Paying thousands for one month of nursing home care. Any advice on average monthly cost?

Sorry to tell everyone, but older folks are living too long because of advanced medical care. The USA is completely broke.

When my dad called the police up on me for a quick run to the store for him, I later contacted a social worker at a local hospital and was told I do the work of 10 people. When he later said it was time for him to go to a place for more intensive care, I took him to several places. If anything had something in one of them he didn’t like, I would get in trouble.

Finally, we visited a faith based facility but the only part open was independent living, which he couldn’t handle, but the lady said there was another section with a dr and nurses but no opening. A few days later, a place opened up, and incredibly he was allowed in. It turned out to be the very best anywhere I could get for him.

But the RN told me at his temporary stay as he had a very minor stroke at home, that I myself looked like I was on the verge of stroke. I was also raising four children in parochial school plus finishing up classes for a career change. Afterwards, I did find out I suffered some brain damage caring for him with COPD and dementia by observing I had developed some dyslexia.

These nursing homes hire dietitians to plan menus that meet all nutritional requirements, plus handlers to properly prepare food. Then you have the laundry people, the pharmaceuticals administration, janitors along with the nursing assistants, the administrative staff…to replace what the one resident used to be able to do for one’s self, all primarily due to aging disease.

So many don’t want to be a burden to their loved ones.

Assisted living, independent living and skilled nursing home care are all expensive. These companies have to build the facilities to comply with federal, state and local regulations. They have to hire people to comply with the follow on regulations for insurance and at least the minimum standard care. Though the minimum standard care isn’t enough.

In many cases, the elderly people who do end up in these facilities either have no one or are difficult and miserably difficult to be with or their families can’t take care of them because they have to work and take care of their children or any number of reasons.

Planning is essential. Unfortunately, Medicare doesn’t pay for this - just for basic healthcare and then not everything. One has to be destitute practically to qualify for Medicaid and the spaces at facilities are limited because reimbursement require a lot of paperwork.

My MIL’s ALF costs $5,500 a month and she wanted to move closer to us. The answer was no. It would have been more expensive and we didn’t want to see her or visit her. She is so unpleasant, vicious and disagreeable, that we couldn’t have her living with us even when she asked to do so.. I told her there would be rules- about going to the doctor, no hoarding, no bringing her dog (would have to get rid of it), would have to adult day care, etc. What she really wanted doesn’t exist.. We think assisted living is worth every penny.

I am paying $125,000/ yr. for my husband's care in an Alzheimer facility, with excellent care. We are fortunate to have a country home in woods, off grid. We gave one son land and helped with cost of building. (The other three children will split our assets). But I was forced to sell some land for four houses, $ from which will go to my husband's care. I am accepting it, hoping I can still enjoy my house and all the birds and wildlife, but two of my other children are furious with me... but have not offered to help with the financing. This is what I call an ancillary cost of our miserable health system. Family tension.

Quality nursing homes cost a lot. Ditto for "high level" assistive living. Others have mentioned the "real estate" expenses but there are a host of other expenses including construction (there are Federal and State compliance regulations for Medicaid and Medicaid qualified facilities from fire, safety, ventilation (more now post COVID). There are all the state and federal requirements regarding "paperwork," "required services," and "required staffing." And this later part, labor costs can be one of the most expensive aspects of any facility as they need 24/7 around the clock staff at various levels (MD, RN, social workers, cleaning staff, laundry staff, meal service, dietitians, geriatric psychiatrists/psychologists, on call podiatrists, dentists, optometrists others who can come and provide services on site). And each of these staff or contracted on call staff have to have a salary, benefits (workers comp, their own employer paid health insurance, 401Ks, sick leave, on and on and meet state or local minimum wage and other things like fully paid family medical leave for themselves....) They have accounting, sales, business folks, folks that handle reimbursement with insurers, staff to interface with family and of course lawyers too...) These facilities are hugely expensive and labor intensive operations.

Just like a high end hotel may charge $500 a night, same goes for these places. My mom's highly rated nursing home (Medicare/Medicaid qualified) charges about $15K a month (we live in an urban area on the east coast) of the US. After spending down all of my mom's assets over about a 7 month period, then Medicaid picks up the bill. My mom has to hand over all of her Social Security check, all of her federal pension except for $93.00 per month and the total in her bank account cannot exceed $2.5K. So sometimes I have to write the nursing home and "extra check" to bring the total bank balance below the $2.5 K. There is only so much candy or snacks food I can buy or the limited clothing items she might need (they provide a "hospital gown," which they prefer at night "easier for clean up" if there are accidents). All to say not much I can spend her funds on at this point, not like she can go anywhere or do much now....My mom has a private room -- a luxury yes, but given her nocturnal and outburst behavior she would not do well with a roommate. They will allow one to decorate the room any way but no carpets. Some of others on her wing have brought in antique highboys, desks, beautiful artwork to make the room look like home. My mom refuses to "decorate" so her room is barren, her choice.

