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Was having some morbid thoughts today and got me wondering. Is our current method of caring for the elderly sustainable. People are living longer but unfortunately that does not necessarily mean healthier. Finding care workers willing to do this type of work is difficult at the best of times, and with the salaries they are offer do not do well to help.



People are not saving properly or simply out living their savings. Which means the bill is left to the states, especially in cases where children let their parents become wards of the state.



This probably can go on like this forever, does anyone else feel like it is time we explored death with dignity acts, and expand on allowing families to make the choice to end their parents suffering early?



I was talking to a social worker about this and what they told me is generally what families do is stop treating issues in hopes they die quicker. If this is the mindset people have wouldn't it be easier just to allow families to opt in to ending their lives.



I am in support groups and a common topic that brings up is people wishing / wanting their family member to just die. One of the supports / organizer of the support group liked to say that for one person with dementia to live carefree, it took a village to maintain that.



Are we getting to the point where the village can not really sustain this?

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WOW..kinda don't get me started on some of these topics.
People do not save. The mindset now is Social Security will be my retirement income. Social Security was NEVER intended to be the sole source of retirement income.

Now the add onto that is
Some parents EXPECT their children to support them
Some children support their parents to the detriment of their retirement savings.

Another "problem" is doctors that want to test, test, treat, treat and fail to accept that there is no cure, there is not going to be a quality of life yet they treat, treat and test some more.
My logic is If there is no point in curing why test or treat? (I am talking someone with Dementia being subjected to a colonoscopy or other testing that may result in a diagnosis that will require either more testing or extreme treatment.

There is nothing wrong with death. We are kinda all going that route. It is another "fact of Life" that no one wants to talk about. (sorta like the sex talk that no one wants to give or get)

I remember sitting next to my Husband the last week of his life and I was holding his hand and talking to him (he was not aware at this point) and I said I was going to miss him and I was crying and it suddenly dawned on me that I was crying what I called "selfish tears". I say selfish because for me to want him to continue to exist the way he was was not fair to him. He would not have wanted to live the last even 2 or 3 years the way he did if he had had anything to say about it.

Abzu00 your thoughts are not morbid. They are valid and insightful
Sounds like you have a good Support Group
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Geaton777 Jul 2023
True, many people don't save at all or enough, but those who did diligently and sacrificially save are reaching retirement now and having their savings outstripped by the rising costs of just about everything. I bet few financial advisors anticipated this rate of increase when doing the planning back then.
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That's really a sick idea. Everyone life is priceless and should be protected at any cost. In fact what I just said is stated in the US Declaration of Independence - that the only reason government is created to "secure life" (and liberty and pursuit of happiness.). You throw out these statements which you believe are facts but the reality is life in practice does not work that way at all.

If you want to do something good for the world learn about good health and teach other people how to engage in healthy behaviors as early as possible. 70+% of adults in the US are overweight and obese. If you want to know who is responsible for 80% of the healthcare costs, it's these people. That certainly may not be sustainable but it is totally preventable.
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Abzu00 Jul 2023
Guess the question is what life are we pursing for our elderly with dementia? What do they truly have to look forward? I know it is sore subject, but the situation with my mom got me thinking. What exactly am I fighting for so hard for? What life will my mother really have in a facility where the caregivers hate her guts. Who is to say the next facility will not hate her guts due to her verbal abuse.

Why I am fighting to waste funds prolonging the life of a person that will not be happy unless she is with her family 24/7 and that is something we cannot do.

I love my mom and I will fight tooth and nail but it just does not seem very logical of me tbh.

I do agree we need to better educate people on healthy habits, proper saving, and proper retirement strategies.

I also do feel how we currently care for the elderly is not 100% sustainable, and if we keep on this road something will have to change like it or not.
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"Guess the question is what life are we pursing for our elderly with dementia?"

That's not a question that needs to be asked. A good question to be asked is:

What if someone (like maybe you someday) is diagnosed with dementia but it is found out some time later that it's not dementia but another condition that has been easily and successfully treated?

