Assisted living hit $7,000 monthly—now Spain is Plan B

Rod Dubitsky says his mother’s assisted living bill in New York runs upward of $7,000 a month, with a medication-management add-on pushing the package higher. With most of the cost covered by her pension and the rest drawn from savings tied to the sale of her

Every time Rod Dubitsky checks his mother’s monthly assisted living statement, the numbers don’t just sting—they reshape the future.

In New York City, his mother’s assisted living costs are upward of $7,000 monthly. Her situation isn’t one of dramatic decline. but a steady tightening: once she could no longer safely drive. her independent routine began to fracture—weekly mahjong games. and her weekly breakfast with friends. Then there were the diabetes-related hospital trips, mostly short-term. And after she started sometimes forgetting to take her medication. the family moved from constant reminders toward a care setup that could handle it.

Dubitsky, 62, a fintech startup founder, says the cost is now pressing hard enough that he’s considering moving to Spain so his own long-term care could be cheaper than in the United States.

His career has been built around finance—covering subprime mortgages during the financial crisis. and later autos. credit cards. and student loans. He founded a fintech startup called The People’s Economist. focused on personal finance issues including budgeting. debt management. and portfolio management. He also studies private equity and private credit insurance companies. which he links to the assisted living and nursing home ecosystem because they influence costs and coverage.

The family story starts with control and independence—then turns into a question of what money can buy when care becomes necessary.

Dubitsky’s mother, 88, lived independently at a retirement home community for a long time. She drove on her own. until she landed in the hospital a few times. mostly for diabetes-related reasons. and sometimes forgot her medication. When the family decided it wasn’t safe for her to keep driving. the reasoning was stark: she had passed out while driving once. creating a risk to herself and others.

After that, she basically couldn’t leave her home. It didn’t crush her immediately—she still had her dog and TV—but it ended her weekly mahjong games and her weekly breakfast with friends.

The family then began monitoring her blood sugar through an app. which Dubitsky describes as a game changer for her short-term memory issues. It also made the logistics of medication harder to deny. “We’d have to call her so many times a day to remind her to take her meds. ” he said. which is what pushed them to look at assisted living.

They also considered in-home care, but Dubitsky says it didn’t fit her medication schedule. If a caregiver is there four hours a day, the help isn’t there when she takes her night insulin.

Less than a year ago, his mother moved into assisted living.

When Dubitsky searched for a facility. he focused on something he believed could affect both quality and cost: who owned it. He said very few owners publish a clear breakdown of costs. He also points to how difficult comparisons become when there’s a crisis. because add-ons can appear that aren’t easily measured against other facilities.

For his mother, the family chose a not-for-profit facility.

Even with that, the assisted living arrangement required a medication management add-on. Dubitsky says that add-on increases the care package by $1,500 a month on top of a $5,800 base monthly pay. He also says the trade-off looked grim: if she stayed in independent living. the cost would be almost as high. but she wouldn’t receive benefits. The low end of independent living. with no meals included. would be $4. 000 monthly. while a “decent facility” with meals and medication management can get to $8. 000.

In his mother’s current setup, Dubitsky says she still manages care for herself, and they haven’t considered memory care. He estimates memory care would add “a couple of thousand dollars a month.”

For transport, there is free transport to a doctor within the facility’s radius. Dubitsky says it works for her now, but could become a problem later if she needs an out-of-network doctor.

The bill is heavy, but it isn’t entirely unsupported.

Dubitsky says all but $2,000 of the monthly assisted living cost is covered by his mother’s pension. The remaining amount comes from savings—and he ties the timeline to the sale of her apartment once that closes. He expects that sale could cover her for a number of years.

There is another financial thread underneath the assisted living decision: what happened to their housing investment.

In 2009, Dubitsky’s mother qualified for an affordable apartment, much cheaper than buying right away on the market. He says the timing—just after the financial crisis—produced a “great deal.”

Now. he says. they’re trying to sell that apartment. but its appreciation has been less than other apartments at market rates. He estimates that. in rough numbers. the apartment value would probably have doubled if it had been a market apartment—money that could have funded more of the assisted living costs.

He doesn’t claim regret for the 2009 choice. He says healthcare inflation has soared far beyond the Consumer Price Index. and a conservative. prudent decision at the time means less money later when health expenses rise. He also draws a parallel to investment decisions—safer moves made 15 years ago might have been prudent then. but may leave less capacity now.

Even after sorting out cost coverage, taxes add another layer of pressure.

Dubitsky says assisted living costs aren’t covered by his mother’s insurance. even though “it’s healthcare.” He says she ends up paying $9. 000 in taxes on her income. He also says she still has to pay taxes despite what he views as the healthcare nature of medication management—something he believes should be deductible. He calls it a broken part of the tax system that tax expenses still have to be factored in even when she ends up effectively negative.

For Dubitsky, this isn’t only about his mother’s monthly budget. It’s also about his own future planning.

He has permanent residency in Spain and an apartment in Barcelona. He says he has to buy private health insurance in Spain because he doesn’t qualify for the national health insurance program. He also says what he pays in two months in New York basically funds his entire year of private health insurance in Spain.

He adds that the cost of care paid out of pocket without insurance is lower in Spain than in the United States—an exchange he believes could reduce his future long-term care burden even if he pays higher taxes in Spain.

Dubitsky says he doesn’t have short-term plans to move to Spain. But he frames his interest in Spain as a response to what he sees as the trajectory of US costs: inflation. healthcare insurance. and a lack of a clear path to fixing the problem. His conclusion is straightforward—if he can reduce what he would pay later, he will.

When people ask him what to do next, he doesn’t point only to assisted living. He argues families need to think beyond the current stage.

Anyone considering assisted living. he says. should look ahead to the “next level” and the wider ecosystem—memory care. nursing homes. and physical therapy. He says the key is to plan for the possibility that the next stage could arrive before you’re ready. If you focus too narrowly. he warns. you end up starting the whole process again—finding a new facility. going back through decisions. and paying the emotional and financial price of delay.

What Dubitsky describes is not one decision or one bill. It’s a system of timing: medication schedules that don’t match in-home care windows. ownership and add-ons that complicate comparisons. pension coverage that still leaves a gap. apartment sale timelines that determine whether savings last. and a tax structure that he says doesn’t properly recognize what is—at least in the family’s view—healthcare.

And behind it all is a simple choice he’s trying to make before he has to: where his life will be when care costs stop being manageable.

assisted living long-term care Spain Barcelona private health insurance New York aging healthcare inflation taxes pension fintech