> putting someone in a skilled nursing facility costs about 10,000/month nominally
Who on earth is able to afford this?
Everywhere I look there are nursing homes full of ordinary people. I can't believe more than 0.1% of these people are literally able to afford $10,000/month. People live in those places for 20 years sometimes. That's $24,000,000. It just doesn't add up, dude.
> Everywhere I look there are nursing homes full of ordinary people. I can't believe more than 0.1% of these people are literally able to afford $10,000/month.
A substantial majority of nursing home patients in the US are paid for by Medicaid; people who have assets often shed them to qualify for Medicaid if they need nursing care.
> People live in those places for 20 years sometimes
IIRC, the average length of long-term care stay is a more like 2 years, with a fairly small fraction over 5 years. And I would think the longer stays tend to be skewed toward assisted living (which is significantly less expensive), not nursing homes.
I have seen financials for a number of nursing homes owned by friends. They get paid by Medicare for short term rehab in their facility and the rate is about $400/day. The majority of the people are long term on Medicaid and the reimbursement is between $120-200 per day depending on case difficulty. There are certain games they play to increase the reimbursement such as getting most of the patients diagnosed with depression. I have heard zingers such as “there is a very fine line between optimizing patient care and Medicaid fraud”. At Medicaid rates the only way it works is if the people providing the care make about $10/hr. All the good caregivers tend to work at the best run facilities, so quality tends to be bimodal.
Here in Germany such facilities will cost around 1500-3000 EUR per month. This is still way more money then most people can stem, so they pay this typically with a combination of
* pension and social security (nursing case security)
* income of the children
* sale of real estate and other property of the invalid person
Yes, nursing facilities are damned expansive. But 10,000 USD/month, that's something almost nobody would be able to pay here.
you have to spend down for Medicaid/Medical -- but Medicare does not look at your assets. Medicare will only cover short term skilled nursing after a hospitalization. Medicaid beds exist for long term skilled nursing.
The breakdown of single-earner families means kids and seniors get institutional care. And there isn’t enough money to socialize care as good as your family.
> The breakdown of single-earner families means kids and seniors get institutional care. And there isn’t enough money to socialize care as good as your family.
I guess we'd save a lot of money if we just had family structures more like people in asian countries.
Yeah. It isn't worth people making bad decisions to support other people's jobs. A key part of what makes a job a job is the worker, in some sense, creating more value for others than the personal cost to themselves.
If people are better off doing something for themselves, then it is a net win if they do. The nursing home employees can go and do something else.
> what makes a job a job is the worker, in some sense, creating more value for others than the personal cost to themselves.
"in some sense" really means in a collective sense. Not everyone falls into the safety net, but those that do certainly could exceed, in expenses, what they paid into the system. That's OK and totally fair.
Who on earth is able to afford this?
Everywhere I look there are nursing homes full of ordinary people. I can't believe more than 0.1% of these people are literally able to afford $10,000/month. People live in those places for 20 years sometimes. That's $24,000,000. It just doesn't add up, dude.
I think the actual cost is way, way, way less.