Elder care costs keep climbing; nursing home bill now $91K

[Omaha Steve]

Source: AP-Excite

By MATTHEW CRAFT

NEW YORK (AP) — The steep cost of caring for the elderly continues to climb. The median bill for a private room in a nursing home is now $91,250 a year, according to an industry survey out Thursday.

The annual "Cost of Care" report from Genworth Financial tracks the staggering rise in expenses for long-term care, a growing financial burden for families, governments and insurers like Genworth. The cost of staying in a nursing home has increased 4 percent every year over the last five years, the report says. Last year, the median bill was $87,600.

"Most people don't realize how expensive this care can be until a parent or family member needs it," said Joe Caldwell, director of long-term services at the National Council on Aging. "And then it's a real shock."

The annual report from Genworth, which sells policies to cover long-term care, looks at costs for a variety of services, including adult daycare, and home health aides. And nursing home bills are rising at the fastest pace, twice the rate of U.S. inflation over the last five years. One year in a nursing home now costs nearly as much as three years of tuition at a private college.

FULL story at link.



FILE - In this Feb. 28, 2013, file photo, Tina Reese leads a word game for residents at a nursing home in Lancaster, Pa. The cost of staying in a nursing home has increased 4 percent every year over the last five years, according to Genworth Financial's annual {201c}Cost of Care{201d} report, released Thursday, April 9, 2015. Last year, the median bill was $87,600. (AP Photo/Intelligencer Journal, Dan Marschka, File)

Read more: http://apnews.excite.com/article/20150409/us-cost-of-aging-7bbe0d4686.html

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I retired early last November for health reasons. I turned 58 in January. On average I'll be needing more care than Marta can provide in about 3 years.

[yeoman6987]

1. Private room.

That says it all right there.

[pnwmom]

6. Private rooms turn out to be important for infection control as well as

Last edited Fri Apr 10, 2015, 12:54 AM - Edit history (1)

for respecting the dignity of the elderly person.

Research has shown that building nursing homes with private rooms saves on infection control costs in just a few years. They should all be built that way.

[yeoman6987]

8. I understand that but if that is the case, of course the costs are going to be more.

91 thousand probably is what it takes to have a private room. That is about right as I know a few that pay 8,000 a month which is 96,000 so maybe 91 thousand is ok. I don't know. 24 hour care is not cheap.

[pnwmom]

9. The initial cost is more, but after a few years the cost of building a private room

is made up for in savings on infection control.

It is still extremely expensive, but private rooms save money for the nursing home in the long run.

[yeoman6987]

10. Sounds like a great idea. I didn't realize that infections were a problem

Definitely if they are which I believe they are then for sure private rooms are best. I am torn on private room for myself if I ever end up in a nursing home. I do like my privacy but I think having a roomie might be fun too....depending on circumstances of course.

[pnwmom]

12. Infections are a significant problem. Conflict among residents is also an often unacknowledged problem

and conflicts are reduced by giving everyone their own private space. When residents with single rooms ARE together, they actually interact more than people who have no private room to retreat to as needed.

http://www.edra.org/sites/default/files/publications/EDRA38-Calkins_1.pdf

[notadmblnd]

27. My sister takes care of a dementia patient 24/7/365, she lives in

does the cooking, cleaning of the house including the yard work. She does the feeding, lifting (getting patient in and out of bed), along with bathing, dressing and changing of diapers. She earns 1800 dollars a month. Of course she does not pay the household bills, the lady's family does that.

I really don't understand why it should cost 91k annually to take care of elderly people in nursing homes. It seems to me it should cost less.

[yeoman6987]

29. I honestly don't know why it costs so much

I haven't has a relative in a nursing home
My one set of grandparents died at 79 and 72
My other set died at 79 and 83
My parents died at 44 and 68

So although they never lived in a nursing home, I wasn't lucky to have them around a very long time either. I was 20 when I had 4 grandparent and 2 parents. At 30 just Mom was left and at my age of 44, my Mom died. Sucks!!!!!

