Long-term care is expensive. By expensive, I mean break-the-bank expensive. As people begin to live longer, they don’t always live well longer. Medical science can keep people alive long after they are no longer able to function. The lack of affordable long-term care is a problem that has no easy solution.
The nursing home referral agency, A Place for Mom, pegs the median cost per month for a private room in a nursing home at $9,034. I have a family member in an assisted living facility where the cost is about $11,000 a month. It’s not easy to shop around. If you go online looking for nursing home prices and dial what you think is a local assisted living facility the call often goes to a referral agency. They inform you they represent numerous nursing homes and create a file on your loved one. They assure you it’s a free service, paid for by nursing homes. Referral agencies earn about equal to one month’s fees for each referral. If your family member can afford to pay cash, they are a much sought after client. There are hedge funds, private equity investors and real estate investment trusts who own nursing homes. They want your money. If you say your family member is broke and needs long term care paid for by Medicaid, few agencies want to talk to you and fewer nursing homes want your family member. They generally direct you to the state Medicaid agency. If you do manage to talk to an actual nursing home, you quickly find they rarely have enough staff to answer your questions. They often say they have little availability, especially if you’re not a cash-pay client. It’s a growing problem that will only get worse with time.
The New York Times reported on the skyrocketing cost of elder care. In less than 30 years the number of Americans over age 65 will increase 50% to 86 million. Of those, Americans over age 85 will triple to 19 million. There aren’t enough nursing homes to care for them, or enough money to pay for all who will need them.
Sheila Littleton, 30, brought her grandfather with dementia to her family home in Houston, then spent months fruitlessly trying to place him in a nursing home with Medicaid coverage. She eventually abandoned him at a psychiatric hospital to force the system to act.
The United States has no coherent system of long term care for those who are unable to care for themselves. About two-thirds of long term is paid for by Medicaid. However, states and the federal government cannot afford to expand long term care to accommodate all who will need it. Few families can afford $100,000 a year to place a family member in assisted living. Few private investors are willing to build facilities that rely on Medicaid funding. Even in situations where family members can take care of aging parents, the price is often at the cost of their own livelihood.
Feylyn Lewis, 35, sacrificed a promising career as a research director in England to return home to Nashville after her mother had a debilitating stroke. They ran up $15,000 in medical and credit card debt while she took on the role of caretaker.
Sometimes an elderly mother or father just needs help with daily activities, such as shopping, food preparation and laundry. Yet, at some point their physical needs overwhelm their caregivers and require full-time professional care. To qualify for Medicaid seniors must exhaust their assets (which makes sense considering Medicaid should not be in the business of protecting inheritance). Where I grew up some rural counties owned and managed nursing homes for local residents. I doubt if that is sustainable as younger people move away to cities and older, poorer people are mostly all who remain.
A few years ago, The New York Times ran an article that suggested three seniors living together could hire around the clock caregivers cheaper than nursing home care. About the same time, I toured some NORCs in Queens, New York. NORC stands for naturally occurring retirement community. They were basically post World War II communities that came together to help seniors stay in their own homes longer. It was a good idea but not likely something most other communities could duplicate.
The need for elder care is a struggle that many families are ill prepared to meet. Women bear the brunt of care giving and women are who long-term care is mostly provided for. If you go into a nursing home, it’s 75% women. Labor is another issue. Few people want a job working in a nursing home. It will take a lot of outside-the-box thinking to alleviate the shortage of long-term care. I suspect most of the solutions will be painful for all those involved.
Read more at The New York Times: