For 10yrs, I supported 1-3 agencies that owned/ran group homes for developmentally disabled adults.
These included homes for clients who were non-ambulatory, clients who had profound health issues and one home for dd-so. Besides living and healthcare expenses, the agencies had regulatory overhead imposed by 3 different governing agencies.
Even with all of this, the clients had lives with daily offsite activities, jobs, public events, theme parks, etc.
The per-client budgets of these group homes were tiny compared to nursing homes. They were funded by client SS disability payments, supplemented by some modest public funding.
These homes where founded and administered by boards made up of the client's families. Importantly, they were non-profit; they lacked the massive overhead that comes with shareholder obligations and executive salaries+perks.
They've been providing superior care for over 4 decades. After I left, they began to experience a persistent risk of funding cuts. These were driven by a major hospital chain executive who became governor and then state senator.
Similar experience talking to people who worked for a nursing home supported by a tribal community. They were able to deliver top quality care because that was their mission - Take Care of Our Elders - not increasing shareholder value.
> These homes where founded and administered by boards made up of the client's families. Importantly, they were non-profit; they lacked the massive overhead that comes with shareholder obligations and executive salaries+perks.
Paramedic here. Those are the good ones, where families come together. Or a family, investing heavily in taking care of their own, brings others in.
But sadly, it can go the other way too, where the other residents are just supplementing the household income to look after grandma while they slowly fade away in their rooms.
But I also have a special ire for the nursing homes that call 911 for anything larger than a bandaid, citing policy and insurance, all the while advertising for, and charging residents sometimes five digits a month, for "24/7 nursing care!"
Baumol effect. TVs[1] are unrealistically cheap. This means that more money is chasing less automatable services. There is no technology that makes caregiving 100x more labor efficient. More money chasing the same supply means prices rise until demand reaches equilibrium. No amount of deregulation can increase the labor efficiency of caregiving to match gains in goods production.
24/7 labor is expensive. The goal is to have a 1:10 ratio of nurses to patients, but to get 24/7 coverage you need almost 5x as many nurses. Add other staff: food, cleaning, maintenance, executive/secretarial, etc and you have about as many non nursing staff as nursing staff.
So in other words you are covering the loaded labour rate for about 1 salary per occupant.
The most visible difference is nursing homes are owned by publicly traded entities, who come with massive overhead of shareholder obligations and executive salaries.
Publicly traded entities which are components of many pension funds. The boomers essentially took out a loan against themselves, and now it's due, with interest to boot.
There's some schadenfreude seeing the boomers complain about getting the enshittification treatment they themselves got rich off.
It takes the same amount of land, nurses, and orderlies to care for a 100 old people as it did in 1970, but the land, nurses, and orderlies all cost more on an inflation adjusted basis. Classic Baumol's cost disease.
I'm in the group of upcoming retirees who can't ever afford to retire - and understand that homelessness is one of our very-possible outcomes. For the millions of folks who get insufficient winning hands in life, a nursing home is far from the worst outcome.
The same line boomers enjoyed riding on while their property and other investments went up massively without any effort on their part, at the expense of subsequent generations.
Now, they're getting a taste of their own medicine as someone else (private equity in this case) wants to ride the line going up and even just robbing subsequent generations isn't enough to pay for it.
I'm sure there would be plenty of things to blame me for, but I'm still waiting to be able to sit and do nothing while my assets grow by an order of magnitude effectively risk-free, and be able to influence local policies to protect that growth no matter the cost. Instead, it seems like the very opposite is happening, with my labor being used to subsidize boomers to this day.
You’d have to go back a long time: the silent generation invested a lot in the public good from electrification to the GI Bill to roads to education and environmental protection. It took the Reagan era cuts to start rolling back investment in the country—I grew up in California during the 80s and 90s and each of the schools I went to had visible decline because they had built infrastructure prior to Prop 13 and then couldn’t afford basic upkeep.
