Low income people or "No income" immigrants can use MediCaid which is provided for low income people. Regular people can not afford nursing home for custodial care. It can cost $7-8K per month depends on where you live. Of course, the quality of care is very different. I worked in this business for over 10 years. All of these facilities are taking from Federal and state govenment. Now, you know why you have to pay so much tax.