The senior population is booming. Caregiving is struggling to keep up

So why are nursing homes so expensive?

The most visible difference is nursing homes are owned by publicly traded entities, who come with massive overhead of shareholder obligations and executive salaries.

Baumol effect. TVs[1] are unrealistically cheap. This means that more money is chasing less automatable services. There is no technology that makes caregiving 100x more labor efficient. More money chasing the same supply means prices rise until demand reaches equilibrium. No amount of deregulation can increase the labor efficiency of caregiving to match gains in goods production.

1. And other goods mass manufactured.

"Line must go up".

The same line boomers enjoyed riding on while their property and other investments went up massively without any effort on their part, at the expense of subsequent generations.

Now, they're getting a taste of their own medicine as someone else (private equity in this case) wants to ride the line going up and even just robbing subsequent generations isn't enough to pay for it.

Publicly traded entities which are components of many pension funds. The boomers essentially took out a loan against themselves, and now it's due, with interest to boot.

There's some schadenfreude seeing the boomers complain about getting the enshittification treatment they themselves got rich off.

Certainly privately owned ones skim a lot off the top to pay shareholders and bonuses, but the reality is that the cost of caregiving is almost entirely labor and rent, and those things do not benefit from efficiency gains, so the cost of service just goes up forever because of Baumol's cost disease.

Realistically the only way to stabilize the price of caregiving is to automate the hell out of it, like Japan is trying to do. It's a rather dystopian thought that the only way senior care won't bankrupt us is if we have robots do it all, but what can you do.

> Publicly traded entities which are components of many pension funds.

A shareholder relationship is parasitical and exploitive by it's nature, as defined by Dodge Brothers v. Ford.

Making pension funds feed on that relationship - that is whatever that is. I couldn't call it a necessary evil because it's by design.

labor cost, which is high because of high housing costs and other jobs that provide good pay competing with nursing home jobs

The Baumol effect is only one component and not the entire story. Those that run these services will extract as many profits as possible for themselves. When the robots will manage geriatric care, there is no reason to not continue exploiting the patients' wallets.

You too will grow old and then... you too will be blamed for everything.

> labor and rent

Labor, who pays a sizeable chunk of their income on rent... and rent, well is rent. Rent is only expensive when demand outstrips supply, and demand keeps being artificially constrained by existing property owners (of which boomers are a large chunk) not willing to take a hit on their property value. Seems like a self-inflicted problem.

I'm sure there would be plenty of things to blame me for, but I'm still waiting to be able to sit and do nothing while my assets grow by an order of magnitude effectively risk-free, and be able to influence local policies to protect that growth no matter the cost. Instead, it seems like the very opposite is happening, with my labor being used to subsidize boomers to this day.

After we either repair all the shit the boomers broke, or fail trying. Not a lot to be blamed for if the ship can't be wrighted.

I also don't recall anyone ever blaming the WWII, or other generations like this.

Boomers coasted off the success of the postwar era, and now we're all poorer for it.

> Not a lot to be blamed for if the ship can't be wrighted.

'Not being wrighted' means a whole lot of boomers won't be getting in-home care, or absolutely terrible minimum "care".

But this started with the Mergers and Acquisitions crisis back in the 80's, and vulture capitalism has really taken off in the last 30y.

Oh, and my SO was a in-home healthcare person. They got paid a WHOLE $14/hr, no benefits naturally. You can probably guess the type and quality of most the candidates and workers. Even a few of them did the petty and felony theft from their dementia/Alzheimer's clients. Not like they'd miss what was stolen :(

Millennials will be called "little boomers" because all future generations will seethe about them living through the ZIRP era.

24/7 labor is expensive. The goal is to have a 1:10 ratio of nurses to patients, but to get 24/7 coverage you need almost 5x as many nurses. Add other staff: food, cleaning, maintenance, executive/secretarial, etc and you have about as many non nursing staff as nursing staff.

So in other words you are covering the loaded labour rate for about 1 salary per occupant.

You’d have to go back a long time: the silent generation invested a lot in the public good from electrification to the GI Bill to roads to education and environmental protection. It took the Reagan era cuts to start rolling back investment in the country—I grew up in California during the 80s and 90s and each of the schools I went to had visible decline because they had built infrastructure prior to Prop 13 and then couldn’t afford basic upkeep.

We're not going to be able to fix the boat with a country as divided as ours. Half of us are hopelessly bailing out water instead of fixing the problems, and the other half are drilling holes in the hull with big grins on their faces.

> You too will grow old and then... you too will be blamed for everything.

Not so. Or at least not so much. I'm part of the group that's responsible for every atrocity, avoidable disaster and systemic failure in history. Adults.

Adults are also the cluelessly stupid group that endlessly blames teens and kids for crap.

> You’d have to go back a long time: the silent generation invested a lot in the public good from electrification to the GI Bill to roads to education and environmental protection.

My parents were silent generation and I'm endlessly surprised how little adults of that generation understood about truly basic things, like psychology.

To be fair, they generally parented a few hours a week. That wasn't much, not compared to the 24/7 adulting that was required of my generation (and is now the standard for every gen of parents).

But... With our modern, unsustainable parenting requirements, birth rates are plummeting. More competence, fewer kids.

> We're not going to be able to fix the boat with a country as divided as ours.

You are correct. However, I couldn't see how we could have fixed it before. In the US, every possible group of people was fully mired in a state of

    No One Anywhere Wants To Clean Their Own House.

I couldn't see how anything could improve before, not while that principle dominated everything. And it's still that now, just 10x worse.

Seems unlikely. Non-profit nursing homes are not noticeably more price-competitive with the for-profit ones.

It takes the same amount of land, nurses, and orderlies to care for a 100 old people as it did in 1970, but the land, nurses, and orderlies all cost more on an inflation adjusted basis. Classic Baumol's cost disease.