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<While most of us would probably want to stay in our own homes for as long as possible, I think in the next 20 years as the large baby boomer population reaches the high scale of the elderly years, we're going to see that the rest of society cannot afford maintaining so many others to live in homes they no longer can do so without dependence on others. >

This issue is the most challenging facing the U.S., Europe, China and Japan over the next 30 years.

With so many elders and a smaller younger cohort, who will take care of the elders? Who will pay for their care? Especially those who do not have family caregivers?

The U.S. has designed a system where emergency rooms must treat all comers, regardless of ability to pay. This is the most expensive type of care.

Nursing home care is very expensive, though less expensive than hospital.

Assisted living is less expensive than nursing homes.

Living at home, with some help (dependent on others for major tasks such as shopping, cooking and housecleaning, but still able to do personal care such as taking a shower) is less expensive than assisted living.

The longer they can stay in the least expensive domicile, the less they will cost society.

Millions of elderly people (most of them women, many of them poor) will not have family to care for them. Most, if not all, will eventually need some kind of assistance.

Should they be allowed to die? If not, what is the most economical way to keep them alive? The most economical way is to purchase the least amount of assistance commensurate with their needs.

Medicare skilled home care actually saves money because it maintains stability at home. If the person does not have the care, they can have a health crisis that will require expensive emergency care, often followed by expensive hospital stays and expensive rehabilitation.

Once society makes the commitment to keep people alive, the most economical way is by maintenance in place.

I am not disagreeing with you. I'm just pointing out that the fundamental choice is life and death...and everything flows from there.

Many societies in history chose to save resources by abandoning or even killing and eating their elders.

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