First, the PAs from the agency who employed them did a better job than we could have. Most of them were current nurses picking up extra money or former nurses who had retired from active work. Save for one who was new to the job and clearly in over her head (and removed from the account after one short shift), they were all competent and conscientious caregivers, if maybe struggling personally one way or another. Not a job anyone chooses to do, I suspect, but one they're often driven to by circumstance.

Second, that kind of care is prohibitively expensive long-term. The memory care facility costs 25% to 30% of the in-home care, and is far safer. We got lucky and had access to a smaller facility with a very low resident-to-staff ratio.

In the US, at least, I don't see the prospects for this kind of care getting anything but worse. I worry that once the Baby Boomer volume of elders passes through the system, the capital that has swallowed so much of elder care up will pull out and a lot of it will collapse and what survives won't be particularly good or affordable, even compared to current levels.

The solution is to pay these positions well enough to attract people who genuinely believe in the profession. But society optimises away from doing that because there's no obvious ROI outside of making running costs cheaper.

I am noting that the current system is dystopian, and pointed out the causes for those dystopian.

I would have hoped that the implication is obvious: the system is at fault.

In the UK at least, I reject that homes are run like prisons, mainly because prisons here have much less staff and a lower standard of cleanliness. We also don't (yet) have private prisons.

"solving" adult social care is a big issue that can't be solved by staffing alone.

But, given the deficiency of the UK to actually grasp the nettle of adult social care, this is probably what we'll get.

A better way, perhaps is better integration of care in the community, as in old people mixed in and around young. (safeguarding issue need to be solved though)

I recently learned of the term “medical divorce”. Elderly couples divorcing, so they’re not saddled with the medical bills if one of them passes away. How insanely cruel is this? Is allowing people to go out on their own terms worse than this?

I don’t know about “generally mandated” but if I am lucid enough to decide, I should be allowed to. It is more humane, safer, cleaner to do with medical professionals than jumping from a bridge.

Our choices are either improve healthcare, elder care so people spend their last years in dignity or give them other options. By now, We have proven that we cannot or will not make healthcare, elder care affordable (it would be ideal to make it affordable). Which leaves us with what other options? Birth rates are falling almost across the world , we’ll have more and more older folks

As compared to be stuck on a bed in your own filth while your body is developing lesions on the back because you can't move? It is basically state sanctioned scaphism. Give me a ticket out of this hell hole.

or even encouraged?

In advanced societies of course, but we have few and unfortunate people travel from far and wide to reach those services.

The government could make time for this and they could tell the lords to do one. They just chose not to.