> 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.
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.