Nursing homes

Individuals generally enter nursing homes or rehabilitation facilities for short-term recovery after surgeries or falls or permanently when they become unable to care for themselves but do not require hospitalization. According to the Centers for Disease Prevention and Control, 1,383,700 US citizens were living in nursing homes in 2012. Almost 80 percent of residents were non-Hispanic white, and almost 70 percent were women. About 42 percent were eighty-five or over, and another nearly 28 percent were between the ages of seventy-five and eighty-four. Approximately 15 percent were between the ages of sixty-five and seventy-four as well as under the age of sixty-five. Most people fear being placed in a nursing home when they are no longer able to care for themselves. A 1996 poll conducted by Alliance for Aging Research found that it was the chief fear of aging Americans.

Background

Before the 1930s, nursing homes were virtually unheard of in the United States, because families cared for older or ill family members in their homes. The poorest segment of the elderly population were sometimes relegated to “poor houses,” where they lived in appalling conditions without adequate health care. By the 1930s, social reformers focused their attention on the needs of the elderly. Congress passed the Social Security Act in 1935 as part of President Franklin Roosevelt’s New Deal. Funding for the Old Age Assistance program was provided by federal grants, which were matched by individual states. Thus, Social Security recipients were able to enter the private nursing homes that opened up around the country. In response to improvements in overall nutrition and health care, the care of nursing home residents also improved.

By the 1950s, most states licensed nursing homes and practiced a certain amount of oversight. However, a number of scandals involving the operation of nursing homes in the 1960s and 1980s revealed that unscrupulous individuals sometimes exploited both the elderly and the system designed to protect them.

Beginning in 1965 with the passage of the Older Americans Act and the establishment of Title III grants that helped states to create community programs for seniors, the US government began trying to help the elderly and the infirm remain in their own homes whenever possible by funding home care programs that include not only health care but also meal-delivery services, assistance to family caretakers, and legal services. Studies have revealed that even simple measures help to improve the health and quality of life for such individuals.

At the request of Congress, the Institute of Medicine conducted a study of nursing homes and discovered widespread neglect and abuse, which led to the Nursing Home Reform Act, a section of the 1987 Omnibus Budget Reconciliation Act. The act stipulated that Medicare and Medicaid would not make payments to nursing homes that failed to meet designated standards. The act also stipulated that in order to be licensed, nursing homes were required to offer regular assessments, comprehensive care plans, nursing care, social services, rehabilitation, pharmaceutical services, and dietary assistance. Furthermore, the act established the Residents’ Bill of Rights, which guaranteed freedom from abuse, mistreatment, and neglect; assurance of privacy; the right to have social as well as medical needs met; and the right to seek redress of grievances without fear of reprisal.

In 2011, passage of the Affordable Care Act under President Barack Obama provided for greater access to consumer information on nursing homes, increased safety for nursing home residents, and created a federal grant program that allowed states to expand criminal background checks for nursing home workers.

Nursing Homes Today

In 2001 the Centers for Medicare and Medicaid Services began offering Nursing Home Compare, a report card on licensed nursing homes in the United States. To help consumers choose the nursing home that best fits their needs, the report rates each facility from one to five stars and offers such information as the availability of social activities, the prevalence of pressure ulcers, the use of physical restraints, and national and state comparisons. The Medicare website also provides access to Medicare Compare. In 2006 the Advancing Excellence Campaign was launched to create a coalition of health care providers who voluntarily work together to improve the quality of nursing homes.

In the United States federal standards for nursing homes are set by the Centers for Medicare and Medicaid Services. In 2012, 175 quality standards had to be met for facilities to be eligible for Medicare and Medicaid. Some states also add additional standards concerning such issues as patient-staff ratio. Thus, the quality of nursing homes varies greatly from state to state. It is the responsibility of designated agencies to monitor nursing homes within each state. Inspections generally take place every nine to fifteen months. These agencies have the authority to issue citations and sanctions, levy fines, or take administrative action. In severe cases, a facility can be forcibly closed. Researchers in the field of gerontology have learned that states with the highest level of regulation tend to have the highest quality nursing homes.

Whether or not an individual will enter a nursing home depends on a number of factors. A majority of nursing home residents are non-Hispanic white, and the majority are female. Additional factors that correlate with admission into a nursing home are socioeconomic status, health, functional abilities, living arrangements, family structures, and the availability of support.

A 2013 study conducted by Thomas Kali and Vincent Mor found that states that provide home-delivery meal services have lower incidences of residents entering low-care nursing homes. In addition to meeting nutritional needs, home-delivery programs offer social interaction and provide an individual to monitor daily conditions. Workers can also summon medical help if needed. Kali and Mor estimate that 85 percent of individuals served by home care are able to delay nursing home entry. With fewer low-care residents in nursing homes, workers are free to devote more time to meeting the needs of high-care patients.

Other alternatives are also available for individuals who dislike the idea of entering a traditional nursing home but who are unable to live independently. As early as the 1970s, the Green House Project began creating residential care facilities that convey the atmosphere of living in one’s own home. Green House facilities have since been established in almost every state. In 1991 Bill Thomas launched the Eden Alternative, a program that trains professionals to view the elder years as a new stage of life development, thereby improving the lives of nursing home residents. Assisted living is another means of providing the elderly and infirm with a measure of independence. By 1998, there were 65,000 assisted living facilities in the United States. According to the Assisted Living Federation of America (ALFA), the average cost in 2009 of assisted living facilities was $3,022 per month. Meanwhile, the cost of nursing home care continues to rise. Between 2009 and 2013, the national average cost of private nursing home care rose from $67,527 to $83,950 per year.

At the end of World War II, veterans returned home to find a booming economy had brought an end to the Great Depression. The birthrate climbed between 1946 and 1964, giving rise to the baby-boom generation. In 2011 the first baby boomers turned sixty-five, swelling the senior population. In 2013, Americans over the age of sixty-five comprised 13.9 percent of the population. By 2030, they will comprise twenty percent of the population. The increased population of elderly Americans is placing new burdens on programs such as Medicare and Medicaid and raising concerns over whether or not long-term facilities will be able to meet demands.

Bibliography

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US Department of Health and Human Services. Long-Term Care Services in the United States: 2013 Overview. Washington, DC: US Dept. of Health and Human Services, 2013. PDF file.