Cost of 24/7 Care

While visiting a client at an expensive memory care community recently, the nurse manager motioned for me to come see her in her office. After closing the door, she told me client X—who I’ll refer to as Sue—needs more private aide time.

After another fall, and in spite of paying almost $8000/month in fees to this high-end community, we had already brought in private aide for four hours per day at an additional cost per month of $2800, bringing their actual monthly cost to $10,800.

Why would anyone need a private aide, you might ask, in a top dollar memory care unit? Sue’s daughter asked me that question, too, and I posed it to the nurse manager.

“We don’t want her to have another fall,” the nurse manager explained. And this is a valid point in today’s litigious climate, especially given that a fall has a fairly high chance of landing someone like Sue in the hospital, then rehab and maybe skilled nursing for the rest of her life.

What the nurse manager did not say was that this particular resident often required the full attention of the Certified Nurse Assistant (CNA) on that hall who was assigned to help six residents simultaneously. (In more economical Memory Care communities, a CNA may be responsible for ten or twelve or even fifteen residents.)

But how much money do you throw at risk management at the end of life? In this particular case, the recent fall that had triggered the conversation had taken place in the middle of the night on the way to the bathroom. Even if the family had had a private aide for 12 hours/day (at the cost of $8400/month plus the $8000 monthly fee), they still would not have prevented it as this fall happened after the private aide left. To prevent all falls would require help 24/7 at an additional cost of $16,800/month.

There are no perfect answers.

In Sue’s case, we did want to reduce risk while also containing costs. Because Sue was still relatively young and could easily (given family history) live another decade, throwing increasing amounts of money at private aide time was simply not sustainable. So we moved her to a family care home that provided an all-inclusive monthly rate capped at $8500/month for her lifetime. (Yes, I know that that number is astronomic, but the alternative—leaving her where she was and adding more and more additional private aide time--would significantly exceed that pretty quickly).

Family care homes have a fixed ratio of one caregiver per three residents. We were banking on this better ratio reducing the additional private aide costs.

What is the take-away? Taking care of our parents is a puzzle with constantly changing pieces. There is never a perfect solution, after which point, you can finally put your feet up and leave them up. Instead, you do the best you can given the current circumstances; be grateful during the periods that are calmer and try to keep your wits about you during the times that are not.

The title of Kay Ryan’s poem, “We’re building the ship as we sail it,” is apt.

I suppose the advice that your parents may have once given to you, "Do your best," is relevant at this point, too. That's all you can do.