The Wall Street Journal reports that we have 97 fewer nursing homes than we did last year. What struck me about this number was how small it was. Not 97 thousand or 97 million. Just 97. That's not very much, is it?
Naturally I was curious about this, but it turns out there's not much data available about long-term care in general. The CDC does some tracking, but its most recent data is from 2018. Sometimes them's the breaks, though, so here's the overall change in the biggest categories of long-term care between 2014 and 2018:
Generally speaking, my instincts were right: There were 15,600 nursing homes in 2018 serving 1.3 million people. A loss of 100 nursing homes (serving about 10,000 people) is indeed a very small number—a little over half a percent.
What's more, this didn't represent a drop in long-term care so much as a reconfiguration. Other options increased, and the overall total was up by 250,000.
However, during this same period the population of people over age 75 increased by 2.1 million That's a lot more than 250,000.
So although the drop in nursing care facilities is probably not significant, especially with the growing trend toward home health care, the fact that long-term care options overall are growing a lot more slowly than the population means that facilities for taking care of our parents are being stretched thin. During the 2014-18 period, long-term care lagged behind population growth by nearly two million slots and I wouldn't be surprised if the same were true for the next four years. It's no wonder that finding long-term care has become so excruciating.
Cool, yep, still a thing.
Now show how much money is paid to the people who do the long term care.
One thing to remember is the selling point. "You don't need nursing care, you need assisted living. You don't need nursing care, you need active adult. You don't need nursing care, this is just rehabilitation."
Like operations of the military, this isn't tracked and it's not on the books.
Is the assumption that everybody over 75 needs long-term care? If so, that's a bad assumption.
I'm puzzled by the relative size of the bars for nursing home vs. residential care. One reason for my puzzlement is the cost-to-service ratio. I would expect that assisted-living facilities would be MUCH more cost efficient, which should bias the balance in the opposite direction--running a nice quality assisted living facility ought to be relatively lower cost to the residents while simultaneously returning better profits to the owners.
The other reason, which also goes along with my previous paragraph, is the attractiveness of the assisted living option for the residents. A nursing home is generally a depressing place, while an assisted living facility is often quite an attractive place to live.
I know many hospices are non-profit; I don't know how true that is for nursing homes, but that would make a difference.
As for assisted living, it depends upon the level of care you require. I've seen some that were "independent living" and basically were expensive apartments equipped with medic-alert buttons and a promise they'd check daily to see if you'd died. A true assisted living community restricts access, provides physical support (and sometimes mental support), and has to do things like monitor medications, and they're looking at a wide range of necessary care (some residents are completely mobile, others need help standing or using the bathroom).
And many people in such facilities are on medications that can cause delusions, loss of impulse control, violent behavior, etc. These behaviors are harder to control in assisted living, where everyone is free to move about, than they are in a nursing home environment.
It's a safe assumption with improvements in some aspects of healthcare that you won't drop dead but instead will have a period where you need care for the last couple of years of your life. My parents didn't need help until their 90s. We're getting to the point where the boomers are aging - the oldest boomers are now in their late 70s so demand for elder care will be exploding. Near me a huge "Independent Living" community is being built and it's nearly sold out already.
Yeah. Kevin's out in left field on this one.
It is a miserable business run usually by decent people where the product and output is dying human beings. I defended a number of facilities and their licenses when my mother's last 10 years were very difficult...when she was setting places on fire, facilities as well as my house and my sister's...when she wasn't down in the park having public sex with the homeless.
Some people were very good to me taking her in...to their regret. I still feel badly towards these clients...It was morally wrong putting her anywhere.
Fortunantly, in here last 6 months or so she couldn't get out of a long term hospital bed in a lock up facility....she died relatively young.
In my time in this business I came to see lots of horror stories...These long term facilities deserve some credit...it is hard, Dangerous work caring for people in extremis or on that road.
Best Wishes, Traveller (ps much of the family back east still haven't forgiven me and maintain that I killed her..well...) pps, in my mother's defense, she just wanted to be warm with all the fires.
