Long Term Care Crisis

[The Atheist]

You've said similar in the two Covid threads as well, that last. I do hope that's an edgy form of humor. But given the other thread, I'm starting to half, or maybe a quarter, suspect that that's literally meant. Apologies if I'm wrong in so suspecting, because it isn't a nice thing, at all, to imagine/suspect about someone.

I'm absolutely not kidding - I did start a thread saying people should be euthanised at 80 and I genuinely believe that.

For starters you wouldn't have two hopeless geriatrics contesting the US election. Tell me that wouldn't be a good thing.

A lot of people in care are vegetatitve and keeping them alive is absurd. They have zero quality of life and take up enormous amounts of resources that would be much better spent on people 60 or 70 years their junior.

No doubt some people are healthy in and beyond their 80s, but they're a minority. Age care takes up a ridiculous percentage of health budgets worldwide and in the not-very-distant future there won't be the money to pay for it.

 

[ponderingturtle]

The obvious that should be pointed out is that we already fund this extensively. Medicaid spends over 214 billion a year on it, over a quarter of its total expenditure. How much will that line item go up when those with the means to pay skirt the responsibility? Who do people think pay for it?

Same with cancer. Any serious disease should render the non rich destitute.

 

[ponderingturtle]

Agreed.

I mean, insurance and healthcare are ****** up things, and in urgent need of drastic reform. In more countries than just the one.
But that specific complaint doesn't seem to have much merit, that I'm having to spend my savings and liquidate my assets to pay for my care, so that my sons and daughters, who are happy to not shoulder that burden themselves, don't get my assets and savings after me. That specific is not one that elicits much sympathy, even if the larger shortcoming it highlights is obviously very real.

Yet people seem to think cancer shouldn't render one destitute, or any of a mirriad other expensive diseases, What is different about long term care? A lot of diseases have long term expenses in the hundreds of thousands of dollars a year, getting those should leave people destitute but for some reason people think society should pay for it.

 

[Nessie]

Dementia is the main cause of the UK care crisis. People can live a long time with dementia, and it is the biggest cause of people having to sell houses and assets to pay for care. I work in home care and see many people being supported to live at home with dementia, who should not be left alone, but family do not want to sell the house to pay for care.

 

[Darat]

Yet people seem to think cancer shouldn't render one destitute, or any of a mirriad other expensive diseases, What is different about long term care? A lot of diseases have long term expenses in the hundreds of thousands of dollars a year, getting those should leave people destitute but for some reason people think society should pay for it.

In the UK your health care will be paid for regardless of your assets at whatever age, social care - the "living with being old" care is generally means tested (varies across the nations). But you don't have to be destitute to have it paid for.

 

[lionking]

In the UK your health care will be paid for regardless of your assets at whatever age, social care - the "living with being old" care is generally means tested (varies across the nations). But you don't have to be destitute to have it paid for.

Same in Australia. I have absolutely no fears about care for my wife and I as we age. We already have approval for a “home care package” which we don’t yet need to access, but provides assistance with cleaning, shopping, gardening and food preparation while we live at home. This continues, at different levels according to need, until the time comes for an aged care home (with the possibility of some time in retirement accommodation, which we don’t fancy, in between).

Aged Care homes are available to everyone, but if you want a better standard, you have to use some home equity to pay for the extra quality.

Yes shortage of aged care workers is an issue, but there have been large pay increases in recent years and immigrant workers are doing a great job.

So the question the OP should be asking is why the US has not been doing what other nations like the UK, Australia and Scandinavian countries (and no doubt others) have done.

 

[rdwight]

In the UK your health care will be paid for regardless of your assets at whatever age, social care - the "living with being old" care is generally means tested (varies across the nations). But you don't have to be destitute to have it paid for.

I don't understand what that means. Care cost is means tested, with the only real difference being your personal assets stop being touched at 30k, as opposed to 3k in the US. Maybe that number should go up in the US, but I don't see this as a large difference.

 

[Beelzebuddy]

So the question the OP should be asking is why the US has not been doing what other nations like the UK, Australia and Scandinavian countries (and no doubt others) have done.

Have you met Americans? Give 'em a few decades they'll all be getting old deliberately just to soak up the old fart money.

 

[Donal]

I'm not sure why those who need care expect not to pay for it, when they have the means/assets to do that. I mean, in general terms I'm all for free health care for all, absolutely: but heirs imagining that they have some kind of right to their parents' assets when they cannot be assed to care for them, seems parasitic. And parents imagining they have both a duty and a right to pass on their assets to their children, when those children are too tied up in their own affairs to care for them (which latter, in and of itself, is fair enough), that on one hand is being stupid and gullible and manipulated by unfair expectations and on the other hand is parasitic (on society at large, to the benefit of one's undeserving offspring/s).

