Facing Financial Ruin as Costs Soar for Elder Care

Yves here. This article makes clear that elder Americans get far less support than their peers in other countries. This outcome is partly the result of concerted efforts over decades for any support that can be demonized as an “entitlement,” aka welfare. It may also be partly the result of our failed experiment with long term care insurance. The market would take care of it! Government help for retirees could be limited to warehouses for the poor, um, substantially Medicaid-paid nursing homes.

But as many readers know well, the long term care insurance industry has largely blown up. Insurers had no experience with this product and grossly overestimated the lapse rates. If a policyholder stops paying, the insurer gets to keep the money and use it to provide services to everyone in the pool. But pretty much no one lapsed. A second factor that was not penciled out properly was that people who had these policies lived longer by virtue of getting better/more consistent care. Longer life = more policy costs (remember, the insurers also benefit when customers die before they’ve used up all the policy benefits).

A final likely factor is the rising level of dementia.

And as many readers likely know, nursing homes and assisted living facilities that are not terrible (save in low income states like Alabama) want residents to join in the independent living phase (very little care, so the fees there subsidize nursing home care) and require a $400,000-$500,000 or even more buy-in, which at many facilities is not refundable at death, even if the resident was current on their monthly fees.

By Reed Abelson, The New York Times and Jordan Rau. Originally published jointly at the New York Times and KFF Health News

Margaret Newcomb, 69, a retired French teacher, is desperately trying to protect her retirement savings by caring for her 82-year-old husband, who has severe dementia, at home in Seattle. She used to fear his disease-induced paranoia, but now he’s so frail and confused that he wanders away with no idea of how to find his way home. He gets lost so often that she attaches a tag to his shoelace with her phone number.

Sheila Littleton, 30, brought her grandfather with dementia to her family home in Houston, then spent months fruitlessly trying to place him in a nursing home with Medicaid coverage. She eventually abandoned him at a psychiatric hospital to force the system to act.

“That was terrible,” she said. “I had to do it.”

Millions of families are facing such daunting life choices — and potential financial ruin — as the escalating costs of in-home care, assisted living facilities, and nursing homes devour the savings and incomes of older Americans and their relatives.

“People are exposed to the possibility of depleting almost all their wealth,” said Richard Johnson, director of the program on retirement policy at the Urban Institute.

The prospect of dying broke looms as an imminent threat for the boomer generation, which vastly expanded the middle class and looked hopefully toward a comfortable retirement on the backbone of 401(k)s and pensions. Roughly 10,000 of them will turn 65 every day until 2030, expecting to live into their 80s and 90s as the price tag for long-term care explodes, outpacing inflation and reaching a half-trillion dollars a year, according to federal researchers.

The challenges will only grow. By 2050, the population of Americans 65 and older is projected to increase by more than 50%, to 86 million, according to census estimates. The number of people 85 or older will nearly triple to 19 million.

The United States has no coherent system of long-term care, mostly a patchwork. The private market, where a minuscule portion of families buy long-term care insurance, has shriveled, reduced over years of giant rate hikes by insurers that had underestimated how much care people would actually use. Labor shortages have left families searching for workers willing to care for their elders in the home. And the cost of a spot in an assisted living facility has soared to an unaffordable level for most middle-class Americans. They have to run out of money to qualify for nursing home care paid for by the government.

For an examination of the crisis in long-term care, The New York Times and KFF Health News interviewed families across the nation as they struggled to obtain care; examined companies that provide it; and analyzed data from the federally funded Health and Retirement Study, the most authoritative national survey of older people about their long-term care needs and financial resources.

About 8 million people 65 and older reported that they had dementia or difficulty with basic daily tasks like bathing and feeding themselves — and nearly 3 million of them had no assistance at all, according to an analysis of the survey data. Most people relied on spouses, children, grandchildren, or friends.

The United States devotes a smaller share of its gross domestic product to long-term care than do most other wealthy countries, including Britain, France, Canada, Germany, Sweden, and Japan, according to the Organization for Economic Cooperation and Development. The United States lags its international peers in another way: It dedicates far less of its overall health spending toward long-term care.

“We just don’t value elders the way that other countries and other cultures do,” said Rachel Werner, executive director of the Leonard Davis Institute of Health Economics at the University of Pennsylvania. “We don’t have a financing and insurance system for long-term care,” she said. “There isn’t the political will to spend that much money.”