The "high level" (meaning they provided the highest level of additional services such as medication management, aids to come get them to take them to meals or meals delivered in the room, meal choices, cleaning, laundry) charge about $18K a month AND THIS IS TOTALLY PRIVATE PAY, no Medicaid coverage. The facilities we looked out were amazing, with lots of things to do, even an in-door pool and hot tub. But one has to bring in or pay for (monthly rental) all of one's furnishings and they require a hospital bed but Medicare may pay for that (about $3.5-$4K for the bed).

The "cheap" ALs were about $9, no private bath, no meals in the room (one has to come to the dinning room). These places are in actual homes and they may take 6-8 seniors. They have full time staff, but NOT an RN but RNs or other more skilled staff may visit one a week. [ A nursing home has to have an RN 24/7.] They want the residents out of their rooms most of the day (so the rooms can be cleaned and it is easier for a couple of low skilled aides to manage them if they are all together rather than ringing buzzers for this or that, or asking for help to toilet. One has to bring in all their furniture including a TV (or rent it monthly) and YES they too require the hospital bed be bought by the resident.

Good Luck!

Yup. $4655 a month in an Assisted Living efficiency room…a beautiful facility in a beautiful area. They do med pass, cable tv, meals, help with a shower 2x week, make the bed and a few activities. 1 nursing assistant days and sometimes 1 at night is hard to find. They care for 14-28 residents. Outrageous. I visit 20 hrs a week…2 days a week we leave the building and do something nice... if mom is at home she isolates {and doctor chases} and her dementia spiraled out of control. At the AL her Lewy Body is in a lower stage. When mom goes broke {$250,000 will be spent first} they have a Legacy Fund which will pay the lacking “rent” we can not afford to pay from moms monthly income but we will need to pay for her meds, Incontinence pads, and other costs from our retirement money. Mom is 89. People now live into 90’s-100. Meds keep us alive. Quality life decreases but no one wants to die.

The cost varies from states to states: some are very expensive; others a bit less. In DC area, the average is between 10k-15k, depending on how much care is needed. And that’s not including supplies, meds, and - get this - private caregivers! This is why I pulled my husband out of memory care (MC) after 2 months (and $30,000 poorer) to care for him at home. I spend less on caregiving at home while he is getting a 1-on-1 care with a caregiver. He’s not neglected and abused, and is living in a familiar setting.

NH, AL, MC, etc., are big businesses. They are there to make money, not to provide free services.

We're are moving toward a nursing home in upstate NY for my mom. Not a lot of choices. It took 3 months for her doctor's office--now owned by a big, health care conglomerate--to release her medical records . SMH. I believe the original cost I was quoted was in the $10,000-$12,000/month range. We're paying about $14,000/month for 24/7 aides at home. Most of whom are, at best adequate.

We just placed my father in a SNF. We're paying $10,850 per month for a top nursing home here in NC. That is before the costs of meds and any extras, like transportation to doctors or haircuts. We are having to sell his home to pay for it, my only inheritance, but it is what it is. If that money runs out, if my father lives that long, then we can apply for Medicaid but the good facilities here wouldn't take a Medicaid-pending resident, and no way was I going to place him in one of the awful facilities here. It stinks that we basically have to bankrupt our edlers so they can get good care (or any care sometimes), and families are left with nothing. The US system is so broken.

We are forgetting that nursing homes aren't sitting on free land and in buildings that are paid off. There are huge mortgages.

In the area that I live, it cost over a million just to purchase one acre alone, and banks only loan out 50% of the land value. Such building sites needs many acres for the size of the building, plus parking. Construction loans come in bits and pieces, and that's just for the shell of the building. Loans need to be taken out to do the inside of the building.

Building a facility cost multi-millions, there will be hefty mortgages. For older sitting facilities, it can cost a million just to remodel, thus new mortgages.

Someone who wants to start a nursing home needs a lot of investors who shell out money, and hopefully get some type of profit years down the road once the facility starts to break even. It is high risk, as the nursing home could find itself closing, thus the investors taking a loss. Some closed during the pandemic. Some closed because it was difficult to find workers.

I paid around $10,000 a month for my nursing home care in Maine and Illinois. My uncle's nursing home was $9800 per month. We both got good care in well maintained and well staffed facilities. I was in one nursing home that didn't very good food. It accepted Medicaid patients and private pay.

