Much to think about, WTG and pique.

Not in order, pique there ARE people who live in, usually sharing the duties (for one thing they need time off).

The New York Times (it's as if they're following WTF) has been publishing myriad articles about the social conundrum resulting from the demographic problems today of population imbalances (this is international, too, of course).

It stood out that it was very hard both for caregivers and the family arranging hiring the caregivers for their needy elders or otherwise disabled family members. (And FWIW the caregivers mentioned, were younger than the care-getters - at least, the ones I read about.)

If I can find it, I'll post one of the key articles (as I think most of you know, there are also many articles about catastrophic nursing home situations - truly despicable franchises expanding across the country. I'm sure you're all saturated by such articles.

The Covid crises highighted the worst of them. Disgusting, unspeakable living situations, and re COVID, one whistle blower described being required to carry out numerous corpses daily to refrigerator trucks.

I think there are even collaborations between the nursing homes and funeral homes.

There are nouveau riche families today basing their growing wealth on owning such franchises. Not sure who's most responsible - govt. and/or owners. The residences are inadequately staffed (always of course, not vaccinated either) and inadequately inspected.

When eventually the Dickensian establishments are pounced on with much belated rule enforcement, they'll be given token fines and shut down.

After that (of course) the owners reopen the joints, on the same or nearby location, under a new name.

And this is growing.

I hate to admit it, that for the last decades (and as I said, increasingly) the caregivers have been immigrants (mostly Hispanic) and some non-registered. To the extent the system has worked to date, it has been by exploiting such impoverished workers, sometimes intimidating them by threatening to report their immigration status.

One reason I've been thinking so much about expatriate living is because I hoped thereby to manage to arrange long-term care overseas, And in such way that those helping me could be supervised so that they would be honest and competent in poorer countries (Costa Rico, India, Thailand, other?).

I'm sure there are such places and adequate caregivers, but there are - again - the language problems besides which, my sons again!

Also, what about Medicare?

Even Israel, which provides home care for their elderly for which I'd qualify, including their free medical care - the home care would be provided in tiers by numbers of hours. That's what I'd like - namely, a certain number of at-home home help hours. (Why should everything be either/or? Move to a residence or somehow tough it out at home?)

Anyhow, in Israel, the helpers are almost exclusively Filipinos, some SE Asians (so much for reviewing my Hebrew!)

But I'm reminded in reading about MEDICAID spend down (thanks to Mic's very useful links), that apparently there are other care arrangements apart from nursing homes - namely, Medicaid paid home help care.

No one has spoken of that in this thread - that is, apart from DIY.

Does anyone know anything about state paid home help, apparently thru Medicaid for those qualifying?

For anyone possessing $2K or more, that means of course, setting up complex trusts for those who want to preserve assets for heirs.

To summarize, a few topics I hope can be touched on somewhere: home care, spend down and trusts, also the differences between Medicaid nursing homes.

It's become clear that some Medicaid facilities are far superior to others, but how could one go about trying to be settled in one of the good ones?

Is it a matter of the state or what?
I wonder about consulting legal experts on such fine points. What aspects are a function of state law and what federal?

Many thanks, WTG, for giving such a detailed and informative reply to my query about your mother's situation and how it affected you. On the face of it, it would certainly have seemed a truly ideal situation, to hire Lithuanian helpers for her when she was losing her memory.

I hear there are a few special homes set up like communities in, say, the '50s so memory impaired elders can kind of step back into their youth.

That would have had many of those advantages for her - favorite childhood dishes, speaking her native tongue, cultural congruity.

I sure give you credit for your valiant efforts to meet her needs!

And also for your clear and very useful narrative about your situation with your mom, including your gradual awareness of the obstacles you ran into in making your initial plans work.

You certainly did your best and also helped others to think through their own situations!

Yes, it's a hard nut to crack. I remember when my mother first moved to Florida in her mid 60s for retirement. It seemed she was always telling "Alzheimer's jokes" - they were really "in" among the new immigrants.

(They all began, "What's good about Alzheimer's?")
"You can hide your own Easter eggs",
and
you can read the same favorite books, see favorite movies and enjoy the surprise endings all over again, etc...)

Not so funny when you're 100 and acting out in the latter stages of that ghastly disease.