A Social Solution?

[imoldernu]

With some experience in senior living situations, and looking at the coming expense bubble for senior healthcare, it seems to me that alternate solutions will be necessary, to keep anything like a stable economy. Without going in to detail, assisted living costs and nursing home costs can range from 35K to 275K per year, and 24/7 homecare well over $125,000/yr.
Costs of Care in Your State - Long-Term Care Information
The scope of the problem is overwhelming, when trying to resolve it under the law, the politics, and the accepted policies that exist today.

To over simplify... to avoid counterproductive argument, I wanted to share and solicit some thinking about possible, practical solutions.

To begin, a situation that I'm familiar with, because it involved a next door neighbor, who was 85, when we moved in to our house, and passed away 2 years ago, peacefully and quietly, after a few days in a nursing home.

Fran, whose husband had passed away 10 years before, was quite independent, well educated, and living on a moderate income in her comfortable home. While she had children who lived within 100 miles, they were both still working in management that required them being on call, 24/7. Besides that, Fran had no desire to move in with them. The problem was severe arthritis, debilitating to the point of requiring assistance, moving from char to wheelchair, to car, and to bed.

The family found, or connected with, Doris, a 60 year old lady from the Ukraine, who they "hired" as a 24/7 companion. Doris was not fluent in English, having been brought over to the US by her husband, who passed away shortly after arrival, leaving her effectively destitute.

Thus began a symbiotic relationship that lasted for 7 years... good for both Fran and Doris. Fran owned her house, and a car, and paid for all of Doris's needs, in return for housing, board, transportation and the security of a nice home, good neighborhood and all of the normal costs of living. A pleasant coexistence.
....................................................................................................

Another situation with which I am even more familiar. A 55 year old man, living on disability, with no possible hope for legal employment in the public sector, and yet with a good education, and very intelligent. Net assets, due to expenses before receiving disability, almost nothing. No car, no home, and no relatives who are able to help. In effect, no future, except squalid living or homelessness. And yet... smart, able to ambulate, drive, do paperwork, and in general live a healthy productive life, subject to legal limitations.

.........................................................................................
This latter situation, posted, not looking for criticism or solutions, but simply to bring the original subject back into focus. The logical, practical and economically sensible solution is to bring those with needs, together... a slightly different version of the "economies of scale".

The problem is... it isn't "legal" in the strict sense of the word.
.........................................................................................

There are thousands of reasons why this isn't done, and why it can't be done.
Instead of developing this list of negatives, maybe looking at it with a "can do" attitude could open some doors to a wider solution... I'm thinking in terms of some kind of internet based social connection like Crag's List, or Dating websites, but with some kind of legal safety net to protect against exploitation. A fine line between bureaucracy and practicality.

I'm sure that this kind of connection already exists, but believe that the potential of bringing together those with different needs could help with the potential problems of the "senior economic bubble" that is waiting in the wings.

Constructive thoughts?

 

[GrayHare]

To some extent, home health care agencies are fulfilling this need, at least for those who can afford to pay. Many of their caregivers are recent immigrants looking for just such an arrangement, but formalizing it via the agency.

 

[Tom52]

Just two weeks ago we had to place Dad in a care facility. It was suggested that we try to find some sort of live in help so Dad could stay at home. He needs 24/7 assistance. Since Sis and I both live 4+ hours drive from Dad's home it makes it very difficult to routinely visit/check up on him or check up on a live in caregiver. Too many horror stories about mistreatment/stealing/reliability to not have a real concern about how well such an arrangement would work out.

If you find the right person, great, I don't think that is so easy to do. What happens when the live in wants to take a vacation? Then you have to find temporary help, sometimes on short notice. As much as we would have loved to allow our Dad to stay at home for the time he has left, it was just not an option we could consider. Now Dad is in a care facility close to Sis so she can visit every day. Not the best solution in Dad's way of thinking but at least he is safe and being well cared for. Sis and I both feel terrible about the whole situation but short of one of us quitting our job and moving in with Dad, we felt this was the best solution.

