Very good article because it covers a variety of programs, instead of just sticking an old person into a home to be sedeted and dies.

The US healthcare system and senior care system is an unwieldly patchwork of public and private agencies that is slowly collapsing. It is very much two-tier - those who can afford the best, and the rest of us.

It often makes me wonder about people who cry out for smaller government, including politicians like Rick Perry who want to eliminate the federal government's ability to collect income taxes. How exactly do they propose to provide social services? If supposedly we don't need SocSec, Medicare, and unemployment benefits, all of which the more extreme conservatives want to eliminate, what social net is left? Not everyone has family members to depend upon, or deep pockets.

This is a sobering article, and the information applies to every region. I know that adult day-care is being slashed here. I wonder how long we can comfort family members with the thought that their loved one could be taken care of via medicaid. The irony is that programs like adult day-care, in home care, etc. save money by keeping the elderly out of nursing homes for a long time. Institutional care is often times much more expensive.

Jkom, I wonder how some people who receive social security, unemployment benefits, and medicare can be so vehemently opposed to these government programs. You're right, not everyone has family members to depend on or has the money to be self supporting.

I remember having a family discussion about my mother-in-law moving into a retirement community that also had assisted living and skilled nursing facilities. She told us that her plan was to just drop dead some day. I replied, "That's the best case scenario." Everyone laughed, but my point was that usually one's health deteriorates little by little until one day you find you are not mobile and cannot take care of yourself. Just because you feel great at 70 doesn't mean you're going to be independent at 80.

Yes, I'm afraid most people like to ignore the statistics and hope for the best while never planning for the worst.

My MIL was fond of saying "I want to die in my own home" and I finally said, "This is America. People don't die at home, they die in hospitals!"

When I asked her to tell me the name of a single person she knew within the last thirty years who had died at home instead of in the hospital, she finally realized that with as many of her friends/family who had died within memory, not a single one had died at home. Every single one had been either in the hospital or some kind of care facility.

Now, it does happen in America (my mother died peacefully and unexpectedly in her apartment), but not that often, and certainly cannot be thought of as a 'given', as my MIL had assumed.

"This is America. People don't die at home, they die in hospitals!"

Well, case-by-case we don't get to know. People go to hospitals with the expectation they're going to leave again. Often it doesn't work that way....logical.

However, plenty of folks do die at home. I've been involved in several of these situations including my father and uncle and the folks next door just a couple of weeks ago. With the advent and expansion of hospice services, it's a viable alternative for many.

Agree it cannot be considered a "given". Except for the consciously suicidal, none of us knows how it's going to go when our turn comes.

Once you are of Medicare age, you have a better than 50-50 chance of dying in a hospital or licensed facility, not at home:

"Today, although most people say they would prefer to die at home, 56% die in hospital and 19% in nursing homes..."
From "Remembering death: public policy in the USA", 2001, Journal of the Royal Society of Medicine
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1282180/

"Of the one-third of (total/all causes) deaths in the US in 2009 that occurred in hospitals....Patients covered by Medicare, the federal health insurance plan for the elderly and disabled, accounted for 67 percent of in-hospital deaths and $12 billion in hospital costs."
From a study by the U.S. Agency for Healthcare Research and Quality,
http://www.reuters.com/article/2009/11/04/us-death-usa-idUSTRE5A34N220091104