I’ll always advocate for every NH resident to have someone watching over their care. It’s as simple as when the staff sees that you’re there and care, they care. We watched this time and again during my mother’s four years in a NH. Her care was kind, compassionate, and competent throughout. When we had issues, and they did arise, we took them to the administrator or director of nursing and they were addressed. I’m not sugar coating it, it was a sad, awful time for our family, most especially my mother, but we remain grateful for her care. Yes, the visits grew old, she couldn’t communicate well and there was little to do, yet we saw the difference in showing up for her. And yes, it’s hugely expensive. My mom burned through a LTC policy in no time, private pay to Medicaid super fast at what was then about $120 a day. We had to turn our focus on her care and well being, getting hung up on the cost was just frustrating and didn’t get us anywhere. And it never hurts to show that underpaid staff some appreciation

NH or other facilities are like any business, profit above all.
So cutting cost is essential, cheap food and less staff.
The sad reality is people who work there are trying to do their best, there is no way they can provide good care with those conditions.
Cost in Canada for govt facilities is about $2,000 -$3000 per month, or pension ( average pension is $1100 plus $500 OAS) less $200 for personal spending. Any private facilities are starting at $ 4000 -7000 per person for dingy, dated studio.
Luxury (and I am using this term loosely)$ 10,000 and up monthly.

It's very expensive. But at some point most of us have to turn to a facility for help because providing care at home has so many negatives.

You are getting taking to the cleaners and when the cleaners get done you get run through the mill.
Nursing homes get away with it because that industry has lined the pockets of a lot of politicians to be able to get away with it.
I hate to be the one to tell you this, but your mother gets nowhere near four hours a day of CNA and nursing care. Even if she's a complete invalid who has to be spoon-fed she gets maybe 90 minutes a day of CNA care. If it's a shower day then longer.
Average cost for a NH in CT and I mean rock bottom quality and not eve in skilled care but long-term room and board care is about $10,000 a month (if paying out of pocket). If Medicaid or LTC is paying they can charge anything they want and they get it.
Make sure that you keep a close eye on your mother's money and her Medicare statements.
A nursing home will double-bill and they do it all the time. Medicare and secondary insurance pays and they still collect it in cash from the family. Make sure you always know who's paying for what. It could very well be that the NH is keeping her longer because insurance is paying and so are you. Talk to her regular doctor and see what they think about why 6 weeks has turned into 5 months. The nursing home staff and doctor will never give you a straight answer. Talk to her doctor. If you're able to, make an appointment for her to see her regular doctor.

It’s always been important to save for one’s old age. It’s never been a good idea to expect younger generations to foot the bill for the older ones, Yet even though in the US we have had prosperity compared to so many other countries, why do so many elders seem not to know that they should have saved and saved and saved? How does it so often come down to no assets left and the kids having to scramble to get their parents decent care? We have a duty to provide for ourselves. Too many elders didn’t get that memo.

When our elderly mother could no longer live safely alone in her home it was time to transition to an ALF private apartment. Yes, there were huge arguments but after a minor car accident we had a solid decision to move. We did some major repairs to her older home to sell for best / full market value - this was her only life savings / investment to be used for her future care. The ALF cost was $6K per month plus phone and laundry fees - limited cable TV access.

After 1.5 years she had a medical event requiring hospitalization, rehab and was medically evaluated that she required to go to a SNF. She was transferred initially as a private resident costing $15K per month. 2 years later all her money was spent and we applied for Medicaid.

Here is a chart by state what SNF charge.
https://www.medicaidplanningassistance.org/nursing-home-costs/

I have NO issue with these fees. My only wish is that the medical staff - nurses and aides are paid fairly for what they do. These facilities must be staffed with the appropriate medical staff to cover 24 hr /7 days including holidays. Frankly, these healthcare workers are saints IMO for what they do considering the huge profits some of these facilities make as businesses. I do wonder where that $15K per month goes as I do not think it is spent on the healthcare staff IMO who deserve it.

I would not be able to provide this care level at home plus the medical monitoring, etc. Our mother is seen weekly by the staff physician - how could I possibly provide doctor evaluation at home with a wheelchair bound disabled elderly person? She is where she needs to be at age 95.

I sympathize with your feeling of sticker shock, but it does bring to mind something that happened that was both sad and an eye-opener.

My LO, whose judgement was never good even when she was "well", was on one of her neverending quests to find a better facility than the one she was in. To her, "better" just meant different... Anyway, she found one!!! She called to inform me of this, but was biting her lip over the cost and wasn't completely sure if she could afford it. I asked her how much? She said $280 per month and still hmmmming and hawing about the cost could she possibly pay that much. I informed her that the $280 is not per MONTH. It's per DAY. That calmed her down pretty quick and curtailed her constant asking to move and her "research" into new places. I already had her Medicaid pending at her current facility as it was the only way she could ever, ever afford that type of care as her total income per month is less than $2K. Caring for her at home was a failure, so I had little alternative. Yeah, the costs are crazy. Way back, my grandmother was paying $68 per day for my grandfather. Even that, at the time, was an insane amount of money.