 

[imoldernu]

Yes, for part time care, commercial healthcare is fine, but with caregiver rates of $14 to $20+ /hour, 24/7 care it's expensive. At $16/hour that comes to $384/day, and more than $140,000/ year. That makes assisted living very inexpensive by comparison.

As important as the cost is, the psychological and emotional effect of being removed from the homestead has to be a major consideration.

Putting together a person with financial need and a person with physical needs, seems to be a win, win situation.

Back to my example of Fran and Doris... Fran had the wherewithal to afford her home and all other living expenses, but needed some help to overcome the physical restrictions. Doris, had good health, but no sustainable income. For little more than the cost of living in her home alone, Fran was able to provide excellent living facilities and financial stability for Doris. A perftect merger, which did several things. Peace of mind for Fran's children, protection of her assets (vs. nursing home expense) over 7 years and providing an additional inheritance of 1/4 to 1/2 million dollars... and most important, a much better lifestyle in the interim. Doris, who had previously lived a touch and go existance in a poor section of Chicago, had her own life improved... and after Fran passed away, found a very satifactory new home in a similar situation, as a caregiver.

The mjor problem, as I see it, is the massive regulatory system, designed to legally indemnify everyone, while providing a hungry bureaucracy.

As I see it, the only way for this to work, would be an extralegal personal network... with suggested basic requirements for the caregiver...
-A physical exam
-A background check
-A financial statement
-Personal recommendations
-Personal interview
-Trial Period
-Personal involvement of family member
-A defined set of "rules"... do's and don'ts
-Some basic training, either formal, or from books, on caregiving.

I do know that in the case of the 55year old man, a situation like this would be an ideal solution to what would otherwise be a gloomy outlook.

All of the above "companion" arrangements occur on a regular basis, and most of us will know of similar arrangements... yet in the face of the coming explosion of an ever larger senior population, there are few recognizeable solutions for the average family.

We have two homeless shelters in our small town. Not everyone who uses these facilities is a drug addict or psychotic... but more cases are situational, especially with those who have workd their entire lives, but have become impovershed and left with little hope.

Somewhere along the way, there has to be a way to bring the needs of both sides together, with a net gain for society.

 

[Sarah in SC]

I think anything like this on a formalized basis would be cost prohibitive, if for no other reason than the checks and review process that would have to take place if it were done by a private company. I've seen it plenty in the informal economy, though. If you are lucky enough to find someone to match up to the needs of the elderly person, and they don't take advantage of them, then it would work really well.

But heck, I have a hard time finding petsitters, so I don't think I'd want to get roped into a plan to find elder sitters.

 

[imoldernu]

Just two weeks ago we had to place Dad in a care facility. It was suggested that we try to find some sort of live in help so Dad could stay at home. He needs 24/7 assistance. Since Sis and I both live 4+ hours drive from Dad's home it makes it very difficult to routinely visit/check up on him or check up on a live in caregiver. Too many horror stories about mistreatment/stealing/reliability to not have a real concern about how well such an arrangement would work out.

Agreed... And I would have the same concern. At the same time, I'd like to hope that some way be found to provide a socially acceptable means to provide some alternative to the kind of expense you are experiencing.

There are good people on both sides of this situation... there must be some way to bring them together.

I wouldn't expect the "companion" arrangement to be workable in a medical situation, but in most of the cases that I have seen, the move to assisted living or a nursing home is a traumatic experience. The "companion" part is for companionship, some physical help in moving to a wheelchair, or help with food prep and general household duties.

In short, I think there's a need, and a resource... There has to be a way to bring the two together. At some point we must "trust" someone. Being defeated by an impersonal legal system, and greed, isn't where our future lies.

