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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?

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Teddy; Have you had a consultation with an Eldercare attorney in your state, one who understands Medicaid?

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.
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I see that too. My parents wanted us to have an inheritance partly because they had it from their parents. They worked hard also so that they could leave us something. There will be none. I suppose the cost of running a care facility is not just for the caregivers. I see the director of my mom's assisted living working on the books and schedules every day. I wouldn't know all that is involved. And I suppose the owners have to make some sort of profit in order to stay open. Taxes and insurance on the building. Upkeep of the property. I'm sure it goes on and on.
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pamzimmrrt Dec 2019
Artist, I agree.. My FIL And mil thought they had enough to leave a big inheritance to their sons, not going to happen, due to some bad decisions and FIL worries about that. But it is what it is,, and we will deal when it happens.. Things these days are not what they used to be, and I am sad about that, because I also hoped to not burden my daughter. I pray I still wont.
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Hopefully your parents consulted a good elder law attorney, there are ways to shelter property. Great grandpa should be able to keep his half.
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Who knows,, I know when my fil was in the hospital once he was worried about the cost,, his sons were worried about his health. I told him it was his money for his care, and we would all be OK. Then MIL ended up in MC,, more money going out. Life is expensive, and the end of life is currently more expensive. Is there any way the Grandsons and their dad can "buy" the farm, with the money going towards GGMs care? I know farming is not a great money maker these days, but it's a thought? I feel for you.
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Yikes, major sticker shock.

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.
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Riverdale Dec 2019
Such a very thorough helpful answer which is all so true. The only issue I have is that costs can vary by several thousands depending on the area but then parts of the country are simply more expensive. In NY the costs for my mother's AL were almost double to what we are paying in SC but then we are in a more expensive area in SC so costs here can be double to other parts of the state but that is not where we have chosen to relocate. At least here in SC they do not have an automatic annual 7% increase as they did in NY which almost seemed criminal. Nothing more was being offered for that increase and as my husband pointed out to the director there what other business has such an annual increase constantly for which she really did not have an adequate answer. I always recommend not for profit facilities if at all possible.
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What is great grandma's quality of life? Does she have a DNR? Too many people have no idea what is involved in resuscitating a body that's 8-9 decades old. It is a terribly violent act that rarely ends in grandma knitting, gardening and reading the grandkids bedtime stories.

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?
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Isthisrealyreal Dec 2019
Amen! Doctors are only interested in seeing how much a body can take and still survive.
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When health care become for profit...that's when this all went off the rails.

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.
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cherokeegrrl54 Dec 2019
Sooo agree!
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Don't know the answer, though; 40% taxes on everyone so nursing homes, education, and medical care is "free"? Maybe.
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mstrbill Dec 2019
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Just affirming that you should spend the money to consult with an experienced, reputable Elder law/estate planning attorney sooner rather than later if you want to know if you can rescue the farm. Do you have financial PoA for your mom? You will probably need this if your mom is not able to make clear decisions.

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.
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Teddy2019 Dec 2019
What I see happening is that many of the AL and MC facilities are understaffed and the staff that is there, underpaid. The food is not steak and shrimp, but corn bread and beans. I understand there are many costs, but lets say they have 100 residents at $6000, that's over half a million a month!
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One example of more efficient health care.