Despite medical advances that have added years to the average life span and allowed people to survive decades more after getting cancer or suffering from heart disease or strokes, federal long-term care for older people has not fundamentally changed in the decades since President Lyndon Johnson signed Medicare and Medicaid into law in 1965. From 1960 to 2021, the number of Americans age 85 and older increased at more than six times the rate of the general population, according to census records.

Medicare, the federal health insurance program for Americans 65 and older, covers the costs of medical care, but generally pays for a home aide or a stay in a nursing home only for a limited time during a recovery from a surgery or a fall or for short-term rehabilitation.

Medicaid, the federal-state program, covers long-term care, usually in a nursing home, but only for the poor. Middle-class people must exhaust their assets to qualify, forcing them to sell much of their property and to empty their bank accounts. If they go into a nursing home, they are permitted to keep a pittance of their retirement income: $50 or less a month in a majority of states. And spouses can hold onto only a modest amount of income and assets, often leaving their children and grandchildren to shoulder some of the financial burden.

“You basically want people to destitute themselves and then you take everything else that they have,” said Gay Glenn, whose mother lived in a nursing home in Kansas until she died in October at age 96.

Her mother, Betty Mae Glenn, had to spend down her savings, paying the home more than $10,000 a month, until she qualified for Medicaid. Glenn, 61, relocated from Chicago to Topeka more than four years ago, moving into one of her mother’s two rental properties and overseeing her care and finances.

Under the state Medicaid program’s byzantine rules, she had to pay rent to her mother, and that income went toward her mother’s care. Glenn sold the family’s house just before her mother’s death in October. Her lawyer told her the estate had to pay Medicaid back about $20,000 from the proceeds.

A play she wrote about her relationship with her mother, titled “If You See Panic in My Eyes,” was read this year at a theater festival.

At any given time, skilled nursing homes house roughly 630,000 older residents whose average age is about 77, according to recent estimates. A long-term resident’s care can easily cost more than $100,000 a year without Medicaid coverage at these institutions, which are supposed to provide round-the-clock nursing coverage.

Nine in 10 people said it would be impossible or very difficult to pay that much, according to a KFF public opinion pollconducted during the pandemic.

Efforts to create a national long-term care system have repeatedly collapsed. Democrats have argued that the federal government needs to take a much stronger hand in subsidizing care. The Biden administration sought to improve wages and working conditions for paid caregivers. But a $150 billion proposal in the Build Back Better Act for in-home and community-based services under Medicaid was dropped to lower the price tag of the final legislation.

“This is an issue that’s coming to the front door of members of Congress,” said Sen. Bob Casey, a Pennsylvania Democrat and chair of the Senate Special Committee on Aging. “No matter where you’re representing — if you’re representing a blue state or red state — families are not going to settle for just having one option,” he said, referring to nursing homes funded under Medicaid. “The federal government has got to do its part, which it hasn’t.”

But leading Republicans in Congress say the federal government cannot be expected to step in more than it already does. Americans need to save for when they will inevitably need care, said Sen. Mike Braun of Indiana, the ranking Republican on the aging committee.

“So often people just think it’s just going to work out,” he said. “Too many people get to the point where they’re 65 and then say, ‘I don’t have that much there.’”

Private Companies’ Prices Have Skyrocketed

The boomer generation is jogging and cycling into retirement, equipped with hip and knee replacements that have slowed their aging. And they are loath to enter the institutional setting of a nursing home.

But they face major expenses for the in-between years: falling along a spectrum between good health and needing round-the-clock care in a nursing home.

That has led them to assisted living centers run by for-profit companies and private equity funds enjoying robust profits in this growing market. Some 850,000 people age 65 or older now live in these facilities that are largely ineligible for federal funds and run the gamut, with some providing only basics like help getting dressed and taking medication and others offering luxury amenities like day trips, gourmet meals, yoga, and spas.

The bills can be staggering.

Half of the nation’s assisted living facilities cost at least $54,000 a year, according to Genworth, a long-term care insurer. That rises substantially in many metropolitan areas with lofty real estate prices. Specialized settings, like locked memory care units for those with dementia, can cost twice as much.

Home care is costly, too. Agencies charge about $27 an hour for a home health aide, according to Genworth. Hiring someone who spends six or seven hours a day cleaning and helping an older person get out of bed or take medications can add up to $60,000 a year.

As Americans live longer, the number who develop dementia, a condition of aging, has soared, as have their needs. Five million to 7 million Americans age 65 and up have dementia, and their ranks are projected to grow to nearly 12 million by 2040. The condition robs people of their memories, mars the ability to speak and understand, and can alter their personalities.

