Yves here. We have been keeping tabs on the deteriorating state of US healthcare, between ever-escalating costs, particularly of insurance, and actual care, due to (among other things) a critical primary care physician shortage, closure of rural hospitals, and reliance of often-deficient stand-ins, from nurse practitioners and physicians to AI that is not ready for prime time.
An additional source of stress is increasing demand for what is politely called eldercare, particularly for intensive-need case of dementia patients. The rise in dementia, particularly Alzheimers, is attributed to an aging population, but I suspect there is an environmental component too. Even though historically, average lifespans were low due to childhood diseases and lack of knowledge of how to treat wounds to prevent infection, a fair number still lived to over 80, as did everyone in my father’s gene pool in the 1700s (the genealogy confirmed by grave markers and church birth/death records). Yet if you read histories and literature, there are descriptions of senility, but not much if any of the personality-erasing Alzheimers sort.
A big and unacknowledged driver of the rising need versus the shortfall in care givers is the nuclear family, the necessity to many of a working spouse (who for geographic or time demand reasons can’t provide much care to an aged parent) and the lack of other relatives nearby who might help out in a pinch. So the burden falls on hired help when more in the past across the population would have been taken up by family.
And how is this going to work with Trump driving out low-wage immigrants, now that the US has increasingly designed its workforce around the assumption of relatively cheap help? The article below reports that about 30% of dementia care workers are immigrants. Disgracefully, roughly half of the eldercare work force does not earn enough to get by and also needs public assistance to get by.
Of course, if overall wage levels were higher, there would be more household budget headroom for this sort of support, so one can argue that the same neoliberalism and rentierism that first pushed families to outsource more and more family care activities has now advanced to the point that it has created pressured making that unsustainable. But that’s no answer to the immediate problem. The outcome is likely to be more eldercare facilities that bear a strong resemblance to the old Bedlam.
From IM Doc at the start of the year, whose data points say that the issue is the rentierism, the admin and professional staff being so richly remunerated that it comes at the price of front-line staff being both egregiously underpaid and overworked/overstressed:
Just FYI – The nursing home crash started long ago. It was already in desperate shape when COVID hit – and that and the vaccine mandates put the nail in the coffin. Now, most of them are breathing fumes.
I will never ever forget the absolute mass exodus of staff in and around SEP and OCT 2021. Literally all at the same time. What was interesting was these employees went out into other industries and found work that paid better and they had better hours and the added benefit of not being peed on as well as not being forced to take meds by the same people screaming at them they were all about preserving health care choices for women. They will not be coming back.
Strikingly, all of these female physicians who are so strident in their pro-choice behavior seem to have absolutely zero insight into how absolutely repulsive they are to younger women who are really put off by the hypocrisy of it all. And mind you – the big concern with these shots at the time, as I repeatedly said, was the effects they were having on menstrual cycles in so many of these young women.
The hospital and nursing home corporate C suites have to find the money to pay the tens of millions in salary for their officers – so the employees doing the work get hen scratch.
This past week or so, my life has been really altered because the very exclusive NH here where I live has now gone through 4 medical directors in the past two years or so. There were two 30 something male internists who only wanted to work 4 hour days – there was then a female FP at age 36 – who got pregnant with her 2nd child and not only quit as the director but retired from medicine totally and then a woman internist in her 40s – who it turns out is the exact definition of the mean girl boss and the patients and staff hated her guts. One of the 30 something guys just up and quit about 2 weeks ago as they are so prone to do. He apparently is now working locum tenens over this part of the country – 1 week here and 1 week there – the rest is play time. This is going on all over the place with so many of them – are you not so relieved that the various states and federal government have invested 2-3 million in each of their educations?
This problem is far far more than just foreigners working in the NH.
I was asked to do the temporary duties because they are in red alert mode. I was shocked this past week ( possibly because of the holidays – we will see this next week ) how absolutely threadbare was the situation there. There is a couple of very elderly there, Hollywood elite types, Oscar on the bookshelf….
By Cynthia Lien, a health writer and geriatrician in New York City. She is a fellow in Journalism and Health Impact at the Dalla Lana School for Public Health. Originally published at Undark
Xavier Erazo remembers lying beside his 93-year-old mother, her small frame helpless as she fell into the late stages of Alzheimer’s disease. He was exhausted from struggling daily to piece together a rotation of paid workers and family caregivers as his mother’s illness spiraled in unexpected ways. “She became more challenging, more confused,” he recalled. But placing her in a nursing home never crossed his mind.