> You’d have to go back a long time: the silent generation invested a lot in the public good from electrification to the GI Bill to roads to education and environmental protection.
My parents were silent generation and I'm endlessly surprised how little adults of that generation understood about truly basic things, like psychology.
To be fair, they generally parented a few hours a week. That wasn't much, not compared to the 24/7 adulting that was required of my generation (and is now the standard for every gen of parents).
But... With our modern, unsustainable parenting requirements, birth rates are plummeting. More competence, fewer kids.
I was a youth leader for ~20 years and I consistently found that young people understood people/psychology better than my generation did and certainly better than my parents' generation.
> You too will grow old and then... you too will be blamed for everything.
Not so. Or at least not so much. I'm part of the group that's responsible for every atrocity, avoidable disaster and systemic failure in history. Adults.
Adults are also the cluelessly stupid group that endlessly blames teens and kids for crap.
Problem is that individuals often know what is right, but can't do the right thing because society as a whole is not collaborating. In a few years we will all be blamed for not taking action when it was clear climate change was going to cause big problems for humanity. There are many who are trying, but as a while society doesn't seem to be able to course correct, see the current disaster in Brazil.
Oh, and the current generation will most likely be blamed for destroying most of the job market and opportunity for people to earn a living by pushing AI so much. There's always something to be blamed for.
We're not going to be able to fix the boat with a country as divided as ours. Half of us are hopelessly bailing out water instead of fixing the problems, and the other half are drilling holes in the hull with big grins on their faces.
> Not a lot to be blamed for if the ship can't be wrighted.
'Not being wrighted' means a whole lot of boomers won't be getting in-home care, or absolutely terrible minimum "care".
But this started with the Mergers and Acquisitions crisis back in the 80's, and vulture capitalism has really taken off in the last 30y.
Oh, and my SO was a in-home healthcare person. They got paid a WHOLE $14/hr, no benefits naturally. You can probably guess the type and quality of most the candidates and workers. Even a few of them did the petty and felony theft from their dementia/Alzheimer's clients. Not like they'd miss what was stolen :(
ZIRP was mostly limited to the US tech industry no? Where as back then even any blue-collar job would allow you to support a family and buy a property outright after some years of savings.
Certainly privately owned ones skim a lot off the top to pay shareholders and bonuses, but the reality is that the cost of caregiving is almost entirely labor and rent, and those things do not benefit from efficiency gains, so the cost of service just goes up forever because of Baumol's cost disease.
Realistically the only way to stabilize the price of caregiving is to automate the hell out of it, like Japan is trying to do. It's a rather dystopian thought that the only way senior care won't bankrupt us is if we have robots do it all, but what can you do.
Labor, who pays a sizeable chunk of their income on rent... and rent, well is rent. Rent is only expensive when demand outstrips supply, and demand keeps being artificially constrained by existing property owners (of which boomers are a large chunk) not willing to take a hit on their property value. Seems like a self-inflicted problem.
The Baumol effect is only one component and not the entire story. Those that run these services will extract as many profits as possible for themselves. When the robots will manage geriatric care, there is no reason to not continue exploiting the patients' wallets.
“It’s not rocket science — you’ve either got to pay more, or you’ve got to let in way more people. … There are wonderful, caring people all over the world who would like to come care for our seniors at the wages we’re willing to pay, and we just have to let them in,” Gruber said.
This is the crux of it. The government should also subsidize and directly administer more senior care, especially given the economic drag from having family members step into these roles
The government actively tries to block any attempt. After two father deaths and now my mother in elderly care, it’s a damned nightmare. They have means but can’t make decisions. They get easily confused. I could go on but my sister and I basically have badges at the facility because of their short staff. We have real jobs this takes away from.
The vast majority of the US population is immigrants, or their descendants. You can think of immigration as the cause of all these expensive to care for retirees.
All of my ancestors came over and did hard jobs for low pay, which is essentially what is being suggested here. The cycle repeats.