In Seattle, Margaret and Tim Newcomb sleep on separate floors of their two-story cottage, with Margaret ever mindful that her husband, who has dementia, can hallucinate and become aggressive if medication fails to tame his symptoms.

“The anger has diminished from the early days,” she said last year.

But earlier on, she had resorted to calling the police when he acted erratically.

“He was hating me and angry, and I didn’t feel safe,” she said.

She considered memory care units, but the least expensive option cost around $8,000 a month and some could reach nearly twice that amount. The couple’s monthly income, with his pension from Seattle City Light, the utility company, and their combined Social Security, is $6,000.

Placing her husband in such a place would have gutted the $500,000 they had saved before she retired from 35 years teaching art and French at a parochial school.

“I’ll let go of everything if I have to, but it’s a very unfair system,” she said. “If you didn’t see ahead or didn’t have the right type of job that provides for you, it’s tough luck.”

In the last year, medication has quelled Tim’s anger, but his health has declined so much that he no longer poses a physical threat. Margaret said she’s reconciled to caring for him as long as she can.

“When I see him sitting out on the porch and appreciating the sun coming on his face, it’s really sweet,” she said.

The financial threat posed by dementia also weighs heavily on adult children who have become guardians of aged parents and have watched their slow, expensive declines.

Claudia Morrell, 64, of Parkville, Maryland, estimated her mother, Regine Hayes, spent more than $1 million during the eight years she needed residential care for dementia. That was possible only because her mother had two pensions, one from her husband’s military service and another from his job at an insurance company, plus savings and Social Security.

Morrell paid legal fees required as her mother’s guardian, as well as $6,000 on a special bed so her mother wouldn’t fall out and on private aides after she suffered repeated small strokes. Her mother died last December at age 87.

“I will never have those kinds of resources,” Morrell, an education consultant, said. “My children will never have those kinds of resources. We didn’t inherit enough or aren’t going to earn enough to have the quality of care she got. You certainly can’t live that way on Social Security.”

Women Bear the Burden of Care

For seven years, Annie Reid abandoned her life in Colorado to sleep in her childhood bedroom in Maryland, living out of her suitcase and caring for her mother, Frances Sampogna, who had dementia. “No one else in my family was able to do this,” she said.

“It just dawned on me, I have to actually unpack and live here,” Reid, 61, remembered thinking. “And how long? There’s no timeline on it.”

After Sampogna died at the end of September 2022, her daughter returned to Colorado and started a furniture redesign business, a craft she taught herself in her mother’s basement. Reid recently had her knee replaced, something she could not do in Maryland because her insurance didn’t cover doctors there.

“It’s amazing how much time went by,” she said. “I’m so grateful to be back in my life again.”

Studies are now calculating the toll of caregiving on children, especially women. The median lost wages for women providing intensive care for their mothers is $24,500 over two years, according to a study led by Norma Coe, an associate professor at the Perelman School of Medicine at the University of Pennsylvania.

Lewis moved back from England to Nashville to care for her mother, a former nurse who had a stroke that put her in a wheelchair.

“I was thrust back into a caregiving role full time,” she said. She gave up a post as a research director for a nonprofit organization. She is also tending to her 87-year-old grandfather, ill with prostate cancer and kidney disease.

Making up for lost income seems daunting while she continues to support her mother.

But she is regaining hope: She was promoted to assistant dean for student affairs at Vanderbilt School of Nursing and was recently married. She and her husband plan to stay in the same apartment with her mother until they can save enough to move into a larger place.

Government Solutions Are Elusive

Over the years, lawmakers in Congress and government officials have sought to ease the financial burdens on individuals, but little has been achieved.

The CLASS Act, part of the Obamacare legislation of 2010, was supposed to give people the option of paying into a long-term insurance program. It was repealed two years later amid compelling evidence that it would never be economically viable.

Two years ago, another proposal, called the WISH Act, outlined a long-term care trust fund, but it never gained traction.

On the home care front, the scarcity of workers has led to a flurry of attempts to improve wages and working conditions for paid caregivers. A provision in the Build Back Better Act to provide more funding for home care under Medicaid was not included in the final Inflation Reduction Act, a less costly version of the original bill that Democrats sought to pass last year.

The labor shortages are largely attributed to low wages for difficult work. In the Medicaid program, demand has clearly outstripped supply, according to a recent analysis. While the number of home aides in the Medicaid program has increased to 1.4 million in 2019 from 840,000 in 2008, the number of aides per 100 people who qualify for home or community care has declined nearly 12%.

