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Comment by mikewarot | Hacker News Reader

  $50,000 / year
  * 5 care takers at a time
  * 3 shifts 
  * 2 (staff, food service, laundry, billing, social services, etc.) 
  * 1.2 (employers part of taxes)
  ------
  $18,000,000 / year
  ÷ 20 patients
  ------
  $90,000 / year
  ÷ 12 months year
  ------
  $7,500 / month

That's just in labor/staff costs, let alone the fact that this is a highly regulated medical establishment.

Edit/correction - thanks subtra3t!

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You can't cover three shifts 7 days a week with three groups of people, unless there's a lot of overtime; that's 56 hours per person. Four groups of people covering a week is 42 hours per person, which you can either take the overtime, adjust individual shift start /stop to manage (assuming you don't need exactly 5 staff on duty at all times), or have managers provide coverage.

Do you really need 24 hour coverage? Are these patients really such a danger to themselves or others that you have to keep an eye on them at all times day and night?

It seems to me that even 4 hour a day care would already result in a huge quality of life improvement over no care at all.

At a live in senior home facility? Almost certainly. At a memory care facility, even more so; some of these patients can't sleep normal hours, and they can do some pretty disruptive stuff in general.

Does it need to be the same staffing at night and during the day, probably not.

For seniors that are generally independent or cared for by family? 4 hours of care could be plenty, sure.

It's usually not all but there's an outlier in there somewhere. Many are critically ill. Some are on dialysis. Many are sick and yet refuse to take their medicine, and yet insist on doing heavy labor.

There's also some who can't go to the bathroom without help. These aren't dangerous, but they require a lot of attention. There's dementia. There's people who poop on the ground then sort their shit.

But many overlap with the above - the ones who can't move about pick up all kinds of illnesses. Pills for both mental health and physical health damage the organs, and so on.

We do see them cutting costs where possible, but nobody can do this on their own in a shift. An old lady who has fallen off her bed can be carried by 1-2 strong people with the right technique, but you still have the others. There's also the question of nobody wanting to do so. We interviewed a bunch of maids to see if they'd take care of the elderly, and nearly all rated it as their last option, compared to watching kids, cleaning cat litter, cooking, etc. There's the legal liability of being the caretaker of a paying customer who's at death's door. Many of the people who leave them there do not care about them, won't even visit them during holidays, they're just paying someone else to watch them die.

I'm guessing the vast majority of people with dementia cannot afford paying $11k/mo. What are their options? Is there an option of paying (much) less to receive a fraction of 24/7 care?

What my wife did was quit her engineering job to take care of her mother (and the kids) full time. But mostly the mother; we can hire babysitters but not afford senior care.

I believe an economist called it an external dependency. The family structure is designed for this kind of thing. But we started outsourcing senior care, which led to retirement plans, etc. It fixes a lot of things, but it may not be sustainable with longer life spans etc.

I expect us to eventually cold turkey and go around back to family-based care, even if we as a society have to take a productivity hit.

The only options are draining all assets to qualify for Medicaid, or family care.

This. Night shift is probably fewer than 5 staff, but even then, 24 hour care is not cheap.

Would it be cheaper just to hire someone to be a full time, live in caretaker for them?

If you need 24/7 coverage, that's a job for 4 people. And you need someone to coordinate and hire (probably a service).

My partner does at-home one-on-one care for people with dementia. No degree. No qualifications other than she really cares and is amazing at it. $25 an hour cash (no taxes). 24-hour care, that comes out to over $18k per month.

Not judging here, but that’s some serious consequence tax fraud if caught.

Somehow I think if the standard salary for this kind of work is 50k/year (~4k/mo), it shouldn’t be too hard to find people willing to do it for double that (8k/mo) especially if it means living rent free.

I think at the last stage you meant to write month and not year.

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