The other wealthier boomers and rich assholes have long decided they'd rather squeeze even more blood from the stone because they have the money to cover any senior care they need. This was a problem slowly coming down the tracks for decades but why fix it when it can be used to turn a profit. Especially when people continue to act against their own self interest.
Same spot because we made the choice to do nothing different with the lead time. At least the population compression is locked in [1], the short term pain will be dealt with regardless.
There is a Melbourne start-up called Andromeda, which makes playful robots for the elderly. https://andromedarobotics.ai/
I always thought this would be a market Japan would dominate with their aging population and early development in robotics, but I don't think I'm seeing that.
The medical industry has not helped itself either. It seems to have jumped at every opportunity to erode public trust.
As just one example, my cardiologist recently scheduled a rigorous stress test for me. The day before the test, I got an unexpected call from some woman at the hospital, who told me that the test would cost $1,700 if I paid right then and there on the phone. If I waited and paid in the morning, it would cost $2,100.
It was like I was dealing with a used car salesman!
I canceled the test instead, deciding on the spot that I'd rather take my chances. I refuse to fund an industry that wants to use my wellbeing against me as ransom.
> I canceled the test instead, deciding on the spot that I'd rather take my chances. I refuse to fund an industry that wants to use my wellbeing against me as ransom.
I'd cancel because I don't have $1700. But then again, if I get a treatable ailment (that risks my life otherwise), I die. Me and millions of other Americans.
You don’t really need a degree to take care of old people. I mean, perhaps some of the staff in this kind of facilities need a degree for certain select procedures, but most of them don’t.
Canada has a much better solution for this: assisted suicide. I've had multiple elderly relatives in a state that necessitated care facilities and every single one said they were ready to die.
The award-winning ABC series ‘Old People’s Home for 4Year Olds’ and 'Old People's Home for Teenagers' were not only heart-warming shows. A new Griffith University study found the series have been instrumental in public recognition of the social and health benefits of intergenerational practice.
There's a lot I can say about older populations and their abilities despite being old, right now I'm have to step out for the day for several hours, possibly more, so I'll just leave this one approach above that's been tried and works well.
Also, the elder population aren't homogenous by any means, there are a good number that can assist others with meals, gardens, etc.
Medicare (US) doesn't cover skilled nursing or long-term care. Medicaid did cover LTC for means-tested individuals, but a significant fraction of that is going away after the midterms to give tax breaks to billionaires. It's going to be a shitshow beyond 2026 and it's only going to get Gilded Age 2.0 worse with massive increasing numbers of elderly homeless people from here on out. Denying healthcare and care is going to kill a lot of people.
For 10yrs, I supported 1-3 agencies that owned/ran group homes for developmentally disabled adults.
These included homes for clients who were non-ambulatory, clients who had profound health issues and one home for dd-so. Besides living and healthcare expenses, the agencies had regulatory overhead imposed by 3 different governing agencies.
Even with all of this, the clients had lives with daily offsite activities, jobs, public events, theme parks, etc.
The per-client budgets of these group homes were tiny compared to nursing homes. They were funded by client SS disability payments, supplemented by some modest public funding.
These homes where founded and administered by boards made up of the client's families. Importantly, they were non-profit; they lacked the massive overhead that comes with shareholder obligations and executive salaries+perks.
They've been providing superior care for over 4 decades. After I left, they began to experience a persistent risk of funding cuts. These were driven by a major hospital chain executive who became governor and then state senator.
Similar experience talking to people who worked for a nursing home supported by a tribal community. They were able to deliver top quality care because that was their mission - Take Care of Our Elders - not increasing shareholder value.
> These homes where founded and administered by boards made up of the client's families. Importantly, they were non-profit; they lacked the massive overhead that comes with shareholder obligations and executive salaries+perks.
Paramedic here. Those are the good ones, where families come together. Or a family, investing heavily in taking care of their own, brings others in.
