At the Diamond Head pickleball courts in Honolulu, I met a man who said he had just put his 94-year-old mother in an eldercare home. Since my parents are 78 and 80, my ears lit up. I know it will be up to me to take care of them when they can no longer take care of themselves. My older sister is in New York City, and I'm not sure she has the capacity or willingness as I do.
I asked the man how much the eldercare home – with seven other residents and a full-time staff – costs a month. He said $18,000, and I was blown away. Was this the Rolls Royce of group homes?
All this time, I thought the cost was closer to $10,000 a month, a cost I've been mentally preparing to pay if necessary. But I realized the $10,000 figure was anchored to prices from years ago, when I last wrote about the cost of long-term care insurance.
Inflation sure has a nasty way of making life more costly. This is why it's so important to fix our largest costs as much as possible.
For most of us, our biggest cost is housing. If we can lock in our living expenses, own one car for 10+ years, and be thoughtful about food spending as prices rise, we'll be okay. I do hope everybody pays off their mortgage by the time they retire.
$18,000 A Month Is Actually A Discount For Eldercare
As we got to talking while waiting for our turn to play, the fellow said he hadn't been planning to move his mother to the eldercare home at $18,000 a month. But a room opened up and he was encouraged to take it. Demand is extraordinarily high on Oahu, where many come to retire and where residents enjoy the longest median life expectancy in the country.
Before transferring his mother to the facility, he had eldercare specialists come to care for her 24/7 at her three-bedroom home in Kahala. The cost? A whopping $35,000 a month, or $420,000 a year!
He said paying for daytime care felt reasonable. It was the night care that really hurt financially, since his mother slept most of the time, so there wasn't that much for the caretakers to do.
He eventually told his mother, who has been suffering from dementia since she was 90, that they were moving. The trust providing for her care would have run out in one year at the current burn rate.
And beyond the finances, they felt it was better for her to live in a community where she could socialize and make friends. The importance of friendships is backed up by the Harvard longitudinal study on happiness, which found that people with close relationships lived the longest and reported the most happiness.
My pickleball friend also mentioned that physical therapists and other specialists visit the facility weekly at extra cost, bringing the likely annual total closer to $230,000 rather than the $216,000 base a year.
The Eldercare Spectrum: What's Actually Out There Nationwide
There are all types of eldercare in the market today. Let me break down the full spectrum.
1. In-Home Care — $5,000–$35,000+/month
The most flexible option, where a caregiver comes to your parent's home. This is usually the most desired option since it's the most familiar and comfortable.
Costs vary wildly based on hours. According to the Alzheimer's Association, a paid non-medical home health aide runs about $34 per hour, or roughly $5,900/month for “standard” full-time care (about 44 hours/week).
But 24/7 live-in care, what my pickleball friend was paying for his mother, can run $20,000 to $35,000+ a month, especially in expensive markets like Hawaii. You're paying for someone to be there even when your parent is asleep, which is where costs can spiral.
Best for: Those who are not yet ready to leave home, have family support to help coordinate care, and don't need intensive medical supervision.
2. Adult Day Services (Daycare) — ~$100/day ($2,000–$3,000/month)
A supervised daytime program where seniors participate in activities, meals, and sometimes therapy, then return home at night. This is an overlooked gem for early-stage needs and for giving family caregivers a break.
Best for: Earlier stages of cognitive or physical decline; families where one member can still manage evenings and nights.
3. Board and Care / Group Homes (6–20 residents) — $3,500–$18,000+/month
This is what my pickleball friend's mother moved into. These are small, often residential-style homes, sometimes literally a converted single-family house, with a handful of residents and a higher staff-to-resident ratio than large facilities.
Nationally, typical costs run $3,500 to $6,000/month for standard care, though in high-cost markets like Honolulu, expect to pay significantly more. The $18,000/month his mother pays reflects both Hawaii's cost of living and the specialized dementia care she requires.
In a residential care home with 6 residents and 3 staff members, each caregiver supports roughly 2 residents, compared to a large facility with 100 residents and 30 staff, where each caregiver manages about 3.3 residents. The tradeoff is a more intimate, personalized experience at a higher per-bed cost.
Best for: Seniors who feel overwhelmed in large institutional settings, those with dementia needing consistent routines, and families who want a family-like atmosphere over a hotel-like amenity package.
4. Assisted Living (50–150+ residents) — $5,000–$11,000/month
Large-scale purpose-built communities offering private apartments or rooms, communal dining, social activities, and 24-hour non-medical staff. The national median monthly cost for assisted living has risen to $6,200 per month. These facilities typically offer a range of care tiers, so residents pay more as their needs increase.