The Skilled Nursing Facility I was looking at here in Denver for my parents was $15K a month. A one bedroom apartment here is about $2K a month to rent, not including utilities, food, etc. Life is ridiculously expensive, especially now with inflation through the roof and taxes increasing, etc. Gas is over $4 a gallon and my food bill for 2 people is about $200 a WEEK. Memory Care for my mother was about $7K a month not including incontinence supplies, doctor bills and medicine.

If you're paying for this out of you're pocket, why are you doing so? Your mother should be footing this bill. If she can't afford to do so, apply for Medicaid.

Elder care is seriously expensive in a seriously expensive world. It is what it is, and complaining about it feels good to do, but won't solve a single thing.

Juloo63, think of this this way.... imagine if that nursing home was your house. The bill for just electricity/gas each month would be in the thousands.... the water bill would be high.... payroll would be through the roof for nurses, aides, call-in doctor or on-site doctor, physical therapist, housekeeping, administration staff, kitchen help, handymen on-site, etc.

Imagine the property tax for the building/land that the facility sits on. There is also building insurance and liability insurance in case someone, be it a resident or staff, gets seriously hurt while on the premises.

There are other "contractors" such as a contract with a private ambulance service. Contract with a lawn mowing/landscaping company for weekly mowing and for snow removal.

Cost of cable TV service with outlets in many rooms, cost of those TV's, cost of telephone service for the building. Cost of internet service and all the laptops used by the staff.

If you think your grocery bill is high, imagine what it would cost for a senior facility doing 3 meals a day, plus snacks for inbetween. And managing special diets.

Cost of the laundry service or having commercial size washers and dryers, and the housekeeping staff that goes from room to room.

There are other costs connected with a nursing home, same with Assisted Living/Memory Care. But this gives you idea what the monthly cost is so high.

When my Dad had 3 shifts of caregivers at home, it was costing him $20k per month, yes per month. Dad was happy to know that when he went into Memory Care it was $7k a month, which felt like a real bargain for him.

Hopefully this is mom's money you are talking about. You shouldn't be paying your money for her nursing home care. Unless you mean your inheritance is being taken away. Mom's money pays for her care until its gone and then she goes on Medicaid. That's how it works.

Is she in an AL or LTC.

Without seeming rude, what did you expect for your money? Because if it was someone being with Mom on a constant basis, that will never happen. CNAs have more than one person they take care of. Rarely do they sit down to entertain the residents. Thats the responsiblity of the activities director. To keep the residents busy doing something. At my Moms AL, aides wore many hats. Besides getting residents up, toileted and dressed they had to make sure they were in the dining room for meals. At Moms AL, they were required to set the tables and serve the food. Some were medtechs so distributed the meds besides other duties. After dinner, those aides have to get their residents ready to go to bed. Get them all situated in their rooms dressed for bed and watching TV then come back later to out them to bed.

A NH is pretty much the same way. And now, there is a shortage of CNAs so the ones still working have more to do.

Folks are flat just gobsmacked at the costs of care. Really until you are personally faced with having a $7,000 - $15,000 monthly bill for a parent or family member to be in skilled nursing care facility (SNF) it’s just not real. The costs are horrendous. Alaska is like avg NH cost is $250K yr but on the flip side some Nh in Deep South are $6K a mo.

Realize that the majority of those in a SNF as a long term resident are in some way under a federal or state program that is paying for their care. Like 60/70% are in a state LTC Medicaid program so that program is paying for their residential room&board costs. Almost all are on Medicare which is paying for most of the direct medical costs like the NH MD bedside visit or their going down to PT once or twice a week for “gait training”. The bill you see is probably just for the room&board costs (a day rate) and maybe a specialty medication management fee if mom is private pay.
There’s likely a good 10/15% in a NH that are also on hospice so are getting some aspects of their care paid by Medicare hospice benefit. I mention all these cause your mom may be eligible to be on a program that will cover some aspects of the cost of her care.

Review her statement and speak with billing office as to what options may be out there. It sounds like mom entered as a post hospitalization rehab patient and that has ended so now LTC resident? Is that it? If so, it might be….. again just might be… that this facility is really geared for rehab and NOT long term residential. If that could be the case, she needs to move into a NH that is way way more about residential care as those will have more activities and events.

if your mom, herself, does not have her own $ to cover costs, then she or you as her POA need to apply for LTC Medicaid. If the current NH does not participate in Maines LTC Medicaid program, unless you have enough $ to pay for care without it ever, EVER, likely to affect your own long term financial future, then your mom needs to spend down and go onto LTC Medicaid & move into a facility that does.



Barb is 100&1% spot on that your mom needs to spend her own money for her care. Not you. Unless you truly can afford to.

Juloo, welcome.

I hope it is mom and not YOU who is paying the Nursing Home. Mom's resources, including Medicaid, should be supporting her medical and housing needs.