In April, President Joe Biden signed an executive order calling for changes to government programs that would improve conditions for workers and encourage initiatives that would relieve some of the burdens on families providing care.

Turning to Medicaid, a Shredded Safety Net

The only true safety net for many Americans is Medicaid, which represents, by far, the largest single source of funding for long-term care.

More than 4 in 5 middle-class people 65 or older who need long-term care for five years or more will eventually enroll, according to an analysis for the federal government by the Urban Institute. Almost half of upper-middle-class couples with lifetime earnings of more than $4.75 million will also end up on Medicaid.

But gaps in Medicaid coverage leave many people without care. Under federal law, the program is obliged to offer nursing home care in every state. In-home care, which is not guaranteed, is provided under state waivers, and the number of participants is limited. Many states have long waiting lists, and it can be extremely difficult to find aides willing to work at the low-paying Medicaid rate.

Qualifying for a slot in a nursing home paid by Medicaid can be formidable, with many families spending thousands of dollars on lawyers and consultants to navigate state rules. Homes may be sold or couples may contemplate divorce to become eligible.

And recipients and their spouses may still have to contribute significant sums. After Stan Markowitz, a former history professor in Baltimore with Parkinson’s disease, and his wife, Dottye Burt, 78, exhausted their savings on his two-year stay in an assisted living facility, he qualified for Medicaid and moved into a nursing home.

He was required to contribute $2,700 a month, which ate up 45% of the couple’s retirement income. Burt, who was a racial justice consultant for nonprofits, rented a modest apartment near the home, all she could afford on what was left of their income.

Markowitz died in September at age 86, easing the financial pressure on her. “I won’t be having to pay the nursing home,” she said.

Even finding a place willing to take someone can be a struggle. Harold Murray, Sheila Littleton’s grandfather, could no longer live safely in rural North Carolina because his worsening dementia led him to wander. She brought him to Houston in November 2020, then spent months trying to enroll him in the state’s Medicaid program so he could be in a locked unit at a nursing home.

She felt she was getting the runaround. Nursing home after nursing home told her there were no beds, or quibbled over when and how he would be eligible for a bed under Medicaid. In desperation, she left him at a psychiatric hospital so it would find him a spot.

“I had to refuse to take him back home,” she said. “They had no choice but to place him.”

He was finally approved for coverage in early 2022, at age 83.

A few months later, he died.

Reed Abelson is a health care reporter for The New York Times. The New York Times’ Kirsten Noyes and graphics editor Albert Sun, KFF Health News data editor Holly K. Hacker, and JoNel Aleccia, formerly of KFF Health News, contributed to this report.

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  1. upstater

    I no sooner posted the below comment in links, then refreshed the browser and the same article was posted above! Maybe delete my comment in links?

    The Grey Lady (aka PMC Pravda) weighs in on the horrendously crapified “system” of elder care in the US. long on description, naturally short on causes and solutions:

    The prospect of dying broke looms as an imminent threat for the boomer generation, which vastly expanded the middle class and looked hopefully toward a comfortable retirement on the backbone of 401(k)s and pensions. Roughly 10,000 of them will turn 65 every day until 2030, expecting to live into their 80s and 90s as the price tag for long-term care explodes, outpacing inflation and reaching a half-trillion dollars a year, according to federal researchers.

    Let’s cut to the crash… DoD and the security state are at least $1.2T, interest of the debt is now $659B. Healthcare sucks 18% of GDP with a huge share to Pharma, corporate parasites such as PE managers, device, equipment and consumables yet delivers crap outcomes. We could obviously afford quality elder care and so much more. But our elected officials choose not to…

    An uncle in Eastern Ontario had dementia and was physically disabled and was in a memory care facility for 7 years. My aunt sings praise about his care (he had a great pension so out of pocket was $3K/mo, the rest covered). Aunt was active in her church, visiting many in care homes and both her parents had long term care. All of her experiences were positive. Unfortunately most of my visits to Medicaid places in NY, MA, LA have been negative (often they smelled of p*** and sh**), but self pay > $10K/month were not as bad.

  2. albrt

    Claudia Morrell, 64, of Parkville, Maryland, estimated her mother, Regine Hayes, spent more than $1 million during the eight years she needed residential care for dementia. That was possible only because her mother had two pensions, one from her husband’s military service and another from his job at an insurance company, plus savings and Social Security.
    * * *
    “I will never have those kinds of resources,” Morrell, an education consultant, said. “My children will never have those kinds of resources. We didn’t inherit enough or aren’t going to earn enough to have the quality of care she got. You certainly can’t live that way on Social Security.”