This is the option that tends to look most like a “retirement resort” – fitness centers, activity calendars, organized outings. The tradeoff is a higher resident-to-caregiver ratio and a more institutional feel.
Best for: Relatively active seniors who value socialization and amenities and need moderate help with daily activities but not intensive medical care. This is the most attractive option for me when I'm really old.
5. Memory Care — $6,700–$12,000+/month
Specialized care for residents with Alzheimer's, dementia, or other cognitive conditions. The median cost for memory care in the U.S. is $8,019 per month as of early 2026. Memory care units feature enhanced security measures, specially trained staff, higher supervision ratios, and dementia-specific programming. They can exist as standalone facilities, as wings within assisted living communities, or within nursing homes.
Compared to standard assisted living at roughly $5,676/month, memory care runs higher due to the specialized level of care; compared to nursing homes at $9,200–$10,300/month, memory care typically costs less because it involves less intensive medical intervention.
Best for: Parents with Alzheimer's or dementia who need secure, specialized supervision and structured cognitive programming.
6. Nursing Homes / Skilled Nursing Facilities (40–200+ beds) — $9,800–$11,300+/month
The most medically intensive residential option. The median cost of a private room in a nursing home is now $376 per day, or $11,294 per month, as of early 2026; semiprivate rooms run a median of $328 per day or $9,842 per month. These are the large facilities my pickleball friend alluded to – hospital-like settings with 24-hour nursing care, rehabilitation services, and on-site medical staff.
Despite being among the most expensive care types by monthly cost, the per-bed cost can sometimes be lower than a boutique group home because of the economies of scale. That's exactly what my pickleball friend discovered: the 100-bed facility near his mother's group home was cheaper per month, even though it offered more clinical infrastructure.
Best for: Those needing daily medical care, skilled nursing, physical/occupational therapy, or who are recovering from surgery or serious illness.
The Edlercare Cost Comparison at a Glance
| Type of Care | Typical Monthly Cost | # of Residents |
|---|---|---|
| Adult Day Services | $2,000–$3,000 | N/A (daytime only) |
| Board & Care / Group Home | $3,500–$18,000+ | 6–20 |
| Assisted Living | $5,000–$11,000 | 50–150+ |
| Memory Care | $6,700–$12,000+ | Varies |
| Nursing Home (semiprivate) | $9,800–$10,900 | 40–200+ |
| Nursing Home (private) | $11,000–$11,500 | 40–200+ |
| 24/7 In-Home Care | $20,000–$35,000+ | 1 (your parent(s)) |
Now that I better understand the different types of eldercare options, my $10,000 a month estimate seems to be in the right ballpark after all.
As I reflect on this more, having a life insurance policy that ultimately pays out to your children, who may help cover the cost of your care, can be a meaningful way to ease the financial burden. None of us wants to put our children in a difficult position, and a policy can help provide some level of reimbursement and peace of mind when the time comes.
My wife and I got matching 20-year life insurance policies through Policygenius. However, upon further reflection, having a policy that provides lifelong coverage may be a more effective way to help reimburse our children for any eldercare costs they may ultimately bear.
The New Financial Quest: Save At Least $1 Million For Eldercare
After retiring in 2012, I thought I was done with my quest to make maximum money. My wife and I were open to being child-free, but we changed our minds and had not one but two children in expensive San Francisco. So I created a financial quest to build enough passive income to cover our higher family expenses.
Since then, I've layered on additional financial quests: fully funding 529 plans for both kids to match the cost of the most expensive private universities (~$400,000 each), opening custodial investment accounts, funding their Roth IRAs, and most recently, committing ~$500,000 to private AI venture funds to hedge against a rough future for them.
At 48, I genuinely thought I was done with financial quests. I'm tired and burned out, as I wrote in my 2026 New Year's resolutions. All I want to do is relax and write my upcoming book, Your Children Will Be OK.
But that conversation at Diamond Head woke me up. I have four parents to potentially care for – my own parents (78 and 80, both medium healthy for now) and my wife's parents (who have limited financial resources).
With eldercare running $150,000 to $230,000+ per year in Hawaii's market, and with nobody else in a position to shoulder these costs, the math lands squarely on me.
I need to save and invest another $1+ million earmarked for eldercare. Oh boy.
Projected Eldercare Cost (for all four parents)
If I use the current estimate for a group home for one person at $230,000 today, that's $920,000 total. If I assume the cost rises by 5% a year, here is what I'll be expected to pay for four parents per year starting in 2031, five years from now.
