Nursing Homes: Perceptions and Realities
By Aprill Jones
Why is there so much misinformation and so many misconceptions when it comes to nursing homes?
Admitting a loved one into a long-term, skilled nursing facility is a difficult and extremely emotional decision for all involved.
Here we will address common misconceptions and cultural perceptions that may or may not be true, but nevertheless influence our decisions and thought processes when a loved one may need the 24/7 care of a skilled nursing facility.
When faced with the daunting task of choosing the best facility for the needs of the patient and the family, the process becomes overwhelming, frustrating and even frightening. It’s hard to know what to believe and what to dismiss. Research is imperative and will go a long way in making you and your aging parent feel good about your choice.
Many of us believe nursing homes are where people go to die.
From her 25 years of experience, Barbara Fordyce, R.N., Case Manager in Senior Resource Management, considers the belief that nursing homes are the last stop before the funeral home to be today’s biggest misconception about nursing homes. She finds this is especially true for those who were in adulthood in the 1930’s and 40’s.
That particular generation is living a lot longer than they expected, and really have no cultural cues in how to handle getting older than anyone else they ever knew. They’ve watched friends grow feeble, forgetful and die. It’s a frightening time for them, and the prospect of going into a nursing home may be an indication to them that their time is drawing to an end.
The fact is, even though many senior adults may require the 24/7 care of a nursing home after surgery, an injury, accident or health event such as stroke or heart attack, once sufficiently recovered, they may be able to return to their previous living arrangement or released to a caregiver for the remainder of their lives.
With people in the United States living longer than ever before, it is estimated that anyone over 65 years of age will have a 43% chance of spending some time in a nursing home. About 24% of these individuals will spend less than a year in residence at a nursing home. (www.therubins.com/homes/stathome.htm)
Even when returning home permanently is not an option, most Medicaid-certified nursing facilities will hold beds for patients during a short visit with family or friends. Each state has rules that vary, so check on how out-of-home visits are treated at any nursing facility your are considering.
I can’t help but think that if my loved one is in a nursing home, they will be miserable and I will feel guilty.
Our culture harbors the belief that when we have a loved one who needs the care of a nursing home, the result is guilt and sadness for the family, and the end of any enjoyment of life for the patient. However, that does not have to be true.
Doing your homework before a relative is admitted into the home is the first step to making you both feel good about your decision. The fact is, some ailing seniors are happy to go to a skilled nursing facility so that they no longer feel guilty about the burden they feel they have been to the caregiver.
Your loved one also may be relieved to receive the medical, rehabilitative and nursing care provided in the nursing home by health care professionals.
And while most nursing home residents may miss day-to-day interaction with old friends, family and even pets, most facilities are upbeat, positive places. Patients often enjoy eating in dining rooms rather than in their rooms, and activities and outings offered each day to stimulate and entertain patients mentally, physically and socially.
Also keep in mind that a nursing home is not like a hospital. There are usually no restrictive visiting hours and your relative may be able to go with you for visits, family events and holidays. Expect nursing facilities to try to be home-like – where people can feel comfortable, make friends, visit with family and continue life's activities appropriate to their age and capabilities.
Your research before admission and frequent visits with your loved one once moved into the facility will ensure that their time in a nursing home is beneficial and pleasant without any misery or guilt.
It seems all the residents lose their privacy.
Fordyce reports that many residents, in their first weeks in a nursing home may experience a shock at their loss of privacy if assigned to a semi-private room. While they are usually allowed some personal items and clothing that help keep their sense of identity and individualism, there is a certain loss of control that many people struggle with for varying periods of time.
You should expect staff to be considerate of the need for privacy and knock on closed doors before entering the room, respect clothing choices and personal preferences when appropriate.
If you have a mother and father who would like to live together at the nursing home, you should expect to find a facility where this is allowed and their privacy is respected.
We’ve come to believe all nursing homes smell bad.
It’s true that incontinence is a fact of life in most nursing homes, but today’s cleaning methods and prompt attention to any sanitary issue is standard in most homes. If you encounter bad odors, the situation should be reported immediately. But in today’s skilled nursing world, stale, lingering, unpleasant odors are no longer an issue that cannot be resolved.
We perceive that when in a nursing home, people lose their dignity.
Because in the past, we may have observed nursing home patients sitting in wheelchairs waiting to be taken to where they are going next, or people wandering the halls seemingly having discussions with themselves, many of us perceive that residents in a nursing home lose all dignity. But Fordyce reports that residents, on average, receive 2.5 hours of skilled nursing care every day. You can expect the staff to be constantly aware of resident whereabouts and needs, and if you feel this is not the case, you should report what you see.
