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The hidden "cost" is on the adult children or friends of the elder. I have been the "friend" in the past and currently have a friend who is the daughter; let me tell you, comparing what it takes to keep a frail demented elder "at home" to maintaining them in a NH is a no brainer. Managing aides who don't get along and who tattle on each other; arranging for the elder to get to doctor appointments; dealing with bedbugs; aides who have no medical knowledge.
My mom got MUCH better care, more consistent care and had more expertise in a Nursing Home. She had access, on site to psychiatric, dental, podiatry and general medical care. The staff included RNs, APRNs and Medical doctors who could advise us about medication and treatment.
My friend's mom is suffering from terrible, terrible anxiety related to her dementia. In my mom's case, there was a geriatric psych to treat my mom. My friend? She decided that her mom takes "too many meds" and stopped her mom's valium.
As soon as you need a significant number of paid person-hours every week just to stay safe and well, the sums fall apart.
"Aging in place" is seen as desirable in every care context that I've ever come across, not just recently but ever since I first heard what a nursing home was, back in the seventies. It's making it safe and affordable that is difficult.
Its very interesting to look at the various charts and graphs showing how and where seniors live.
Here is a link.
https://www.census.gov/content/dam/Census/library/publications/2014/demo/p23-212.pdf
My Dad was in his 90's when he decided it was just too much work maintaining his home. Plus he was paying $20k per month for professional caregivers [3 shifts per day] who were licensed, bonded, and insured. Yes, $20k per month. Thank goodness he had saved for this rainy day.
My Dad decided it was time to sell his house and move to senior living. He was so relieved not to worry about house repairs.... no more real estate property taxes... no more paying someone to mow his lawn, and shovel the snow... no more homeowner's insurance.... no more buying groceries so that the caregivers could prepare his meals... no more paying all the utilities... no more retrofitting the house to make it easier for Dad to get around.... etc. Oh, he also sold his car.
By moving it was costing Dad $5k per month for Independent Living, and when his dementia was progressing, he moved to Assisted Living/Memory Care at the cost of $6k to $7k per month. The monthly rent included 3 meals per day, weekly housekeeping, weekly linen service, cable TV, and a handyman on call. In Memory Care, Dad's housekeeping and linen service was daily.
Big difference compared to $20k per month aging in place. When my Mom was in a nursing home/long-term-care it was $12k per month, but she needed a village to take care of her. Even though was Mom was a meer 90 lbs, it took 2 Staff members to pick her up and place her in her wheelchair.
Another issue with aging in place, can the elder afford to keep the house running smoothly? Can that person afford to replace the refrigerator or stove when it can no longer work correctly? What about the furnace? A broken water pipe? Etc.
Aging in place would create an issue in the resale of homes. The inventory would be down, and when inventory is down, prices go up. The first time buyer would find it difficult to purchase a home.
If you hired at $10 an hr thats $240 a day x 7 days =$1680= $87,360 a year. A nice AL is 5k to 7k a month. You get a nice studio apt. Three meals a day. An RN, CNAs and Med techs. There is no guarantee that the aides you hire will come to work when in ur own home. Then what will the senior do?
Then another problem is the home is not equipped for the seniors disabilities. Maybe 2 story with no bath downstairs and person can no longer do stairs. Doors need to be widened so a wheelchair can get thru. Shower not excessible. Railings have to be installed. There are lots that has to be considered before someone is able to stay in their house.
The state governments paying out this kind of money so people can stay in their homes will never happen. Medicaid is being cut back. What needs to be done is stop telling seniors they can stay in their homes. They need to realize that this is not always an option. People who have tried to keep a Senior in their home will tell you its hard getting it all to work. Sometimes Dementia/ALZ makes it impossible. You are still leaving responsibility to family who may have to work or have health problems of their own. We have Seniors caring for Seniors.
What needs to be done is the cost of healthcare come down. Prescriptions more affordable. ALs cheaper.