- Year 5: $1,174,200
- Year 6: $1,232,892
- Year 7: $1,294,532
- Year 8: $1,359,300
- Year 9: $1,427,196
- Year 10: $1,498,588
- Year 11: $1,573,476
- Year 12: $1,652,228
- Year 13: $1,734,844
- Year 14: $1,821,508
- Year 15: $1,912,588
With such high costs and limited financial resources, you may face a financial dilemma on who to save first: your parents, your children, or you.
Nobody Is Coming To Save You Or Your Parents
We don't want to fund this alone, but we have to be realistic about who can contribute.
My wife's parents are poor, but her sister and family are doing well and can contribute. Her father lives in a cabin in the woods in West Virginia; her mother still carries a large mortgage relative to her home in Charlottesville, which should have been paid off 15+ years ago. We already send them money each year to help make ends meet.
My sister has some assets from her previous marriage, but she's an artist making modest income and lives far away in New York City. I can't count on her to research Hawaii eldercare options or make meaningful financial contributions.
My parents have pensions from three decades in the foreign service, but their pensions won't come close to covering $230,000 a year in eldercare costs for one person, let alone $460,000 for both of them.
Mom has generously given much of her wealth to fund the kids' 529 plans. Dad has the house his parents left him and a stock portfolio of unknown size. Maybe he'll tell me the balance after he reads this post.
The financial responsibility rests largely on us and my sister-in-law's family. So we've got to discuss and strategize coverage.
My Plan To Save At Least $1 Million For Eldercare
This new financial quest requires a clear-eyed look at the timeline, the income sources I have available, and a realistic savings and investment strategy that doesn't require me to come out of FIRE retirement.
Step 1: Estimate the Timeline
I'm guessing with 70% probability I have at least 5 years for three parents, and a 30% probability for one parent before either parent needs significant eldercare. I also estimate there is a with 55% probability I have 10 years.
I plan to return to Hawaii permanently in 2029 to care for them and help coordinate professional care when needed. My hands-on involvement, supplemented with part-time professional support, could cover at least a year or two of needs from passive income. It all depends on their health and how much care my parents need.
That gives me roughly a 5-to-10-year runway to accumulate.
Step 2: Estimate the Target Amount Needed
For four parents, here's a rough framework:
- My parents (2 people in Hawaii): I estimate they have eight-to-ten years before they need professional help. By then, the cost per person will be $340,000 – $390,000, or $680,000 – $780,000 a year for two. Therefore, I need to plan to pay for around three times that amount, or $2,040,000 – $2,340,000.
- In-laws (2 people in W. Virginia / Virginia): I estimate they have five-to-eight years before needing professional help. By then, the cost per person will likely be around $170,000 – $195,000 per person, or $340,000 – $585,000 a year. If I multiply by three, that's $1,020,000 – $1,755,000.
- Total realistic cost for four: ~$3,060,000 – $4,095,000
The average time of stay at an eldercare facility runs from 2-3 years, but up to 5 years. This is why I've multiplied the future yearly costs by three and five. It's funny how I wrote about having a parental existential crisis because I met all my family's financial obligations already. Oops, I sure forgot to properly account for this one!
Conservative Future Estimates
Here's the conservative math if all four parents go to a small group home facility that costs $18,000 a month in today's dollars. However, realistically, the cost should be about 35% lower give two parents live in lower cost states.
- Three to five year cost of eldercare for four people starting in 2031: $3,522,600 – $5,871,000
- Three to five year cost of eldercare for four people starting in 2032: $3,698,676 – $6,164,460
- Three to five year cost of eldercare for four people starting in 2033: $3,883,596 – $6,472,660
- Three to five year cost of eldercare for four people starting in 2034: $4,077,900 – $6,796,500
- Three to five year cost of eldercare for four people starting in 2035: $4,281,588 – $7,135,980
- Three to five year cost of eldercare for four people starting in 2036: $4,495,764 – $7,492,940
- Three to five year cost of eldercare for four people starting in 2037: $4,720,428 – $7,867,380
- Three to five year cost of eldercare for four people starting in 2038: $4,956,684 – $8,261,140
- Three to five year cost of eldercare for four people starting in 2039: $5,204,532 – $8,674,220
- Three to five year cost of eldercare for four people starting in 2040: $5,464,524 – $9,107,540
- Three to five year cost of eldercare for four people starting in 2041: $5,737,764 – $9,562,940
Step 3: Know Your Income Streams — and What They Can Bear
As someone who is FIRE with no day job, and a wife who also doesn't work a traditional job, my income sources are:
- Passive investment income (dividends, interest, rent, real estate distributions, venture capital distributions)
- Book income (advance, royalties)
- Financial Samurai advertising and partnership income (more difficult as AI changes the way people search)
Sadly, $1 million saved for eldercare will likely be short since the low-end estimate I have is $3,060,000. But I've got to start somewhere and try, so $1 million is the initial target.