    Things will change when this dynamic plays itself out. The middle class of the next generation simply won’t have any wealth that the for-profit healthcare system can strip from them. There is a zero percent chance that our current political system will do anything to prepare for the hard landing.

    1. Vicky Cookies

      And as life expectancy (for the working class) falls off a cliff, a recent cover story in The Economist touted “Living to 120”.

      Will these childish fantasies of the ruling class be refuted by the realities others have been made to face in dealing with aging in health-care systems set up by adherents to The Economist’s worldview? Will their greed begin to effect even themselves?

  3. Lunker Walleye

    Father passed in ’63 and left mother a 250,000 life insurance policy. Mother was a depression-era woman and knew how to save. There were three teenagers at home at the time. Family members helped her protect and re-invest the money in CD’s. She went to assisted living in her early 90’s and then to a less than desirable on campus dementia unit. She lived to be 99. She would have qualified for Medicare the month after she died. The remaining 22.46 was divided up among the children so that they could go out for pie and coffee:)

    1. lyman alpha blob

      It sure seems like the answer to “How much will this all cost?” is “Whatever your family’s net worth happens to be”.

      1. Reply

        Ask your Congressionals about their health and care coverage.
        Press for details.
        Do that during one of their public appearances, where an audience and maybe even the press can take in the lies and spin, or the hasty exit.

      2. Lunker Walleye

        Yes. We were so fortunate to not have to worry too much about money. It is alarming to hear how many people are suffering because they don’t have the money or cannot jump through the hoops to find a place for their loved ones. Mother’s care was quite expensive in the early 2000’s and it would be prohibitive now. Of course the life insurance came with the penalty of Dad’s death when he was only 56 but I’m so grateful for his foresight.

  4. tegnost

    One might think that this fleecing is good for bidens economic numbers…and someone here mentioned that those elderly covid deaths caused some churn as inheritances got divvied up

  5. Wukchumni

    When mom hit 90 she decided the big house with 2 stories and dreaded stairs had to go, and off to an assisted living place she went, and I always joked that it was tantamount to a cruise ship that never left port, pretty nice and towards the end before she passed away, spendy @ $7,500 a month.

    That was one commonality among all the residents there, they had bought homes in LA in 1965 for $22k or thereabouts, and it seemed to me that the largess was paying for their stay there.

    In the end, mom was there 8 years and the assisted living place got every last Cent that she received in selling my childhood home.

    1. CanCyn

      “ it seemed to me that the largess was paying for their stay there.“ Ding, ding, ding, we have a winner! I am not the only one to comment here that the retirement care industry is a racket (what isn’t these days?) and its sole purpose is to extract residents’ life savings. My MIL spent her last couple of years in a very spendy retirement place. No matter how I did the math, figure meals, housekeeping, etc. I couldn’t figure out how she was getting anywhere near the value for her $6500 per month (she died in 2016).

      1. Betty

        A best friend was in charge of her father’s savings and care, and I recall her going through the invoices every month, and how the “home” relentlessly added various items he did not use, nor need, to the bill, pushing it up another thousand or so. Each month she would have to call and fight to dismiss the items, or visit the site. During his last months, she would drop by every day, at least once, to make sure he ok, and assist in his care, feed him, arrange his room for the evening.

        She was living in Ohio, and I began to experience the state as one institutionalized setting, with friends, families, and caretakers driving from place to place, caring for relatives and clients in decline. Friendships formed, many long lasting, extending beyond loved ones’ deaths. Civil society permeated the loopholes of institutional care life structured increasingly by private equity. And in a parallel world, black and brown families are caring for their loved ones through the carceral state, structured increasingly via private equity. So this is our lives?

  6. ciroc

    Well, just wait and see. In a few years, pentobarbital will be distributed by the federal government to senior citizens who want it… no kidding.

    1. ambrit

      And yet no one mentions the, *ahem*, “forced retirement” of the financial wizards who designed and run this giant ‘life extraction’ scheme.
      The Left needs to become very “robust” in their ‘objections’ to the status quo.
      Sacco and Vanzetti, we hardly knew ye.

