My grandsons had dreams of farming their great grandfather's farm. He told them it would someday be theirs. Now, the dream is going to a nursing home for great grandma. Thousands and thousands a month for a small empty room. Why does it cost so much? It doesn't seem to be going to the employees. They aren't paid that well. Can anyone justify the costs to me? Why does my father's hope that his grandsons will farm the same farm that his grandfather farmed have to be given up?
It is likely too late to do anything (Medicaid planning needs to be done 5 years in advance) but it is certainly worth it to get a free hour's consultation.
Some states have exemptions for family farms.
Also, I hope that great grandma's means are being used to fund her care, not your father's. Your post does not make that clear.
To answer why is a nursing home is so expensive we need to realize how many costs are involved in running such a facility. I know it won't make your bill seen sweeter, but it will give you some idea why the cost...
First thing is the cost of the land, zoning changes, building designers, land development such as the footprint for the building, parking, water and sewer, road construction, etc. all need before the building is even built. Back and forth to the County/City for approvals. The cost of the new building itself, which can easily run into the multi-multi-millions. Imagine paying the mortgage and insurance on that !! Even an older facility would still have a mortgage, plus constant repairs.
The building needs to be Staffed, not only with 3 shifts of caregivers, nurses, Aides, but also with kitchen help, inside cleaning help daily, Administration, maintenance personal. Payroll is extremely expensive. Then add in payroll taxes, workman's comp, etc. Office computers, and telephone service. Alarm systems for fire and carbon monoxide. Constant laundry, washers and dryers going all day long. Don't forget the landscapers and winter plowing. Plus business licenses. And contracts with medical transporters, which are similar to ambulances, to take a patient to and from a medical appointment.
Now, lets look at the cost of the electric/gas bill, imagine what that would look like. Then the water bill must be over the top. Then there is furniture, hospital beds, special mattresses, cabinets for the rooms, hoya lifts, oxygen equipment, dining room furniture, nursing stations, WiFi. Then the cost of food for 3 meals per day with a lot of special diets. Let's not forget cost of bedding and towels. Oh, having meds and medical supplies on hand.
Here's a biggee, real estate tax on the building and land, and liability insurance. Plus malpractice insurance.
Some places have on-staff physical therapy with a small gym and all the equipment for the gym. Or a place has a contract with a sub-contractor for physical therapy which is done in a patient's room.
How old are your parents? Does your Dad still farm? If Dad is slowing down, could he rent out land to other farmers to grow crops or to have cattle graze? I don't know if that income would help with nursing home payments.
Her meds are probably doing a good job of keeping her alive? If so, perhaps it's time to wean her off and focus on her quality of life rather than quantity.
Her doctors and the nursing home have zero incentive to change her drug regimen. After all, Medicare is a cash cow and the milk runs dry once the patient dies.
And yes, I have grown very cynical about the medical system and doctors. After seeing what was done to my MIL, who had a neurodegenerative disease, I will never choose for quantity of life over quality. How does great grandma feel? How do her children feel?
corporations believe that the only thing they need to produce is the largest possible profit for their owners. All health care in this country cost far more than any where else in the advanced western countries...yet have the worst out comes.
once for profit realized that draining the elderly was a GREAT source of more revenue...well..nursing homes and assisted living were taken over (trade on the NYSE). This amounts to a massive wealth transfer from not just is generation...but because it is sucking up all the lifetimes earnings of the elderly...it also ensures there is no opportunity for the next generation to get a leg up. Even reverse mortgages came into play....
this level of capitalism is just plain evil.
Regarding the cost of care: employees are usually the biggest expense of any business. The more employees, the higher the organization's expenses. And insurances (yes, including for malpractice), business/liability, Workers Comp, benefits, medical and office supplies, personal care supplies provided to residents (toothpaste, shampoo, lotions, etc), upkeep/maintenance of large facilities, the food they serve to residents, the events, activities and field trips they sponsor (some charge a nominal amount), the buses they own to transport people plus gas/maintenance of those, the cost to heat and cool (utilities), landscaping, and other taxes state, local, federal, property, etc.
I don't understand how people complain that the NH staff are underpaid and then complain that the cost of the care is too high? Or that there's not enough staff? Do you not understand that the 2 are completely connected? My MIL is in a faith-based non-profit NH and the private pay amount is still several thousands a month for basic care.
