In the US, not even $11,000 a month can buy you dignity at the end of your life(theguardian.com)
theguardian.com
In the US, not even $11,000 a month can buy you dignity at the end of your life
https://www.theguardian.com/society/ng-interactive/2025/may/01/nursing-home-assisted-living-costs-care
34 comments
My mom plans to go overseas back to (our birthplace in Bangladesh) for assisted living... where you can have a personal servant for less than $1k. The US is just ridiculous with inflated salaries and "care".
I don't expect to have dignity at the end of my life, I've already made the decision to end it on my terms. The right to end my life is just as important to me as my right to life itself.
I don't want to be judgmental because I know these are extremely difficult situations with no easy answers, but what strikes me about this article is that the author blames the profit motive after what can be uncharitably viewed as taking an elderly parent and paying a third party to make the "problem" go away from your life.
This industry is driven solely by demand and there are highly-developed countries where it doesn't exist, or doesn't exist on this scale, simply because of different social norms and taboos.
What's the outcome we're hoping for? We're talking elderly folks we'd rather not care for ourselves and that we don't want to watch declining and dying, and we're dumping them into a large-scale... well, death facility.
This industry is driven solely by demand and there are highly-developed countries where it doesn't exist, or doesn't exist on this scale, simply because of different social norms and taboos.
What's the outcome we're hoping for? We're talking elderly folks we'd rather not care for ourselves and that we don't want to watch declining and dying, and we're dumping them into a large-scale... well, death facility.
> We're talking elderly folks we'd rather not care for ourselves and that we don't want to watch declining and dying, and we're dumping them into a large-scale... well, death facility.
This is pretty cynical. Not everyone puts their aging relative into a home because they want to make it someone else's problem. Taking care of elderly people is basically a full-time job. It's not easy to drop every other responsibility in your life (work, children) and focus on deathcare for someone else.
> there are highly-developed countries where it doesn't exist, or doesn't exist on this scale, simply because of different social norms and taboos
Are we sure this isn't because these countries regulate these industries in such a way that people actually want to work for these places and patients don't get gauged?
> What's the outcome we're hoping for?
The outcome is the same (death), but how you get here is what the central complaint is. Elderly people pay a shit ton and you don't even get the basic services agreed to by the other party - maybe if they're shelling out $11,000 a month they should be. Nursing homes have effectively become a scam, but they do not have to be.
This is pretty cynical. Not everyone puts their aging relative into a home because they want to make it someone else's problem. Taking care of elderly people is basically a full-time job. It's not easy to drop every other responsibility in your life (work, children) and focus on deathcare for someone else.
> there are highly-developed countries where it doesn't exist, or doesn't exist on this scale, simply because of different social norms and taboos
Are we sure this isn't because these countries regulate these industries in such a way that people actually want to work for these places and patients don't get gauged?
> What's the outcome we're hoping for?
The outcome is the same (death), but how you get here is what the central complaint is. Elderly people pay a shit ton and you don't even get the basic services agreed to by the other party - maybe if they're shelling out $11,000 a month they should be. Nursing homes have effectively become a scam, but they do not have to be.
Aye. I feel like I have it bad in my situation with one elderly parent...
I have a coworker with both his elderly parents and his wife's elderly parents. All four of them are deteriorating rapidly and need constant care and hospital visits. On top of that he has two sick, aging dogs.
We commiserate about the multiple full-time jobs that we have, but seriously he has it unfathomably worse than I do. I'm stressed to my limit and can't even imagine where he's at.
I have a coworker with both his elderly parents and his wife's elderly parents. All four of them are deteriorating rapidly and need constant care and hospital visits. On top of that he has two sick, aging dogs.
We commiserate about the multiple full-time jobs that we have, but seriously he has it unfathomably worse than I do. I'm stressed to my limit and can't even imagine where he's at.
I think this goes back to cultural expectations to some extent. In some cultures the response to that is, "Your parents probably had full-time jobs and then they raised you on top of it, and part of the cycle of life is 'paying that back' when they're old and sick." Granted smaller and more diffuse family units make that harder, but part of it is just the lack of a sense of filial debt to the people who bore and raised you.