  7. NYMutza

    Things will get worse before they get better. Societies may need to re-examine the wisdom of finding ways to keep people alive well into their 80s and 90s when the costs of doing so are so high. With resources becoming ever more constrained, and the ongoing and worsening climate/environment crisis forcing a reduction in economic activity, the needy elderly will simply need to die sooner rather than later, perhaps with a gentle assistance from society. It will serve no good purpose to devote a large chunk of society’s resources caring for a relatively small piece of the population at the expense of younger people who also require resources. I’ve read that the bulk of Medicare expenses are incurred in the last two years of a person’s life. Something has to give, and the solution will never be free or near-free assisted living for all.

    1. bassmule

      Well. This sounds very much like Lambert’s description of the NeoCon approach to health:
      1. Because Markets!
      2. Go die!

      1. i just dont like the gravy

        The ERoEI will continue shrinking. Unfortunately the neocons, in their infinite sociopathy, recognize what the future holds and are forcing a solution in their interests.

        Until the rest of us start forcing solutions in our interests then the neocon approach to health will continue.

          1. JonnyJames

            But there is plenty of wealth redistribution in the opposite direction: the deafening soundof all the resources being hoovered up by the oligarchy, while the quality of life declines for the vast majority of the population. Techno-totalitarian neo-feudalism

            1. ambrit

              My question is; How bad does life have to get for the “average” person in a society before real revolutionary movements arise. (I am not at all sure about “spontaneous” versus “led” movements.)
              I have yet to see any serious attempts to enlist the newly homeless in political ‘movements.’ I remember that the Tea Party started as an older folks movement and was later co-opted by “sinister forces.”

          2. Grayce

            It already exists. Unfortunately, it is from the less well-off to the already well-off. Here’s one example: Economists name Investment AND Savings as if they were two different things. But aren’t they just the remainder after activities of daily living are paid for? Yet, “The Economy” bends into pretzels to make interest work for debt-based investment. And “The Economy” assumes that interest-bearing accounts are worth a fraction of a percent annual yield. In modern monetary theory, banks can count as assets any IOU from an entrepreneur, but there is no collateral. On the other hand, their real assets in interest-bearing accounts are overlooked. QUESTION: is the life purpose of the entry level “investor” aka saver, to be a Consumer? Is the life purpose of the real estate developer class aka “debt-based investor” to be a free market profiteer or rentier?

      2. Reply

        You come into this world with nothing.
        You will go out with nothing under that scheme.

        Your heirs will be saddled with problems, clawbacks, bureaucratic snafus and general incompetence of those who should be helping, whether Fed, State, County or somebody else.

        Think of that as LAAS, Life as a Service (or Subscription), where the autorenewal keeps going based on the infernal calculus. Maybe call it ALAS, After-Life Autorenewal Suction?

        The collection efforts, fees, interest and liens will continue until the medical or life maintenance debt can no longer be considered collectible. In the end, a write-off. Somewhere there has to be an Internal Revenue Code in the works to send out a 1099 for forgiveness of debt.

        That ice floe looks better every day. :/

    2. SG

      “[T]he needy elderly will simply need to die sooner rather than later, perhaps with a gentle assistance from society. ”

      I’m just waiting for Zeke Emanuel to turn 70. I’ll make popcorn.

  8. Laurence

    There is a case for optimism.
    CPI just came out and said healthcare costs are down 34%.
    My premium only is up about 14% but I am happy the others are getting the benefits of this huge reduction.

    1. tegnost

      do you have a link?
      I searched “healthcare costs are down 34%” and nothing recent showed up
      This is the most recent 34% from october last…
      Medical debt is leading many people to delay or avoid getting care or filling prescriptions: more than one-third (34%) of people with medical debt in employer plans, 39 percent in marketplace or individual-market plans, 31 percent in Medicaid, and 32 percent in Medicare.

      Cited from:

          1. John Steinbach

            Essentially what they did is to subtract insurance health care payouts from the cost of insurance, thus leading to a 37% reduction in health insurance costs despite sky rocketing premiums.

  9. Jason Boxman

    Buying long term care insurance seems treacherous as well.

    The Looming Collapse of a Long-Term Care Insurer Raises Questions for DFS (In NYS)

    The long-term care insurance market is a disaster. Can Washington state offer a better path forward?

    A year from this summer, the state of Washington will launch the country’s first fully fleshed out public insurance program for long-term care, the missing component in complete coverage for its residents’ health care needs. It will be a very big deal. Paying for long-term care has always been a challenge for families, and over the years a few states have tinkered with such programs. None have succeeded in providing and funding one. Meanwhile, the once-lauded private market solution of long-term care insurance has encountered insurmountable problems: Most Americans can’t afford it, with premiums now running several thousand dollars a year.