During this time, I was Erazo’s mother’s geriatrician. Through the eyes and voices of caregivers for people with dementia, I have learned the value of consistent, quality care at every stage of the illness. In reality, however, finding such care can be arduous.
For increasing numbers of Americans, caring for their aging parents themselves could become their only option. A tsunami of frail elders is surging ahead just as the primary supply of direct care workers — many of them low-paid, untrained, and undocumented immigrants — is being depleted by political and economic forces.
“We have this level of need that’s coming, that we do not have the workforce or the systems to meet,” said Nicole Jorwic, chief program officer at Caring Across Generations, a national advocacy group that supports the rights of caregivers and care workers. “As a society, it’s the back-burner issue, but we’re running out of time.”
The final wave of baby boomers is approaching 65 and the number of people living with dementia in the U.S. will balloon from nearly 7 million in 2025 to 14 million over the next 35 years. Adults newly diagnosed with dementia are projected to reach 1 million per year by 2060, nearly twice the rate in 2020.
This rapid growth in older adults, chronically ill and care dependent, is poised to push America’s long-term care system to a critical tipping point. Already, before the surge, there were not enough workers to care for the aging population — even if those like Erazo had wished to lean on them.
Families already shoulder the bulk of care for elders with complex needs. AARP and the National Alliance for Caregiving reported that 63 million family caregivers, mostly unpaid and unprepared, are providing “invisible labor,” struggling to balance care for their parents and children while holding down full-time jobs.
Isolated and stressed, they seek relief from direct care workers — about 30 percent of whom are immigrants who form the backbone of dementia care.
Direct care workers, which include nursing and home health aides, continue to face harsh burdens driven by decades of race, gender, and economic inequities. Nearly half of them, mostly women of color, rely on public assistance like Medicaid and the Supplemental Nutrition Assistance Program, according to the Public Health Institute, a national research and advocacy group. More than one-third live in low-income homes or near the poverty line.
At the brink of survival, many choose to leave care work because of low pay and poor working conditions, leading to critical worker shortages and alarmingly high job turnover rates in nursing homes and eldercare facilities. Workplace injury is nearly five times more common among nursing assistants that work in these spaces than for the average U.S. worker, often leading to extended leaves of absence or job transfers and further driving down worker numbers.
This deficit coincides with the explosion in demand for such workers, a need greater than “in any other single occupation in the United States” according to a 2025 Alzheimer’s Association report. The Public Health Institute estimates 8.9 million total direct care job openings from 2022 to 2032, but vacancies will be tough to fill.
Without a steady pipeline to recruit, retain, and grow a sustainable dementia care workforce, the shortage is “only going to get worse,” Jorwic said. “That same pressure is going to get put back onto families.”
While Erazo vowed to never place his mother into a nursing home, such homes are increasingly hard to find. The worker deficit coincides with more than 800 nursing home closures across the nation in the last 10 years, and nearly 600 more may be at risk of shutting down, leaving family caregivers to support older adults in their own homes and communities as dementia care needs escalate over time.
Many people with severe dementia living at home — the phase when care needs are most intense — are themselves ethnic minorities and foreign-born. Families depend on the comforting presence of a care worker who shares the same ethnicity, culture, and language as the elder. America’s harsh and restrictive foreign policies against immigrants could devastate the hundreds of thousands of noncitizen workers supporting elders in homes and facilities, about one-third of them undocumented, threatening an already strained workforce and families that lean on them.
Loss of a care worker due to deportation or being forced to flee the country out of fear could “disrupt a complete family system,” said Jorwic. Without the critical continuity and communication of a trusted caregiver, elders are at risk of hazardous medication errors and hospitalization, said Amanda Bergson-Shilcock, a senior fellow at the National Skills Coalition, an organization that advocates for U.S. worker education and training.
On top of existing challenges, recent federal budget cuts to Medicaid slashed funds to long-term care services that account for nearly one-third of the $781 billion annual cost of dementia care. The cuts instantly overturned moves in the Biden-Harris era that paved the way for better worker turnover rates, training opportunities, and staffing in nursing homes.
Without federal oversight, and the systems and supports to protect them, dementia care workers continue to face escalating burdens while their stories remain unseen. But care should not be a burden, said Jorwic. And for family caregivers, “our goal is to get to a point where there are enough systems and supports where care is a choice.”
