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For most there is simply no other alternative today. Most families don't have the means or physical ability to take care of their elder LO once the LO has deteriorated beyond a certain point. I would say most would rather have their LO stay at home as long as possible but cannot afford the cost. Personally, I would have preferred to have my father stay home longer, but he needed 24 hr supervision, and I had to work and there wasn't enough money to pay private help. There was no other option. I would also tell you for many if not most, it is not "poor Planning". In a lot of cases, circumstances beyond one's control happen (major illness, job loss or lack of decent wage opportunity} and many people aren't able to save for later in life. Currently, over 10% of Americans live in poverty, and a greater percentage are just getting by, living paycheck to paycheck.
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To return to the actual question, there is another important element to take into account:

Suppose you belong to a family that looks after its own, would never place the burden of care on the state, considers it unethical and immoral to do so - but makes an absolutely crap job of it? Where does that leave you? Hidden in the bosom of your family, tied to your armchair to stop you wandering and covered in pressure sores, that's where.
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Beatty Mar 2022
That's what a relative found when doing aid work in Asia somewhere... An 'old' lady (65ish) with a #hip left in bed all day while the family went to work. They cut a hole in a plastic chair to make commode so the lady could be carried over the toilet occasionally.

It happens here too. A woman so proud of meeting her 'no nursing home promise' admitted she left her late 90s parents in their chairs (recliners?) in an upstairs apartment while she went to work. Left drinks & sandwiches within reach. Cleaned them up when home.

Yes she was reported.
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Margaret, I think you've put your finger on the issue of taxation and funding of services. Only: in democratic societies where government is dominated by political parties, the one priority of any government is re-election. It is the responsibility not of governments but of the electorate to decide its priorities and its taxation structure - but the electorate doesn't know and doesn't care to calculate the cost of care on the one hand, or the cost of low taxation on the other. We're a sentimental, wishful-thinking lot who want everyone to be cherished and happy and live forever but don't want to pay for it (or do the work), and the parties are driven by our system to promise us that lo! it shall be so.
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Chuckle.

"There is no such thing as society. There are individual men and women, and there are families." - Margaret Thatcher.

"If Margaret Thatcher wins on Thursday–
– I warn you not to be ordinary
– I warn you not to be young
– I warn you not to fall ill
– I warn you not to get old." - Neil Kinnock, then leader of the Labour Party.

No prizes for guessing who your Korean friend would have voted for, then!
(Mrs Thatcher did win, by the way. Which is why you've probably never heard of Neil Kinnock.)
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The cultural differences raise questions that come up regularly in different ways:.

One set of answers:
a) In all countries with a reasonable average standard of living and adequate health care, people are living far longer than they used to. The ways of the past were based on shorter lives.
b) In most countries in the past, and more recently in lower-income countries, the in-home care was nearly always done by women. Their care was ‘free’. That was women’s role, their work options were less, so losing their potential income mattered less, and they weren’t given other choices. In countries like the USA, this is not now the case.

The other set of answers:
c) We pay taxes to the Government, which should cover the costs of people in need. If they don’t cover the costs, Governments needs to reconsider its priorities and its tax structure.
d) Our many communities (government, churches, medical professions, families) have not come to consider the ethics of keeping so many older people alive artificially with such low quality of life. Or the ethics of spending tax payers’ funds on this, rather than other priorities for younger people whose lives can be ‘turned around’ - in part so that they can also pay taxes, rather than spend expensive time in jail.
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GardenArtist Mar 2022
Margaret, I couldn't help smiling at this comment of yours:

"Governments needs to reconsider its priorities and its tax structure."

IF ONLY that could be true! There is so much waste, and despite being subject to voters' action, legislators can get away with it ....and still get paid.

Your (d) observation is so, so, so true, and sad, when quantity (duration) if substituted for quality.

I think the issue of "younger people whose lives can be ‘turned around" might be more controversial. When I worked in the Juvenile Court, and also based on comments from a friend who was a visiting nurse through the city education system, I was surprised how many people aren't interested in "turning around" their lives.

They just didn't have the family support needed, or they lacked confidence in themselves, or a lot of other reasons.
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I want to applaud you for being culturally curious!