 

[Bestwifeever]

There are people in DH's home town who do this, on both sides. LTC insurance policies will not pay for these less formal arrangements with uncertified workers, and the workers are not interested in becoming certified and having to give part of their typically under the table earnings to an agency. In their small town everyone knows everyone back three or four generations so they would all laugh at a background check (the rumor mill has already vetted everyone's misdeeds within moments of them happening),

I would be more likely to hire a lost soul as described by the OP to do yard work or housework than senior care for a loved one, without some track record of being a responsible worker.

 

[imoldernu]

I think anything like this on a formalized basis would be cost prohibitive, if for no other reason than the checks and review process that would have to take place if it were done by a private company. I've seen it plenty in the informal economy, though. If you are lucky enough to find someone to match up to the needs of the elderly person, and they don't take advantage of them, then it would work really well.

But heck, I have a hard time finding petsitters, so I don't think I'd want to get roped into a plan to find elder sitters.

Sarah... I agree... and this is probably pie in the sky.

Two of our close friends were faced with the problem of a "not too diabled" dad, who wanted to live in his home, instead of a nursing home. While they were reaonably comfortable enough with their own assets, to spend some of the winter in Florida, four years of paying home healthcare for 6 hours per day, cost them about $30,000 extra per year... an expense they could no longer afford.

I guess I'm just looking at what could be, instead of what "is".

I have been in touch with some of the volunteers who handle the food kitchen and a homeless center called "PADS"... in our town. While there are, and always will be, problems with crime of some sort, my friends tell me that these people are in the minority... Most are just looking for some stability and safety... Anything to avoid sleeping under bridges or in cars.

I wonder if we have come to the point of just maintaining the poor through charities and churches, and have given up on finding a way back. I don't see that way back coming from a person (who is downtrodden, but has much to offer) who will place an ad in the newspaper "I will be a companion in exchange for room and board"... That just ain't gonna happen.

I guess that I look long term, and worry that a continued decline in money to help this situation (both sides)... could lead to anarchy. There aren't enough gated communities for all of us.

 

[imoldernu]

There are people in DH's home town who do this, on both sides. LTC insurance policies will not pay for these less formal arrangements with uncertified workers, and the workers are not interested in becoming certified and having to give part of their typically under the table earnings to an agency. In their small town everyone knows everyone back three or four generations so they would all laugh at a background check (the rumor mill has already vetted everyone's misdeeds within moments of them happening),

I would be more likely to hire a lost soul as described by the OP to do yard work or housework than senior care for a loved one, without some track record of being a responsible worker.

What you said... yes. Exactly the problem... trust and legality. With no solution in sight, though, where DO we go from here? The coming "statistical needs" for seniors are almost inconceiveable, and the Long Term Care policies will only cover a tiny percent of the problem. As of today, I don't see any light at the end of the tunnel when the problem is stated in $$$ terms.

Where I do see some hope, is in the idea of people helping people. I suppose it's called socialism, and we can never use that word, but it still seems that we have the means to merge needs from both sides, to bring a better outcome.

 

[Free To Canoe]

Sometimes the caregiver never leaves home. I know of a couple of instances where the son ended up living/staying with the parents. One person who is on disability has two sets of parents that he lives near and devotes himself to visiting and caring for.

I know that almost every senior becomes disabled and needs help at some point. I also know that we probably don't have any family stepping up to the plate to help us if we make it that far. Therefore, I am interested in learning more about the other options. Good thread.

 

[MRG]

Thank to the OP for having the courage to talk about this.

This touches me personally due to current care for my elder Father and what may be my future care needs. I don't have any solutions, but I agree, there has to be a better way.

Is anyone aware of other places in this world that have workable solutions? Seems like outside of this great country there are others ahead of us in health care.

MRG

 

[Walt34]

There are people in DH's home town who do this, on both sides. LTC insurance policies will not pay for these less formal arrangements with uncertified workers, and the workers are not interested in becoming certified and having to give part of their typically under the table earnings to an agency. In their small town everyone knows everyone back three or four generations so they would all laugh at a background check (the rumor mill has already vetted everyone's misdeeds within moments of them happening).