What if there are new drugs for dementia that slow the progression? (like the most recent breakthrough for Alzheimer's)

You never want give up hope because situations can change for the better. Not always but it's always better to be on the safe side. I've seen it with my own eyes. It is sustainable. It doesn't take a whole village to care for one dementia patient.
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Abzu00 Jul 2023
Idk my mom is a handful, I could not imagine taking care of her by myself. Based off stories I have heard from others dementia is not really something one or two people can handle on their own. It takes an entire care team.

I understand about hope, but has their even been a drug that reverses the damage already caused after years of having the disease? Like the ALZ drug it slows progression in early cases, not much is said about impact on those that have already suffered for years and have progressed. It is great for newly diagnosed and future diagnosed but sadly does not do much for those that have progressed. Unless I misunderstood the data.

The sustainable part also comes from places telling me they do not accept cases like my mother because last thing they need is people leaving the job because they do not want to deal with verbal name calling. My mom is in her early 60's, she can go another 20 years maybe 30. That is a long time. It is not cheap caring for someone that long. Is that really sustainable?

I get it though this is just my morbid thoughts everyone is different and I am not trying to sway people one way or another. I am glad you do not seem to have such thoughts and have a system that works for you.
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I'm not crazy about the idea of families opting to end their parents' lives. I do think that people are living longer and not always for the better, but I know people with severely handicapped children who might say the same. I think that people are important, even when they're really, really inconvenient.
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patpaul Jul 2023
"I'm not crazy about the idea of families opting to end their parents' lives."

NO KIDDING!!! Lord help us. Where would that end?
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I believe in death with dignity. It’s what I want for myself. I don’t believe that families should end a loved one’s life merely for their convenience or to save their inheritance.

My view is that I, while cognizant, should study and understand my right to direct my next-of-kin to follow the instructions I’ve set on record. That would be doctor-assisted death when my quality of life can’t meet the standards I’ve previously decided upon.

I also advocate that each person upon reaching Medicare age or before should be counseled by their doctors about their right to die.

People need education for old age. The current model where they never think about who’s going to support them when they’re in decline isn’t working. We have generations of worn-out family caregivers that almost no one cares about. We have sick elders with no money who expect the government (Medicaid) to provide nursing care into their 100s. That’s not fair to taxpayers.
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Abzu00 Jul 2023
Proper education is important I agree. Often people worry about old age after it is really too late to do anything meaningful.

Which then puts the burden on the government, and I just cannot see how that can be sustainable for the long haul.
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It’s not sustainable and I personally would rather be allowed to have the option for assisted suicide than die a horrible painful death .
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AndSoItGoes Jul 2023
I wholeheartedly agree--though I don't think we would need "assisted" suicide if the medical profession hadn't brought all medicines under their paternalistic control. Many doctors boast about having what they need tucked away for when the time comes, but the rest of us, without dr. friends and prescription pads, will have to grind through or roll the dice with something less reliable.
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One of the biggest issues is food in America is worse then in many places in the World. Good food can equal good health.
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Because of the moral/spiritual component and the vulnerability for having something like this abused... this should be something set up in advance by each person, similar to a Advance Healthcare Directive: ie, others don't get to decide to take this route for someone else, but each person can choose it for themselves in when they are in their right minds and when certain conditions are in play.
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Abzu00 Jul 2023
I agree, hopefully in the future death is not such a scary topic to engage with. Though I do think at a certain point things may get to the point where funds will not be present to allow people to "live" the way they want at the expense of others be it family or tax payers.

I think we are getting close to the point where we may have to put our foot down with care expectations and what is covered going forward. Was looking at what the facility bills, granted they do not get the full amount but it is crazy how much medcaid pays.
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Some elders just don’t understand that doctor’s can’t fix everything . My in laws act surprised when that happens . Recently my FIL was in ICU and I was walking with DH down the hall . My DH commented about two patients we passed that looked very old on respirators. My husband said please don’t save me if I’m like that .
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"I am glad you do not seem to have such thoughts"

Yes, because such thoughts are abhorrent.
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Abzu00 Jul 2023
Not everyone has to share the same thoughts or have the same views. I would not say that, but agree to disagree.
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I agree Geaton ,
Sadly. the current political climate in the US at least will never allow it . I can’t speak for other countries.
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Geaton777 Jul 2023
Many things weren't "allowed" the first time they were presented. It is something that requires a chipping away in order to get it to happen. Think about civil rights, abortion, gay marriage, equal pay...any "hot button" emotional issue (and I'm not taking a stand pro or con on anything, just using them as illustrations).
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"If all that isn’t a village, I don’t know what is. I couldn’t have done it alone."