[forthemiddle]

33. I do not know about exclusively "private pay" nursing homes

But I do know the ones I am aware of in our area have a mix of private pay and Medical Assistance.
Part of the problem is that MA does not pay enough to cover all care, so the private pay patients make up the difference. This is very similar to Medicare vs Private insurance, vs no insurance.
Medicare pays the least, then private insurance with their contracted amounts, then self pay payors that end up being the only people that pay the full amount.

[qwlauren35]

42. 24 hour care... it's not really.

The ratio of staff-to-patient shows that it's more like 24 hour "on-call", but not care. No one is turning these people every hour, no one is engaging these people constantly, no one is with these people all the time.

My uncle had "care". Someone sat beside him for 8 hours a day. And someone stayed up all night to make sure he didn't do anything dangerous in the middle of the night.

I never asked what it cost. The care-giver was not a nurse. But the number of nurses in a nursing home is probably very low.

To me, nursing homes are a scam, and I'm really glad to see more and more alternatives.

[haikugal]

13. Very important for infection control...

I'm ill and I've decided that I can't afford anything other than possibly having someone come in to help now and then. I worry about my son and being a burden on him financially and emotionally. This is why they will allow us to choose to die in my view. The poor won't have a choice. The rich have everything available.

I really don't want to go to one of those places...I've seen them and no thanks. If it comes to that I'll opt out, just my thoughts on the subject.

[pnwmom]

17. My mother is happier in her new home than she's been in years.

I don't know where you live, but if you ever decide to look, this is the kind of nursing home you should look for. My mother's in a home like this and we are so grateful.

http://thegreenhouseproject.org/green-house-model

[hibbing]

18. My mom moved to assisted living

My father recently died and my mom moved to assisted living. She does not need a lot of help right now, but she seems to be doing okay. She has a nice little apartment. Meals are provided and activities. Luckily, my parents had long term care insurance. Her apartment is almost 5K a month.

Peace

[pnwmom]

19. My mother-in-law lived in a nice assisted living place

until the end. When she was in hospice, they let her hire outside aides to come in and provide the 24 hr. skilled care that she needed.

I'm glad your parents have good insurance. That gives them options.

In the case of my mother, she had broken her second hip and was in a wheelchair and she needed more care than the assisted living places near her would provide. But she found a nursing home that was better for her, anyway. And they've got her up and walking again, so it's been amazing.

[Larry Engels]

43. Thanks for pointing this out.

My mom was in a nursing home in the 1990s, and the bill was $36K per year. I thought that was expensive--prohibitive for a lot of people. When I signed her up, I asked about a private room and the director told me that I didn't even want to know about how much that costs.

[Pharaoh]

2. for profit healthcare AKA Captalism

verses socialism,AKA medicare,

so regulating eldercare, insurance companys and drug companys to a reasonable fixed profit margin, would fix most of our problems.Do you realize what the profits are on most drugs? Astronomical!!

[yeoman6987]

11. As you can see below

Most of the costs are picked up by Medicaid which is a form of socialism which we prefer.

[valerief]

28. Regulations? Isn't that like communism?

[former9thward]

36. Medicare has nothing to do with socialism.

State medical insurance was invented by the Iron Chancellor of Germany, Otto Bismarck, in the 1880s. He was a bitter opponent of socialism.

[qwlauren35]

3. More and more alternatives to nursing homes.

As we age, it's important to research these things for ourselves and our elders. Assisted living may be a cheaper alternative to a nursing home, and many elders prefer it.

There are also now small "group homes" for elders and these are also less expensive. Maybe $3000 a month, which sounds high, but is still less than a nursing home.

As for the comment about a private room, being old and infirm does not remove the desire for privacy. In fact, it increases it. No one with complete faculties but an ailing body is going to want another person in the room during the most personal aspects of care.

[dhol82]

4. Medicare pays for 180 days of nursing home care

That's it. Then you use up your savings. Then you can go on Medicaid - if there is any left by the time you get there and depending on your state. Then you have to make sure the facility takes Medicaid.