But sadly, it can go the other way too, where the other residents are just supplementing the household income to look after grandma while they slowly fade away in their rooms.
But I also have a special ire for the nursing homes that call 911 for anything larger than a bandaid, citing policy and insurance, all the while advertising for, and charging residents sometimes five digits a month, for "24/7 nursing care!"
So why are nursing homes so expensive?
Baumol effect. TVs[1] are unrealistically cheap. This means that more money is chasing less automatable services. There is no technology that makes caregiving 100x more labor efficient. More money chasing the same supply means prices rise until demand reaches equilibrium. No amount of deregulation can increase the labor efficiency of caregiving to match gains in goods production.
1. And other goods mass manufactured.
24/7 labor is expensive. The goal is to have a 1:10 ratio of nurses to patients, but to get 24/7 coverage you need almost 5x as many nurses. Add other staff: food, cleaning, maintenance, executive/secretarial, etc and you have about as many non nursing staff as nursing staff.
So in other words you are covering the loaded labour rate for about 1 salary per occupant.
The most visible difference is nursing homes are owned by publicly traded entities, who come with massive overhead of shareholder obligations and executive salaries.
Seems unlikely. Non-profit nursing homes are not noticeably more price-competitive with the for-profit ones.
Publicly traded entities which are components of many pension funds. The boomers essentially took out a loan against themselves, and now it's due, with interest to boot.
There's some schadenfreude seeing the boomers complain about getting the enshittification treatment they themselves got rich off.
> Publicly traded entities which are components of many pension funds.
A shareholder relationship is parasitical and exploitive by it's nature, as defined by Dodge Brothers v. Ford.
Making pension funds feed on that relationship - that is whatever that is. I couldn't call it a necessary evil because it's by design.
It takes the same amount of land, nurses, and orderlies to care for a 100 old people as it did in 1970, but the land, nurses, and orderlies all cost more on an inflation adjusted basis. Classic Baumol's cost disease.
Culture has changed though. My mother is 69 and she'd rather commit euthanasia than spend the last years in a nursing home.
People born after 1945 are used to making their own choices and living by their own rules.
I'm in the group of upcoming retirees who can't ever afford to retire - and understand that homelessness is one of our very-possible outcomes. For the millions of folks who get insufficient winning hands in life, a nursing home is far from the worst outcome.
labor cost, which is high because of high housing costs and other jobs that provide good pay competing with nursing home jobs
https://www.cnbc.com/2025/03/01/why-nursing-homes-and-hospic...
nursing people has always been expensive.
it's just that everything else's price dropped (economy of scale, new technology etc.) while nursing stayed as expensive as ever.
"Line must go up".
The same line boomers enjoyed riding on while their property and other investments went up massively without any effort on their part, at the expense of subsequent generations.
Now, they're getting a taste of their own medicine as someone else (private equity in this case) wants to ride the line going up and even just robbing subsequent generations isn't enough to pay for it.
You too will grow old and then... you too will be blamed for everything.
I'm sure there would be plenty of things to blame me for, but I'm still waiting to be able to sit and do nothing while my assets grow by an order of magnitude effectively risk-free, and be able to influence local policies to protect that growth no matter the cost. Instead, it seems like the very opposite is happening, with my labor being used to subsidize boomers to this day.
I also don't recall anyone ever blaming the WWII, or other generations like this.
Boomers coasted off the success of the postwar era, and now we're all poorer for it.
You’d have to go back a long time: the silent generation invested a lot in the public good from electrification to the GI Bill to roads to education and environmental protection. It took the Reagan era cuts to start rolling back investment in the country—I grew up in California during the 80s and 90s and each of the schools I went to had visible decline because they had built infrastructure prior to Prop 13 and then couldn’t afford basic upkeep.
> You’d have to go back a long time: the silent generation invested a lot in the public good from electrification to the GI Bill to roads to education and environmental protection.