That can work, and does where everyone knows everyone else, as in my grandparent's case for a while. And there are a few of those arrangements around here to but as you say the caregiver's great-grandparents grew up nearby. Absent that the long history that establishes the requisite trust just isn't there.

I just don't see it happening on a large scale given the potentials for misbehavior. That's where all the legal vetting (and expense) comes in.

 

[pb4uski]

Great tread. In the past here in the US (and still today in other parts of the world) this problem/dilemma has been addressed by multi-generational households. When we visited my wife's family in Italy, our generation lived on the main floor and the grandmother and grandson had separate flats upstairs and the grandson kept tabs on grandmother (as did her daughter and SIL).

In our case, I live ~3 minute walk from 82 yo Mom (who thankfully is still pretty independent) and I (and DW and DS who still lives with us) check on her now and then. I could see a day where if she needs closer monitoring that DS might move in with her rather than live with us and it would be mutually beneficial.

Mom winters alone in FL now which concerns us as she is aging and becoming more frail and less steady. We are considering having Mom move to TX where my sisters live near each other for winters and initially take up an apartment nearby where she can still be independent but can be monitored. Sis and BIL are in the process of buying land and building a new home and plan to have a separate guest house on the property that Mom can use during the winters.

While there can be trust/abuse issues with relatives as well as strangers, I would think (hope) less and the family hopefully would have a sense of whether it will work out.

Around here we have a home sharing agency that matches up people who need certain levels of monitoring/companionship and a home with those who are able but have little means. The agency does interviews, checks references, background checks and monitors situations and has mediation available if conflicts arise in the new relationship. This may be another solution for those who don't have relatives nearby effectively creating matches like the Fran/Doris relationship that imoldernu describes.

 

[harley]

What you said... yes. Exactly the problem... trust and legality. With no solution in sight, though, where DO we go from here? The coming "statistical needs" for seniors are almost inconceiveable, and the Long Term Care policies will only cover a tiny percent of the problem.

Logan's Run (trailer) - YouTube

 

[Newventurer]

Interesting thought regarding some sort of clearinghouse or Internet matching site. The sheer need that will develop in the future due to the numbers and economics may force a solution of this sort. I have been interested in a concept called co-housing that seems to be gaining some traction.

I wonder if the situation that you describe regarding shared living would be more difficult for male than female due to female willingness (stereotype?) to be caregivers and their longevity.

 

[travelover]

I think anything like this on a formalized basis would be cost prohibitive, if for no other reason than the checks and review process that would have to take place if it were done by a private company...........

I asked our local seniors director if she could match me up with local seniors that need help with small repairs and maintenance to enable them to stay in their homes (for free of course). She was horrified at the prospect, quickly envisioning herself on the news as the one that sent to ax murderer into the home of the elderly couple. Sigh.

 

[Texas Proud]

Man, this is hard with a cat laying in front of my keyboard....


But, there are tax and legal issues that are not addressed in this situation...

There is an employee/employer relationship.... that means you need to withhold SS etc... next, the value of the house and other items are considered income and should be reported... what about workman's comp, unemployment etc. etc......

It seems like it can be viewed as taking advantage of someone and not paying them a proper wage...

 

[pb4uski]

While I see your line of thinking, the key question would be where does a roommate relationship where costs and responsibilities are not pro-rata end and an employee/employer relationship begin?

In many cases, if an employer/employee relationship exists the room and board could be construed as for the convenience of the employer and therefore not taxable but I agree there are issues that would need to be considered. Of course, it would be best to structure the arrangement to avoid an employer/employee relationship.

 

[imoldernu]

Such a complex problem... and for every possible solution, ten reasons why it can't be done.
Here's an over simple short prediction of the direction of senior care. 8 Predictions on the Future of Senior Care
The part about community involvement spoke to me, though the idea of building homes for seniors seems a little extreme in terms of 'practical', given the cost.
The part about an increase of 70% in healthcare providers also seems too expensive, given the available funds, and the ability to pay. Even now, we can look ahead 25 years, and see that the economic state of those who will join the ranks of the aged , will not be sufficient to pay for their own care.