  10. JonnyJames

    It seems a couple of commenters missed the point, we are getting ripped off and extorted in our most vulnerable time of life. That’s a great indicator of a society in general.

    No worries, the US has a declining average life-expectancy. Folks in the lower and median income groups will not live, on average, into their 80s and 90s. Only the upper income groups will live that long, on average.

    Plus, we don’t have a health care system in the US, it is insurance extortion. Only well-to-do folks can get quality health care consistently. Only in merka. That’s one reason why I plan on leaving the country, as increasing numbers of US dwellers who can.

    1. Roxan

      At 73, I see no point in constantly running to the doctor and taking horrible meds so I can (maybe!) live to be 80 or 90. Alzheimers runs in our family, both my mother and her mother required long, drawn out care. One time, I asked my MD friend, how I could avoid that sort of thing? She replied, ‘that’s easy! Just don’t treat whatever ailments you have, same as folks did in the old days.’ I have kept her advice in mind.

      1. Paris

        Right? I am younger than you, one generation, and we don’t have the German in the family, BUT, I always think that if I get an incurable disease, I’ll serve myself bacon and eggs everyday and die of an easy and painless heart attack. It seems to me that people live horrible lives, full of disease and pain, and still hold on to dear life because….? Are they afraid to die?

      2. JonnyJames

        Yeah, back in my day, you worked hard, drank hard and died young, and we loved it! We didn’t need no stinikin health care. (h/t Dana Carvey)

  11. Peter Pan

    When my mother was diagnosed with dementia, her PCP declared, “success!”. Frankly, I think that comment was totally unwarranted. It’s more like another medical failure.

    I took care of my mother for two years before placing her in a “memory care” assisted living facility. Unfortunately, my younger sister passed away two days prior to my mother’s placement. Double downer!

    She has LTC insurance through Genworthless, which only pays out at a 60% level for assisted living. A 100% payout requires a skilled nursing facility. Regardless, the payout amount in both cases only covers a portion of the fee. In a month or two she’ll be confined to a reclining wheel chair due to her inability to walk properly even with a walker, which she often forgets to use resulting in frequent falls. That should raise the monthly fee by about 2k-3k.

    I typically visit her Monday through Friday & sometimes on Sat/Sun. The range of symptoms exhibited by other individuals placed there is startling. It took me a while to get used to it. If I ever get a diagnosis of mild dementia, I’d definitely take up any offer of pentobarbital.

  12. redleg

    This is what disturbs me:
    The first of a couple requires elder care. They exhaust their resources getting that care. Then what of the survivor? How are they to live? It’s adding insult to injury.
    This happened to a friend of mine and now his dad is only left with a fraction of his and his wife’s life savings, and that fraction is there only because Covid took his wife as is decimated the residents.
    The cruelty is a feature, not a bug, “A Christian nation” my ass.

  13. Jason Boxman

    “We just don’t value elders [human life] the way that other countries and other cultures do,” said Dr. Rachel M. Werner, the executive director of the Leonard Davis Institute of Health Economics at the University of Pennsylvania.

    Fixed it for ya!

  14. Paris

    2/3 of the country’s wealth are in boomers/older hands. You can’t force younge generations to cough up even more money for their care.

    1. Altandmain

      What needs to happen is a transfer of wealth from rich to poor. That means rich old people will need to pay for the old.

      That could be through something like steeply progressive taxes.

      1. Paris

        Sorry, I ain’t no Democrat. I hear tax increases and the filthy billionaires are still not paying anything (and funding their pet politicians and NGO’s) and they end up taxing me, part of the middle class. No way I am in favor of tax increases.

        1. redleg

          But paying ridiculous prices to private companies owned by those filthy billionaires with the legal backing of the government is all fine and dandy!

    2. tiebie66

      I disagree, isn’t it beyond clear that there would be more than enough money if it were not wasted on forever wars and military boondoggles? We are meant to turn on each other so that the real culprits can get away with it.

  15. antidlc

    My Mom passed away last year.

    She held on to her LTC policy for years. As the premiums went up, she debated whether to keep the policy or not. She kept it for decades.

    She suffered a stroke and the day she was to be moved to LTC, she passed away.

  16. Benny Profane

    This is why older people should never get married. One could impoverish the other.

    But, lucky to even have the possibility. How many seniors develop dementia pretty much alone?