My parents were silent generation and I'm endlessly surprised how little adults of that generation understood about truly basic things, like psychology.
To be fair, they generally parented a few hours a week. That wasn't much, not compared to the 24/7 adulting that was required of my generation (and is now the standard for every gen of parents).
But... With our modern, unsustainable parenting requirements, birth rates are plummeting. More competence, fewer kids.
What's the evidence for more competence?
I was a youth leader for ~20 years and I consistently found that young people understood people/psychology better than my generation did and certainly better than my parents' generation.
> You too will grow old and then... you too will be blamed for everything.
Not so. Or at least not so much. I'm part of the group that's responsible for every atrocity, avoidable disaster and systemic failure in history. Adults.
Adults are also the cluelessly stupid group that endlessly blames teens and kids for crap.
After we either repair all the shit the boomers broke, or fail trying. Not a lot to be blamed for if the ship can't be wrighted.
Problem is that individuals often know what is right, but can't do the right thing because society as a whole is not collaborating. In a few years we will all be blamed for not taking action when it was clear climate change was going to cause big problems for humanity. There are many who are trying, but as a while society doesn't seem to be able to course correct, see the current disaster in Brazil.
Oh, and the current generation will most likely be blamed for destroying most of the job market and opportunity for people to earn a living by pushing AI so much. There's always something to be blamed for.
We're not going to be able to fix the boat with a country as divided as ours. Half of us are hopelessly bailing out water instead of fixing the problems, and the other half are drilling holes in the hull with big grins on their faces.
> We're not going to be able to fix the boat with a country as divided as ours.
You are correct. However, I couldn't see how we could have fixed it before. In the US, every possible group of people was fully mired in a state of
I couldn't see how anything could improve before, not while that principle dominated everything. And it's still that now, just 10x worse.> Not a lot to be blamed for if the ship can't be wrighted.
'Not being wrighted' means a whole lot of boomers won't be getting in-home care, or absolutely terrible minimum "care".
But this started with the Mergers and Acquisitions crisis back in the 80's, and vulture capitalism has really taken off in the last 30y.
Oh, and my SO was a in-home healthcare person. They got paid a WHOLE $14/hr, no benefits naturally. You can probably guess the type and quality of most the candidates and workers. Even a few of them did the petty and felony theft from their dementia/Alzheimer's clients. Not like they'd miss what was stolen :(
Millennials will be called "little boomers" because all future generations will seethe about them living through the ZIRP era.
ZIRP was mostly limited to the US tech industry no? Where as back then even any blue-collar job would allow you to support a family and buy a property outright after some years of savings.
Certainly privately owned ones skim a lot off the top to pay shareholders and bonuses, but the reality is that the cost of caregiving is almost entirely labor and rent, and those things do not benefit from efficiency gains, so the cost of service just goes up forever because of Baumol's cost disease.
Realistically the only way to stabilize the price of caregiving is to automate the hell out of it, like Japan is trying to do. It's a rather dystopian thought that the only way senior care won't bankrupt us is if we have robots do it all, but what can you do.
> labor and rent
Labor, who pays a sizeable chunk of their income on rent... and rent, well is rent. Rent is only expensive when demand outstrips supply, and demand keeps being artificially constrained by existing property owners (of which boomers are a large chunk) not willing to take a hit on their property value. Seems like a self-inflicted problem.
The Baumol effect is only one component and not the entire story. Those that run these services will extract as many profits as possible for themselves. When the robots will manage geriatric care, there is no reason to not continue exploiting the patients' wallets.
“It’s not rocket science — you’ve either got to pay more, or you’ve got to let in way more people. … There are wonderful, caring people all over the world who would like to come care for our seniors at the wages we’re willing to pay, and we just have to let them in,” Gruber said.