I was lucky. My mom was only in a nursing facility for one year. $6000/month in 2007. She had enough saved to carry her through. It was a wonderful facility that treated her very well, but I would not have been able to get her accepted to this place if she had not been self-pay.

[forthemiddle]

34. Medicare only pays that 180 days IF you have a chance of rehab.

So if you need to go to a nursing home because you broke your hip, or had a stroke, they will pay for 180 days of rehab, not for "long term, or end of life" care.
You must be admitted directly from hospital care for this, if however you just need constant care for the rest of your life (example dementia patients) they will not cover that. Then you have to go into the "spend down" and liquidate your assets to under $2000.00 and then Medical Assistance will take over.
If you are end of life, and on hospice then you may qualify for the nursing care through Medicare, but you will still have the residential fee that you will have to self pay.

[dhol82]

37. Thanks for that explanation

My mother was already pretty much gone mentally when she went into the nursing home. They listed her as being able to be rehabbed to get that 180 days.

That's probably rather common.

Her psychiatrist kept doing weekly visits up until her death even though she was totally gone for at least 5 months before she finally died. Medicare kept paying.

[forthemiddle]

38. Yes that's the way they usually do it

My Mother also had probably no chance of rehab, but the doctors also agreed to the rehab possibility until she finally went on hospice.

When it came to my Dad, there was no way he could be rehabed (respiratory failure) yet Medicare deemed he was no longer eligible to stay in the hospital so we had to make the decision to put him in the nursing home as a private pay patient. Because he was hospice the nursing care would have been paid but not the residential portion.
The night before he was to be transferred he died in his sleep so it wasn't a problem for us.

[jwirr]

5. Steve, does your state have in home health care? A lot of that is happening here in MN lately. My

granddaughter is an RN and she is actually a private duty nurse for a little child in her own home.

When I was working at Social Services we were just starting to develop plans for in home care because our administration told us that when the baby boomers retired we would either need to build a great many more nursing homes or find ways to keep retirees home longer. I have used it for taking care of my disabled daughter and now a little bit already for myself. It can be a good thing. And even back then we knew that it was cheaper than a nursing home.

[Omaha Steve]

15. Yes it does

My healthcare is locked in by my union contract. It covers 60 days a year for nursing home. But in home is covered. I will still need more than home care in about 3 years.

I've said several times on the DU I'm terminal and going out on my terms long before hospice.

OS

[jwirr]

24. Yes. Just wanted you to know that there is some good care in the mean time.

[enough]

22. If you need 24-hour care, in-home care can end up costing more than a nursing home,

even though many of those care workers are getting paid very little.

Many frail elderly and especially dementia sufferers need someone there all the time.

[RobinA]

23. Getting Paid

very little with little to no training. I think home care is a great idea theoretically, but in practice in my observation it leaves quite a lot to be desired. Intuitively (to me, anyway), good home care should be more expensive than nursing home care, because you don't have economies of scale. For example, the physical therapist must drive from house to house instead of walking from room to room, thus spending much less time doing therapy. That is, if home care includes physical therapy, a big "if" in my experience. Home care is cheaper for a reason.

[jwirr]

26. I have not seen that but then in MN home care does not mean that you do not go to the doctors or

other specialists like PT for their services. Home care means that you have nursing care to stay in the home as long as you can. That nursing care is usually not an RN but then I do not think the one to one care in a nursing home is either. They still higher LPNs and nurses aides. As to not training that probably depends on the state you live in. Ours are required to take training.

[RobinA]

40. Maybe It Is Better

in your state. I live in PA. My mother (85) has a friend (85) with an advanced neurological movement disorder. She has home care living with her. The home care lady is very nice, cooks and makes sure my mother's friend doesn't fall on her face, dresses, tends to hygiene, etc. She has no education and rudimentary training (as little as they can get away with). She doesn't drive. Until recently, my mother took her friend to some appointments but this has stopped because my mother can't lift the wheel chair into the car anymore. Not sure who will be doing this going forward. The friend has a doctor for her condition who prescribes medication but that's about it. She receives no physical therapy and there is no one who sees her who knows anything about adaptive equipment for her rather common condition that might help her have an easier time of life. Her mind is sharp as a tack. She lies all day in front of the TV in her home while the home care lady knits and takes her to the bathroom. This situation is her choice, so fine. She's a cheap elder because she doesn't know what she is not getting. Were it my mother or sister in this situation I would be rocking some boats.

