[michaelsmanley]

We just finished a 6-week period where my mother-in-law was cared for at home 24/7 by personal assistants, with three shifts per day. Whole dumb, long story on why we had to do this, and I am very glad it is over (she's in memory care now), but I can say:

First, the PAs from the agency who employed them did a better job than we could have. Most of them were current nurses picking up extra money or former nurses who had retired from active work. Save for one who was new to the job and clearly in over her head (and removed from the account after one short shift), they were all competent and conscientious caregivers, if maybe struggling personally one way or another. Not a job anyone chooses to do, I suspect, but one they're often driven to by circumstance.

Second, that kind of care is prohibitively expensive long-term. The memory care facility costs 25% to 30% of the in-home care, and is far safer. We got lucky and had access to a smaller facility with a very low resident-to-staff ratio.

In the US, at least, I don't see the prospects for this kind of care getting anything but worse. I worry that once the Baby Boomer volume of elders passes through the system, the capital that has swallowed so much of elder care up will pull out and a lot of it will collapse and what survives won't be particularly good or affordable, even compared to current levels.