This is the crux of it. The government should also subsidize and directly administer more senior care, especially given the economic drag from having family members step into these roles
The government actively tries to block any attempt. After two father deaths and now my mother in elderly care, it’s a damned nightmare. They have means but can’t make decisions. They get easily confused. I could go on but my sister and I basically have badges at the facility because of their short staff. We have real jobs this takes away from.
The vast majority of the US population is immigrants, or their descendants. You can think of immigration as the cause of all these expensive to care for retirees.
All of my ancestors came over and did hard jobs for low pay, which is essentially what is being suggested here. The cycle repeats.
The other wealthier boomers and rich assholes have long decided they'd rather squeeze even more blood from the stone because they have the money to cover any senior care they need. This was a problem slowly coming down the tracks for decades but why fix it when it can be used to turn a profit. Especially when people continue to act against their own self interest.
It was predicted a few decades ago by looking a demographics. Where would we be now if we hadn't had all that time to prepare?
Same spot because we made the choice to do nothing different with the lead time. At least the population compression is locked in [1], the short term pain will be dealt with regardless.
[1] https://www.sas.upenn.edu/~jesusfv/Slides_London.pdf
There is a Melbourne start-up called Andromeda, which makes playful robots for the elderly. https://andromedarobotics.ai/
I always thought this would be a market Japan would dominate with their aging population and early development in robotics, but I don't think I'm seeing that.
With the pace things are developing at, I would not be surprised at all to be surrounded by robots in old age and when I pass.
Time to train up a generation to enter this field and then have them be out of work in 30 years when the demographics flip. Tale as old as time.
On the other hand, it's becoming harder for nursing students to finance their education. :/
https://www.the-independent.com/news/world/americas/us-polit...
The medical industry has not helped itself either. It seems to have jumped at every opportunity to erode public trust.
As just one example, my cardiologist recently scheduled a rigorous stress test for me. The day before the test, I got an unexpected call from some woman at the hospital, who told me that the test would cost $1,700 if I paid right then and there on the phone. If I waited and paid in the morning, it would cost $2,100.
It was like I was dealing with a used car salesman!
I canceled the test instead, deciding on the spot that I'd rather take my chances. I refuse to fund an industry that wants to use my wellbeing against me as ransom.
> I canceled the test instead, deciding on the spot that I'd rather take my chances. I refuse to fund an industry that wants to use my wellbeing against me as ransom.
I'd cancel because I don't have $1700. But then again, if I get a treatable ailment (that risks my life otherwise), I die. Me and millions of other Americans.
You don’t really need a degree to take care of old people. I mean, perhaps some of the staff in this kind of facilities need a degree for certain select procedures, but most of them don’t.
Canada has a much better solution for this: assisted suicide. I've had multiple elderly relatives in a state that necessitated care facilities and every single one said they were ready to die.
I wonder how many people that need care have the mental capability to make those sort of decisions. My guess would be not very many.
For general interest:
~ https://www.youtube.com/watch?v=mRlgQ8bVV1o~ https://iview.abc.net.au/show/old-people-s-home-for-4-year-o...
There's a lot I can say about older populations and their abilities despite being old, right now I'm have to step out for the day for several hours, possibly more, so I'll just leave this one approach above that's been tried and works well.
Also, the elder population aren't homogenous by any means, there are a good number that can assist others with meals, gardens, etc.
A matchmaking service there might be good, so younger and older have stuff to talk about.
Medicare (US) doesn't cover skilled nursing or long-term care. Medicaid did cover LTC for means-tested individuals, but a significant fraction of that is going away after the midterms to give tax breaks to billionaires. It's going to be a shitshow beyond 2026 and it's only going to get Gilded Age 2.0 worse with massive increasing numbers of elderly homeless people from here on out. Denying healthcare and care is going to kill a lot of people.
Well you know, the option that conservatives proposed during COVID is always on the table right? Lol.
https://www.vanityfair.com/news/2020/03/dan-patrick-coronavi...
https://knowyourmeme.com/memes/day-of-the-pillow