I need to direct a large portion of my income toward a dedicated eldercare fund consistently over 5-10 years. There is a chance that in 5-10 years, I'll also have excess passive income that will help pay.
That said, if I can get my sister-in-law's family to help contribute to her parents, and my sister to pitch in, $1 million from me plus cash flow should hopefully be enough.
Here's a framework:
| Savings Period | Annual Savings Target | Total Accumulated (w/ 7% avg return) |
|---|---|---|
| 5 years | ~$150,000/yr | ~$870,000 |
| 7 years | ~$110,000/yr | ~$990,000 |
| 10 years | ~$80,000/yr | ~$1,100,000 |
The 7% assumed return is realistic for a diversified portfolio of stocks, bonds, venture capital, and real estate investments.
Step 4: Where to Invest the Eldercare Fund
This isn't a 529 with tax advantages, or a retirement account with contribution limits. It's an ordinary taxable account, which means flexibility is my friend. I can access the money whenever needed.
The recommended allocation for a 5–10 year eldercare fund:
- 60% – 70% in diversified equities (broad index funds): The long end of the window gives you time for growth. S&P 500 index funds or a global index fund work well.
- 20% in real estate income / REITs / private real estate funds: Real estate provides inflation-hedged income and can help cover eldercare costs in real-time rather than waiting to liquidate equities.
- 10–20% in short/medium bonds or high-yield savings: The cushion. As eldercare needs become more imminent, more of the portfolio will shift here.
For my eldercare fund, I will not invest in illiquid traditional venture capital funds with a 10-year payback window. This is not speculative money. It needs to be deployable within a few years.
Be Conservative With Your Assumptions
These represent realistic conservative financial scenarios where I’m responsible for covering care for four parents for three-to-five years in a high-quality group home setting with 5–8 residents in an expensive state.
At this level of expense, there’s no way I can save and earn enough to fully fund it through income alone. I'd have to go back to work in a senior capacity at the next hot AI startup to have a chance.
But I don't need to save up the full cost of eldercare for four parents in 5-10 years because I should be able to grow my passive investment income to pay at least a portion as I go. Although, I'm also being crunched by the cost of independent grade school tuition over the next 9-12 years. At least college is already account for with 529 plans.
More realistically, the only viable option would be to sell a significant portion of my assets. I could do it, but there would be tremendous tax liability and a big setback in supporting my children.
It’s a real mindbender. You want to give your parents the best possible care in their final years, without bankrupting yourself or shortchanging your children, who hopefully have decades of life ahead of them.
Step 5: Use Parental Assets Smartly
Before writing a check for eldercare, I will help my parents (and in-laws, where possible) structure their own assets:
- Long-term care insurance: Likely too expensive to purchase at 78-80 years old, and underwriting will probably decline them. But worth a call to confirm. There are many conditions in place to have long-term care insurance actually pay out, such as getting written notification fro your doctor and waiting 100 days before payment.
- Home equity: A reverse mortgage or eventual sale can fund years of care. This requires an honest family conversation, but it's real money on the table.
- Pension/Social Security optimization: Even if pensions can't cover full eldercare costs, $2,000–$10,000/month in pension income offsets what you need to provide. Social Security may pay up to 30 days for for long-term care while you're in the grace period.
- Gifting rules and Medicaid: Depending on my parent's assets, Medicaid can eventually step in to fund nursing home care. But the rules around asset transfers are complex and vary by state. I'll need to consult an elder law attorney before any major money moves.
- State services: There are state services that will pay you to be the caregiver, instead of a professional. In California, it's called IHSS and in Honolulu, it's called The Institute for Human Services. The median pay is about $50,000, which isn't huge. But at least it's something and you don't have to pay someone else for eldercare. I'm going to apply to this program when the time comes.
Staying Motivated Without Burning Out
The idea of grinding for another decade does not excite me the way it used to. But I now have a renewed sense of purpose in helping take care of my parents as part of this next financial goal.
The objective is not to maximize every dollar or squeeze out every last basis point of return. The goal is to build a dedicated safety net so that when the time comes, our parents and in-laws can receive the care they deserve without financial stress or panic.
To stay grounded, a few simple principles help.
First, protect your energy. Burnout often comes from forcing effort without meaning. Focusing on what genuinely matters tends to be more sustainable over the long run.
Second, treat any extra income as a bonus rather than something you depend on. Directing windfalls toward long-term obligations like eldercare can make a meaningful difference over time.
Third, invest with discipline. Consistent, thoughtful investing remains one of the most reliable ways to build the resources needed for large future expenses.
Finally, do not let the issue consume you. Check in periodically, adjust the plan as needed, then move on with your life.