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.
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If you don't like the cost you do it yourself or find a cheaper alternative. That's what we have to do in many other aspects of life....yard maintenance, cleaning the roof, shoveling the snow, car repairs at the dealership, passing up the sitdown restaurant for a meal at home, child care, and on and on. We get upset at the really high cost of this type of service. We go through life without confronting this societal problem until it affects us personally, just like we do for many other issues....climate change, affordable and available public transportation, hungry homeless people in our streets of America. Yes there are reasons the cost of medical or custodial care is expensive but how many of us make an effort to effect societal change for all of our country? The world? Instead we react with shock when something bad happens close to us, whether it's crime, the fires and floods and climate refugees resulting from climate change, or a horrible health issue that we can't solve with some rest and chicken soup. In my job at a welfare office yesterday, among the people I saw were a blind man with a wife and children, a woman who had fled her husband who had been physically abusing her and she was now living in her car with two cats and whose quadriplegic son was not allowed to be in the home by this husband, a veteran dying of lung cancer, a grandmother aged refugee from the former Soviet Union, an undocumented alien from Central America (who does yard work) to get help for his citizen children, and a man living in his van who now has a physical problem that made it difficult to collect his cans for recycling, which is on top of his PTSD, bipolar, schizophrenia and anxiety disorders for which he's been hospitalized four times. And those just the ones I remember from yesterday who found there way in for food stamps. What are we doing to deal with societal problems before aspects of it smack us upside the head and crush our hearts? Can you do anything today? For me, I'm headed to work now. Who will I see today? And what will I do besides the job I get paid to do? How about you?
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KathyT124 Dec 2019
And how many of these clients will you have to say “no,” to because of the new cuts to food stamps that take effect April 1? Right now, the government is trying to limit access to the minimal safety net we have in this country.
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We lost Dad five years ago. I continue to rent out the farm and that is the income we are using at this time for great-grandma's care. Even though we were assured of a certain price for her care, it has gone up 25% in just the two months she's been there! I may have to pay the farm taxes and expenses out of my savings, which will take it all. I find it hard to sleep at night, concentrate on things I need to do, and feel my health is being affected. I realize, there are many, many people in much greater dire need than I am. I know there are people right here in my location living under a bridge. I know poverty is horrible and there is much suffering in our world. I wish I could save everyone of them. I wish I could continue to try to educate the uneducated, to feed the hungry, stop all wars and make our planet healthy. Unfortunately, I can only do what I am able to do. Knowing this, doesn't make me feel very good. I wish I could be like Ghandi, Budda, or Jesus, but I can't. I just have to take care of what I am able. Right now, that is my husband with congestive hearth failure, my grandsons without their mother, my mother in memory care, and the farm, my home, and everyone that I can. I appreciate all the advice you all have given me. Your ideas are very helpful. I live in Iowa, so not sure of what laws are available to us to save the farm for the next family generation farmers. We have worked with a lawyer for many years. His advice to my father years ago, was to put the farm in a corporation. He told me that I will need to sell if my mother needs the money for the care.
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!
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mstrbill Dec 2019
Yes, you are right Teddy. NHs are for profit organizations and just like most other for profit organizations in our society the folks at the top of the pyramid do very very well while the ones at the bottom might not get paid enough to make ends meet. The CNA's who bathe and clean and "bathroom" and otherwise do the bulk of the hands on care of our elders typically get paid close to minimum wage, maybe a few dollars/hr more, which is not enough to afford to live independently.
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You need to get GGF on medicaid. The farm is a exempt asset. There's no reason to lose the farm.
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Teddy2019 Dec 2019
What makes you believe the farm is exempt? Is that the law in Iowa? I haven't heard that, but it sure would be a blessing! I've been advised to enlist an elder attorney. I don't know of one yet. I've been working with my parent's attorney that they've used for many, many years. The farm is a corporation. Does anyone know how that works?
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You are correct in thinking that this all seems very unfair given what the family's hopes and expectations were, Teddy, but the truth is that folks used to die EARLY and they died at HOME in the care of the extended family. So the farms were passed in that way. That isn't the way of the world now. When I was a young child, on the family dairy farm in IL., the family had 7 kids. They had them to work on the farm. I could choose whether to fork down silage with Bill or put together and sterilize the milk machines with Larry, and that was only the BEGINNING of it. There was no "Am I going out for Hockey or Basketball this year". None of that. No uniforms and no activities. Our activity was going out on the manure spreader in the evening. So things are much changed. That isn't the way of the world, and sadly, most farms don't pass in the family anymore. The corn rows I remember? You could walk between the rows. We hunted pheasant for our Thanksgiving. The way of life was much much different.
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.
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anonymous275053 Dec 2019
Your Post is beautiful to read AlvaDeer as you recall such lovely memories of your youth growing up on the Family farm. I can recall such memories of growing up on our Family farm too, when all the work was done manually and once your head hit the pillow at night you would be fast asleep. A time when the Family Prayed the Holy Rosary together every night, and sat together around the table at meal times as every one talked their story of the day, and so much more of beautiful times that We were so Blessed to grow up in,and are long gone.
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My mother’s 5 1/2 years in residential care cost nearly a million dollars, all of it HER MONEY.

I have zero in regrets.
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People are living way too long, many being kept alive by artificial means, like my step father, on dialysis for 6+ years, he is 90 and has zero quality of life. He and his wife are in AL paying 6K a month, self pay, she is 81 and has dementia.

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.
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And here are some old ideas - saving for our old age, saving for a rainy day, living within one’s means, living a frugal lifestyle.
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mstrbill Dec 2019
Old and true ideas, yes, but doing so just enables more of an estate to go to the nursing home in many cases, until its all gone and then the state takes over just like the state does for those who haven't been so frugal.
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Hi Teddy. Unfortunately your great question will apply to most of Us too. I have asked myself this same question also, and I figure such as we have Here in Ireland The Fair Deal Scheme which is Government funded to pay for Citizens who have no means of covering the costs of care in a Nursing Home Facility Themselves hence the Government is covered on the cheap while People who can afford to pay for their loved ones are hit on the double.
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The new reality is this: if you want to pass down any kind of legacy (tangible or monetary), plan for it when you're young, not when you are at the door of a LTC facility. The nuclear family is rapidly disappearing... and the very old tradition of family caring for family is disappearing at an even faster rate.

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.
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Teddy2019 I think you need to consider that perhaps the advice the lawyer gave your father years ago no longer suits the current situation, and this lawyer might no longer be the right one for you, especially if the lawyer is set on just keeping things the way they have been, and doesn't know about new possibilities.
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.
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https://www.naela.org/findlawyer

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.
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