  17. Glossolalia

    My 86 year old mother has dementia and has maybe 12-18 months of funds to pay for her assisted living facility. Then I guess it’s off to some medicaid nursing home. I feel tremendous guilt about not bringing her to live with me and my family, but the truth is the level of disruption and cost would be ruinous. We have a small house and both work full time. Our son heading in to his final year of high school. It just wouldn’t be doable without one of us not working which would have serious long term consequences for our child’s education and our own retirement. It may sound cruel but that’s the reality.

    1. CanCyn

      Been there Glossalia. My Dad had an incapacitating stroke at age 80 and with no savings and we kids in your boat of being unable to do full-time care, he ended up in long term care. We spent as much time with him as we could. We could at least afford to pay for an upgrade to a private room and for cable and Internet. It was a pretty terrible 4 years before he died. Not to say there weren’t good times, between the three of us we managed decent daily visits (not just quick pop ins) and we always brought in Saturday night dinners and overall spent some good times together. But that glosses over dealing with the less than adequate care and dealing with emergencies, specialists, etc. It was pretty tough on me and my siblings, I honestly can’t imagine how any of us would have been able to cope caring for him at home. One thing most articles focused on cost miss is the mental health toll that elder care has on carers. I am still traumatized by seeing first hand how poorly we care for our elders and by the guilt that I couldn’t care for my father at home. When my husband’s cousin expressed relief at getting her mom into LTC, I warned that she was only trading one set of problems for another. She called me in less than a month to say I was right.

  18. anon y'mouse

    everything described herein is pure evil, and so is the society that allows it.

    meanwhile, none of us will be getting up to do anything about it. because the owners want it this way, and we have enough going on already in our personal lives to deal with.

  19. John9

    Things seem to be working perfectly according to plan…start with asset stripping…and then leave the catered hulk as a ward of the state. Didn’t we allow predators to do that to our entire industrial base that was not sent to China? Privatize the profits, socialize the costs or not.
    Covid really hasn’t been effective enough for the oligarchs plan…but I’m sure in a bioweapons lab somewhere it is being worked on.
    Cruelty is a basic part of the plan.
    Want proof. Just visit any corporate Medicaid nursing home. You’ll see the overworked desperate attempting to care for the abandoned hopeless.
    Meanwhile the MIC gets trillions to kill anything that moves.

  20. kareninca

    I always keep an eye on the Westerly, RI obituaries, since it is near where I grew up and it is an Italian American small city. The life expectancy there has always been a zillion; those Italian people lived forever on their diet of garlic and pasta. Not anymore. I think covid is going to solve this problem. For the old, for the young, it will solve that costly “living” problem for a whole lot of people.

    1. kareninca

      If I sound flip, it is actually fear. Not of death exactly; more of the terrible mess that that is coming, and all the sorrow.

  21. JohnnyGL

    Ugh…bringing back awful memories of my mother’s decline into depression and dimentia in 2021 and 2022.

    Lots of money spent on elder care attorneys to limit the drain of the assisted living facility before she declined and needed nursing home care.

    A big word of advice to all in the chat. GIVE IT AWAY BEFORE YOUR HEALTH DECLINES!!! IF YOU DO NOT DIE BROKE, YOU DID IT WRONG!!!

  22. Gregorio

    We should just start calling these elderly warehouses what they actually are, “wealth extraction facilities.”
    We moved my mother, now 88, from to states to live with us in Mexico two years ago, for less than one year’s expense in a “WEF” we were able to build her a nice casita where she will live out her days. She’s actually flourished since we got her away from the U.S. sick care system, where they were telling us that we needed to start thinking about hospice care for her, she required O2 24/7, a walker to get from one room to another, had to be wheeled from the car, to her at least once a week visit to a medical facility, where they kept adjusting and changing the enormous quantity of medications she was on. Within in a couple months of being here, she no longer required any O2, the walker, or the wheelchair, her pill intake has been drastically reduced, as well as the doctor visits, (she’s down to a couple of check ups a year) she can negotiate a flight of stairs on her own, and goes shopping with my wife and walks around Walmart unassisted. When I brought her here, I was pretty much convinced that she would be dead in a few months, now I’m starting to worry that she’ll outlive me.

  23. jane owings

    Republican Senator Mike Braun of Indiana, who is on the Senate Committee on aging suggested people need to start saving more to prepare for old age. Yeah right. Tell that to an aging school teacher caring for her elderly parents. That’s a cruel statement. There seem to be a lot of cruel politicians out there.


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