With millions of experts working on this concern for an aging population, we certainly won't solve the problem here, so these musings are just that...

I think it's time to think outside the box (sic), to face some of the realities that get lost between the pragmatists and the dreamers, so here goes... my two cents:
..........................................................................

The marginal care, short of assisted living and nursing home, cannot be based on pay for services in the normal sense of the words, ie., no minimum pay as in a minimum wage scale. In effect, this means a change in law, whereby there's a de facto recognition of a non regulated system... not subject to taxes or the same kind of legal contracts that bind employer-employee. More of a barter system or the type of self regulation that exists in social structures like communes. Not to eliminate "Law", but to adjust to a system that is based on serious need to serve a new social sector, without requiring a hemlock solution.

The basic concept, as I see it, is not a universal system that affects all seniors, but a sector apart to provide care without stigma, that can become an accepted part of society. A two part system that brings together the needs of two groups...
1. those who have enough money to live independently, but cannot do it alone.
2. those who have not been able to secure enough assets to live independently, but have the physical and mental ability to help, in return for the security and comfortable lifestyle that could come from the symbiotic relationship.

Obviously, this runs counter to what we have been taught about the sacredness of law... the idea of lawsuits and regulation and government control and government guarantees. Facing reality, even now, before the rise in the numbers of the elderly, more than 50 million Americans live below the poverty line... (basically healthy people with fewer life sustaining needs.)
As these number grow and the needs become greater, the most vulnerable will inevitably be at the most risk. Even today, as the government looks to defund the safety nets of food stamps and social security, the lifeline becomes weaker.

So, logically, why not find a way to bring the "needs" together... without adding to the expense.

Think of it this way... Bringing together the 80 year old marginally financially independent senior, with the 55 year old, who hasn't for whatever reason saved enough to retire, and who is too old to start over.

Dangers? of course... but for one who is drowning, not the time to question the quality of the life preserver. A simple means of protection could come with tweaking the laws designed to protect seniors...making the penalties severe enough to discourage theft or fraud. As mentioned in an earlier thread, the simple requirements or suggestions for security checks and references are relatively inexpensive considering the longer term benefits. No less intrusive or more expensive than most rental background checks.
..................................................................

FWIW, I agree with everyone who has pointed out the problems, and the likelyhood of anything happening in a major way is almost nil... still, the problem exists, and thusfar, no real solutions have gained general acceptance. Just sharing thoughts and posing possiblities.

edit..OMG.. in the time I've been writing this, there have been 8 posts... gotta go back and read them... Thanks for the input...

 

[pb4uski]

How would the risk of abuse be any different than the checks and balances that the law/society put in place to protect seniors from other in-home care (I'm thinking of visiting nurses, home-health aides, etc.). Just have some clearing house that can run potential roommates through the same background check and periodic monitoring.

I concede it is different because a roommate is there for more time, but I wonder if the in-home care protections could be expanded to such roommate situations. DS is an LNA and he had a bunch of background checks and such to jump through as part of his licensure process.

 

[imoldernu]

How would the risk of abuse be any different than the checks and balances that the law/society put in place to protect seniors from other in-home care (I'm thinking of visiting nurses, home-health aides, etc.). Just have some clearing house that can run potential roommates through the same background check and periodic monitoring.

I concede it is different because a roommate is there for more time, but I wonder if the in-home care protections could be expanded to such roommate situations. DS is an LNA and he had a bunch of background checks and such to jump through as part of his licensure process.

I agree... and that's likely to be the eventual solution...
My concern is the cost... If you ever get a chance, talk to an administrator of a nursing home... even that small home with four or five residents, living in a normal residential setting. DW worked in a nursing home for many years. Even then, the rules and regulations were so severe that profitability was marginal, and even with a large organization supporting the home, it eventually was closed leaving the 50 residents to relocate.