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I have some experience with this and your take is a bit uncharitable. I am classified as a senior citizen and am relatively healthy. My MIL is 86 years old, has dementia, fallen several times and broken her hip, shoulders etc. She is tiny; but when I try to lift her up by myself...it is almost impossible. I tell her to grab my shoulders while I face her and cradle her butt with my hands and do my best to stand up straight imitating the squat exercise I do on a daily basis. Even when I do manage to get her off the ground, she complains I should have done it more slowly. I don't bother replying, because she has dementia. She falls because she refuses to use her walker. When reminded to always have the walker, she is very argumentative. Extremely argumentative.
The good thing is that we were able to keep her in own home and get her on medicaid. She had exhausted all of her funds already. Medicaid pays for a nurse to check on her weekly. Medicaid also pays for "attendant services" to remind her to take her medication, get in and out of the shower, and keep the house presentable. A charity and my wife brings prepared meals that the attendant heats up. My MIL is a handful. She is abusive to everyone, screaming/shouting/argumentative non-stop, and quickly forgets what she just said.
We know one day, we will have to send her to a nursing home where they will likely sedate her with meds. We are trying to keep her in own home. And she argues about that as well. We actually had a one month argument where she demanded to be sent to a nursing home. When we told her that the one she named was cited for abusing patients, she kept arguing.
The good thing is that we were able to keep her in own home and get her on medicaid. She had exhausted all of her funds already. Medicaid pays for a nurse to check on her weekly. Medicaid also pays for "attendant services" to remind her to take her medication, get in and out of the shower, and keep the house presentable. A charity and my wife brings prepared meals that the attendant heats up. My MIL is a handful. She is abusive to everyone, screaming/shouting/argumentative non-stop, and quickly forgets what she just said.
We know one day, we will have to send her to a nursing home where they will likely sedate her with meds. We are trying to keep her in own home. And she argues about that as well. We actually had a one month argument where she demanded to be sent to a nursing home. When we told her that the one she named was cited for abusing patients, she kept arguing.
Get a Hoyer Lift - it should be covered by hospice. And speaking of hospice, consider it. With dementia she'll be approved. The Hoyer Lift will make moving her about much easier.
I guess the outcome we’re hoping for is to shame people for not finding the correct balance to keep their source of income in a cutthroat capitalist reality while taking care of aging parents who need constant supervision at the same time.
I'm sorry, but people have lives and kids of their own. To frame this as "Children are being cruel by putting their parents in nursing homes" is totally disingenuous and ignores the realities of modern society.
Caring for the elderly who cannot care for themselves is a full-time job that requires more than a little bit of specialized medical expertise. Throw a 3 year-old into that environment, and it's a recipe for disaster, injury, and marital dysfunction.
Caring for the elderly who cannot care for themselves is a full-time job that requires more than a little bit of specialized medical expertise. Throw a 3 year-old into that environment, and it's a recipe for disaster, injury, and marital dysfunction.
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For 11.000 Dollar you can hire like 3 people living with him.
"you can't buy love", as they say... Nobody will take care of loved ones as well as kin, as onerous as that may be...
I'm sorry but this isn't true. I'm taking care of my 80+ year old mother with dementia and my brother and I pay people to come look in on her specifically because we can't be there for her like that. More specifically, she's a narcissist and extremely abusive and we just won't/can't put up with that.
She needs way more than that too, but the money just isn't there. The entire situation is frustrating, exhausting and hopeless. She didn't provide for herself to live this long and probably will deteriorate over the next decade while we continue to not be able to provide her with good enough care.
Looking ahead to the later years of my own life, I don't have any family to take care of me and don't expect to be wealthy. I'm looking at assisted suicide as the way out of that kind of aging. Honestly it all seems a bit fucked.
She needs way more than that too, but the money just isn't there. The entire situation is frustrating, exhausting and hopeless. She didn't provide for herself to live this long and probably will deteriorate over the next decade while we continue to not be able to provide her with good enough care.
Looking ahead to the later years of my own life, I don't have any family to take care of me and don't expect to be wealthy. I'm looking at assisted suicide as the way out of that kind of aging. Honestly it all seems a bit fucked.
