This public versus private nursing home or ALF thing may not be as obvious as people think. It is very situational.
Assuming that basic minimal standards of safety, hygiene, etc. are present (not always the case but usually the basics are intact), the add-ons sometimes bring more comfort to the family than to the elderly resident.
Depending on the level of awareness and cognition, it may be that the patient would be as content in a sparse NH than at the Ritz. With family involvement, the amenities that really matter can be sustained even in a "public" Medicaid facility. Visits, small mementos from home, a small privately owned TV and radio, the occasional home-made meal, regular visits, treating the staff and nurses so they feel appreciated, etc.
Yes, there are some places that are horrible (including expensive places) but I think some of the predominantly Medicaid facilities manage to do a decent job. We ran into this when my FIL became unexpectedly placed in such a facility during the 2004 hurricane outbreak in Fla. At first the family was horrified at the lack of frills. But the place was clean, the staff was 90% sincere and caring, and bad as that time was, it could have been a lot worse.
I also am opposed to people scheming to dump the cost of such a stay on the taxpayers when they have the assets to offset those costs. Planning is one thing, scheming is another.
My dad passed without going to a nursing home and so far my mother has avoided it and she's 92. Never bought LTC insurance either.