Long term care is a time bomb that is hiding in plain sight but nobody wants to deal with until it hits them personally. Our failure to deal with this on a national scale means that companies providing the care will bleed families of their generational wealth so the advantage that middle class white families had over Black families will diminish. Or will the problem get bad enough in the next ten years that it causes a political realignment and movement towards an "Obamacare" for long term care? Or will we go the Logan's Run route and create a culture where the elderly are expected to die deaths of despair to save their families from having to deal with this?
There's a huge staffing crisis in the nursing home industry right now. The aides who work in these homes are mostly immigrant women getting minimum wage and few to no benefits for backbreaking, sometimes dangerous work (having to move a large patient in their bed, change adult diapers, deal with violent behavior due to dementia, etc.). Unless the Medicaid reimbursement formula changes, owners can't raise wages to attract new workers, so facilities will continue to close because they're simply not financially viable -- except the ones catering to a wealthy clientelle that take cash only, no insurance.
Yep, it's a ticking time bomb getting ready to explode if we don't deal with this soon.
People in nursing homes end up on Medicaid, when Medicaid covered such care. Alzheimer's care typically is not covered, nor any dementia. Treatments, yes, but not long term care. Yes, it varies by state. As for long term care policies--they can help, but are also limited in nature:
https://www.aarp.org/caregiving/financial-legal/info-2021/understanding-long-term-care-insurance.html
So, with a recent health issue, I did some looking and discovered that California's average life expectancy is only 79, a 3 year drop. We start dying younger and the long term care issues are likely to decline, i.e. Covid is a positive in a weird sense in a specific way. This will also, obviously, be a negative because of the costs of Covid, just thinking about things differently.
Yes, I'm aware that Kevin's data is from 2018 and 2014.
As an aside, I lost a ton of weight in the last year, some intentional, and some not, the side effect of that is I have completely normal blood pressure, in fact normal for me when I was in my 20's.
Work from home options may change the amount of long term care needed, and also result in more financial disparities.
My parents were able to care for my grandmother at home for years because of flexible work-from-home policies for one of my parents. That made hiring help for just a few days a week affordable. Grandma didn't go to a nursing home until she was getting up multiple times a night and she was no longer physically able to do things like bathe herself. At that point nursing care was for months, not years.
I can see hybrid work making patchwork eldercare more feasible for many families. Many elderly people do not need constant care, but also cannot live alone. Most people working from home can make sure mom gets her meals, has a bit of conversation during the day, and doesn't get injured in a fall.
This will also mean that people who work from home will be able to save a lot of money compared to people who must work in person. The same dynamic happens with childcare for schoolage kids. That could be a huge issue going forward. Who will want to work in a hospital or school when you can get an "office" job that pays the same but saves you tens of thousands on care costs for family members?
The interesting thing, around here, it seems a number of the nursing homes are becoming memory care and the nursing homes seem to have a whole lot of dementia folks.
I still do not understand how the figures for care correlate to the figures for the total aged population. Wouldn't one need data on the average need for long term care in order to understand what is going on?
Anyway, long term care is not only "memory care" (what a silly euphemism!), it is any care that lasts longer than a certain time, including physical ailments and sometimes even the prospect of becoming self sufficient again.
Another point: Home care usually means a spouse or daughter is working unpaid, more or less full time (as long as that is possible), hence the need for paid personnel is not equivalent to nursing home care. This is why it looks cheaper.
I heartily endorse reading Ageism Unmasked by Tracey Gendron.
https://www.penguinrandomhouse.com/books/700435/ageism-unmasked-by-tracey-gendron/
Republicans are running an ad in my state about how nursing homes are drying up like a summer rain. The reason? Democrats won't provide enough nurses. Every nurse I've ever known says people leave the profession because the hours are long and the pay is shit. As with all other employment problems, it can be solved by offering pay commensurate with the demand. But since a big chunk of that pay comes out of Medicaid, Republicans will never let it happen.
Why did you include hospice with long term care?