We have come to a point where legal restrictions have smothered good intentions throughout the healthcare industry. Just imagine buying a bed for a qualifying home. The law defined the specifications, and only one or two manufacturers can comply... therefore, the hospital bed that would cost $2500 in the private market, actually costs $20,000... made of stainless steel, and compliant with 15 pages of specifications.

Even the simplest things like checking the patient, or turning him/her every hour to prevent bed sores, is under scrutiny by the inspection team of 5 to 7 government employees. the temperature of meals being served, even combing hair are all parts of an inspection that takes a whole day... and if, the rating goes below a certain level, fines, suspension, or more frequent inspections. We're friends with the administrator in our CCRC complex, and these points are minor compared to some of the requirements. Frankly, I can't see how they can maintain profitability.

It's not that I or anyone would want to throw the protections to the wolves, but those rules and regulations come with a cost... Is Society prepared to pay that cost?

 

[Billy]

Great thread, Imoldernu. Thanks for starting it.

Someone asked what might be done about this type of situation in other countries, and having lived off and on in Latin America since 1993, I could give a couple of insights.

Yes, of course, there is inter-generational living and it is expected that the family pick up any slack when it comes to taking care of a family member in need. And attitudes towards the elderly are different here than in the States. There is more respect and understanding and it is not unusual to see a young man helping a total stranger across the street or carrying bags for someone who is struggling. Or helping someone off or on a bus.

But what do Expats do?

The focus here is on aging in place with the hiring of help for cleaning, buying groceries, transport and such. Wages are lower here and of course there isn't the cost of providing health care for employees in a situation such as this. Nor does one need to worry about purchasing other sorts of insurance say, in case an “employee” cuts themselves or falls down.

In our town of Chapala, Mexico, there are several assisted living places and 24/7 care places which run about $1500 - $2k a month which includes all meals, transport to visit friends or go to the theater, transport to the doctor's office, room cleaning, laundry service, WiFi, on property nurse or doctor available and such. Medicines are extra, as are diapers, etc. if needed.

I have several links to stories we have done on these places and for a list of them if someone wants to PM me for those. Can't list them here.

Mexico is very aware of this segment of aging population in the States and see it as an economic opportunity for them. Plans for aging-in-place-then-move-to-assisted-living-then-24/7-care are in the works. More assisted living facilities will be springing up as time goes on.

By the way, I agree about the severe regulation limiting viable solutions. People talk about the cost of risk, but do people think about the cost of "safety?" I think we are dealing a bit with this here on this topic.

 

[pb4uski]

...It's not that I or anyone would want to throw the protections to the wolves, but those rules and regulations come with a cost... Is Society prepared to pay that cost?

+1 but there is a frightening lack of common sense in most government regulation and a tendency to overcook things.

I think that in many cases family does take up the slack if they are nearby - the problem is that due to the mobility of our society in many cases family are not nearby.

 

[Silver]

+1 but there is a frightening lack of common sense in most government regulation and a tendency to overcook things.

I think that in many cases family does take up the slack if they are nearby - the problem is that due to the mobility of our society in many cases family are not nearby.

Or...there is no family at all. My husband and I are in that situation. We have no children and zero family members alive. We talk about needing to buy into a progressive care living situation in the future.

There are a couple of them nearby where we live in Florida. The initial cost to buy in is somewhere between $50 and $100k and then a monthly fee for your apartment. When needed, you transition to assisted care then skilled care, and the monthly fees increase as you move. LTC insurance doesn't cover anything until skilled care services are needed.

On average, the monthly fee for an independent living apartment is $2500-$3500 a month. Assisted care is $4500 and skilled $5000-$6000 a month.

For people with no family and limited finanical resources, end of life issues are very, very tough.

 

[Bestwifeever]

There is probably nothing stopping individuals from doing these arrangements on an informal basis if they want to. They can do or not do their own due diligence re the other party. No need for some government or other authority (church, not-for-profit, et.) to be involved, as these would understandably create a bureaucracy to CYA if something went wrong.