From all I've read and experienced, private equity not only strips all the money from nursing home companies but also from the residents
This touches upon something that Europeans generally don’t understand about Americans’ individual wealth: the very last years of your life can drain almost any retirement account.
I’ve often had the conversation with Finns who are envious of American 401k balances. But they fail to see the real value of a national pension system that is guaranteed to pay roughly 52% of your last salary for the rest of your life, and a healthcare system that guarantees that the expensive cancer you get won’t mean selling your house.
Not having to think about whether you’ll be bankrupt at 80 is a kind of freedom too.
I’ve often had the conversation with Finns who are envious of American 401k balances. But they fail to see the real value of a national pension system that is guaranteed to pay roughly 52% of your last salary for the rest of your life, and a healthcare system that guarantees that the expensive cancer you get won’t mean selling your house.
Not having to think about whether you’ll be bankrupt at 80 is a kind of freedom too.
> This touches upon something that Europeans generally don’t understand about Americans’ individual wealth: the very last years of your life can drain almost any retirement account.
This is also true in some parts Europe. Retirement home is very expensive, and the service is usually mediocre at best. There's also been the same kind of stories with some kindergartens lately.
On many services, we're much better off than the US, but when it comes to retirement homes, we're very bad aswell.
This is also true in some parts Europe. Retirement home is very expensive, and the service is usually mediocre at best. There's also been the same kind of stories with some kindergartens lately.
On many services, we're much better off than the US, but when it comes to retirement homes, we're very bad aswell.
Europe also seems to more readily accept "A cold snap killed off thousands of elderly people living alone", and that's doubly true in the UK. It tends not to get covered in the US because after all it's very local news and we already barely cover major world events, but if you pay attention to country-specific news it's surprisingly grim.
Maybe it was different before 2008, but since then in the age of "austerity" I wouldn't want to be old, sick, and alone in Europe.
Maybe it was different before 2008, but since then in the age of "austerity" I wouldn't want to be old, sick, and alone in Europe.
Old people dying in the US is simply not news because there isn’t a murderer with a gun or a knife, or someone trying to take away said person’s gun.
It was plain during Covid. For most American media, the real news wasn’t how elderly people were dying like flies, but how somebody was forced to wear a mask.
It was plain during Covid. For most American media, the real news wasn’t how elderly people were dying like flies, but how somebody was forced to wear a mask.
Why is no one starting a new care facility that isn’t as profit-driven / greed-motivated?
They do exist. If you search for the top rated ones, most are affiliated with a religious organization.
https://www.medicare.gov/care-compare/?redirect=true&provide...
https://www.medicare.gov/care-compare/?redirect=true&provide...
My grandmother recently transferred to a small, independent facility. For $10k a month she lives in a small house with a live-in caretaker and only two other patients. It's much more comfortable for her than the retirement community, but nobody can figure out why it's still so expensive.
The costs involved are mind-boggling. You'd think that $100k+ a year should basically buy you personal round-the-clock care in your own home. But either there are not enough people interested in the career or too many rules to make such a deal. (Heck, why can't she just pay her own children to take care of her?)
Baby boomers are just now starting to enter retirement homes and think about end-of-life care. It's bad enough now, but things are going to get so much worse.
The costs involved are mind-boggling. You'd think that $100k+ a year should basically buy you personal round-the-clock care in your own home. But either there are not enough people interested in the career or too many rules to make such a deal. (Heck, why can't she just pay her own children to take care of her?)
Baby boomers are just now starting to enter retirement homes and think about end-of-life care. It's bad enough now, but things are going to get so much worse.
Round the clock care is 168 hours per week. That's more than 4 salaries. You're not going to get that for $100k/year.
Using a throwaway. Apologies.
My grandfather died of cancer before he was 75. I don’t know what it was, but the symptoms and his rapid decline were horrific.
My father died of multiple myeloma before he was 75. He was lucky not to suffer chemo, but from diagnosis to death took 14 months.
Now I have started observing the same symptoms which my father had at my age and have started planning ahead. I’m too cowardly to get a checkup.
