For some folks with no other options…they need to go to a place, spend down their assets, and be in a place where medicaid pays for basically custodial care. Our state, and many others do have provisions for care at home payment…so that can happen too…but it doesn’t pay $20,000 a month.
Modern medicine seems to be doing a good job keeping people alive longer, but the support they need is just not there.
The homecare robots in Japan aren’t ready for all the things people need help with either.
This may be the only viable option, not just because of costs, but because it might provide the best care for that person. My father has gotten better care in a skilled nursing facility than he could possibly get with round the clock live in or visiting care. He has access to nurses, doctors, and diagnostic facilities (labs, scans, pharmacy, etc.) 24 hours a day. They often take care of things immediately in house that when he was in an assisted living facility meant an ER visit and a hospital stay.
He had already spent down all his assets paying AL with extra aides and Medicaid is covering his bill.
Honestly, this is how the ‘system’ works. There are people that could cobble together a better life circumstance if they had the funds. Many people in the US just don’t plan retirement funds, don’t plan for a ‘rainy day’, don’t consider how they will live with some aging issues.
Look at the recent post where the daughter suggested that her parents include a senior shower with downstairs half bath remodel in 2021, and they didn’t feel they needed it! 2026 and now the dad needs it!
And many, many people just get by financially–no pension and no extra money to save. We are relatively fortunate here.
Yes, countless people in US live paycheck to paycheck. Hard to save when expenses exceed expenses.
My father had made $1M on the sale of his home, all of which was spent in AL and aides during the pandemic. My point is that skilled nursing facilities make sense for people with money and those without. It is all about the level of care they provide.
Yep, I guess if you are Bill Gates you can afford the type of round the clock care that a nursing home provides, by basically building one in your home. But that is not the story for most people, including those who saved for retirement and didn’t ever live paycheck to paycheck.
another consideration is many elder Americans do not live where these sorts of services even exist. It took us 2 days and 5-8 phone calls to find someone to put a cast on my mom’s arm, and the closest was 1 hr away. No public transit.
When my father had a breathing crisis as his lungs failed, an RN at our local (only) hospital told us that in the future it would be best to take him to the big hospital 2 hrs away. Ourselves.
I know of literally zero elders where I grew up who have had in home care. There’s nobody to hire. My mom’s AL facility is staffed at the absolute minimum. My parents had more than enough money and then some to hire 24/7 help – but there isn’t anyone to hire.
Anyway. Lots of magical thinking goes on with future planning. What do elders with few resources and little money do? They die. They. die.
Lots of rules etc. but a friend finally got approved under the VA Family Care-giver assistance program. She takes care of her dad 24/7 and has had huge problems getting competent help even though she’s not in a rural area. This allows her to get a stipend to hire help on her own and it’s been great. She can’t work full time because of taking care of him and it allows her to get just enough assistance to make life a bit easier.
https://thehill.com/policy/healthcare/5996677-part-d-subsidies-expiring-2027/
Offered for informational purposes
"The Trump administration on Tuesday said it would move to end a Biden-era Medicare premium subsidy program, alleging it benefited insurance companies more than enrollees.
As a result, Medicare Part D subsidies will expire at the end of the year and no longer be offered in 2027. "
I’m sad to hear that people who are having a tough time paying for meds will have an even harder time due to these cuts. It makes me very concerned that more and more people will likely go without (& of course end up in overcrowded ERs & hospitals for things that COULD be treated if folks COULD afford the maintenance medications).
You have to understand that drug costs have gone down so it may be that Medicare D premiums have actually gone down. I have seen this between 2025 and 2026 - the only drug that has kept DH’s Medicare D high is a blood thinner that is still under patent years.
I agree that some communities have better depth of medical services. Where one retires needs to take into consideration health care - and I see many retirees moving to be near their children/grandchildren – who over time may then help the senior with navigating health care and services when the time comes.
Mom is digging in about only having part-time help in the house when Dad is discharged. We got in a bit of an argument about it yesterday and I told her that in addition to it not being in his best interests, the effort/stress is likely to land her in the hospital.
His discharge date is next Thursday (8/6) at the moment (extended out from the original one planned for today) The team meets weekly and reassesses and I imagine this date will likely get pushed out at least another week. He is in no condition to be discharged right now.
I have decided that she’s going to do what she’s going to do, and the only thing I can really control about the situation is my reaction/response to it all. I’m going to have to draw some sort of boundary, because it is unsustainable for me to try and be as involved as I had been when he was at home before in an effort to make things easier for her. I was running to their house several evenings a week after work, skipping dinners with H and my kids. My own nuclear family life was suffering. I was willing to do that when it seemed like a terrible situation that had befallen them, but I’m not willing to do it when they are consciously making choices that will likely lead them back into a terrible situation.
Let’s hope I have the fortitude to stand my ground 
I think it’s really important for you to have good boundaries and to make sure that your mom understands that you are not a backup caregiver. Good luck getting her to see some reason!
Your mother says she doesn’t want a caregiver? Then you need to make it clear that you are her daughter…and you want to be her daughter…NOT her caregiver. So…you will do things a loving daughter does…come visit, take her out to lunch or bring her lunch to her, do things with her that she enjoys, etc. This means someone else will need to be the caregiver…bathe , change clothes and possibly adult diapers, change linens multiple times a day, do multiple loads of laundry every day, be able to lift your dad if he were to fall (which is likely to happen)…and this in addition to being a loving wife (which she should want to be her first responsibility) who cooks meals, keeps your dad company, etc.
Caregiver responsibilities are huge…and in my opinion (if affordable) should be something that family members do not take the primary responsibility to do.
I’ve already told my kids and spouse…if I need caregiver level of help, I do not want them doing that. I want them to be my kids, and my spouse…not my caregivers.
I am so sorry that you are dealing with this situation.
Agree with @thumper1 to be firm on your stance that you will support as a daughter but that caregiver role will be hers and not yours.
Also if rehab decides that he’s not improving, they will discharge him.
Unless he continues to need hospital care, they will discharge him. They will recommend rehab or home care or something…but he won’t be able to occupy a
Hospital bed for a long time…unless he needs medical care.
he is in an acute in-patient rehab within the hospital.
For rehab…at least here…if the patient is not continuing to make reasonable progress, Medicare will not continue to pay for their care or services. For my mom (sample of one), the rehab therapists did continue to see her and noted even small levels of progress for the time duration that Medicare would cover.
In my mom’s case, she actually died just as her Medicare supported rehab stay time was ending.
Your mom has to understand that you will not be doing what you have been doing (and now claim your life back) - spell out exactly what your routine will be, and she is going beyond what she is capable of having happen with ‘her plan’. Do not skip dinner with your family and make your husband/kids your priority as it should be. You have helped ‘in crisis’ and the crisis period cannot continue due to your mother’s choices.
Your mom has to snap out of ‘magical thinking’.
She is going to have a crisis happen within a short time if and when your dad gets discharged to home, and her plan will fail if she follows through with detrimental consequences to your dad, your mom, or both of them.