I’m building a passive house with a walkout basement. The basement includes an ADU (additional dwelling unit) set up as a standalone apartment (kitchen, washer/drier etc). The idea is that the ADU is the guest suite in good times, can be rented in bad times for income, and can be occupied by a carer in geriatric times as part of the deal. Oh, and all doors are 36″ to be wheelchair friendly, and the bathrooms are wet rooms such is common in Australia (too right, mate!) to make showers accessible because no shower door. Obviously this only works with a budget to so, but so much useful stuff in a small house is only practical let alone economic if installed at build time. For example… if you plan to collect rainwater, use a metal roof (ideally standing seam so that the fasteners are concealed). See this Canadian firm in freezing Ontario for practical ideas https://ekobuilt.com/
death by 1000 cuts… have a family friend who is a CNA. It’s her first real career job after immigrating to the US.
one big issue: CNAs, etc. need licensure.
that licensing and relevant coursework costs money. It is inexcuseable that a bulk/all of that cost can’t be spread out over high school and community colleges.
then toss in that even if licensing and coursework was 100% free, wages are too low for the working conditions.
but market mechanisms are broken given the role of Medicaid, frontline workers getting paid only after management, and there is an assembly line of people who would prefer to work as a Morlock in US health care for the bare minimum than be an au pair in Hong Kong.
no easy fix because too many bread bowls will be broken
You’re onto something with the bread bowls. There is a very odd arrangement across the street from me in my neighborhood that is zoned for residential use. The best I can tell, the landlord rents the house to a business which in turn houses a couple extremely autistic adults who need round the clock care. The care is provided by recent African immigrants. Technically they should not be running a business in this neighborhood, but they get around this by hiding behind HIPAA laws. There was some suspicious activity at the house and the landlord refused to tell us what was going on, citing confidentiality, but we found out the arrangement from the police department after they’d been called to the house multiple times and were nice enough (because legally, they probably should not have told us either) to reassure us that it was not criminal activity but they were there because the autistic residents got nervous and called the police on their own caregivers.
I’m not 100% sure how the whole arrangement works, but I did find out that in general in my area, the caregivers get paid relatively well. I believe the business itself gets compensated by a government or non-profit entity and once the rent and caregivers are paid, they pocket the difference. Nice work if you can get it.
And while the caregivers get paid relatively well in the $25/hr range, that still isn’t enough to afford the rent or buy a house in the area. Pretty sure the one making real money off the deal is the business that rents from the landlord. And possibly the landlord too, who is not known as a particularly nice guy. The rent is very high and the business probably just passes on the cost to whomever ultimately picks up the tab, whether that’s the government, the families of the autistic people, or some combination of both.
All I know is that this is far from an ideal arrangement. It musty be extremely difficult for largely non-verbal adults on the spectrum to deal with caregivers who do speak, but not the same native language. And the caregivers themselves likely have higher aspirations than what they’ve been relegated to doing after arriving in the US. And it’s not ideal for the neighbors who see law enforcement coming and going in the formerly quiet neighborhood and aren’t being told why. But someone is definitely cashing in on it.
In my neighborhood, residential, there are about four adults ( I don’t think they are related) who have suffered strokes or some such, who take a minibus to adult day care during the week – no cars at house during day. Evenings, mornings and weekends, caregivers are there to assist them. I think there is a Medicare/Medicaid program to keep people out of nursing homes but still provide services, all legal.
But as Lambert was apt to say, “because markets, go die”, Indiana’s General Assembly is considering a bill to reduce compensation for caregivers as they also want to cut taxes (as always – funny that, as state is overall Republican for decades, they would have cut taxes sufficiently by now).
Silly rabbit! There are never enough “taxes” to cut as long as there remain any “commons” unenclosed.
An eldercare worker I know was injured on the job and has been recovering slowly for seven months with no return to work in sight, due to the following sequence of events:
An elderly fatwoman needed help getting from bed to wheelchair > inadequate/worn brakes on a wheelchair slipped, causing the patient to fall > caregiver’s dominant hand was pinned between the falling patient and chair, but prevented a fall to the floor > caregiver’s hand was bandaged, sent home for a few days > three weeks later it became obvious that the hand was getting worse not better > x-ray showed hairline crack in the little finger. Months later an MRI was finally approved by insurance to examine why the finger was crooked. It revealed that a fluid is trapped there. Surgery is not being considered yet.
So, continuing to work with an undiagnosed but relatively minor injury, as the job insisted, has led to something much worse. It remains to be seen if there will be a full recovery. Btw, worker’s compensation payments did not begin for five months.
