Adult Day Cares in the Rio Grande Valley | Hacker News Reader

Adult Day Cares in the Rio Grande Valley

texasobserver.org

45 pointsonemind47 comments

https://acl.gov/sites/default/files/Aging%20and%20Disability...

Over the next 20 years, the number of elderly over the age of 85 is projected to go from 6.4 to 14.6 million. 10% of the population is over 65. That's a lot of people who don't work and need care in the next 2 decades. We are probably going to see a big uptick in Y combinator graduating companies who focus on elderly care.

I really hope so. There's a huge need for a sea change in eldercare. My spouse and I have spent at least three months of this year helping older relatives, and I worry it'll consume a bigger chunk of next year.

One interesting bright light is that a lot of the startups targeted towards younger people are actually godsends for senior independence -- grocery delivery, meal delivery, ridesharing. Not to mention how much cheaper it is to order assistive devices -- the very same assistive devices for a quarter of the price -- online vs. the local medical device rental places.

I believe this is an unsolvable problem. The math just doesn't work anymore. Back when exponential population growth was more of an option you'd just have 6 kids to spread the cost of elder care across. It doesn't matter whether you care for your parents or hire someone to, the fact of the matter is there is increasingly just not enough young people to provide the elder care and also perform the other kinds of productive work we need to get done in society.

Maybe we should start letting in all those young immigrants from demographics who have lots of children who want to move to the US.

Not to mention...those who are already here contribute billions of dollars to Medicare and Social Security every year -- just their existence in this country helps seniors (unfortunately, so much of the propaganda pointed at older Americans buries this fact).

I wonder if you'd have better luck if you told those older Americans that your goal was to redistribute the wealth of poor minorities from other countries to them.

Or maybe we could provide a better social safety net and more incentive/assistance for having children.

I think people, in part, feel like they don't need to have as many kids because of the existing social safety nets. When times are extremely tough a big family isn't more mouths to feed, it's more workers/fighters/etc.

I'm pro immigrant, but this doesn't solve the problem. At best it postpones it slightly because as soon as those immigrants become a little more prosperous they stop having so many kids too.

If you "postpone" it often enough, that's basically the same as fixing it.

Postpone means "fixing it for now, but not for all time." Fix it for now, then let tomorrow figure out how to postpone it again.

That's only a problem if postponing it involves incurring worse future problems.

Exponential population growth is hard to keep going indefinitely.

Whether or not it creates worse future problems depends primarily on whether or not it creates net tax revenue. So the new immigrants pay taxes, that helps. But presumably this new elder care is going to be funded in part or in whole by an increase in taxes.

Your argument comes across to me like "Let's not do a thing I agree would be short-term useful and helpful because it's all bad news, all the time." It sound super pessimistic.

Long experience suggests to me that fixing what can be fixed today makes tomorrow better. What a lot of people scoff at as bandaid solutions are very often perfectly good solutions.

Bandaids need to changed regularly while the wound heals. You don't slap a bandaid on and leave it there forever.

It's only worse than doing nothing if it isn't sterile and thereby introduces infection to the wound.

As long as your metaphorical bandaid solution is sterile, it's probably better than doing nothing.

Sometimes, fixing today is the best way to arrive at a brighter tomorrow.

I think we have very deep problem in our culture where so many systems are built on unsustainable exponential growth. It encompasses everything from our elder pension/healthcare system to tenure at the universities. Huge cultural, social, and economic changes are going to be necessary and it's not going to be pretty. Eric Weinstein calls this phenomenon EGOs, or embedded growth obligations.

On the good news front, one of the current trends in elderly care is an increased reliance on tech to help elderly individuals maintain their independence. They are increasingly using alarms, text messaging notifications and similar to help them take their medication without a person supervising that in person and to notify a relative if they fall and fail to get back up and similar.

Technology is helping to address the issue in a way which reduces the need younger labor to care for an aging population while simultaneously improving quality of life for the elderly. Win/Win.

Postponing the problem now gives more time to find ways to postpone more later, like fixing the societal issues that drive people to delay starting families well past when they do in other prosperous countries.

Elder day care can be reasonably cheap.

It's also worth noting that the elderly have a big chunk of wealth :

https://dqydj.com/the-net-worth-of-different-age-groups-in-a...

Eldercare for more serious ailments is pretty pricey if you stay aboveboard, but healthcare benefits in the US for 65+ are pretty great. Combine Medicare with their private plans, and as a person under 65 watching the medical care my elders get: it's mind-blowing.