[jwirr]

46. Definitely boats need to be rocked in that situation. Medicare usually can provide wheel chair

accessible transportation for starters. And her doctor should be prescribing PT also as it is also paid for by Medicare. My guess is she thinks that she is not eligible for many of the things she needs. Many elderly are not aware of what is available and many also think that Medicare comes after your estate when you die. Not true - they do come after it if the program is Medcaid. I am actually surprised that Medicare pays for a live-in. We never did that. But maybe she is paying for it herself.

[RobinA]

48. She's Probably

paying for it herself. I do think she isn't aware of what she should be getting as well as what she could afford, but without the staff that a nursing home would provide to help her... Hence, one of my many problems with home care.

[jwirr]

25. Yes, the little child my grand daughter cares for is one of those. Her mother takes her shift but

she has 24 hour care of a RN. Very expensive but no other real place for a child.

[No Vested Interest]

45. True that in-home care can cost more than a nursing facility, and

there may not be the equipment and oversight needed to properly care for the patient. Many patients are hard or impossible for an aide to handle or lift, either because of weight or, even if not heavy, patient can become like dead weight or become anxious or agitated when being moved or transferred. A nursing facility has a device called a Hoyer lift which enables a patient to be moved/lifted to and from a bed, a chair, a shower, etc. Aides cannot/should not risk injuring themselves lifting certain patients.

Also, unless you have the same person/people regularly, it can be a pain/burden to receive and give direction to new and different aides on a daily or frequent basis. I'm speaking of orienting new people to the patient and his/her needs and preferences, as well as orienting them to the household into which they've come.

[pnwmom]

7. That's for people paying full freight. Just like with college students, many residents

get financial aid -- in this case, Medicaid. Medicaid pays its allowed amount to nursing homes, which is considerably lower.

http://www.payingforseniorcare.com/longtermcare/paying-for-nursing-homes.html#cost-table

Medicaid and Nursing Homes

Medicaid through its state affiliates is the largest single payer for nursing home care. While estimates vary it is safe to say that Medicaid pays at least 40% of the total nursing home costs in the United States. While on the surface, this may sound encouraging for families whose loved one requires nursing home care, it is important to be aware that Medicaid is a means-tested program, meaning that the applicant's income and financial assets are closely analyzed prior to acceptance into the program. Persons must meet strict financial guidelines in order to qualify. However, should an individual qualify, Medicaid will pay for 100% of their nursing home costs at a Medicaid approved skilled nursing facility.

Medicaid's eligibility requirements vary depending on the age, marital status and state of residence of the applicant. A rule of thumb for financial eligibility is the $2,000 / $2,000 rule. The applicant's monthly income cannot be greater than $2,163 and the value of their financial resources cannot be greater than $2,000. However, they are many exceptions to these rules. Certain resources, such as one's home, are considered exempt from counting, other resources can be allocated to a non-applicant spouse. There are similar exceptions made for the applicant's income. Learn more about Medicaid eligibility or find assistance qualifying for Medicaid.

[Frances]

14. My advice: Visit a nursing home where the patients are on medicaid

It is an eye opener.

[pnwmom]

16. Most of them suck. But my mother's is wonderful. So I know it's possible -- though much too rare.

All the rooms are private and have private bathrooms. There are two "elder assistants" caring for 10 elders, in addition to specialized staff (physical therapists, etc.) Yet, for Medicaid eligible patients, they take the standard payment Medicaid pays any nursing home. (About 70% of the residents are on Medicaid) They ARE very expensive for people who still have money. But they are a nonprofit so they aren't trying to make money at the expense of the elderly residents.