Because if you dwell on it every day, you risk burning out long before you ever reach the finish line.
The FIRE Reality Check Nobody Told You About
If you're thinking about FIRE, please model your future expenses carefully. I didn't forecast having two kids in San Francisco, which led me to scramble more than I wanted to. I didn't forecast $3-$5 million in eldercare obligations either. These missed calculations are now causing a tremendous challenge for me, right at a time when I want to relax.
Build a generous buffer. Maintain income streams that can flex up when needed, not just down. And don't be too proud to go back to work if necessary. People are depending on you.
The $18,000/month conversation at the pickleball courts was an expensive lesson. I'm grateful I got it now, while there's still time to prepare.
What about you? Have you started planning for your parents' eldercare costs? How do regular people afford millions of dollars to afford eldercare for their sick parents? If you've had to take care of your elderly parents, how did you do it in a cost-effective way that also provided great love and care?
Protect Your Family With Affordable Life Insurance
One of the simplest ways to reduce financial stress during life’s most difficult moments is to have the right life insurance in place.
My wife and I got matching 20-year term life insurance policies through Policygenius. Once we secured coverage, the sense of relief was immediate. No matter what happens to us, we know our children will be financially supported.
When you’re thinking about eldercare costs, college tuition, and everything in between, life insurance becomes less of a “nice to have” and more of a financial backstop. It ensures that one unexpected event doesn’t derail everything you’ve worked so hard to build.
Well, I have already decided. My parents are long gone I am 72 and my wife is 70. She is from Nicaragua. If I need long term care. I am headed to Mexico. I speak the language. This would be if my wife predeceases me. But there is no way I am spending my hard-earned life savings on LTC and there is a burgeoning industry for LTC for Americans in Mexico. My kids don’t believe me, but that is what I am going to do.
There are many “transitional” facilities, like the one my mom is in which has a selection of homes for independent living people often enter in their 60s and 70s, to cottages for singles/widow (my 93 year old mom entered at age 80), to apartments, to apartments with parttime nursing, to full assisted living, to hospitalization and and of life care including memory areas. Your have an initial significant cost of to get in – like a country club initiation fee (for my mom it was 200k, 12 years ago), which the facility keeps. It is like a lump sum long term care purchase. She then pays monthly rent and utilities. If she goes into assisted living before she dies, then her assets are tapped. If they run out before she passes away, then the facility picks up the rest of the tab (what he benefits don’t cover). She doesn’t get thrown out and her relatives can’t be tapped for assistance.
Its a business model that works for both. My mom knows she will never run out of care and won’t have to deplete her kids resources (be a burden). She has enough in assets where she cold pay the freight for probably 2-3 years of full care (end of life).
The facility gets that upfront “initiation” money they can invest and grow for many years. In many cases folks will die before they use significant long term care resources at the facility. My dad was only there about one month. Its kinda like life insurance model. My wife and I will likely enter one by out mid-70s to make sure we are not a burden to kids.
Hi Sam,
Another great piece from you today. We sure live in a world that probably few anticipated just a few short years ago.
A few words about age and parents. You said that after 40 and certainly after 70, we are largely set in our ways, and so it certainly may seem. My own vantage point may be a bit different because I am 75.
Inside, I feel the same as always, and thus perhaps, yes, “set in my ways.” But it’s really not just that, it’s more. As an old man I have seen so much come and go, many decades’ worth of tech, fashions, opinions, norms. And, overall, of all that I have seen and experienced, some is better, some is worse, and some is irrelevant. So if I am not interested in some “new” things, it’s not always that “we” old folks just don’t get it or are too set in our ways — it’s often just that if we have something that works for us, and may have for a long time, we don’t always feel we have to drop everything and learn something new that may or may not be better. And we experience younger generations’ insistence that we instantly adopt whatever they consider hot and new a bit, well, annoying. :-)
You wonder if your own parents have always been “this” way, and conclude that, sadly, yes. That may well be so. But I can tell you from my age 75 vantage point that as middle-age or younger adults, we grossly underestimate and under-value our parents. I did that, too. And hugely regret it. I so wish I’d have spent more time with my parents, having true adult-to-adult conversations, truly relate to them as adults, as the people who had me and made me. I know that’s almost impossible. But the intrinsic value of truly “knowing” your parents — without potential anger, frustration, etc. — something we perhaps only realize later in life.
C
Having seen so many family members go through painful, drawn-out and financially ruinous end-of-life trajectories, I have a plan more or less figured out. Don’t tell my family this though.
When the time comes I’ll figure out the farthest north town in Canada that it’s possible to get a commercial flight to. From there, without a GPS or cell phone, I’ll go on the longest solo canoe expedition of my life.