There is no all right way or all wrong way, just different ways...

Issues around childrearing, affording education & housing, caring for elders affect us all. They change too.

Two centuries ago my people had 10 or so kids, unmarried aunts or grands minded the babies, older kids cared for the younger kids, by 12yrs they were off to work, the old or infirm moved in with relatives. 50 was OLD.

These days- if I quit my paid job to care fulltime for old & infirm relatives, it would leave my children without.

The simple answer is I have to use the help of non-family helpers.

It's maths: The base of support differs.
There are just not 10 adult kids + offspring to support 2 elders..

it's 1 to support many on top!
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Maggie61r Mar 2022
I've never thought of it, but what you say is very true. Previous generations had alot of offspring and taking care of them could be spread out between a few of them. Even when I was in school (I'm 62), families of 4 or more kids were not uncommon.
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Ask your Korean friend who was doing the caregiving in his home: was it the women? Is it generally the women in Korean who provide the hands-on care (and give up much)? Just curious if it's the same in Korea as in so many other countries where women are assumed into this role.
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Sighopinion Mar 2022
Next game night I will ask, though I will assume it was his mother since she did not work if I recall, but I will still ask.
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Lealonnie, I pulled this out from your comments. I was beginning to get lost in who had responded to what and wanted to make a point.

"Our government sees no problem printing MONEY to finance whatever wild hair they get up their butts,..."

If you want to read something unsettling if not shocking, read the FARS (Federal Acquisition Regulations) , the requirements and guidelines for federal procurement.

https://www.acquisition.gov/browse/index/far

When I worked for an agency that received federal funds, I had plenty of time before our project went online, so I read the entire manual. I was shocked at the special interest clauses buried in the rules, which had nothing to do with federal procurement, but did have cushy provisions for various legislators' home states. It wasn't hard to conclude that these pork barrel projects were buried in something most people never read.

It was really disgusting to see how legislators can manipulate legislation and get what they want. But it's not surprising.
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The problem is that the government can spend easily millions to keep a senior alive through increasingly exotic cancer treatments, endless operations and so forth and that leaves less money to subsidize SNFs.

By that time, the senior and family are fully primed to think that the government will just subsidize the level of care a senior and their family are now expecting.
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Sighopinion Mar 2022
The extant we go to prolong life does create issues I agree.
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I would simply say "Not how it works in the USA. I understand your own country is different."
To be frank, culturally it is simply too long an explanation.
Care for our elderly and how good it is when provided by our government is again a whole other issue.
I think I would simple say to my Korean friend: "Hon, you have 1,000s of generations of doing things a certain way. We have not quite so many, but we have a few generations of doing it a whole other way. Far be it for me to even begin to try to explain the differences in our cultures. Not for elder care. Not for marriage. Not for child rearing. Not for politics. And not for anything else".
Then I would smile sweetly and offer tea.
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Sighopinion Mar 2022
I enjoy these discussions with my friends, and it is interesting to get different perspectives. It is also nice to hear how other think things work in the U.S. I had one friend from south America that thought the avg income in here was 200k cause he hangs out with people like us, or that you can just walk into a store and by a fully automatic rifle.

I do agree that is just not how it works here and it is interesting to me to see how it works elsewhere.
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The government should be there to help those who need it. But if you have the resources pay your own way.
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Sighopinion Mar 2022
I agree with this, but for some it does seem some view family as a viable resource. Even from personal experience when I trying to find means for my LO to get MC or HHA covered often family was brought up as a means. One social worker even tried to tell me I owed my success to my family and should share that income. One MC wanted me to become the guarantor, I refused and was called selfish.
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Do I feel it's 'proper, ethical or moral to put the care of a LO on the local/federal government?' Yes, I DO. And I'll tell you why. My parents have paid taxes their whole lives. Worked and paid into the system, played by The Rules, like good little soldiers, were never on the dole, never took a dime from the government, even as immigrants when my father had to wear cardboard on the bottom of his shoes b/c his family couldn't afford to go to the shoemaker for new soles. By the grace of God almighty, they had 2 stocks which were cashed out and paid enough money to finance their lives as seniors right up until they died, at 91 for dad and at 95 for mom. If those stocks didn't exist and they only had the cash on hand for the sale of their home, you bet yours sweet bippy I would have applied for Medicaid to finance their stay in Skilled Nursing for the last years of their lives. Without batting an eye and with no feelings of 'guilt' or 'remorse' at all.

