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Comment by maxerickson | Hacker News Reader

The amusing thing about your "cynicism" here is that $200,000 would be a substantial savings compared to what happens now, never mind the huge value an effective treatment would provide.

In the US, the government (and thus society at large) bears much of the cost:

http://act.alz.org/site/DocServer/2012_Costs_Fact_Sheet_vers...

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4-5 years of a nursing home vs cured alzheimer's isn't even a hard decision

Looking at ~350k-400k for my dad if he lives another 5 years. Given his spending before Alzheimer's 200k would be an easy choice for us even even from a purely cold financial perspective.

And you have fallen into a different statistics trap. The number that matters isn't the cost of treating the patient. What matters is the increased lifetime costs of a paticular disease over the average. We all have to die of something. Diseases like lung cancer are cheap. The patients are either cured or dead relatively quickly. Demential is slow. Costs pile on for decades, starting often with forced early retirement long before formal medical costs are noticed. But we still have to normalize for the fact that, be it cancer, heart disease or dementia, most all of us will eventually need expensive care for some number of years.

Nursing homes are among the cruelest and most in humane institutions, worse than prison in many ways. Anything that avoids nursing home days is worth it’s weight in gold.

I have worked in many as a care aid providin direct care to residents. I worked for 7 years in one facility that worked with advanced Alzheimer's and dementia like condition clients. I would not describe the nursing home as cruel or in-human, though to a person with sound mind it certainly would. The people who resided there simply could not live alone. They would soon be seriously hurt or die. So yes when they enter the facility they don't have all the same freedoms as you and I. It is not safe. They leave ovens on, let strangers have access to their money, go wondering in the night no regard to weather or other important factors and so on. Now on the family side of things they have been probably spending months trying to manage their loved one and at the same time are grieving the loss of that loved one as they watch the person they once knew fade away. Every hour for the family is spent wondering if mom or dad is safe at home and eventually their lives come to a halt and they start to experience care giver burn out. The facility provided a safe harbour for their loved ones. We ensured medications were taken on time. That they would get up in the morning and put on clean clothing and wash up as needed. We tried to entertain the residents with music, games and various activities. The facility I worked at made it so the families could finally breath and know their loved on me was safe at the end of the day. I hope others find the nursing homes they deal with to be the same experience.

My grandpa spent the last several years of his life with Alzheimers in a nursing home. Furthermore, I spent several years as a telephone technician, and I worked plenty in nursing homes. My overall impression (at least of the ones in my county) is that they are poorly managed and the employees are overworked, and presumably are very underfunded. My grandpa received excellent care, but that was because my grandma went in almost every day to check in on him. There were several occasions when she raised hell because he wasn't being taken care of properly.

There are indeed excellent facilities for elder care. But there are many horrific ones, and the difference between them can be hard for outsiders to determine (whether for families, or for yourself).

Case in point: My parents had one hell of a time finding good care for my grandfolk (incl. siblings of grandparents). In their state, there is an entire industry of corrupt nursing homes, which also have all sorts of "awards" for the excellence of their care. Just the tip of the iceberg: staff physicians who never, ever appear on site, yet who collects a paycheck by prescribing tranquilizing drugs for any resident at the facility's request, all sight unseen. The facility routinely dubs its residents as "troublesome" or "aggressive" to dope them up and 1) mean they have to provide no active care, because turnips in wheelchairs/beds don't do anything and 2) ensure a relatively quick decline in all residents, because total immobility is a great slow-acting poison, especially on the vulnerable elderly. Thus quick turnover and higher profits are ensured, all while labor costs are kept low. Eventually good facilities were found, the best of which was a wonderful VA program in a home with a live-in nurse, specializing in care for those with dementia. But not before the horror shows had taken their toll.

> quick turnover and higher profits

Why would turnover increase profits for a nursing home?

The quick turnovers are likely caused by being understaffed and underpaying employees. Both of which would help with profits.

Most people don’t have a lot of assets. Medicare pays a decent reimbursement rate that declines over time. Medicare also pays for rehab tied to outcome, and nursing homes tend to have bad outcomes so they only get 90-180 days of that.

Once you’re off Medicare, if you cannot private pay (or once you run out of cash), you go on Medicaid. The county seizes your remaining assets and pays a very low reimbursement.

The ideal nursing home patient either has cash or requires short term rehab, and either leaves or dies in <180 days. The old ladies watching judge Judy or playing checkers are low margin.

Some also charge a $80k+ admittance fee. They try and make it sound nice by saying the fee is so they will never kick them out if they run out of money.

I would suspect there must be some fine print somewhere that states that you would be kicked out if you ran out of money eventually. The facility I worked at charged $4500 a month which was considered really cheap as another one near by had no problem charging $6500 a month but provided half the care my facility did, just a nicer setting along a lake with a beautiful view. At even $4500 a month it is $54,000 annually. I can also tell you things can move very slowly in the medical field for these elderly people so say if something big in the family did happen and they suddenly could not pay, that $80k would get eaten up very quickly as they tried to locate additional funds for that individual. The facility that I worked at only required a single months deposit. When people could not afford to pay my boss would often cut them deals to have them stay longer.

Often what another poster said: there's a large admittance fee and/or you sign all of your assets over. Combined with the Medicare/Medicaid issues cited by another sibling post, there's a strong financial disincentive to have residents live longer.

> staff physicians who never, ever appear on site, yet who collects a paycheck by prescribing tranquilizing drugs for any resident at the facility's request, all sight unseen

My mother and her siblings have had EXACTLY this experience with my grandfather – and they've had prior experience choosing nursing homes. It's horrible. They dope him up on who knows what medications for perceived illnesses without consulting family. Thank goodness my attentive and no-bullshit aunt discovered they were medicating him for "pneumonia" and "congestive heart failure" prescribed by a call-in quack for what turned out to be a bit of aspirated fluid. She forced them to get him off the meds and he returned to normal (modulo Alzheimer's) in days.

The whole industry is based around appearing like they're doing something to oblivious or disinterested families (which unfortunately exist), while doping their helpless patients into a slow meaningless death. There are good individuals (my folks made sure to make ties with them, else my grandfather would quite literally have died due to negligence by now), but the industry as a whole is rotten.

Can you provide referrals and / or known good facilities? Direct email welcome.

The linked pdf says that (in 2012), end of life care for Alzheimer's and other dementia patients was $110,000 more expensive than a couple of types of cancer.

I remember a professor talking about the tobacco industry trials and they were talking about damages that the tobacco companies should pay to the state for increased healthcare costs due to lung cancer, and he said that the supremely ironic thing was that people who die from lung cancer at 45 have much less lifetime medical spending than people who die from most everything else at old age. He said exactly what you did, that people forget we all die of something, and the older we get, the more likely we are to have repeated long hospital stays or need long term care.

Obviously that isn't to say it's good for people to die young from lung cancer, but analyzing anything medical from a money perspective is tricky.

Thy dystopian Logan's Run [1] featured a society optimized for total lifetime cost, where everyone gets euthanized at a certain age. Not sure we want to go that way :)

1: https://en.wikipedia.org/wiki/Logan%27s_Run

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