It has been known for decades now that there would be a huge pulse of Baby Boomers entering retirement and that planning and preparations would have to be made to cope with them. Even watched a doco about this very subject about thirty years ago. But I am not sure if there was any serious plan made to do something about it. Certainly you have had many retirement homes being built to tap into all the savings that those boomers had managed to accumulate and make bank. I’m thinking that for some time now that the real plan was this. If you had money, then you would be right. But if you did out, then you were all out of luck and it was all on you. Those oldies were on their own.
>>>>Certainly you have had many retirement homes being built to tap into all the savings that those boomers had managed to accumulate and make bank.
those retirees, and the workers who support them, have relatively no problems. The local, well-respected, well-managed, Presbyterian senior community started a $$$$ expansion and my mother constantly gets bombarded by adverts and free meal teasers to “get sent to the home,” lmao.
for the top 15%, and those workers, they’re getting the treatment you’d think that a civilized society could afford tor everyone.
It’s the bottom 85% that (seemingly via anecdotes) is positively dystopian.
My dad was in the top 15%, and having just dealt with his final months I can tell you it sucked. He did not get the attentive treatment he was paying for, for a whole bunch of institutional and bureaucratic reasons.
But you are correct that it’s much worse if you have less money.
I have a friend whose parents both developed dementia. Her mother had been a schoolteacher in NJ and so had long term care insurance as part of her retirement plan. She ended up in a facility here in CA (near my friend); her care was adequate. My friend’s father had worked in low wage jobs in the private sector (his PhD did not help with income) and had no such insurance and no money; he ended up nearby in a Medicaid death trap, with a UTI that went to his kidneys and a call cord that was cut.
Sounds like the management of that place is due for a visit from Saint Luigi.
It’s a state run home in CA.
Hmmm… This sounds like a case for resort to good old Tom Paine!
Maybe a pinch of apple seed dust in the manager’s lunchtime glass of Bordeaux.
Stay extra safe.
According to techbros an army of humanoid domestic telemetric robots is supposed to monitor many residents at once by emitting phrases to assess cognitive function and physical distress (“tell me about your grandchildren”, “you have fallen, help is on the way”). How this is supposed to work in fiscal reality is of course TBD. Here is one assessment
https://pmc.ncbi.nlm.nih.gov/articles/PMC10178192/
Actually, what happened in the US was that the building of all those retirement homes, at least in the first decade or so, did such a good job of extending lifespans as to make the care problem worse. Or so has been claimed by long-term care insurers.
In Canada the story I heard was that with community care initiatives and at home support designed to keep people at home as long as possible, people in nursing homes are far sicker than they were before. Money allocated to nursing homes has not been increased to deal with this. Our experience with our 8 parents (divorce) If you are in nursing homes because of physical health your experience will be a lot better than if you are there because of dementia (Alzheimers in our case). Being able to advocate for yourself is very important. Nursing homes charge “room and board” with care being covered by the government. All prices are regulated.
That is overall true but the problem is that blood sugar issues (even in non-diabetics; non diabetic old people often get weird intermittent blood sugar lows that cause falls and delirium) and UTIs can cause confusion and delirium that is at least temporarily as bad as dementia, and can keep a person in a facility from advocating for him or herself.
This hits sooooo close to home now. My mother is in her early 80s and generally fit as a fiddle (she ways the same as she did in HS!); however, her incipient dementia (only noticeable if you spent a LOT of time around her) took a turn for the worse after an apparent “mini stroke” in mid-August. Now she forgets to turn the stove off, forgets where she parked (on top of forgetting where she was going and why she was going there) and is easily flustered. While there is some money for a facility, it would essentially wipe her out financially . . . and the quality was incredibly poor ten years ago when looking for one for my auntie (who died alone during Covid as we were not allowed to visit, those folks cannot be punished enough).
As a result, we’ve developed a “stop gap” in that my daughter, attending engineering school 20 miles from her grandmother’s home, has moved out of the dorms and in to a spare bedroom. Now she acts as a bit of a carer, driving her to appointments and cooking dinners. We’ve only being doing this for a couple of weeks, and it seems to be working out so far, but this requires an enormous sacrifice on the part of my daughter. How long it can continue, we don’t know, but the families I know that have done this long term (a friend spent 4 years essentially acting as his father’s caretaker for 25-30 hours a week as his wife refused to move him to a home, despite being able to afford him – her reasoning being she found the quality of the care staff generally sub par to put it politely) have been emotionally and physically wrecked for years due to the toll it took (generally working PLUS care PLUS worry).
I don’t see a way out of this without upsetting a LOT of iron rice bowls, and therefore any change will come AFTER the catastrophe, sigh.
