I don't necessarily disagree about the costs of decentralization, but will say that it appears to rely on some assumptions that the family won't be providing any care, etc.

I don't think that doctors and nurses are the limiting factor for home care, but rather home health aids and CNA's - basically people that check in on patients around the clock and make sure they're kept clean.

In the context of the US system, your original comment is just completely off the mark. Our healthcare system is universally terrible, independent of the cost ("not my job" at every level). Consigning a elderly person to that system is basically the last thing anybody wants to do, hence the focus on dying at home etc.

I can't speak about Germany's system. But it's worth remembering that money is not equivalent to resources, and that spending an imprudent amount of money on elder care right now doesn't imply that there won't be resources left for you later. Whether the system is "burnt to the ground" has more to do with if the institution is destroyed or hollowed out, rather than how much it costs.