I feel this way too. I don’t want to ever be a burden to my kids.
Thankfully both of my parents and I qualify for long-term healthcare through the VA. Nursing home co-pays max out at 97/day and in home help at 15/day.
Also, I really appreciate how you respond to all the comments. It makes commenting much more rewarding!
My goal is to take care of my parents in our home. We are lucky (in that we made sacrifices to make it work) that my wife doesn’t have to work outside the home. We are fully prepared to bring our parents into our home when they get to that age (like in the old days). Our parents raised, housed, fed, and clothed us. We are prepared to pay them back by doing the same for them. It is true that it will get hard if they live long enough to get dementia or whatever, but as long as we can physically take care of them we will.
We’ve tried to teach our kids the same duty to their parents and grandparents. They can take over when we can no longer manage. In our culture, we don’t near enough appreciate what our parents did for us nor do we have the respect and love for those that are going before us in life.
If more people sacrificed for their parents, while true life may not be as easy or enjoyable, what a better world we’d have. Selfishness is destroying us culturally.
Hi Sam,
I enjoy your content, and I hope you can take this in a positive light, but it appears that recently you have focused very much on a first person perspective. Although you want to provide it appears you are very committed to being identified as the hero provider. I feel you lessen your wife’s impact, partnership and role. I have been feeling this for many months – the posts are all me me me. They are insightful but selfish, and I wish you a bigger life. I think you may be stuck in a loop.
Regarding this post, you missed a category- “independent living”. This is an overlooked category. Our in-laws relocated to be close to us and moved into such a facility about 5 to 8 years ago. The commitment is month-to-month, which offers an extreme flexibility at the stage in their life and there is a home health service on site (Independent of the facility). Our mid to late 90s parents have been able to ratchet up and down care, as needed. We have found that there is a level of boomerang in advanced aging. There have been periods where lots of assistance is needed and periods where they seem to do quite well for many months without help, PT, quick runs to urgent care and ER (often for such things as constipation and relatively simple problems, but impactful at that age).
We recently went through hospice there. Dignified, calm, and at “home”. When they die they have already disposed of their real estate assets, used the cash to cover several years of expenses, and SS/ Div the rest. Portfolios have grown. And it’s an at will monthly agreement for rent. Meals provided, community programming, lots of support – yet a closed door to your apartment that you choose who walks through (not true in some alternatives).
Recommend the book, Being Mortal, by Ariel Gawande. It is an excellent way to think about the over medicalization of death and dying.
I wish you and your family the best.
Thank you for your comment and I am sorry to being selfish. I thought I was trying to be thoughtful and thinking about how to prepare for eldercare for my in-laws and parents, as well as encouraging readers to do the same.
I write from firsthand experience, so it’s from my point of view. Do you suggest I write in third person perhaps to be less selfish? I’ve tried to have my wife write, but she says she’s too busy. I’ll also let her know your suggestion to have her contribute more financially.
I’d appreciate any advice you have on me being less selfish and more helpful. What were some ways in which you became selfless?
I may just take a break from writing because everything is for free, and these posts takes hours to write, yet, it’s still not appreciated.
That is nice that your in-laws moved close to you guys so you don’t have to move close to them. Are you paying for their elder care? If not, that is a wonderful relief not to have to experience this financial responsibility. What are you doing for your own parents and how do you juggle caring for your kids and parents at the same time?
By the way, based on my 17 years of experience reading comments, I’ve noticed that most people comment is a reflection of their own situation. Is there any chance that you are actually feeling neglected and unappreciated by your husband and parents and in-laws? If so, I’m sorry to hear and I hope you can solve the problem by directing your frustration to them too.
Thanks
Your lack of empathy is impressive with Sam sharing his concerns, his research, and solutions about taking care of his elders. I, for one, had no idea about the various types of eldercare. I’m now going to have a discussion with my parents and start saving and investing some money for them.
How else would you suggest someone write from their own personal perspective? This is not a mass media outlet that employees hundreds of journalists reporting the news. The personal perspective is what is the most insightful and helpful.
You share no costs and numbers about how much you’re spending. For all we know, you’re a divorced woman who doesn’t contribute much, if anything, to the cost of eldercare. Because you sure sound bitter about men. You’re definitely not someone I’d like to be with.
Are you at the end of life yourself? Not sure why the grumps. I suggest looking at the positives of life instead of criticizing other people for which you do not know the full circumstance.
This article does a great service to highlighting the high cost of elder care that many people don’t think about them until they need elder care. And then by then, it’s too late to save unless or get affordable long term care insurance.
Encouraging family members to have these discussions does a tremendous service to society. That is selfless.
