended up footing the bill (if I recall, the charges were around $5000 per month.) She did not live long after that as her heath continued to decline.

I don't know how long we could have kept up the $5000 per month, and yet, she was too sick to be cared for at home, and not sick enough to be hospitalized.

Healthcare and its costs at the end of one's life is a major problem that needs to be addressed. You can be willing to keep the person at home, but logistically that can be impossible, and around the clock nursing care is prohibitive in cost.

[iowamark]

Seventy-five thousand dollars is the average yearly cost of living in a nursing home

$75000 per year/$205 per day is the average cost of a nursing home?

[neb52]

We use to have a customer that is a chain of nursing homes. They are mostly in rural towns. They charge $3,000 a month to non Medicaid and I think Medicaid paid out $2,000. The non Medicaid were paying more to cover the difference. I think the real cost was $2,500 a month. The nursing staff are specialist so they get paid more than most other RNs. We lost them as a customer because they had racked up a debt of $60,000 and starting complaining about our service(go figure) and changed IT services. They always have problems paying on time and that comes from other vendors not just us. The new IT guy called not to shortly asking us what he got himself into. Haha!

[neb52]

Its a New York paper, so up ther it may cost that much.

[GeorgefromGeorgia]

My Wife and I took in my Mother-in-Law who had Altheimers for two dreadful years. We finally had to put her in a NH after we couldn't handle her care, she died within 5 months. I just put my 80 year old Mom into assisted living. We have sold her car, much of her furniture and house. She has not adjusted to losing her independence. Her medical condition is COPD due to smoking from age 18-72. Now she is spending 40K per year on the assisting living. Her long term care policy doesn't pay because she can still bathe, feed and generally care for herself. Her doctor advised us that she could not live alone any more, yet she is not yet at the state of drooling and pooping in her pants. Having to deal with elderly parents is one of the most difficult things that my Wife and I have had to deal with. I offered my Mom to come and live with us, but she still wants some independence in the city where she has lived for the last 40 years.
One thing that I have learned is that medical decision are frequently made based on what Medicare will pay. No wonder we have a huge shortfall coming up with boomers like me getting old.
I sincerely hope that I can avoid living through the state of old age where what I have to look forward to is four walls, diapers, drooling and no short term memory.

[mr_hammer]

Yes sir, my Great Grandma is 92 and lives in a home that charges approx. $6000.00 a month. Phone usage is extra, no kidding!

[MrLee]

"Hope I die before I get old"! Really!!

[dawn53]

I agree, dealing with elderly parent's health issues can be very stressful. Both my in-laws have died, but my parents health for the past few years has been deteriorating.

My dad had a stroke, and thankfully, we were able to do his reahab at my sister's home instead of a rehab facility. She had an extra room and medicare was more than happy to pay for in-home therapists as long as somebody would be with him 24/7. Between my sister and I, our hubbies and our kids, we knew we could make that happen.

We did have to pick up the cost of renting a hospital bed (Medicare paid for stroke aids like commode seat, walker, etc., but didn't feel he needed a hospital bed, and we thought he did.) Rehabing at my sister's home saved us endless trips to a rehab facility, and we knew he'd get better care. We all live in the same neighborhood. That was a blessing too because my mom would come over and visit during the day and our teenagers would take turns staying overnight with her, as she has health problems of her own.

Thankfully, he almost fully recovered from the stroke in a short time and was back at home within a month of being released from the hospital.

As to avoiding that stage ourselves, here's to hoping, but it seems more medical advances mean longer life, and longer life creates more end of life issues.

[Dudoight]

Buy a good Long Term Care policy by the time you are 50-55 and still in good health so you can qualify. If you buy it at that time, you will have paid in, over a 20-25 year period, MUCH less than what a year in a nursing home would cost.

I have had my policy for several years. I will be a burden on no one, not even the government.

[M. Dodge Thomas]

Who takes care of the hiring and supervision of the caretakers of those two or three seniors, does all the paperwork, attends the doctors appointments, deals with the landlord when the toilet leaks, etc, etc, etc.? Been there - done that – twice - and it is often a 20+ hour a week job to keep things running even if someone else is “doing all the work.

[DogBarkTree]

My MIL is in a nursing home that cost 9,000 per month total. Its not even that nice of a nursing home either.

[surrey]

We just went through this with my FIL. Within the year, he went from an Independent Living facility ,in Georgia, to Assisted Living to a Nursing Home here in MA. With each move the cost increased. At the Nursing Home they determined he was not on a road to recovery so Medicare stopped.
He has a house on Long Island worth about $500,000 but it won't sell. It's his only asset. We learned that if he applies for Medicaid they will determine when we need to reduce the price and by how much. We decided to foot the bill ourselves but he died in Nov.
Now my 89 year old Mom has decided she wants to leave her home and go into an Assisted Living facility. She can well afford it but is reluctant because she wants her grandchildren to inherit her estate. She refuses to live with us so she changes her mind every day.

[dawn53]

Now my 89 year old Mom has decided she wants to leave her home and go into an Assisted Living facility. She can well afford it but is reluctant because she wants her grandchildren to inherit her estate. She refuses to live with us so she changes her mind every day

We contacted an Elder Affairs Attorney and he was very helpful in determining what kind of financial arrangements could/should be made, making sure we had proper advance directives, Health Care Surrogate, and POA documentation. His advice was well worth the money we paid him.

[MRobert]

I find that interesting. We placed my FIL in an Alzheimer's lockdown unit about 15 miles from our residence when he was constantly wandering away and getting lost. Since that time his health has deteriorated and we mentioned we may move him to a regular nursing home closer to us. The nursing staff begged us not to move him as they are so fond of him and would miss him.

We are paying for his care from his savings and income at a rate of about $3,900 per month. The regular nursing home would be cheaper and closer to us. I wondered why the lockdown unit personnel were so adamant about not moving him and now I think I have the answer.

[GeorgefromGeorgia]

I have been through caring for my Mother-in-Law(Altheimers-now deceased) and Mother(in assisted living). The relationship reverses, and you become like the parent caring for the child. Elderly parents don't always adjust to that change. Just when I think that my Wife and I have been through the ropes with our parents, I hear about cases that are even worse. I have a friend who's Mom has been in a nursing home, virtually in a coma for 8 years. They don't want to pull the plug. I don't understand why. Her life is over. I guess that I should be grateful that I don't have to make that decision. It does pay to have a living will.

[Gritty]

I see euthanasia coming soon.

The next generation is not going to put up with all the oldsters (everyone else's, of course) cramping their lifestyles and multiplying their taxes.

[surrey]

When my FIL went into the hospital for the final time our family Dr., and personal friend, took my husband aside and laid out the facts. He was intubated and there was no hope of recovery. He suggested,strongly, that my husband put him on some oxygen and let nature take it's course. A tough decision but it took nature 40 minutes.

[Marysecretary]

I tried to get insurance for nursing home care and couldn't because I'm diabetic. Now, if sick people can't get insurance, that kinda makes it tough for just about anyone to get in, doesn't it? What a crock. I hate insurance companies.

[Marysecretary]

I had a nursing home ministry with several folks. We would go in and sing and visit. They loved us. But I saw a lot of the drooling and pooping kinds of things. Some of the homes stunk to high heaven with pee. I hope I die before I have to go into one but the one that's closest to us isn't too bad a place. They do a lot for their patients and I've yet to smell pissy people there. IF I had to go, that would be the place. But I really don't want to!