Based on what I have read about nursing home care in the US, unless maybe you have a lot more money than we have, spending my last days in one of those places does not appeal to me.
People in the DR are accustomed to taking care of the elderly at home. Consequently, it is possible to employ people to work in your home who have had experience. This includes registered nurses.
Perhaps our experience will help someone to make plans. We are currently supporting a very old and greatly loved relative who is in an assisted living facility in the US. He did well throughout his life and can afford good care. Even then it is very expensive. Monthly rent is US$3,000, including a main meal per day and the apartment is going back to the assisted living facility after death. Then, utilities .. on top of that the other two meals and on top of that any medication, nursing care or cleaning and laundry required.
The piece of the care that is missing though, is the personal touch. We found that it is not possible to leave stuff like paying bills (medicare stuff is a nightmare to reconcile) and taxes and making daily life decisions to care givers. Although our old relative still has a good mind, he is now blind and cannot see to make decisions about his affairs. Being old, there is also a matter of who to trust to write your checks - and in this case, sign the checks. Simple stuff becomes problematic... like buying a new chair to sit on 'cause the old one is broken, arranging for books on tape, getting the walker adjusted for height and oiled because it squeeks, purchasing some little thing that the assisted living facility does not have on hand, or cleaning out the fridge. Simple things but things that determine quality of life.
This experience is truly teaching me a few lessons and has made us adjust our plans for our old age.
My old relative is still quite with-it but he does wonder why he could still be alive? He did not plan on having such a long life for sure and the physical deterioration is hard to deal with for a proud and highly educated man. The medical care in the US is also very different, for example, he has a pace maker. In my mind, it is almost criminal to fit a very old person with a pace maker. Especially one that is ready to move on and out of this life. There is a feeling of a medical system that functions on taking the life savings of the old person away from them. We've had to deal with a dentist that would like to give him a new set of implanted teeth, an eye doctor that wants to operate on the off chance that 5% of eyesight can be restored, another internist or something that wants to do something about incontinence and so on and so on.
The issues around the 'no resuscitation' paperwork are also complex and legally fraught with difficulty.
We're fortunate that we discuss life and death without a problem and had a good laugh a few days ago... he was talking again that he does not understand why he still is in life and a joke came up ... skip the next pacemaker service call! I think he is going to do just that.
Seems to me that there is very little left of the idea of growing old and dying with some dignity, normally and surrounded by loving people.