I have to believe that a good chunk of Medicare-for-All folks are middle-aged people who see how the over-65s don't worry a whit about how much anything costs, because it's all covered, while younger folks are setting their own broken bones or dying over insulin or going bankrupt due to bike accidents.

Anyway, lesson here is: The +65s vote reliably and politicians allocate benefits accordingly. Dear everyone who is not 65+: please vote.

Society is 10x as productive as it was 30years ago. The number of people is irrelevant. Just need to spend more on elder care from the huge economic pie.

I agree that it's an unsolvable problem. It's also largely cultural. I don't think it has to do with unconstrained exponential growth.

Visit any poor regions of the world and you'll find there's a lot more emphasis on taking care of the elders regardless of the median number of children per family.

For a variety of reasons, that kind of culture gets wiped out in developed nations, to the detriment of everyone. Outsourcing it out of the family and building a capitalist industry around it is super dystonian yet here we are.

> My spouse and I have spent at least three months of this year helping older relatives, and I worry it'll consume a bigger chunk of next year.

I’m curious about this mindset. Why would you worry about it consuming more time? Isn’t that what family is for?

Most people want to be independent and to have their children and grandchildren to visit as guests, not full-time caregivers. We are very blessed that we're in the position to be able to easily pop from state to state helping and can work wherever we happen to be, but at the same time, they want to live their lives independently, too.

Also, think about where caregivers might have to relocate and how they might alter their futures by spending it caretaking. I have family members who sacrificed a very significant amount of their adult lives taking care of their parents and missed out on their own lives and wrecked their own health doing it (it's hard mental and physical work, and in some cases can be very thankless).

I also know people who gave up everything to take care of their parents and ended up homeless after their deaths.

I’ve structured my career (work from home, not management, no on call) and my finances (in my 30s) so when my father needs care (my mother has already passed), we’ll move him in with us and if I need to take time off to care for him, I can. This is an implicit generational contract IMHO. My parents raised and cared for me for a third of their life, it would be unreasonable to not do the same in return.

Why would we expect others to do this work? Or that it would scale to do so?

Have you also structured your finances so that you can take care of aunts and uncles and in-laws and grandparents? What about older relatives without help that live in different states? I think you're making a lot of assumptions about others here, and it (and all of the edits you're making to your comment) seems kind of silly and unnecessary. Have a nice night.

Yes, I am willing and able to take in any family necessary, regardless of relation. If they’re unwilling to relocate, we are (I work from home, and we live light).

I’m not saying it’s easy, by any means. I’m saying it’s necessary, unless you’re financially wealthy enough to outsource all of the support services elder care requires, which most people cannot (I am not at that wealth level, but I can take time off to provide care).

My intent is not to poke at you specifically by any means, but to point out these are systemic problems the country will face as an older generation ages and the wealth doesn’t exist to provide them white glove service until death. The solution is not startups, it’s community and family (along with having enough savings, FMLA, and vacation time).

> the wealth doesn’t exist to provide them white glove service until death. The solution is not startups, it’s community and family (along with having enough savings, FMLA, and vacation time).

The linked article seems to suggest that adult day cares actually work best when resources are limited, because they allow older people to be independent for longer (which is good regardless of the resources available):

> When they both retired in 2004, they tried staying at home, but found it hard to manage on their own due to Beatriz’s bad knees, Guillermo’s health woes, including quintuple bypass surgery, and their youngest son Ray’s schizophrenia and depression. > ... > The prevalence of adult day cares in the Valley, which is 90 percent Hispanic, is part cultural, part economic. Hispanic seniors are more likely than Anglos to live at home with their children or other family members. The Valley also has a persistently high poverty rate and a percentage of seniors with diabetes, heart disease, depression and dementia that is alarmingly higher than the national average. > ... > Adult day cares like those in the Valley can offer a kind of middle way between round-the-clock care by family caregivers — who frequently burn out and experience physical and mental problems themselves — and expensive, sometimes impersonal nursing home care.

As the article mentions, it works for Hispanic culture. TBD how the rest of aging America handles it.

Well if you casually observed the last two generations of my Hispanic family, you would say we made it work too. But that is because the culture pushes the youngest daughters to not get married and have no children. So now we have multiple women in our family who are bitter, boring, poor, and have destroyed their careers prospects because "it works" for the rest of the family.

Would those career prospects be substantially different if those women chose to have children? Or if they chose to postpone their careers to care for aging parents when the time came? Maybe their career goes well but to remain in it becomes a financial hardship so care can be paid for while they still work. Hard to say, lots of variables.