If you have children, I hope they call you. And if they don’t, try and make an effort to make amends while you’re still alive.
Thanks Sam for highlighting this very important topic and the cost of eldercare/LTC, especially for families who have strong familial ties where children are raised (ie: cultural expectations) with the understanding that they will not let their elderly parents be dropped off to a medicaid paid facility when they approach EOL. Sorry for the very long message, but this topic is near and dear to my heart especially being in the thick of it now.
A current data point for you, the average cost of a good (not luxury nor brand new) assisted living facility in San Diego is $11K-$13K/mo, which includes rent for a 1 BR apt plus meals, once weekly laundry and housekeeping service, and scheduled daily activities, etc. Additional services like medication management, continence care, memory care, etc all cost extra.
We currently pay $15.5K/mo+ including extra services, but without memory care. Memory care at this ALF would likely costs $16-18K/mo for a studio apt., and the memory care unit is 100% rented all the time, with a very long wait list. In spring 2024, the ALF costs started at $12K including rent and medication management, and has increased each year for inflation and adding a couple extra services.
We expect to completely exhaust the LTC benefits by the end of this year, and then will dip into retirement savings until the end. All told, I would expect that her total cost of long term care in San Diego will be $500K-$700K for 1 person, depending on how many more years until we say our final goodbyes. Thankfully, Dad didn’t need any paid LTC and we shared 24/7 in home caregiving responsibilities for 7 months during the height of covid until his EOL. Dad saved all of their hard-earned retirement savings for Mom’s LTC, which we’re grateful for now.
While LTC costs are crazy expensive in California, we know that mom is in the best and safest place possible for her situation, especially because none of us kids could accommodate her to come live with us and provide in-home caregiving until the end, it’s just not possible!
My final comment, I’ve budgeted $1.5M each, for our LTC/EOL (yes, a total of $3M “budgeted” for LTC in today’s dollars, so my 2 kids won’t have to sacrifice their middle aged years nor their retirement savings nor their mental health and well-being to take care of us. The kids will inherit whatever remaining LTC/EOL budget exists after we’re gone. The cultural/familial expectation stops with my generation!
People who have NOT had the honor of recently caregiving for one or both parents for a decent duration of time, they have no idea what’s really involved and so I find it naive when they say that they’ll simply let their parent spend down their savings and go into a medicaid facility until they pass. I strongly recommend that y’all go visit a few of those medicaid facilities and then make the decision that you’re willing to put your parent(s) there. I’ve seen many medicaid patients who have been dropped off by their families at several SNF’s and nursing homes when they ran out of money, and basically left there to die; it’s not a pretty picture and it’s a very sad way to go. You’ll have nightmares until the end of your days!
But, to each their own … that’s why it’s called “personal finance” and everyone needs to make their own financial decisions for themselves and their families. Good luck with planning for your parents and in-laws, your numbers above are pretty spot on for VHCOL locales.
Sam, thanks for writing about this important topic. It’s a topic that we as normal people generally choose to avoid talking about because let’s face it, who wants to think about death and the preceding years leading up to it. The numbers you have worked up are staggering and I know you are being conservative and have estimated the high end as a goal to shoot for and be as prepared as possible. Even on the low end the reality is that most people will not even come close to saving and budgeting enough money for their parents long term care. If the median salary in CA is $106,000 per year how is one supposed to save for annual long term expense of $180,000 per year (LTC cost in Oakland, CA the last I checked).
I think the other realization that your article helps to reveal is how broken our system of healthcare is, especially when it comes to LTC. I have a lot of experience and exposure workiing with the elderly and disabled and many if not most are on Medicaid (aka as Medi-Cal in CA) in assisted living facilities. The costs are so high and out of control, it is often depressing to think about and even more depressing to see in person (my father had a stroke and spent the last 3 years of his life in a nursing home).
I appreciate the post and understand the intent for us readers to try and prepare the best we can. Unfortunately, I think as the population ages we will see more dependence on Medi-Cal unless there is a radical change in the future that can reduce LTC and healthcare costs in general.
I’m grateful that I was in a position to live with and take care of my mother in her final years. My siblings are also grateful. I realize this is not a realistic option for most folks, but it ended up working out well for us. Living with Mom enabled me to save enough to finally purchase a home in my ridiculously expensive home county on my single income when she finally passed.
Life is full of trade-offs. With no family of my own to worry about, I was able to make Mom’s final years as comfortable, happy, and peaceful as they could have been. That was a gift to me as well as her. I feel for the “sandwich” folks who need to worry about both their kids and their parents— it’s a lot to manage!
I just need to worry about saving up enough for my OWN eldercare now! I guess it never gets easier. But I’ll always be grateful for being able to make Mom happy in the end— she deserved it.