Your only avenue for adequate care in a nursing home is if a family member can visit every day and can advocate for decent conditions. My sister was available to do that for our mother (my wife is disabled and so I was absolved of much day to day concerns with my mother). I also gave my sister carte blanche for our mother’s care. We t bought she needed better care and transferred her to what was supposedly better nursing home, but care was worse. Returned her to first one, then covid hit, and everybody got worse. Sister pulled Mom out to live with her about a week before Mom died, about the only good thing in the whole ordeal.
It’s obvious to me that the ‘quietus’ is coming. (In PD James “Children of Men”, the ‘quietus’ was the mass killing of any elderly that showed any sign of weakness. Superficially it was ‘voluntary’, but was actually State coerced.)
Opposition to euthanasia seems right-coded in the US due to the Christian pro-life crowd, but I think it is very important for the Left to adopt ASAP. Because it’s obvious (to me anyway) that rather than supporting families and finding ways to pay and staff eldercare workers appropriately and ensure the money goes to care and not execs, we’re going to kill the elderly instead (while making a little show about it being their “choice” so that consciences aren’t too offended). We’ll probably even set it up so that the execs get a bonus per kill, which will truly supercharge it as that’s all it takes for them. It’s also clear that any Christian pro-life opposition will get rapidly rolled by the MAGA / tech-libertarian crowd on the Right who have no such qualms, so any opposition needs to come from the Left.
Though with Boomer hatred starting to bloom on all sides of the younger generations, I’m not optimistic. This is going to get ugly. (yes, once again we see the neoliberal solution “go die”)
My ultra-left-wing Christian aunt in Michigan is eager to be euthanized as soon as she has real problems. And I can tell you that the young (so called) progressives on reddit think euthanasia for the old is great. I think you are going to have to pin any hopes on right wingers. I’m not saying that will work but I am seeing almost no-one on the left in my own life or online who is anti-euthanasia.
Having watched my parents endure years of dementia care (excellent care in my late father’s case, somewhat less so for my mother), I will be doing what I can to ensure I don’t live too long, short of killing myself right now. Unfortunately, euthanasia once certain thresholds are met is not yet an option where I live.
I’ve spent a lot of time in the secure wards of long term care facilities over the past few years. I’m not sure where anyone would get the idea that it’s always better to be alive. Perhaps they should spend some time volunteering at such places to test their convictions.
If you’re opposed to euthanasia for yourself, that’s fine. But please have some respect for people who have different views rather than assuming they have a malicious agenda.
Unfortunately, euthanasia at the society wide level always becomes politicized. Soon, “undesirables” and, horrors!, “deplorables” are sent to the head of the list for “terminal treatment.” See how the Reich, which America is becoming quite like, handled their “untermenschen.”
The main question will be, when will “liquidation” become mandated by the State?
Stay safe. Do not go gentle into that good night.
As a retired RN I know well, that the level of care required for the care of the elderly is never enough, in hospitals and care homes. I live in Canada and we have euthanasia and I would use it if needed. I am coming up on 80 and am in good shape so I hope that continues
Perhaps this post should be combined with the one on immigration since both are about middle class country’s needing lower class workers with less demanding living standards. Of course in earlier more balanced times large family sizes meant the elderly could find care from among their own progeny. It was said that the desire for later care was one reason for the Chinese resistance to the one child policy.
In my mother’s farm family of twelve children my grandmother never did have to go to a nursing home at the end of her long life.
My Mom “only had” three children and we managed to have her live with Little Sister and her family up until the very end. Having seen first-hand how even an “upscale” “Retirement Home” is run when Phyl’s folks ended their days in one, I can attest that almost anything else is better for the “Dearly Pre-Departed.”
Frankly, most “Retirement Homes” are warehouses for those whose families either don’t care about them or cannot manage to care for them. Perhaps the exception that proves the rule here would be the Veterans Administration elder facilities. (Comments from knowledgeable persons will be appreciated.)
Stay safe. Die at home if you can manage it.
We can’t put my exceedingly ancient father-in-law in the VA since they don’t allow marijuana in any form, and THC gummies are the only thing that helps his compression fracture pain.
Oh boy. Talk about stupid bureaucracies! In the old days, sailors were infamous for partaking of the “Devil’s Weed.” So, throw out a big chunk of the Navy Veterans?
I remember my uncle in England who owned and ran an old folks home there. They had to have a safe on the premises to lock up the heroin supply. In civilized places, serious long term pain is handled with heroin. You are there and able to function, unlike with morphine.
