My MIL is going to assisted living tomorrow

[Chicken lady]

Wow.

dh and I were talking about this the other day. A local situation caused him to say “sometimes I think about us being left with one parent. I’m afraid it’s going to be my mother.”

intold him not to worry. His mother is going into the long term care facility where she put his grandfather and it is 9 hours away. This is because:
1) She has stated that this is what she and his father are going to do.
2) When my mother was spending most of her days caring for my grandmother in gram’s home because that is what mom wanted to do (well, I think she *wanted* to move back in, but that conflicted with being married to my dad....) My mother in law took every opportunity to tell my mother what a terrible burden she was suffering and how it was beyond understanding that she didn’t put her mother in a nursing home because OBVIOUSLY that was the best solution and my grandmother was so unreasonable to let her sacrifice her life.... in spite of my attempts to change the conversation, some of the things she said were absolutely cruel and left my mother teary and speechless.
3) I don’t like her.
4) dh loves her, but he doesn’t like her either.
5) if she can’t afford it (unlikely) we can.

if his siblings disagree, they can make any arrangements they like. We will probably even still send money if needed.

my mother will move in with us if needed/possible (if she needs more intensive medical care than she can get in our home, we will find the best we can nearby or near my brother if the care is better.)

in the extremely unlikely event that my father outlives my mother - and doesn’t commit suicide (i’m Really not sure if he’s joking) he can afford to make whatever arrangements suit him. We both know it will not be living here. His best friends are professional nurses close to my age.

i have no idea what we will do about dh father. Unless he has already moved to assisted living with dh mother, he is likely to insist on living his life unchanged until the day he has a heart attack or stroke, or falls from the roof or into the river and dies because he is alone on a farm 45 minutes from town, has no friends, and leaves his cell phone turned off on his dresser unless he knows he is going somewhere where he might want to make a call. And if you told him that, the response you would be likely to get would be something along the line of “sounds like a plan.”

much like my father’s “I have absolutely no intention of outliving your mother.”

[SteveinMN]

We need a market disrupter. Just like Uber and airbnb a company that connects regular caregivers with regular customers without going through the home health care staffing companies with their markups.

I'm not sure what that disrupter might be. Uber and AirBnB both took on highly-regulated public-facing businesses with almost-completely-unregulated temporary workers. Not that things were perfect with the taxi and hotel industries. But pretty much all Uber and AirBnB have done is apply advanced logistics and flexible pricing to markets that don't require any particular industry-specific knowledge (How many of us can drive or make a bed? How many of us know how to use a Hoyer lift?).

I can tell you, both from DW's standpoint (she and her co-workers pay home-health-care-staffing companies) and my standpoint (as someone who has a relative using those services), unless the staffing company has a brand name tied to a regional health care system or hospital and works only privately, no one is making a huge markup on health-care staffing. Certainly the markup that exists is no more than it is for other companies that supply un- or lightly-skilled temporary workers (like assembly or office help).

The staffing company hires and fires; pays for background checks, fingerprinting, things like Mantoux tests, and minimal training; manages payroll; and makes sure shifts are staffed. Almost all of the companies I'm aware of are 1-3 person operations in crappy offices with used furniture and with a steadily churning stream of workers who actually visit the homes. And the need for more people is chronic. Nobody has a "bench" of people waiting to work, especially if particular skills (like catheter flushing) are needed. The situation is better for private pay, but for medical assistance/Medicare, the staffing company is not paid enough hourly to offer more than $10-13/hr to the home workers. It's hard to keep people working for $10/hr cleaning up people's poop while they're yelling at you to go back to the country you came from. And it's not like the staffing company can magically offer $20/hr ("surge pricing") for the real PITA clients or because nobody wants to work on Christmas Eve.

I would be happy to see something improve the current situation. But I can't see it as just a logistical issue.

[Tammy]

Accurate description. I see it every day. Nurse extenders - as described by Steve - also keep many hospitals running. They do the literal poop work and take verbal abuse for $10-15 an hour.