That's not a village at all. Those are service providers with professional specialties. "A village" is where everyone, or nearly everyone, in a village is giving their time and efforts to help someone. A village is not just professionals.

The economy can revolve around health care and I agree it's getting worse really fast. The solution for me is to stay healthy by engaging in healthy practices. Like for example, I walk an hour a day. I do not smoke or drink alcohol. I try to eat healthy. Just those 4 things done or not done, smoking and drinking, account for like 80% or more of the total healthcare costs. It's an individual responsibility. Not one to be be mandated by others who think they know better.
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Abzu00 Jul 2023
You know it takes a village is just a turn of phrase right? It means it takes many hands like you stated to care for someone with dementia.

No one is arguing preventive care is important, but let us be fair that can only go so far. My mother was not overweight, never drank nor smoked. Did not have high blood pressure, heart disease, diabetes. She worked out regularly.

For whatever reason she had a stroke, and now she is how she is. You can only do so much to prevent something from happening.
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"Many people don't consider life to be priceless."

And that's why everyone should take a stand against abuse in all forms. I will totally agree though that many people do not even know they are being abused! Sometimes by their family and "friends"!
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It makes sense if you believe there was no creator of life, the earth came into existence from a big-bang, we are just evolved animals. Notice how no one's ever fossil evidence of one thing turning into another. There's a reason it's still called the THEORY of evolution. It's only a theory after all these years. A theory designed to take the idea of a creator and God out of the picture. It devalues life!

Each person born is a child of God and God decides when it's time for each life to end. Period.
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sp196902 Jul 2023
Careful PatPaul with your assertion that "God decides when it's time for each life to end." I highly doubt god is doing any such thing. He doesn't have to because he created viruses and disease for the specific purpose of culling both the human, animal, vegetable and mineral life forms on our planet.

If you are going to assert that god decides when it is time for each life to end one has to wonder why some endings are more barbaric than others. For example a child that is beaten to death. A woman raped and murdered. Someone with cancer that causes them excruciating pain for months on end. Starvation. And the list of horrible and terrible ways to exit this life can go on and on.

Faith is just as much a theory as evolution is.

But this isn't the place to spout and argue religious semantics because it has nothing to do with the purpose of this forum and it will be my only comment on this topic.
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I am guilty of that mindset myself when my father got pneumonia and died. I was livid with the hospital, I was asking questions how did they miss it. How could they not do a chest xray, why did they not give him stronger antibiotics.

Reality is he was unhappy and it was his time to go. Doctors saving him would have meant more years of suffering. Doctors cannot work magic they are also only human.
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In a word, yes, it may be time. I think many middle-income older adults (I speak primarily for those of "The Silent Generation", of which I am a member) did try to plan and provide for their old age, but at least in some cases their plan has been derailed by unexpected longevity and the cost of long-term care. Neither my husband (93) nor I (86) ever anticipated reaching our respective ages--but here we are. Even when older people have savings, at today's care rates of $10,000+/month (in our area), they are likely to be exhausted within 2-5 years.

I do not believe that the current system is sustainable. There really is no established "village" to support it. Unfortunately, I do not have a comprehensive solution. Personally, I am a strong advocate for mentally competent individuals having agency over their own end-of-life choices. I also think that older people should be able to designate in advance, in writing, what they want done/NOT done if they develop dementia or other life-destroying medical conditions.

Prolonging the existence of very old, very ill, very frail, very dependent people who have NO quality of life and have outlived their resources just seems totally unsustainable and untenable--to me. There is no "cure" for old-old age and a worn-out, failing body. Why continue to test/treat/test some more? My healthcare directive calls for no heroic measures and specifies in detail what I consider these to be. I also have a POLST and a personal letter. I have tried to do what I can NOT to become an ongoing problem to our adult children.

