It is very expensive to be old and frail in the US.
In my area, private care agencies will charge roughly $35 per hour for an aide to help with bathing, dressing, medication support, and supervision/errands, and most agencies will want a 4-hour minimum, if not 12 hours, due to the shortage of caregivers. (Caregivers don’t want to drive and do the work for a short shift.)
Adult day programs or, for those who are able, spending the day at a senior center even in an unstructured program, can be wonderful, but most are not free.
Assisted living residences play a wonderful role but they are not covered by most insurances and cost $8000-$16,000 a month in my area, and that just covers room and board and basic services. If the resident requires more than very basic, twice a day help with bathing, dressing, toileting, or ambulating, there will be additional fees. If the resident requires someone to sit with them, for safety supervision or for medication administration or even just to be there to help within moments vs. half an hour or more, residents may have to hire private care on top of the ALR fee.
Medicare does not cover long term care in a nursing home; residents have to spend down any savings for room and board in a skilled nursing facility, before being able to move to Medicaid-covered room and board. Most skilled nursing facilities in my area are around $15,000 per month.
For those on hospice, hospice does not cover room and board in a facility, so, family will still have to pay facility room and board (medical care is covered by hospice, but not any significant “custodial care”).
Most people need some sort of self-care in order to be a caregiver and not burn out completely, even if we’re caring for the most wonderful and loving and interesting and inspiring elders. May we all be able to include a horse in that self-care.