Our government sees no problem printing MONEY to finance whatever wild hair they get up their butts, so they can ALSO finance old folks' lives in care as needed.

Old folks lives are valuable, no matter what you or anyone else may think, and whether they saved 'enough' to finance their old age at ASTRONOMICAL costs is neither here nor there, really. It's like asking if a $250,000 bill for a surgery in a hospital is fair, and whether you should be expected to pay it b/c the hospital billed you for it and you didn't have insurance? If you aren't expected to pay IT b/c you can claim indigence, then by God, I should not be expected to pay for long term care at $12K or more PER MONTH in a SNF if I don't have the funds to do so either.
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Sighopinion Mar 2022
I agree but can we really expect the government to keep up with these prices? As one person mentioned it may become a requirement that one has nothing to spend for themselves, and it may extend to family. While not healthcare related nor the same situation when I went to school my parents income was a requirement to apply to student aid my parents barred me from getting any type of aid. I could see this type of system being extended to health care costs in the future.

As proven countless times when it comes to spending money on the people government will always count pennies. Aren't we shooting future gens in the foot if we try to bleed the stone dry now. Costs are only projected to go up. I fall in your camp I will not give up my income to pay for my LO's care I will rather share the cost across the board of tax payers but on the same token I do know that is not viable long term.
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Interesting points, and yeah we save our serious for those DOTA 2 nights.

Jokes aside this is a complex subject and coupled with the end of life thread it got me thinking. As per example my LO is in SNF, and supposedly they bill medicaid little over 5k a month, and my LO is 66 and has no underline health issues so 10 to 15 years, so anywhere from 600 to 900k. I has got me thinking where exactly does the money come from.

Also the point of inherentiece is interesting, cause that was something that was brought up. I was shocked how alone I was when it came to a parents wealth should go towards their care, many did feel that a parent should be able to pass on that wealth especially properly. Granted, many of my friends come from older money and not no one else is going through what I am since we are younger, many of us are not even 30 yet, oldest is 32. Will be interesting to see to see if their position changes as their parents age.

Point of SS is also a fair point and brings up a concern I have, birth rates are lower and with us living longer that means larger costs. Can our government sustain this? Not sure tbh.

Saving for retirement is also memed on in our group. Many live in the moment, saving for the possibility to be able to do things as you are older just does not make sense to many in my circle. As they say "Why would I want to do things when I am a washed up 60 year old."

I am a little obsessed about savings, investing, property etc... I hate spending money I still drive the same used 08 civic even though I make good money. So I also get a lot flake. It does seem saving is not something that is relatively common anymore. Either by choice or inability.
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That reminds me GA, how the government has used our vets sending them to war, then returning, has let them down when they can no longer care for themselves.
There is definitely a group that the government would do well to step up some really helpful end of life care. However, the government is not good at doing it, are they?

(That reminds me-of you caregiving your veteran father.)
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GardenArtist Mar 2022
Send, you're right. Vets deserve a lot more than they get. But they're the first to have to put their lives on the line for other countries. I'm going to be very upset if we end up sending our troops to Ukraine to fight the Russians, regardless of how valuable they could be.

The Vietnam Vets really got shafted and didn't get the respect they were due. It wasn't their fault that we got mired in an unsolvable situation.
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I come from a blue collar family and my DH worked for an auto company. If I had remained single, my SS would not have been enough to live on. I was raising a child in my late 20s on my own. I was lucky I could pay the bills let alone save money. My Dad was forced to retire at 52. Mom cared for him, they lived pay to pay. My husband was the saver and I worked f/t and p/t jobs. So we have money invested but not enough to care for both of us. My Mom paid for her care until the last 5 months of her life when she had Medicaid. My Dads insurance money paid for it. No way could I, retired, and my brothers, one with college age kids, could have afforded 10k a month to care for my Mom.

