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It's not because the people doing all the hands on work are getting rich, that's for sure.
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Why? Mainly because the elderly require SO MUCH care. They need 24/7 supervision. They need other people take care of their physical needs, their health needs, their financial needs, their emotional needs, their housing needs, their end of life needs, their final arrangements, their wills/probates/estates, their everything. That means they need caregivers, nurses, doctors, administrators, lawyers. Nobody wants to work for free, do they?Do we?

Then, you add in the costs of medicines, medical supplies, testing, ERs, surgeries, food, housing, and transportation. I’m sure there are more costs that I haven’t thought of.None of the above comes cheap.
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Rent for a one bedroom flat is $400 per week in my city on average. Housesharing maybe $200 per week plus bills. Add cleaning, cooking, medications, companionship/supervisoon, 24/7.. I can't do the math this late at night.. nor could I run my own Nursing Home.

I volunteeted once for a week in a NH. It takes a LOT of people to run these places. Cooks, cleaners, carers, one RN oer shift, a Manager. I had food thrown at me, yelled at, was nearly biten, saw more wee & poo than I ever want to, yet also saw staff who really cared, family who cared.

Love. Money. It all makes the world go round.
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If you’ve ever done elder care, you should know.
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I too would like to know why it costs $9000 (or more) a month for a shared room in a SNF.
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Well, like most other things in the USA it is follow the money. It's about businesses and profits; about supply and need.
When you think on it, the cost of a single room in ALF at 5,000 a month covers a LOT in a good facility: food, activities, cleaning, laundry, beautiful grounds, staff, assistance, transportation and etc.
In a poorly run facility, however, it's no bargain. So it is a matter of finding a good facility, something my brother was lucky enough to do.

Then you have the fact that these facilities are often run by huge companies, owning many facilities with huge staff, both local staffs and out of state. I think one would actually have to work in the industry to make any judgements on your question, but when you see that now Hospice models are much changed from when they were real vocations and missions, and when you note this happened when they began to be bought up by hedge funds? Well, it is a matter of following the money.

My brother is gone now for some three years. His ALF was wonderful and worth every penny. I follow it because his ex partner and friend still lived there until his recent death, and this ALF in Southern California is STILL wonderful.
As a nurse I became acquainted with and aware of a few family-run Board and Cares in my area back in the day. And all I can say is I don't know how they did it for the cost--a tough job.

So there are many factors here, and your question would be a great one for "Discussions" on AC.
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An apartment in Denver with no services, food, internet, tv, activities, entertainment, or utilities is about $2500 a month. Just the cost of heat/ac and gas/electric for the memory care AL I worked at for one month was in excess of $20k BEFORE inflation crushed the USA. Food since then has gone up at least 40%. You do the math.

Why does life in the USA cost so much, would be a better question.
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This can’t be a serious question.
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Fawnby Jun 2023
Ya think???? Maybe somebody needs to resend the memo. :-/
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Great answers below, but here are few more: property taxes, insurances, and facility maintenance are through the roof.
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All the answers below plus the fact that just being in business is expensive, especially if you have employees. Employees are the majority of the overhead expenses of almost any business: quarterly withholding taxes, benefits, the admin person and time required to manage just the HR part, regulatory compliance for the industry, etc. Facilities have to pay for business essentials like communications (internet, website, phones), printed materials like brochures and stationary, postage, lines of credit/banking fees, etc. There are so many little expenses that add up, it's like death by a thousand paper cuts.

The cost also varies by location, by how "fancy" the facility is and the amenities it offers, and by the ratio of staff to resident. Right now there is a labor shortage (even for unskilled labor) which is driving up costs.
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