Prey Without Predators
Re “Man and Beast” by Valentine Faure [August 24/31]: Predators are a big influence on animal behavior. Prey herds will move constantly and never overgraze an area if there are active predators. Without them, herds overgraze and kill their forage. I applaud this effort to rewild the Oostvaardersplassen, but we must be humble enough to realize that we don’t understand the complexity of natural ecosystems that we may try to re-create. Don’t give up. It is a worthy experiment, but it will require human intervention until the sweet spot is found.
The Costs of Long-Term Care
Great story on nursing homes [“It’s Time to Abolish Nursing Homes” by Sara Luterman, August 24/31]. But two important points were not mentioned. First, nearly 80 percent of nursing home residents come directly from hospitals, which send patients there after the hospitals can no longer receive additional insurance, Medicare, or Medicaid reimbursement. The federal government could require hospitals to notify patients of in-home care options before dumping them in nursing homes. Second, Congress could amend Medicaid to make in-home long-term care an entitlement, the same as with nursing homes.
My mother is in an assisted-living facility because this is what she can afford, even with two long-term-care insurance policies. Medicaid is available only after all your assets are exhausted. (Would there even be a home to remain in at that point?)
At current rates (about $25 per hour), it would cost approximately $18,000 per month for round-the-clock in-home care. That buys you an attendant—no doctor, no nursing care, both of which are readily available in assisted-living and skilled-nursing facilities. By contrast, an assisted-living facility costs about $7,000 per month.
So how do we pay home health workers more and also make the care affordable for patients? In-home care is too costly to be practical for all but the most privileged. At some point, we can’t live on our own. We’ll need help, and an aging spouse or hardworking children can’t always be the answer. Facilities that are designed with people’s physical needs in mind and are properly staffed provide a reasonable and cost-effective alternative.
The goal should be to make such places more workable for those who live there, including greater flexibility with schedules and more control over daily choices such as meals. The loss of independence is real, but so is the cost of private care.