Having recently "assisted" my parents in their declining years and eventual death, I have told my wife that when the time comes, find the best facility you can find, come see me twice a week, make sure I have a working computer and tv, and bring two handles of Glen Livet each visit.
I'm only half joking. Spending 5 years (of my "Golden Years") taking care of declining parents has shown me that one of the horrible things about AD is that the person becomes...an inconvenience...a burden. That's a hard thing to say but it is the truth. As Mo said above, "you've gotta die of something."
$20B annually could built some decent facilities...and that's another thing, "decent" doesn't have to be the Driscoll Hotel. Cinder block construction, good lighting, plastic covered mattresses, that is adequate. When someone shits the bed two or three times a day ease of clean up becomes the priority, not Stiffel lamps with crystal bobbles. Over staff the place. Don't use "the minimum required by law." And we've got to get over the notion that *judicious* use of medications is wrong. If a medication can bring a person out of a snit, or a rage, or a hallucination, then use the damn medication. The patient will be more comfortable, and the staff will not get furious with the patient which leads to abuse.
I know it would only be a matter of time, a short time, before graft and corruption would set in, but I think it might be 20 Bill better spent as opposed to some medication chase that appears to be going no where. Oh, and when you find the corruption, put the mother fuckers in prison. Not just some bullshit fine. Lock 'em up. They are stealing from the most vulnerable in our society. They are monsters.