I fully recognize that some will disagree. That's entirely O.K. End-of-life is--and should be--purely an individual decision. In an ideal situation (which is rarely the case in today's world) it would be made in conjunction with a knowledgeable and caring healthcare team, other appropriate professionals, and a fully informed and understanding family.
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"You know it takes a village is just a turn of phrase right? "

"Takes a village" is an African proverb that means the village as community, not just those with professional specialties.
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Abzu00 Jul 2023
You are right it is an African proverb but it legit just means it takes many people to care for someone. In case of the proverb I believe it was aimed towards children.

With that being said do you not everyone involved in caring for your LO people? Are they just hired hands nothing more nothing less?
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I am not advocating for family members to opt in to end the life of someone against their well, to save money, or convince. I understand this could be abused, what I am saying wondering is are we reaching the tipping point where what a person wants can no longer be considered? If a person is willing to drain all their personal funds that is one thing, but when a person relies on tax payer dollars to sustain themselves, especially someone who has little quality of life is it right to keep footing that bill and to what end?

As an example I know what my mother wants, and I cannot give that to her. So does that mean she should spend the next 20 to 30 years in a holding cell as someone put it?

In the future see it as a strong possibility that either families will be forced to provide care for their LO, or real hard talks will have to happen cause no way this cost can be sustained.
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patpaul Jul 2023
Of course the cost can't be sustained. It's been like that for years and they keep spending. I think there's a crash coming. It will lead to the last 7 years. All part of God's plan. Have you ever read the bible? Not one thing predicted hundreds, sometimes thousands of years in advance has ever failed to come true exactly as predicted. Look into it. It's TRUE! No one's ever been able to prove it wrong, though countless numbers have tried.

There's still predictions (prophecies) yet to come. Everything's lining up in perfect order. I don't think you'll need to worry about death with dignity Abzu. Get a bible. Read the book of Revelation. The same ending is mirrored in the book of Daniel for the Jewish people. Ask God if it's true. Ask God if He's real. He said "Anyone who searches for Me with all of their heart will find Me." I pray for you to search and find because these solutions to snuff out our seniors earlier than God intends are, as another poster wrote, "abhorent!"

I do not think you're a bad person. Just misguided in your present thinking.
I'll pray for your enlightenment. I'm believing that prayer will be answered.

I'll close my soapbox now and bid you all a pleasant day.
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I absolutely believe in death with dignity. So did my parents.

My mother certainly didn’t want to live to be 95 years old with Parkinson’s disease and dementia. I cared for her and it was horrific for me to watch her decline.

My father died when he was 85. He had heart disease and a stroke. I cared for my dad too.

My parents were tired of living after losing their quality of life. I don’t blame them one bit.

I truly hope that I don’t live as long as my mother did if my health starts going downhill.
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Abzu00 Jul 2023
Likewise, I have pediatric MS, and I hope my go long before I become a burden to my family.
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Abzu,
NO ONE has to have any medical care they don't want! That exists now. They can get an infection, opt-out on antibiotics and call in hospice. THAT EXISTS NOW! We had a relative who did this 15 years ago.

You are proposing something different, no?

I'll be back to see your answer tomorrow.
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Abzu00 Jul 2023
That is my point, families already opt into a much slower and painful method.

Why prolong the suffering for years to come. I am not saying it should be an option for people that have a quality of life, more so for people that really have nothing going on?

LIke one resident at my mom's care facility has no family that comes to see them all they do is stare at their wall for the entire day.

Seems cruel does it not? Another person can no longer look at mirrors because their appearance frightens them to the point where they will try to attack the reflection.

What I am saying is why is the slow process okay for people but the quicker one is taboo to talk about?

