Dr. Diane E. Meier, a geriatrician at Mount Sinai Medical Center in New York, is an expert on end-of-life care. So when her elderly parents needed long-term help at home with bathing, dressing and cooking after her father’s stroke, she knew where to find assistance.New Options (and Risks) in Home Care for the Elderly (New York Times, 1 March 2007)
It was not through agencies in Manhattan that provide home health aides who are bonded, insured and certified. A year of custodial care from such an agency would cost her family $150,000, and in short order exhaust its savings because aides are not covered by government assistance unless patients are poor or fresh from a hospital stay.
Instead Dr. Meier turned to “a little list” of aides from the so-called gray market, an over-the-back-fence network of women. They are usually untrained, unscreened and unsupervised, but more affordable without an agency’s fee, less constrained by regulations and hired through personal recommendation.
We are very lucky in that we can afford (due in no small part to my parents' forward-thinking purchase of long-term care insurance) certified, licensed nursing assistants to live with my mom.
Most families aren't so lucky.
Most choices aren't so good.