My mother will most likely use up all her money living there, and it will be worth it. Because of Medicaid, we won't have to worry about what happens to her when she runs out, and she's happier since she moved in than she'd been in years.

All over the country there are people starting up nursing homes based on this smaller, elder-centered model. And they are working. Here is a website with more info.

http://thegreenhouseproject.org/green-house-model

P.S. The interactive map on the site is incomplete. I personally know of at least half a dozen that aren't on the map, so I don't know how many others might have been left off. So anyone searching for a good place should not stop with this list. But at least the site shows what to aim for.

[No Vested Interest]

21. There are attorneys who advise clients on how to protect

assets legally so that they will qualify for Medicaid, and supposedly have something to leave for their families.

I have to wonder if they tell the clients that Medicaid will take all of their Social Security payment, except for $40, which the person has for personal expenses - clothing, hairdo and cuts, personal and sanitary products, etc. (hat was the amount a few yeas ago when a relative was in a Medicaid facility.)

I'll admit the family was decent enough, though the relative had to spend her last years sharing a room with someone she would not have chosen. Family paid for some of her extras - a phone, hair cuts, and her brother and I sent a modest check monthly.

My personal opinion is that these attorneys who advocate impoverishing oneself to qualify for Medicaid are not only doing the client a disservice, but are helping the client skirt the intent of the law and thereby cheating the balance of the American population who are paying the unnecessary cost. If a person has the funds to pay for nursing care, that's what the money was earned and saved for, not for the inheritance of children and others. I do not include the spouse, as I believe the spouse should be protected and not left impoverished by the illness of the patient.

[qwlauren35]

44. When I volunteered for hospice, this was discussed.

And it really was to protect the spouse, not the inheriting children.

To use up all of the money on the first spouse and leave the second spouse destitute is a horrific thing, and understandable to be avoided if at all possible.

[Skittles]

20. well of course, just in time for the tsunami of old folk

can't miss that financial opportunity

[dembotoz]

30. walkers wisconsin is growing more aggressive in recovering every penny they can

going thru probate right now for my mom's estate


"lucky" for us she died quickly

[leftyladyfrommo]

31. I'm going to have to find a comfortable ice flow

and float away into the sunset.

[Paper Roses]

35. Care for company? I worry about care if I am too old to take care of myself.

With the price of elder care, I could stay in a hotel for less.

If I ever get to the stage where I need a home, I hope I have enough clear thought left to take the accumulation of pills that I have set aside. I worked all my life for what I have and do not want what little I have left for my kids to go to some bureaucracy who may do nothing for me but change my clothes and give me jello several times a day. It is not worth it.

Who says we have to live in a home just because we are old! This is a crap idea and thought need to be given to those of us who want no care. I'd rather drift off into the sunset on my couch.

[Vinca]

47. I was about to write nearly the exact thing.

The idea of ending up in a nursing home scares me to death and it's got nothing to do with money. I only hope if the time comes I have my wits about me so I can end it all.

[One_Life_To_Give]

32. Is that what Medicaid Pays?

Since many people in Nursing Homes end up having Medicaid pay for it. Is that what Medicaid Pays? Or is that what they charge people to help subsidize what medicaid pays?

Listening to all the advertisements for setting up trusts to avoid paying nursing home fees. I wonder who really benefits and who is paying the real costs for all this.

[madville]

39. Been going through all this with my 92 yo gma

The facility she is currently looking at is $7,000 a month for the nursing home. Assisted living is about $4,000 a month.

She has a couple hundred grand left outside the trust that can carry her a few years, it's nuts though.

She's still in her own house though, I do all her shopping, drive her around and stay a couple of nights a week but she'll probably need more help in the near future.

She says she would rather die than go to some of the dumps her friends have landed in, I don't blame her, those places are miserable.

[ProudProg2u]

41. So, much like the corrupt medical system ..

in the US the elder care cost for a single aspirin has gone up from $35.00 to $55.00...???