But I’m not going to waste 90% of my retirement savings on cancer treatment, of all things. Would rather leave it for the next generation.
https://en.wikipedia.org/wiki/Sallekhana
My grandfather died of cancer before he was 75. I don’t know what it was, but the symptoms and his rapid decline were horrific.
My father died of multiple myeloma before he was 75. He was lucky not to suffer chemo, but from diagnosis to death took 14 months.
Now I have started observing the same symptoms which my father had at my age and have started planning ahead. I’m too cowardly to get a checkup.
But I’m not going to waste 90% of my retirement savings on cancer treatment, of all things. Would rather leave it for the next generation.
https://en.wikipedia.org/wiki/Sallekhana
Thank you for sharing that link. This whole question has been on my mind a lot lately. I am 55 years old, and my son is 11. Both of my parents died in nursing homes. I don’t yet know how I want to die, but I have a good idea of how I don’t want to die. The idea of being in an institution that essentially holds me prisoner while depleting anything left I have saved for my son keeps me awake at night. I’d rather take a long walk into the woods on a cold night, but I’m afraid that I will lose my nerve and miss my chance. I hope that time is still a few decades away. Sallekhana seems like a more intentional, natural way to die than the way most Americans do today.
fwiw, I hear you & have had close relative with similar story.
Five Wishes provides a simple form that seems worthwhile (am curious as to anyone who has experience with how the 5 wishes document is handled/honored irl)
https://www.fivewishes.org/
Five Wishes provides a simple form that seems worthwhile (am curious as to anyone who has experience with how the 5 wishes document is handled/honored irl)
https://www.fivewishes.org/
I have a flippant but not unserious suggestion:
I had a doctor friend who put it succinctly: "You want to die of heart failure. It's relatively painless, it's instant, and it's cheap. But heart disease is so easily preventable in a controlled environment that we can drag out lives much longer than they should be lived."
In a nursing home, they are obsessed with low fat, low sodium, heart-healthy diets. But you should consider a retirement of red meats and high activity.
I had a doctor friend who put it succinctly: "You want to die of heart failure. It's relatively painless, it's instant, and it's cheap. But heart disease is so easily preventable in a controlled environment that we can drag out lives much longer than they should be lived."
In a nursing home, they are obsessed with low fat, low sodium, heart-healthy diets. But you should consider a retirement of red meats and high activity.
I heard a podcast interview with the doctor recently who said that we have technology that can be implanted into someone who is at risk for dying of sudden cardiac arrest that will prevent it from happening. It tends to add a few years onto someone’s life, but it also consigns them to die slowly and painfully from congestive heart failure. The doctor said his patients grasp for anything that might extend their life, if even only for a few months. He often feels conflicted about installing these devices.
We got both of my grandparents into a care home, with my grandmother having advanced dementia, and my grandfather a brain injury he got after a fall while going through hip-replacement rehab. Prior to that, my aunt, uncle, and rest of the family had been more or less 100% caretakers for them. Nurses would come by 2-3 times a day to give them medicine.
But even as the dementia (of my grandmother) progressed, the care facility was simply too understaffed and over capacity to take them in - it took us around a year to finally find a room.
Luckily the care they received there was good - but my plan is the following: If I get diagnosed with dementia, I'm going to end it on my own terms. Having witnessed dementia up-close as a caregiver, and then see other dementia patients...it is not a life. The person becomes an empty shell / husk of themselves.
But even as the dementia (of my grandmother) progressed, the care facility was simply too understaffed and over capacity to take them in - it took us around a year to finally find a room.
Luckily the care they received there was good - but my plan is the following: If I get diagnosed with dementia, I'm going to end it on my own terms. Having witnessed dementia up-close as a caregiver, and then see other dementia patients...it is not a life. The person becomes an empty shell / husk of themselves.
I guess maybe that doesn't account for profits being made by any contractors providing medicines, food, etc, which maybe could be done more cheaply without the profit motive. But 10% just doesn't scream "evil nursing home executives getting fat off of the elderly" to me.
It's a labor-intensive and difficult service to provide. The article's suggestion to professionalize care work seems right, but will increase costs. The two areas of dissatisfaction (high cost and poor quality) seem fundamentally at odds to me, are there proposals which would address them both?