That framing comes across like "Women are losers with no lives anyway, amirite?! So, fuck em!"

Ideally, a healthy social contract benefits all involved parties and doesn't sacrifice some particular subgroup so that everyone else can be happy, but they're screwed no matter what they do because all options open to them are horrible.

We don’t have a healthy social contact. My impression was that’s what this thread was about, and what my comment you’re responding to observes (I don’t call women “losers”, nor do I believe that they are or that they have no lives).

Most options are poor options, through little fault of the individual. You’re doing the best you can with the hand you’ve been dealt.

I was a homemaker for a lot of years. It's a thing I've thought a lot about.

When 1+1=3 and you divide the pie such that everyone gets more than they would have on their own, no, it's not all downside and it's not unhealthy.

It's all downside when 1+1=3, but one party consistently gets less than what they would have on their own. Then, why should they go along with this?

That's where you get bitter people.

Edit: For the record, you've done a lot of editing of both of your comments here, which potentially changes how my replies look. I did my best to not personally accuse you of anything and to only state that the way the comment was written was not coming across well.

No worries, I wish HN tracked edits. I tried to keep my comments as non directed as possible to focus on ideas, not people.

Your comments stand on their own, and it has been pointed out I have made edits (which I’ve attempted to make in good faith).

Their prospect would be around similar to prospects of older daughters or sons. Who are not bitter, poor and boring.

They would not be in loose loose "we blame you for not choosing this and then blame you for consequences of choosing this" situation.

There can be gender differences at play. As a guess, jen_h sounds like a female name.

Women tend to be saddled with caretaking work in a way that can easily be abusive. In some cultures, the social contract is that women get taken care of financially for doing the women's work, but that's not universal.

White American culture can be very ugly about treating women like they are all undeserving, lazy mooches who need a paycheck on top of their obligation to provide care for relatives. Not all subcultures do that.

So it's possible that there are both cultural and gender differences that involve a lot of implicit, baked in assumptions that neither of you are explicitly spelling out in comments and are the source of different viewpoints.

Without addressing such, you may be unable to reach some kind of agreement because you can't even effectively communicate.

These are great points as usual. To be clear, my assumptions are simply that there are not enough available resources where elder care will be cheap and children will not be bothered with their care. Sacrifices will need to be made (but that’s an internal discussion for each family to make), and plans should be made accordingly. Hope for the best, but plan for the worst. Japan is a glimpse of what the future looks like, and technology/startups didn’t fix their elder care issues. People just die old, alone, and forgotten.

Honestly, one thing I’d like to see more of is cohousing projects out of the demographic shift. Theoretically there could be some leveraging of Qualified Opportunity Zone areas to help spur development, but ultimately the structure needs to be done in a way that serves community rather than maximizing profit.

I disagree that we’ll see an uptick. The elderly care industry is very labour intensive. You can have software that, for example, makes it easier to track who the nurse should give medication to, but you still need a nurse to do it. You still need an orderly to clean their room when they crap on the floor. You still need 3 people to flip obese, bed-ridden grandpa on to his other side.

You can have software that alerts you about care, or tracks progress, or stores patient information, but those things were never the expensive part of elderly care. The expensive part is always going to be paying a person to do X because elderly person can’t do X.

I wonder what that will do for communicable disease, a much increased population of immune weakened people.

Possibly one big market for robotics cos as well

I am very interested to see how many Latinos work here. At least here in Canada elderly care workers are mostly indentured Filipino workers whose immigration files are delayed by the Federal govt essentially making them indentured servants. It is appalling to see first world countries exploiting third world workers by indentured servitude to take care of their parents & elderly.

These two comments are about nursing homes, different from adult day care / community centers.

Uh, 'latinos' (a lot of people in this area prefer hispanic or tejano) make up the vast majority of the population in the RGV so, presumably quite a few.

I am sorry for my ignorance. I am a new citizen of this part of the world. Too late to edit it.

I have family members who work for similar groups in another country - they pick up the seniors in a van every morning and have activities at a comfortable base location that emulates a sitting room. It's a non-profit supported by the community, knowing that mental health leads to better physical health: ultimately leading to lower hospitalisation rates, catching problems early due to good communication, and therefore lower costs. It's extremely beneficial for all involved, and the women who run it tend to be older themselves nearing retirement age, as it's undemanding work for those who don't have much education or were "home makers" (being an older generation of women).

Can the title be updated to include the date on the Article as 2018? This particular piece is nearly 2 years old.

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