Is a cruise ship a cheap alternative to an old folks’ home?

June 8, 2012

Dear Cecil:

I’ve heard that instead of heading to an old folks’ home when you reach that age, it's actually cheaper (and presumably more fun) to go on an endless cruise. All your meals are covered, apparently first-rate medical attention is available, and hey, you get to see the world. It also means you don't have to take a bus to visit a casino. If you don’t need 24/7 medical care, is a cruise the way to go?

Cecil replies:

I’m not sure if this is a testament to what a bargain cruise ships are or an indictment of the geriatric care industry. But at first glance at least, a long-term sunset cruise, so to speak, looks like a pretty good deal.

Booking yourself an extended cruise isn’t much different from permanently checking into a luxury hotel: in each case you get maid service, utilities and maintenance are covered, and you never have to cook another meal in your life. With a hotel, though, you’re stuck in one place, whereas on a cruise ship you can get to just about any interesting coastal locale on earth.

In 2004 geriatrics doctors Lee Lindquist and Robert Golub studied the tradeoffs between a permanent cruise and an assisted living facility, which serves seniors who need help with daily activities but not constant attention. They didn’t extend the comparison to include nursing homes, presumably due to the difficulty of caring for elderly people with serious mobility or health-management issues aboard a ship. They found the national average rate for assisted living was about $79 per day, or $28,689 per year. There was considerable variation: Chicago-area assisted living care was nearly $40,000 a year, and homes for the upper crust approached $50,000. But even using the average figure, the cruise option cost only $2,422 more over 20 years.

The authors placed a lot of value on the greater amenities available on cruise ships. Although sleeping rooms are likely to be smaller on a ship, common and entertainment areas are larger and more numerous. Cruise ships have a much higher employee-to-guest ratio than assisted living facilities. All meals are provided, with escorts if needed, and laundry, hair salons, and other white-glove services are common. Conclusion: for roughly the same money as assisted living, cruising gives you a much better quality of life.

Sound too good to be true? My guess is it probably is. There’s no indication Lindquist and Golub ran their little scheme past a cruise boat operator to see if it would actually work. As anyone who’s dealt with elderly parents knows, by the time most people are ready for assisted living, they’re past the point where an endless cruise would be anywhere near as much fun as it sounds.

Lindquist and Golub tacitly acknowledge this. They say the ideal cruise candidate is mentally sharp and capable of community living. But they also say more than half of those in assisted living facilities suffer from dementia and a quarter have been diagnosed as depressed. Even if you don’t fall into those categories, you’re still likely to require a lot more maintenance than cruise ships are accustomed to providing — help with bathing and going to the toilet, and maybe just getting out of bed.

Inevitably the elderly are going to have a lot more medical issues than cruise ships are set up to handle. Fact is, onboard medical staff is often stretched thin even under normal circumstances. One study of medical care on a world cruise found that with an average passenger count of about 700 and a staff complement of around 540, medical personnel saw an average of 37 patients per day for everything from the usual colds and owies to cardiac arrest. Overall, cruise ship doctors saw two to three times as many patients as their land-based colleagues.

In addition, while onboard medical staffers are generally well trained, they don’t include the range of specialists the elderly typically see on a regular basis. If an emergency arises that they’re not ready for and you can’t wait till the ship reaches the next port, your ambulance ride is almost certainly going to be an airlift, which can be expensive and logistically problematic.

A long cruise exposes you to passengers from different countries with varying levels of health care and vaccination. Contagious illness can sweep through a ship — the Centers for Disease Control lists more than 130 serious outbreaks of gastrointestinal ailments on international cruise vessels from 2005 to date. In 2010, for example, more than 400 of 1,800 passengers on the cruise ship Celebrity Mercury developed diarrhea and vomiting due to a virus. That’s not pleasant for anybody, but the elderly suffer more.

And let’s face it: constant travel, just like you and me, gets old. We in the developed world can enjoy a cruise or some other adventure quite late in life by historical standards. But the day will come when we’ll aspire to nothing grander than the comfort of friends and family and a quiet place to sit.

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References

Dahl, Eilif “Anatomy of a World Cruise” Journal of Travel Medicine 6.3 (1999): 168-171. 

Lindquist, Lee A. and Golub, Robert M. “Cruise Ship Care: A Proposed Alternative to Assisted Living Facilities” Journal of the American Geriatrics Society 52 (2004): 1951-1954.

“Market Survey of Long-Term Care Costs” The 2011 MetLife Market Survey of Nursing Home, Assisted Living, Adult Day Services, and Home Care Costs. October, 2011. MetLife Mature Market Institute.

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