I also think people should be educated on their right to die and what it entails. It should be a conversation to have like any other when one gets older.
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True. We have a good financial advisor, but he's not psychic. No one could have predicted the timing of COVID-19, what happened to supply lines, serious workforce shortages and inflation--at least not to the extent they have occurred. Many older people saved a percentage of what they were earning plus perhaps 2-3% inflation. It wasn't enough, but who knew then? And who anticipated that they would live as long as they have? The premiums for long-term care insurance have skyrocketed, so even elders who wisely bought policies may now be priced out just when they need it. Even professional actuaries underestimated longevity and the cost of care.
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I don’t think Medicare should be paying for pacemakers for 94 year olds as it did in my mother’s case. The hospital
bill was $319,000, my mother owed $200.

My father overrode her DNR last year and insisted she get it. My sisters and I felt she had no quality of life. She had mobility issues, arthritis, was in pain because she could not get decent pain meds for her arthritis. We thought it was her time.

That $319,000 would have been better spent providing her with 24/7 care. Now we are left with a woman who complains every single day that she is still here.

Instead, the cardiologist and hospital made money off of the government. My mothers money is dwindling now and she will probably outlive it.
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Basictakes99 Jul 2023
This is a good point, if the money that insurances paid out for life prolonging treatments just went into paying for homecare for families this may be a different conversation. The fact insurance is willing to pay a facility as much as they do to provide care, but deny families home care coverage because it "costs too much" is beyond me.

Currently got my wife to get get mother on Medicaid and the amount of hoops you have to go through to get home care funded is insane, but if we drop her off the hospital and say we will not take her home, they are willing to fund stays like that.

The system at the core is broken,
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What the economy "can" do is different then what it "wants" to do. We can educate people until we are blue in the face that benefits of healthier life style choices, and proper planning required for have a carefree retirement . Does not matter if people do not listen or take action,

Facts are simple the United States government is massively in debt, and what programs do you think they will cut when they are crying poor? Entitlements and social services this is just the way things will play out. What we are doing is not sustainable, but no good alterative has ever been presented, and I doubt one ever will. This is a situation that has no good answer, and just like many of us are told regarding caring for our loved ones, sometimes it is not a choice between good or bad, but a choice of the least bad.

Best any of us can do in this moment right now moving forward is make sure you do what you can to not leave your families and loved ones with a burden when you get older.
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Basictakes99 Jul 2023
One other point, advice from my FP. In most cases, even the most diligent of savers will outlive their saves. Retirement is not just about saving and investment. You need to create other lasting revenue streams. This is why he suggested I get into real estate. Relying on just investments tied to a 401k just do not cut it anymore. Which sadly a lot of people think will be enough.
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"I did the healthy stuff, too, but at 86 I've developed some age-related physical problems"

Obviously by 86 health issues are a real possibility, regardless of the care anyone took. What you, and many people do not understand, is that it is not just living a long life; it's the QUALITY of that life from the time you are born for the next several decades AND the fact that you may not have lived that long otherwise that is so important.
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ElizabethAR37 Jul 2023
If you've run across some of my earlier comments, you'll see that I'm a huge proponent of quality of life, especially towards the end. Part of the elder care problem is one of unforeseen longevity without quality. As I've mentioned before, there are "super elders" who are working full time, climbing mountains and jumping out of airplanes at 90, but most of us probably won't be among them.

A significant percentage of those 85+ are likely to face a period of declining health, loss of ability, increasing dependency and financial uncertainty. Our system is not set up to deal with large numbers of people in that situation over the long term. Elder care should not be a "profit center" for hedge fund billionaires but currently--and unfortunately--it often is.
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Yup, totally agree the only way to avoid age related problems is not to get old. We don't always have a choice though. . .
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Way2tired Jul 2023
Agreed,
I was just being snarky.
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I wonder if a part of the answer is to offer people a choice between the $300,000 operation and $300,000 towards long term care. Of course the medical industry would never allow this—but it would make SO much more sense.

In in our case, the interventions were done largely to prolong mom and dad’s ability to continue to live on their own, vs the not-very-nice AL they could afford for a few years before being sent to the Medicaid facility. In-home care does not always solve the problem of aging in place.

