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> 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.

I think the actual cost is way, way, way less.



> 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.


I think most of us would legitimately meet the diagnostic criteria for clinical depression if we were trapped in one of those places.


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.


There's levels of care. Skilled nursing is among the highest.

A nice assisted living facility might be $8,000 a month.

A retirement community will be less yet.


You added an extra 0, $10,000/month x 20 years = $2,400,000. Still a lot of money however.


Medicaid pays for it if you can't afford it. You must spend down your assets first, before medicaid will pay.


You are confusing Medicare with Medicaid.


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.


> That's $24,000,000. It just doesn't add up, dude.

You've got an extra 10x in there. 20 years * 12 months * $10000 = $2.4 million


Medicaid


Do you think most citizens pay in that much tax in their lifetime? How do you imagine this is adding up?


This is why people call it a pyramid scheme.

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.


If we spent the same money supporting family educational choice and preferred elderly in-home care, I suspect we'd be ahead of where we are.

Obviously, some people will need school and care that family can't give, and I'm not against paying for it.

But these policies encourage assets to be wasted so that you can get in the safety net.


wouldn't that lead to a lot of job losses in the nursing homes / facilities sectors?


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.


Only a small percentage of people end up in a skilled nursing facility, of these the typical stay is almost always less than 2 years.

The numbers add up in bulk. It's a safety net that not everyone falls into.


> Do you think most citizens pay in that much tax in their lifetime?

For a fraction of them to need long-term care at some level, mostly not the nursing level, for on average around 2-3 years? Yes, easily.


It doesn’t, which is why benefits are the biggest portion of US government spending.

https://www.thebalance.com/u-s-federal-budget-breakdown-3305...

>Mandatory expenditures, such as Social Security, Medicare, and the Supplemental Nutrition Assistance Program account for about 60% of the budget.

Technically Medicaid is from state governments or at least some portion of it, but it probably looks the same there.


Which will pay for 2/3rds of it, and cause your social security payment to drop substantially




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