Assisted living facilities: U.S. eldercare

As people live longer, we need to think harder about end-of-life and late-in-life care of all sorts.

 The Guardian has the story (much of which focuses on a particular difficult situation):

In the US, not even $11,000 a month can buy you dignity at the end of your life  by Laura Fraser

"how much longer will we accept a future where most of us lose our sense of human worth in old age?"

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"Currently, about 65% of US elders are cared for by their families at home. For 13% of those who aren’t living with family, the gap is partially filled by assisted living establishments.

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"Nursing homes, assisted living and memory care (special units for people with dementia) are interchangeable in many people’s minds. But there are big differences. Nursing homes, funded by Medicare and Medicaid, are federally regulated. Assisted living and memory care are state-regulated, and mostly paid for out of pocket; some states have subsidies for certain conditions, so about 20% of all assisted living costs are paid for by Medicaid. The median cost of care in the US is $5,900 a month, but ancillary services provided on top of that base rate, including extra skilled nursing care, and can bring that cost up to $20,000 a month.

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"Assisted living and memory care communities are covered by a range of 350 licensing regulations that vary widely from state to state – but with little oversight or enforcement of what few regulations exist. Most regulations don’t require minimum staffing ratios, or are worded as “sufficient” to meet residents’ needs. While this standard is vague, some advocates say that being more prescriptive would be problematic given staffing availability, costs and residents’ needs. Caregivers are typically required to have only a few hours’ training; only about half of communities employ a nurse, usually voluntarily. State and regional long-term care ombudsmen have the right to enter and investigate and informally mediate complaints at these residences, but they have no ability to enforce regulations, other than making a complaint to the state licensing agency.