Good luck with it all.
Stay safe.
I have done a couple of stints in care homes (in the UK), most recently through the first year and a half of the pandemic.
Night shifts, woefully understaffed, under equipped (because pads cost money), badly managed and paid £11.72/HR.
We couldn’t find new staff. Most of the existing staff were Asian/African/Caribbean immigrants and those with criminal records or personalities unsuited to standard jobs.
There was a big grant from the government to send in staff living costs if they caught COVID. Unfortunately when I caught COVID at work I was told the money was gone. No staff received a penny. Curiously the owners had some expensive landscaping done during this period.
The residents lived miserable lives, waiting to die, hoping the staff would have time to clean up the excrement they were lying in. Food was terrible, activities minimal. Watch TV and wait for death.
I quit eventually as my back was getting bad.Health and safety // lifting rules are a joke – “sure I need a 2nd person to comply with the rules but I’m the only person here and this resident needs to move”
I cannot fully describe the awfulness of the institution. Bear in mind, this was the best home in the area, but still awful.
Loved a lot about the job but would never go back. When I reach that age I’ll be reaching for the helium and plastic bag.
The rise in dementia, particularly Alzheimers, is attributed to an aging population, but I suspect there is an environmental component too.
Aside from pollutants, we should probably give mention to a certain ongoing viral-outbreak as well…
In addition to a lack of qualified workers in the US, needed care for elderly persons and assistance to caregivers may be withheld by intent or design– something I’ve recently seen, experienced, firsthand, but that’s a story that will have to wait a little bit longer.
There has to be an insurance-based solution to this: about 25% of people will need multi-year residential nursing care, the other 75% being self-sufficient until a final medical deterioration overtakes them in their own or a hospital bed over a shorter span. Basically the system can only be financed if everyone has to a pay a premium at retirement age maybe 15 years before they know if they are not in the 25%. The fortunate must pay for the less fortunate. I would imagine fixing the premium so that the policy can pay out a cash sum around 75% of nursing home costs for around 24 months; longer stays will involve private capital or state aid, but the overall hit to the state and the private estates will be much less. Nursing home fees should also be tax deductible.
Finance would help increase conditions on the front line.
No, one was attempted in the US. Long-term care insurers have all gone bankrupt or close to that. They had no actuarial basis for pricing the policies and all set the premiums too low. New policies are pretty much not affordable unless you start VERY young.
I know of a couple of boomer parents of a friend who are VERY well off and happened to have paid in to two of these policies for decades, one with a payout of $8k towards care a month and one with a payout of $12k or so per month . . . and neither have liked the available options (that also require moving away from their lifelong friends and family who currently live within fifteen minutes of the couple) to find quality care, so have decided to forgo said services until the bitter end.
My gut hunch is many will find there is no room at the end between not wanting to leave friends/family, no monies, no quality care areas, etc.
The newly built nursing home memory care unit that my 95 year friend went into 4 years ago cost $11k a month, northern CA. Initial staff were ok, but the turnover was massive and care quality went down, price up. Now about $15k/mo. Moved her into a converted duplex with about 14 residents and amazing permanent staff that have been there for ever. $9k/mo. Lucky to get her in.
I keep thinking we should all have ready access to pure, pharma-grade fentanyl in lethal doses.
I would think the capitalists would NOT object— folks at a stage in life where they could contemplate such a choice are likely not great prospective employees from whom to extract excess labor capital.
As to the ‘christians’ or others of varying faiths who might object to health choices in the US, I have no answers.
Go Die! I can picture a black bumper sticker, with large white font, akin to the Got Milk? Campaign…
add a small red white and blue elephant on one end, and a kicking mule in same colorway on the other, bracketing The Message . Many ways to read THAT one, eh?
Ah! An excellent business prospect!
My neighbor whose parents both developed dementia hopes to find a company that she can hire to monitor her and execute her painlessly (without her noticing) if and when she develops the symptoms. By the way she is a Christian. I think that lots of people would pay good money for that. Sure it isn’t legal now but things could change.
Elderly people who require care are neither productive workers nor consumers. It’s easy to imagine how the government views them.
Maybe a description of an event this AM can help shed some light on another aspect of this problem which was only tangentially discussed in the article above.