Also, scarcity forces prices up (Law of Supply and Demand). When all the baby boomers started to require NHs, there weren't enough in existence, and this drives up the prices. And there is an unskilled labor shortage right now, which also drives up the wages. Here in MN they are building NHs faster than can be believed. So, after the boomers pass, this should drive the prices down. But the labor/wage issue is its own thing.
A healthcare system I worked for used digital monitors reporting vital signs to computers to reduce hospital death and complication rates significantly (and the costs associated with the required "extra" treatment for those complications). The continuous improvement health care teams consisting of doctors and nurses met and created a list of changes or patterns in patient vital signs that should be monitored. Then the IT department wrote a program to search through the recorded patient vital signs each hour looking for those patterns and providing a list of patients to give more attention. The computer system caught patients trending into trouble sooner than the staff. When the hospital saw the initial results, they accelerated their program of converting to digital monitors. In the first year of hospital wide digital monitors, the cost savings in this one health care system was more than $10 million dollars, even after Medicare refused to pay for any additional tests ordered for patients identified solely by the computer program. Additionally the reduced death rate meant 50+ more people got to go home.
I realize the expenses are great for these facilities, but I don't think the employees are being overpaid, that's for sure. But when you take the number of residents times the amount being paid, someone is making some bucks!
Was all of it good? I guess not. But pushing 80 and thinking back it SEEMS good. It sure was "different".
I wish your family much look going forward. So sorry for all the painful loss.
I have zero in regrets.
Thus far he has cost we tax payers over 10M to keep him alive, gotta wonder.
My family owns a small farm, so far it has been passed down from generation to generation, the elders lived on the farm till the very end, the children cared for them, but they died at a more reasonable age, 70's & early 80's.
The medical world wants everyone to live to 100, it is big business, they will just keep pumping meds in the elderly doing surgery on a half dead person just to make more money. Then we have families who just won't let go, they have to keep a 90 yo relative alive at any cost to them and or society.
It is a very complex situation, one that needs a total revamping and I know that I will never see it in my lifetime.
I would enlist an attorney to address your situation.
Yes, LTC facilities are expensive but consider this to put it into perspective: my FIL is now in Personal Care at modest local LTC facility. The cost is $120/day or about $3700/month (which, from reading the forums, is cheap). Sounds like a lot but consider what it includes: a completely furnished LARGE private room, all his meals, snacks, beverages, heat, electricity, water, recreational activities, help from nursing staff and aides, assistance with bathing, housekeeping that cleans his room once a week and makes his bed and empties the garbage daily, and medication management (that's a godsend in itself). A doctor makes regular wellness checks and a PA is on call 24/7. They can provide transportation to medical appointments. He has a private phone and cable television which he pays $42/month total for both. The staff check on him and all the residents throughout the night and day. He has a help button on a pendant that they gave him so he is much less fearful when he has difficulty breathing from the black lung- he knows somebody is now always available to help and it's alleviated his anxiety tremendously. He always has company and someone to talk to whenever he wants. His days are full of activity and interesting things. A month ago he was sitting in an apartment alone, with nothing to do, as he had been doing for more than a year after his wife died.
$120/day for all that. DH and I stayed at a crappy Hyatt Hotel earlier this summer that cost double that amount and the room was terrible. And nobody came around each evening offering us cookies and juice, either.
We're outliving the ability to take care of ourselves and somebody has to do it. I'm just glad there are places that will take care of us in our old age, whatever it costs.
You say the farm is a corporation - a business as well as a primary residence?
Who are the shareholders and officers of the corporation, the same people as when it was first incorporated, or different? Is great grandma one of the shareholders? Does she receive any income from the farm?
I do think you need to consult an Eldercare attorney in your state - even by phone if there isn't one in your immediate area. The situation you are in sounds complex, and arrangements that were for the best decades ago might no longer be for the best now.
Enter your zip or city state to get a list of EC attorneys in your area.
This is really the only option for you and your family. We can't/shouldn't be advising on what is or isn't exempt - yours is a complicated scenario (farm, incorporated, etc) and really needs good legal advice. A regular attorney is fine, however consulting with an EC attorney would be better as they would be more likely to know ALL the ins and outs of this situation.