I pay BIG taxes in NJ. Property, Sales and income tax. Our lottery is suppose to support Seniors and schools. So there is money there to help those who don't have money for care.
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Send, I have never considered that care costs might someday become a mandatory deduction. I hope I never live to see that. I can't imagine the federal government involved in mandatory care.
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Be careful, the solution to having nothing to care for oneself might become an additional mandatory deduction on a person's income (like social security deductions) for their end of life care and housing.

I don't feel qualified to judge other people's morals, or ethics when it comes to caring or not caring for their elderly family members.

However, it did seem right, loving, and honorable that my friend's siblings each contributed to their mother's care in an AL home, but there were 5 of them.

That describes only one situation. My view from my tiny life is limited.

I would need to think more about this question/discussion.
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Interesting that your friend is Korean.

Have you seen this documentary about the Korean Pastor who has saved many abandoned babies? A culture that values seniors, or at least wants to save face by providing care to seniors in the home, is also a country that has few supports in place for single mothers. Including access to birth control to prevent the pregnancy in the first place.

It is very easy to pick and choose our morality and ethics. I have reached the age where I have observed that when an action can be seen by others, like senior care, it will be judged by others, at times quite harshly. But hidden actions seem to operate on a different scale.

I am Canadian and one of the differences between our two countries are social programs, such as 12-18 months maternity leave (federal), subsidized daycare (Provincial) in some provinces, healthcare and some publicly funded spaces in nursing homes, (Provincial). We pay higher taxes to afford these programs.

I am in BC and there are large Asian populations in SW BC. Within these Asian communities there are nursing homes, where the staff speak the language, food and culture are respected. An elderly Aunt chose to move into a Chinese nursing home, as it had the best reviews. She was not Chinese. Although South Asian families may live in mutligenerational homes and keep their seniors at home, it is not easy.

Another issue in Southern Ontario and BC, is that the cost of housing is through the roof. If a family has a mortgage, both parents need to work to cover the cost of housing. My house, which would be a family home in what used to be a low cost of living community would easily sell for $650,000. The value has doubled in 3 years. Although it is a family home, and large at 1800 sq/f with up to 5 bedrooms, there are stairs to enter it and the bathrooms are not accessible to someone in a wheelchair or using a walker.
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I am a saver and a planner - lifelong. My parents and grandparents were as well. I believe it is my responsibility to take care of myself. I don't want the government to decide what level of care I get or where. I don't want to be in a shared room. I'm in a private pay nursing home right now. I will be moving to assisted living in a few months hopefully. I am paying just under $10,000 for NH. My LTC insurance will kick in a few months and it will also pay a portion of AL. My cost for AL will go down to $6000. My son knows that if I live as long as the other women in my family, he won't be getting a big inheritance and maybe nothing.
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Myownlife Mar 2022
That is good you could do that. But for my mom, who along with my dad (died 20 years ago) saved a good amount of money over their lifetime. But for my Mom it leaves only enough for less than a year in a nursing home. Luckily, she is still at home; but that could change. Thank God there is Medicaid, because if it is needed, it will have to be so. And I won't feel ashamed having Mom use it, or for myself in the future if it is needed.
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I'm the daughter of Korean immigrants and my whole extended family is fully culturally Korean. Even these culturally correct Koreans chose to place Gram in a government NH even though by that time even the grands had mansions. So I'm really annoyed by these Koreans who say it's a cultural thing because it isn't.
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Sighopinion Mar 2022
That is interesting, my sample size is smaller but generally from what I can see just amongst his family and friends Multi-Generational Living is extremely common and taking care of your parents is a major factor in their planning towards the future.
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Our tax dollars we pay, go for care of people in need, food stamps, health care etc. Yes, Spending is a choice, but also a necessity. Our culture is very diverse in how much money we make and how do we care for not only ourselves but others. Our families are spread out, which makes it harder to care for those we love. If the government offers to help care for people and our tax dollars pay for that care, why not use it when needed? It's a cultural difference I believe. Some cultures are forced to give up their lives taking care of their loved ones whether they like to or not. We are very lucky IMO.
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Let's step back even before one needs care...
Back to when a person starts working.
People do not think about what happens in 30, 40, 50 years.
So people starting do not save for retirement.
So many take it that Social Security IS their retirement fund. It may have been when people had a much shorter lifespan. We now live more years retired then we worked.
It is unfair, irresponsible for a parent to assume that it is their child's responsibility to care for them when they get older. If that means application for Medicaid then so be it.