When I was a young physician, no one, and I mean no one was offered heart bypass surgery if they were older than about 75. There are many reasons for this not the least of which is this is a profoundly invasive and very stressful procedure. The kidneys, lungs, liver, arteries and brain are all over 75 and with that kind of stress there is a very high chance of a life-altering issue occurring. Furthermore, studies have repeatedly demonstrated that the incidence of things like strokes and heart attacks are very elevated in the postop recovery timeframe. These based on evidence are not little events and they are often profoundly damaging and will lead the patient to have unfixable permanent disability. This almost always involves the patient staying in NH care for 15-20 grand a month for the rest of their life. And because the underlying problem was repaired or improved they are much less likely to pass.
In my youth, this was absolutely considered a no-no. You just simply did not do this. But then the past 10-15 years came along – a time in which not only my profession but the entire culture lost its marbles about life expectations. And now we do open heart surgeries really a lot on 80 and 90 year olds. It is very concerning.
My admission to the NH this AM was a 91 year old ( YES 91 year old) who had an open heart valve surgery done on a bad valve about a month ago. This was done in one of the nation’s premier tertiary care centers. The patient had a massive stroke on day 3 – that left the patient paralyzed on the right side, unable to sit, feed themselves, talk. But if fed, they can swallow. Because the valve was replaced, what would have been a likely “do not wake up in the AM” death in the next 6 months has been converted to “who knows?” they could live 10 years like this……..
Again, we have lost our marbles. I do everything I can to talk to patients and their families about their upcoming death. How we can make them feel better and enjoy what time they have left hopefully away from a NH. So many in my profession, especially the younger ones, are absolutely allergic to even mentioning death. It is really so sad. Death is not a failure. It is the path that everyone of us will take and somehow as a culture this has been completely forgotten.
This is not cheap. This type of thing is a large segment of the NH population. And the costs to our system are enormous. I would even dare call this a type of fraud……..and our country is going to have to make some seriously tough decisions going forward. I have no answers. Only to do my level best with the patients that sit before me not to put them through all of this.
I understand what you are saying. I believe that just because we can do something eg give a 90 year old life saving heart surgery doesn’t mean that we should. This is not the same as direct euthanasia. Comfort and care until death rather than surgery is not a horrible thing. I think the same is true at the other end of the life spectrum where we take extraordinary measures to save premature and severely incapacitated babies at birth only to then abandon their parents to the care of them with little to no support for the rest of their lives. There is a reason that indigenous peoples let those babies die. We place far too much emphasis on life saving and nowhere near enough on caregiving.
Having been through my Dad’s almost 5 years of post stroke life, paralyzed and unable to walk and without the cognitive capacity to care for himself, I know what I would choose for myself. I would much rather die from a stroke or heart attack than be resuscitated to live paralyzed or mentally incapacitated and be cared for by strangers in an institution. My sister and brother and I were not in the position to care for my Dad in any of our homes. Even if we’d had the ability to fix one of our homes to accommodate my Dad’s needs, getting the caregivers in to help while we were at work would have been difficult if not impossible. I saw others try to do that juggling act, never knowing if a caregiver would show up to provide need care or a meal. Had we had the social safety net to quit our jobs to care for my Dad, we would have been risking our own health helping him to toilet and bathe. I was the youngest in my 50s. My brother has his own heart problems and my sister was over 60 and overweight at the time. Caring for a paralyzed person is very difficult physically, there is a reason that long term care workers are off work with injuries, it’s usually their backs or shoulders. We spent much time supporting my Dad in long term care as best we could, including daily visits and bringing in meals or taking him out for short times on weekends. While in some ways I am grateful for the extra time with him, given a choice I’m sure he wished that the stroke had killed him. I felt much guilty relief when he did finally die – a week long ordeal after subsequent strokes and refusing further treatment that I would not wish on anyone. My siblings and I still live with the trauma of that time, long term care is not for the faint of heart. My mother-in-law, with much more money than my Dad, ended her days in a pretty fancy retirement home which I found to be soulless and institutional, not a much better situation than my Dad’s frankly, just nicer decor. She luckily died from a heart attack before becoming overly incapacitated by her smoking related COPD. They died the same week, a few days apart. All the money in the world won’t get you good care if there is no one to care for you. And even if you believe in prolonging life at all costs, even if we had a total mindset change right now and socialized health care completely, where would we find the people to do the work? Even if we support people financially to care for their loved ones, it just isn’t enough. I have a friend whose 75 year old (none too healthy) parents spent the last 5 years caring for her over 100 year old grandmother. Their last years of good health are now gone, and now my friend is trying to juggle work and teenagers to help them. So forgive me, but I repeat, give me a heart attack that kills me in my sleep over dottering away in the old folks’ home any day. Or euthanasia before the dementia sets in if that’s what comes for me. It ain’t the years in your life, it’s the life in your years.