” I was able to make Mom’s final years as comfortable, happy, and peaceful as they could have been. ”
This is wonderful. Great job!
And SF Bay Area home prices are on a tear again. Enjoy your home and feel good knowing it’s appreciating.
Hi Sam – last year, my wife and I moved from the Bay Area to Boston to care for my 90 year old parents. My dad sublet his apartment to us, and downsized to an apartment right next door.
Everyone wins in this situation! Our rent is 2/3 of our rent in Menlo Park; and my wife and I feed my parents every day. I moved my business from CA to Massachusetts without issue and my wife found a job that she loves within a short distance from our apartment.
Both families have enough resources to weather two long term care scenarios. With two incomes plus my parents’ required minimum distributions, we can manage the monthly expenses easily and let our savings grow.
Slow and steady will win the race!
Hi Steve- That’s great you both were able to move closer to your parents. Where do her parents live, if still alive, and how do you think about taking care of them? This is a dilemma we have b/c if we move to Honolulu, my wife moves 6 hours farther away from her parents on the east coast.
Also, do you have kids? If so, how do you feel about the cost of raising them and taking care of your parents?
thx
My in-laws live in Southern California and my sister in law lives there with her husband and family. So we are playing a zone defense!
Our kids attend college now and we have their tuition ready to pay for college in full.
Both sets of humans have expensive needs; and we feel ready to help them when they need it. My wife and I will work for another ten years and shore up our own finances. It’s work worth doing!
Sam, my parents live together in an Assisted Living facility in Southern California, about 15 minutes from me. Their base cost is about $5000/mo for their 250sqft apartment, plus $1500/mo for the second resident (my mom) plus another $250×2/mo. for their “care levels” so, just under &7000/mo for both of them. They both came from nothing, but between his Navy retirement, modest rent from 3 little houses he bought in the 80s, social security, and interest from their savings, they are still saving money each month.
I drive them to their doctors, and see them several times a week, but food shopping, cooking, cleaning, laundry etc. is all solved for them. The resident PT staff bills their Medicare, so costs are minimal. The facility staff calls me if they have a concern. I can’t believe how lucky we all are in this scenario. My parents are 88 and 94 and all is well. I hope your experience going forward is easier than you imagine. It’s never easy, but easier is good! Blessings.
Thank you for sharing Kathie. It’s wonderful you are only 15 minutes away from them and you can assist with so many things. I want to be like you.
$7,000/month for two is quiet affordable. That gives me hope! Thanks.
Well, not to be horrible, but I would not bankrupt myself or my children for my parents – or in-laws. Nor would they want me to do so. From one viewpoint – make sure to consider this so as not to leave a burden on your own children (anyone’s). From a child to parent viewpoint – work with what they have, in order to get medicaid, you’ll have to liquidate all assets aside from home if the other partner is living in it, and then i think you may have to liquidate that as repayment to medicaid if the other partner dies, rather than having it left (no expert here), and contribute their pensions/SS. But, it does tend to at that point cover a basic nursing home when needed…meaning you do not have to take this massive expense on your own shoulders, you just won’t get an inheritance. and that’s far better than destroying your own finances to buy luxury end of life care.
The best thing you can do is spend a little time instead of more money – living close enough (bringing them to a nursing home close enough to where you live) to check regularly on their care can be the biggest asset you can offer, at the lowest cost. Some nursing homes as we well know are not the greatest places for care – but the staff knowing you will be there 3 times a week to check in, and will always answer the phone about concerns, can go a long way to your family not being the ones overlooked.
Also be aware, you do NOT have to provide medical interventions for life-saving measures – antibiotics for an elderly person with poor quality of life may be more harm than good – you could let them go peacefully from the first UTI or pneumonia (“old man’s friend”), by simply refusing to treat it. You can involve hospice (hospice is great! the real ones…not the CA version…) as early as possible, to guide comfort-based care and avoid life-prolonging interventions. I will insist on this from my kids – let me out at the first available exit, particularly when i’m not even there, such as dementia!!!
Thanks for sharing your thoughts. Do you have experience providing eldercare for your parents?
It’s a logical approach to how to capital allocate to the people you care for the most. I’m working on a follow up post about this topic, given money is finite.
Being close by to your parents is definitely a great plan, and one that I wish to execute. Lots of synergies, like me texting my dad whether they need anything from this restaurant and hardware store I went to yesterday, and them saying yes.
First and secondhand personal experience (in laws, grandparents, great grandparents – involved but not the primary caregiver – including situations where the affected family member had enough money for their own care and when they didn’t)…we’ve moved back closer to my parents who don’t yet need significant help but presumably might at some point. and plenty of professional experience.