I have saved for my retirement. I have planned and IF and or when I need care I can afford it part in thanks to the insurance I am currently paying for. (would I like to do other things with that money...you bet I would)
I want to make the choice to stay in my home or if necessary I want to pick where I will have to go in order to be cared for safely. I do not want my family having to make that choice nor do I want a Court appointed Guardian making that kind of decision for me and I sure as heck do not want Medicaid to select where I have to go.
This is not to say ALL places that accept Medicaid are substandard but I want the right to chose.
I will say that a caregiver in a facility is not going to treat Ms. Smith in bed A any differently than Ms. jones in bed B simply because 1 happens to be on Medicaid. The food for Ms. Smith and Ms. Jones is going to be the same, the shower they get is the same, electricity is the same, the water the same......

You must have some fun game nights.
What do you do for a serious discussion?😉
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You raise some interesting questions; I'm glad you addressed the cultural difference, as I think this plays a very strong part in whether or not a family feels a need, necessity and/or obligation to care for elders.

As to whether or not government should "become the solution for poor planning", I think first, and I write this nicely and not to be critical, you're assuming "facts not in evidence", specifically that poor planning is or was involved. I think that's a contemporary view, arising from a variety of life changing situations over the years.

Additionally, I'm not sure how much any level of government should be a "solution" for poor planning, for a variety of reasons.

In addition, some people don't know how to plan, not only for elder years, but also for daily life. That's not a criticism though; it's an observation. Some people can be geniuses but have little or no ability to manage finances.  

I don't have supporting data, but I do think that's true as society becomes more oriented toward possessions, accumulation of goods and/or assets, and more focused on the here and now as opposed to the future. We also haven't been through a depression and experienced the horror of not being able to buy what we needed. And there obviously still are people in this dire situation.

A few weeks ago I watched a news clip in which an anchor on one of the major broadcast stations interviewed a woman who complained of harassment by the police. She was dressed "to the nines", beautiful jewelry, hair style which seemed to be professionally done, expensive looking clothing...very attractive and professional appearing.

But she felt she was being discriminated against b/ she had had no vehicle insurance (couldn't afford it), and had other similar vehicle charges against her. I don't recall whether or not she even had a driver's license. I could feel no compassion for her b/c she made a choice and spent her money foolishly, not even considering that drivers have obligations to themselves and others to at least carry liability insurance.

My point is that expenditures are often a choice, not a mandate. Similar circumstances can exist at the government level. Beyond voting, or being active ourselves, what control can we exert to ensure that "wise" decisions are made? And that applies all the way up the government ladder, as well as to small governments in smaller areas.

A close example: the local government decided to create a "downtown" attraction for residents. It created the "attraction', closed off local streets, and traffic rerouted itself down 2 adjacent streets, that already were heavily traveled b/c the "government" did nothing about controlling traffic, especially speeding.

The noise level increased drastically, affecting not only air quality but safety. Accidents occurred on what was previously a quiet street. Potholes and cracks in the pavement developed. Garbage thrown out of cars appeared more often.
Booting out the politicians isn't possible b/c no one runs against them any more.

I wouldn't want any of these characters making decisions on my end of life treatment. And that's one of the drawbacks of government involvement, i.e., the caliber and intelligence of some of those involved in decision making.

OTOH, are all families in a position to create care opportunities for their own families?

You raise a complex scenario. I know that I certainly wouldn't rely on the federal government for my care. I don't even bother with the community senior center b/c I've seen what it has to offer: not much.

On the issue of "poor planning", I would suggest that the federal government hasn't necessarily demonstrated good planning; it's driven by political interests, by self interests and client interests. There are some dedicated politicians and ones who understand the need for real legislative action that addresses those in need. But they face off against self interest.
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freqflyer Mar 2022
GardenArtist, I saw that newscast, too, where the lady was saying it was "discrimination" because she couldn't afford car insurance. It was a "Wait... what?" moment.
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