Sure, if adequate health care is available to everyone, that's best, that's ideal. And nor is it an impossible utopian ideal. But as long as we're not there, it seems fair that those who end up needing care, and have built up assets and savings, should draw those down to pay for it.



eta: And agreed, caregivers deserve to be paid a great deal more than they do now. It is a **** job, and a thankless one on the whole other than occasional platitudes. But again, an overhaul of caregivers' compensation paradigm (from bottom of the pile to a much higher level) will mean even more costs. Again, it is good if the state bears that, for everyone. But as long as we're not there, it is fair that those who use that care pay for it when they can, by drawing down assets if need be.

Except that inheritted wealth is one of the best methods for social mobility. And a lack of inherritted wealth is one of the biggest reasons for the wealth gap among races in the US.

I'm not talking about Bill Gates here. I'm talking about my friend's mom who got out of an abusive marriage to raise 2 boys on her own, put herself through nursing school, build her career to become the head of her department, and then watch everything she built flushed away because we failed as a society.

I don't totally disagree with having people be responsible for part of their long term care. There's no easy solution or silver bullet. It's going to get a lot worse with an aging population and labor protections like unions being rolled back the last few decades.

 

[Donal]

Increase birth rate.

We won't do that, but we could.

And how does the upcoming generation afford these new worker drones...err children?

You know waht else we can do that would be more effective over all? Stop concentrating wealth into the hands of a few ********.

 

[Donal]

Have you met Americans? Give 'em a few decades they'll all be getting old deliberately just to soak up the old fart money.

It's true. I'm abouit 63% into my scam to get full benefits from Social Security.

 

[Chanakya]

I'm absolutely not kidding - I did start a thread saying people should be euthanised at 80 and I genuinely believe that.

For starters you wouldn't have two hopeless geriatrics contesting the US election. Tell me that wouldn't be a good thing.

A lot of people in care are vegetatitve and keeping them alive is absurd. They have zero quality of life and take up enormous amounts of resources that would be much better spent on people 60 or 70 years their junior.

No doubt some people are healthy in and beyond their 80s, but they're a minority. Age care takes up a ridiculous percentage of health budgets worldwide and in the not-very-distant future there won't be the money to pay for it.

Uhhh, okay, so you did mean all of that quite literally!

I don’t really know where to begin. This sounds like some weird planned-economy-gone-complete-dystopian thinking to me. How can you look on a segment of the population as somehow less worthy of living, even if they do need more care?

I mean, it is up to society, up to us all, to shape up our economy such that we accommodate all who are part of that society. And not the other way around. What is the point of a shiny economy if that is the result of “culling”, whether literally or figuratively, portions of the populace?

(I feel a bit ridiculous arguing this, much like I did in the other thread, because I keep thinking you’re doing the tongue-in-cheek thing here.)

 

[Chanakya]

Yet people seem to think cancer shouldn't render one destitute, or any of a mirriad other expensive diseases, What is different about long term care? A lot of diseases have long term expenses in the hundreds of thousands of dollars a year, getting those should leave people destitute but for some reason people think society should pay for it.

Oh, I agree. Where I was coming from is, I’m 100% for having a society, an economy, where free quality healthcare is available to everyone. Like some countries already do have. But:

As long as we’re not there yet, then this particular specific, where one is at a place where on one hand the care one needs one will keep needing throughout, it is not a temporary thing for that person; and on the other hand, that person already has savings and assets: then to focus on that particular situation as something to lament about, seems completely misplaced. In our dysfunctional society where healthcare isn’t available to all, I don’t think that particular hill is worth singling out for defending, or even seeking sympathy for.

Like I said already, the larger shortcomings this issue highlights absolutely 100% does need fixing. But this specific probably doesn’t stand out much, or at all, as something that elicits an overdose of sympathy.

(Someone who’s ill, and hasn’t the money to pay for treatment? Absolutely, we should fix that. Elderly person who needs long-term care, and hasn’t the wherewithal to pay? Absolutely, society should take care of that. But elderly person who needs long-term care, and who has the money to pay for it, but, within this imperfect system, is nevertheless lamenting about using up their savings and assets, because nothing will be left for the family? What better use for those assets than to treat the person who earned it in the first place, and who needs it now? Probably this would be last in priority of things that need fixing, if you look at subsets of the health situation that need fixing. At least that’s how it strikes me.)

 

[Ziggurat]

And how does the upcoming generation afford these new worker drones...err children?

Birth rates are higher among the poor than the rich, even within the US. Costs can help incentivize lower birth rates (even among the rich), but they aren't actually the limiting factor. And there are all sorts of contributing factors, many unintended. For example, car seat regulations have lowered birth rates.

 

[Chanakya]

Except that inheritted wealth is one of the best methods for social mobility. And a lack of inherritted wealth is one of the biggest reasons for the wealth gap among races in the US.

