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By industry, I hope the following helps explain how our system works, by how it applies to my mum. I’d be interested in how it is similar/different in the US.
Mum is 91, and ordinarily would be entitled to an aged pension.
Mum is means tested. That is, her assets and income are scrutinised by Centrelink, the Government welfare department.
As she has too much money remaining from the sale of her family home and purchasing a villa in a retirement village, she is deemed to be able to provide for herself without welfare.
And that’s a reasonable enough scenario, although that excludes subsidies for medicines which are costly.
She is further assessed for the level of care - there are 4 levels, 1 being least needy, 4 being most needy.
Like many Government departments, this assessment can take up to 9 months to be finalised, and in many cases, many elderly have died waiting.
This of course costs - in mum’s case as a Level 3, she is set a budget she has to use annually. As an example, this costs $445 AUD per month.
When I speak of carers I’m talking about paid, trained people, who provide this service.
Weekly, she receives 3 x 1 hour visits (by carers) for showering, 1 x 2 hours for shopping and 1 x 2 hours cleaning. That fits within her allocated budget.
If she was on a Government pension (welfare), then part of her pension would provide the service.
This is a convoluted way to get to my point about this being an industry.
The Government will only do the assessment through MyAgedCare (a Government run department).
They do not allocate a provider for the service that cleans, does the personal showering, or the shopping. That search is up to the family, and this where we find a myriad of suppliers, at a variety of costs.
I guess you’d call them agents.
Mum pays the agent for her services. Then the Government pays the agent for providing the service - double dipping I think you’d call it.
Of course, the agents make a decent profit between mum’s contribution, and the Government subsidy.
Carers earn very little as an hourly rate ($20AUD/hour) compared to other workers.
The Government used to have carers, providers etc - but it is all privatised nowadays.
The same goes for assisted care facilities - all run privately, as a business. I’ve read elsewhere on this website it’s similar in the US.
Put simply, the Government do not own facilities, or caring staff for the elderly.
“You pays your money and yous take your choice” - and you get what you pay for.
Your post definitely encourages discussion, in which I'd like to engage, but for now I only want to address the industry of caregiving.
I'm not so sure the US government (generally, not this specific iteration) has encouraged anything, except by omission. As you probably know, what happens in D.C. is strongly affected by lobbyists who have their client's interests in their pockets, and to my knowledge there is no strong lobby for Elder Care.
That needs to change, but a lot will depend on whether or not the US is able to get back on a positive, forward path.
Industry is in some senses predatory by nature, except for those very conscientious and socially oriented to do good works. Otherwise, money is a dominant factor, and it's a challenge to balance that with good help and good care.
There are some fields for which few viable options occur. And as Geaton wrote, the family has to be the management focus and step in when government or private sector don't offer reasonable or affordable solutions. Family really isn't the fallback option though; it's a primary, first responder type situation, with family having to search out solutions which may be provided through government or localized apparently self governing agencies.
It's not a good situation.