I try to imagine the way the world would have to be in order for me to not feel this way and I can almost see it. One where I would know that I would be valued and cared for well no matter how ill or how old. One where we can leave good jobs to care for our families with support to do the things that we can’t do. Once there, it wouldn’t be that hard. But I don’t believe we’re capable of disappearing the neoliberals and coming together and turning away from profiteering and rentierism and individualism on a large enough scale to make that world happen. And soon enough we’ll be too busy trying to survive climate related disasters to even try.
My mom is 83 years old and in rehab for a fall at home due to a UTI. She had carers coming in during the day but not at night (her fall pendant worked fine; the pendant people called emergency services and called me; the EMTs came and picked her up; I called a local friend who came and spent a couple of hours with her that night (she was not injured). The next morning it was clear that something was going on (the UTI) so she went to the ER, was in the hospital for a day and now rehab.
I am 3,000 miles away. She does not want to leave New England because all her connections are there. She does have a close friend who is helping me a lot with her arrangements (since my father and brother died it is otherwise just me).
I want her home ASAP since she got a second UTI in rehab (they refuse to give her maintenance antibiotics due to regulations), and has fallen twice there. She will need 24/7 care for when she returns home. I found the cheapest safe option; a person from Ghana who is here legally and is highly skilled. It will be 12k a month; we pay by check and then at the end of the year provide a 1099. So this is not horrible wages. My mother can afford this for 4-5 years (assuming it works out) and then decisions will have to be made about the house and suchlike. Really I don’t know if it will work out. She does not have dementia but so many people develop dementia; that might make it too hard for the carer.
If she moves out with me on the West Coast, quarters will be extremely tight. I am already caring for a 101 year old relative in our condo (fortunately he is totally lucid and still follows chess games online). Local facilities and care costs are far higher here, so if something happens to me and she is out here and I can’t tend her, her money would go very quickly. Local Medicaid facilities in CA are death traps.
I spend lot of time on reddit aging parents and reddit caregivers. There are a LOT of people developing dementia much younger now than in the past (I have a relative by marriage who developed it two years into the pandemic in his early 60s; he recently died). Long covid causes a big increase in tau: https://www.unmc.edu/healthsecurity/transmission/2026/01/14/alzheimers-protein-detected-in-long-covid-patients/#:~:text=A%20study%20of%20227%20individuals,in%20nerves%20and%20especially%20in.
This is NOT going to be just an aging population thing.
Are you in a position to retire early ? I have just spent the last 6 years nursing my wife at home with emphysema and PAH, I have a mother with age related dementia and a brother with PCA. This is in Australia with good public health systems but still it would not have been possible without being able to retire at 60.I am so glad we had 5 good years of retirement before real trouble hit.
Eventually both my mother, father and brother had to go into a nursing home. 24 hr care is a killer long term. I have an NDIS plan for my brother and picked his carer myself, a young man from Nepal who works on his own account, he is 60% the cost of a big company and excellent, it is the way to go. Don’t feel guilty if they have to go in a home, keep looking for a good one, we went with the Wesley Mission and couldn’t be happier.
They never tell you that your retirement will be spent looking after your family but with longer lives it is always going to happen, people should factor it into their planning.
I’m a little confused. Why would I want to retire early? As it happens, I don’t work outside the home; I stay at home tending my 101 year old relative. He is not portable, and my husband’s job is not portable (and we need his health insurance). But my mother is 3,000 miles away, and doesn’t want to move here.
It doesn’t work to “keep looking” for a good care home in my area; they are all extraordinarily expensive; 11k a month for basic assisted living (my mother already needs more than that); dementia care is 18k a month. The state run ones are absolute death traps, and that is where you end up when you run out of money.
My mom’s rehab/nursing facility in New England has a covid outbreak right now, of course. So all hairdressing appointments have been cancelled, and surgical masks have been passed out. I’m sure that will do the trick.
Please, get her some N95 masks at the very least. It being an institutional setting, going full “Darth Vader” is probably the best option. Also, if she has an individual room, an air cleaner is a good idea. The Corsi Rosenthal DIY air purifier should be the minimum accepted for this.
Please help as much as you can.
When she’s gone, she’s gone. No do overs.
Stay safe, all of you.
She won’t wear one. I got her a box of 400 early in the pandemic and she hasn’t worn a single one. It is not what people do where she is, and she is not going to do otherwise. She does have the windows open most of the time in mid-winter due to preference; that may help.