What?! Surely you mean the other way around? It is inherited wealth that is the biggest impediment to social mobility, I should have thought. …I mean, your second sentence makes that exact same argument, isn’t it? …Sure, even without inheritance per se, you’d still come across this gap, given that parents with greater income will lavish more of it on their children’s upbringing and education and to get them started. But still, surely inheritance kind of seals the deal on the rich-stay-rich situation?

Now I've nothing against inheriting wealth, not in general terms. But when it comes to a ****** up economy that doesn't offer health care to all, then to focus on end-of-life long-term health care, and specifically in terms that seeks to protect assets from the perspective of being able to pass it on to one's heirs, well that seems a bit off to me. All of it needs fixing, sure; but probably as far as priority this probably comes in about last, was how it struck me.

I'm not talking about Bill Gates here. I'm talking about my friend's mom who got out of an abusive marriage to raise 2 boys on her own, put herself through nursing school, build her career to become the head of her department, and then watch everything she built flushed away because we failed as a society.

But where does inheritance come into this? If you meant this in general terms, then I agree, the system is indeed ****** up, in general terms. ...And agreed, “long-term care” doesn’t have to necessarily mean the elderly, with adult kids. If “family” means young children, then I agree, not being able to provide for them despite having built up assets, is a completely ****** up thing.

I don't totally disagree with having people be responsible for part of their long term care. There's no easy solution or silver bullet. It's going to get a lot worse with an aging population and labor protections like unions being rolled back the last few decades.

I don't think we disagree overall. Except about the question of how and where you emphasize this. That is, I do agree we need full health care for everybody, old and young alike, and for the old no less than for the young. That should be the yardstick for every civilized society, and indeed some are already there. …But if you must pick a section of the population to highlight this situation, then to choose the portion that owns assets but is loath to touch those because they'd rather pass that on to heirs who cannot be assed to care for them in their time of need but nevertheless feel entitled to these goodies, seems like picking the subset of society least deserving of subsidization, to highlight a very real issue that is better highlighted by shining the light on other, more deserving candidates, whose situation is more dire. Which is not to say that ideally everyone shouldn’t be covered, including this segment as well, like lionking discusses for Australia for instance.

 

[Donal]

Birth rates are higher among the poor than the rich, even within the US. Costs can help incentivize lower birth rates (even among the rich), but they aren't actually the limiting factor. And there are all sorts of contributing factors, many unintended. For example, car seat regulations have lowered birth rates.

Ya, that's insane and shows the person who wrote it has no ideas how families work. As someone with 2 young kids and discussing a third with his wife, I assure you the "where do we put the extra carseat" discussion is way down the list of conserns. We just leased a larger vehicle so we could accomidate a bigger family.

we are way more concerned with how we afford child care and groceries.

I'm led to believe that is a parody meant to point out why we shouldn't listen to tech and finance bros trying to math our every issue.

 

[Hercules56]

Somewhat related to this topic, my father has had a Genworth long-term care insurance policy since 2001.

He's been paying his premiums four times a year like a good boy.

Last year the company was sued because they did not have enough funds to cover people who had an unlimited policy, so now everyone is facing 20% yearly premium increases. It's insane. And according to the policy they are totally allowed to do this. Luckily my mom is already in a nursing home so she pays no more premiums.

 

[Ziggurat]

Ya, that's insane and shows the person who wrote it has no ideas how families work. As someone with 2 young kids and discussing a third with his wife, I assure you the "where do we put the extra carseat" discussion is way down the list of conserns. We just leased a larger vehicle so we could accomidate a bigger family.

we are way more concerned with how we afford child care and groceries.

If you're considering leasing a bigger car but you're worried about how to afford groceries, you're managing your finances wrong. Leasing a car is a bad financial deal.

And again, the issue isn't simply that people can't afford more kids. It's that they're incentivized not to. Lots of people who can afford to have more kids still choose not to because they'd rather spend that money on something else. And yes, car seat regulations provide an incentive to have fewer kids. Not everyone responds the same way to the same incentive, but it's there, and some people do respond by having fewer kids. And the data backs that up.

 

[Donal]

So, even when you do "the right thing", you still get screwed.

 

[Donal]

If you're considering leasing a bigger car but you're worried about how to afford groceries, you're managing your finances wrong. Leasing a car is a bad financial deal.

We understand our finances quite well, thank you very much. We didn't approach it lightly.

And again, the issue isn't simply that people can't afford more kids. It's that they're incentivized not to.

"Not starving" isn't exactly what I'd call and incentive.

Lots of people who can afford to have more kids still choose not to because they'd rather spend that money on something else.

Ya, real extravagences like shelter and healthcare.

And yes, car seat regulations provide an incentive to have fewer kids. Not everyone responds the same way to the same incentive, but it's there, and some people do respond by having fewer kids. And the data backs that up.

You know people wouldn't be looking to replace kids who died in car accidents, right? Not everyone, anyway.

I'm telling you, the ChatGPT Guide to Family Budgeting is missing a few details.