Not sure how we begin to shift resources away from medical to elder care. How neat that would be if all the elders suddenly had the resources for a NICE AL or nursing home, and aides and nursing staff were paid really well and not overworked, and cooks in the facility were paid a true living wage, and on and on. Right now elder care is the latest money funnel scheme for investors.

I suspect, actually, that many of the health problems might go away if you took away the stress of worrying about the future.
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I think instead of denying medical care and hoping people die instead simply because they're old and broke is barbaric and uncivilized.

Caregiving for the elderly as we do it now is unsustainable. Most elderly people if they live long enough will end up on Medicaid unless they are wealthy or have very good LTC insurance which can also bankrupt a person.

If the obscene and heinous greed were removed from the healthcare, decent care for all people (not just the elderly) could be realized.

The first huge mistake is healthcare became an industry. It's not supposed to be an industry. It's supposed to be a service. Like the U.S. Mail, police departments, and public schools. A service that answers to the federal government and is regulated by them. Medicare should be telling drug companies how much they can sell their medicines for in the United States. Not drug companies telling Medicare what they're going to be paying.

Hospitals, rehabs, memory care facilities, etc... are not supposed to be run my shareholders and investment groups. Yet they are.

Homecare agencies can afford to pay their employees a decent wage because they bring in enough from that employee's labor to do so.
When it comes to labor I was always a believer in you get what you pay for. Fair pay for fair work. It's simple. I do it every day.

As for the "village" not being able to sustain it. It can't because the shareholders and investment groups that own the care industry usually end up owning the entire village because a poorly insured person got sick or an elder needed to go into managed care.

So what follows is no one inherits from their elderly parents and they get ahead. Then their children do, and generationally lives improve like they did in the past. Each generation is better off than the one before them. That is what's supposed to happen, but it doesn't anymore.
That needs to come back because if it doesn't then there will be only two classes of people. Rich and dirt poor. There will be no middle class in between.
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Way2tired Jul 2023
There will be only 2 classes, rich and poor. People with money are protecting it in trusts , rather than using it to fund their care in nursing homes. They go on Medicaid. IMO this is the same as working and collecting unemployment at the same time. These families will get richer and richer each generation that passes that trust money on to the next.

I know not everyone agrees , but Imo retirement savings is for taking care of you when you are old. If there is any left after you die to pass on , that’s a bonus. Why should Medicaid ( taxes we pay ) pay for a rich person’s nursing home bill ? This is part of the problem .

Meanwhile our taxes will keep going up, as we all are the ones funding Medicaid , making it difficult for people who are not rich to save money or get ahead . Those families will get poorer each generation.

Last year , my husband took my FIL to get POA and the lawyer convinced my FIL to have her draw up papers for a trust fund “ so the nursing home doesn’t take your money “ is what she told him. She charged $6000 for that to be drawn up. I thought it was very unethical due to his advanced age . I wonder how many lawyers do this for people who obviously don’t have 5 more years to live .

Putting money in a trust is subject to the 5 year look back. Even if he lives 5 more years , he will be in a nursing home long before the 5 year look back period would end. And he will die before he could apply for Medicaid or run out of money .
It was a waste of $6,000. My DH never went to the bank to finish setting up the trust . There is no point . So FIL still only has a will and no trust set up .
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Sort of related, here is an interesting article about "hospital at home" programs.

https://www.npr.org/sections/health-shots/2023/07/18/1188058399/hospital-at-home-caregivers-family-stress
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Yes, it’s unsustainable.
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I consider many of the treatments and operations doctors and surgeons do on old people in poor health to be abuse. Prolonging death is not natural. It's called futile care. And I'm against it across the board.

I believe that Italy did the right thing, for example, during COVID when they prioritized younger people over older people to get ventilators. But that wouldn't fly here in the U.S. among the Silent Generation and their Baby Boomer children who would cry "ageism". And the politicians, most of whom are themselves beyond long in the tooth, have no incentive to lead any overhaul.

I believe the entire system - from birth to death - needs an overhaul. But I've seen too much, know too much, am too realistic about how much money drives things in this country to believe that an overhaul will happen. Rather, I think it will just continue to implode.
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Hothouseflower Jul 2023
I think you are right.
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