GJ48 wrote: ↑
Thu Sep 05, 2019 2:22 pm
CULater wrote: ↑
Thu Sep 05, 2019 7:16 am
….I'm not sure remaining at home and depending on home healthcare aides is a more economic solution....
Since 2015 my spouse and I are managing with home health aides for her and expect to do so for as long as possible. It'll be either aides at home or a nursing home. Her condition is complicated and her medication schedule is extensive. Neither of us ever seriously considered assisted living for her because there's just too much going on with her throughout the day.
I read with interest the following opinion piece in the New York Times last week:
https://www.nytimes.com/2019/08/29/opin ... iving.html
"The irony of assisted living is, it’s great if you don’t need too much assistance. If you don’t, the social life, the spalike facilities, the myriad activities and the extensive menus might make assisted living the right choice. But if you have trouble walking or using the bathroom, or have dementia and sometimes wander off, assisting living facilities aren’t the answer, no matter how desperately we wish they were....Assisted living has a role to play for the fittest among the elderly, as was its original intent. But if it is to be a long-term solution for seniors who need substantial care, then it needs serious reform, including requirements for higher staffing levels and substantial training."
My sympathies for your situation. But it sounds like your spouse is almost needing skilled nursing (versus assisted living).
I don't fully agree with that article. Or rather, it fails to emphasize the major issue, which I'll get to below.
Usually memory care units are basically assisted living, plus, well, locked doors (wandering is a serious issue with some dementia patients), and extra supervision. They vary in quality. Group homes can work well for many people with dementia.
Many people in assisted living need lots of help. At times, they may have to wait for that help. But in many situations, things work okay. They may need help getting to the dining room, but are able to putter about the apartment okay. Meals are provided -- can can be brought up -- etc.
I don't want to pretend that US assisted living facilities are just fine the way they are. Yet they remain reasonable choices for many people.
Back to the major issue I mentioned above. There are many frail elderly, who, due to either mental or physical problems, would greatly benefit from having someone attending to them just about 100% of the time. And that's the problem. There is no universe where that is going to be remotely cost effective. You are essentially dedicating one person to keep another person going.
Here is an article on Japan's solution (approvingly referred to in the NY Times article):
http://theconversation.com/social-care- ... tion-96936
If you read through it, you come to this key phrase (regarding the community model they have):
While the idea of ageing in one’s own home and fostering supportive communities of care is undoubtedly positive in many ways, it is important to recognise – as those in the NGO sector in Osaka have pointed out to me – that it relies on the unpaid work of many volunteers, many of whom have cared for family members themselves and so understand the burden it involves.
There is no magic here. Supporting someone at home means *somebody* -- paid staff, family, unpaid volunteers as noted above -- is there helping.
Let's go back to the NY Times article:
But if it is to be a long-term solution for seniors who need substantial care, then it needs serious reform, including requirements for higher staffing levels and substantial training.
And this will greatly raise the cost of assisted living. I don't know the right solution from a cost standpoint. I know that 1-1 care is very expensive.