It is true that a large number of nursing facility residents have Alzheimer's. However, in most homes, Alzheimer's patients live in distinct units where they can be among people having the same limitations and receive the specialized care they require in a secure setting.
In your loved one’s nursing home, you should not encounter lingering odors or signs of neglect or disrespect resulting in loss of dignity. If you do, exercise you option to report the conditions. You have every right to have your concerns addressed and a plan of action shared with you.
It only seems logical that private pay surely results in better quality of care than when paid through Medicare or Medicaid.
According to Hillary Kaylor, Regional Long-term Care Ombudsman in Charlotte, NC, there should be no difference in quality of care between Medicare/Medicaid payment vs. private pay vs. long term care or Worker’s Compensation insurance payments. Quality is not based on payor source, but rather from influences such as the administrator, the size and number of beds in the home, and how closely the services offered at the home match the needs of the residents.
Kaylor says that nursing home operations are usually run by private corporations, hospital systems, or, more and more rarely, a “mom and pop” type organization.
All nursing homes in the United States that receive Medicare and/or Medicaid funding are subject to federal regulations. (American Association of Homes and Services for the Aging). The nursing home industry is one of the most heavily regulated operations in the United States. Each and every nursing facility is expected to meet minimum government quality standards, and undergo regular inspections by state surveyors.
Kaylor states that as an employed ombudsman, it is part of her job to urge facilities to do better than the minimum. If a problem is found, a prompt correction plan is required. Most areas have an active, government-supervised Ombudsman program that advocates for patients and families in the case of oversight.
It IS true that nursing homes have changed!
Nursing homes haves changed a good deal over the past decade, according to Kaylor. They are no longer a place where grandma sits and waits for someone to change the television to her afternoon soaps and for her once a week visit from the family. With more and more focus on rehab and recovery, nursing homes often have a diverse population, which includes both younger and elderly people.
A good place to start making nursing home comparisons for your particular area, according to Fordyce, is through the Centers for Medicare and Medicaid Services, which provides a nursing home compare tool. Go to www.medicare.gov, go to “Search Tools” and click on “Compare Nursing Homes in Your Area”, or call 1-800-633-4227.
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Aprill Jones holds a B.A. in English from the State University of New York. A writer for over 15 years, she has experience with a variety of clients in the healthcare field, including neuro rehab, optometry, radiology, dentistry and pharmacy as well as work in health insurance. She lives in North Carolina.
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Resources
Nursing Home Fact verus Ficton
For a nursing home fact vs. fiction quick reference chart, go to www.commonwealthfund.org, from E. Carlson, "Twenty Common Nursing Home Problems and the Laws to Resolve Them," Clearinghouse Review Journal of Poverty Law and Policy, Jan./Feb. 2006.
Comments (1 to 7 of 7)
alzheimersideas
21 hrs ago
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Very good article. People must understand nursing homes have changed and must adhere to certain standards as mandated by the department of public health
Susan Berg, author and dementia healthcare professional
PersonCareDotNet
19 hrs ago
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This article about nursing homes is very accurate and timely. Similar to when you may have looked for a day care center for a child, the child day care center's director is the key. In a nursing home, the administrator/management is the most important part of a caring nursing home.
Bob, experienced professional in the healthcare industry for equipment/supplies
alzheimersideas
18 hrs ago
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I think the director of nurses is also extremely important
Susan Berg
author and dementia healthcare professional
Cat
15 hrs ago
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Sorry to burst your bubble, but this article is lovely, but not realistic - unless you have money and are a relative of the administrator. I notice that the only people commenting on this article are in the industry. Speaking from "both sides of the fence" the truth is that in a recent poll in LTC Magazine 90% of the vote on the question: I wouldn't want to be a resident in my own nursing home - be it SNF, LTC, Assisted Living, etc.
Where are these lovely nursing homes where everyone visits - eats in the dining room and plays games? In a movie? I haven't seen any in Los Angeles County that were not high-end private pay. Sorry - aren't out there.
As far as Medi-Cal versus private pay goes - it is very nice to say that there is no difference - and you are right, it is mandated that there be no difference in care - but there is. Regardless of where the blame lies, the industry is run as FOR PROFIT and with Medicare, HMO and Medi-programs cutting reimbursable amounts it is a perfect storm of problems, an aging infrastructure, low paying jobs and a patient population that is many times in no position to object. Yes there is an Ombudsman, but abuses do occur and it is impossible to regulate things like "not caring" -
I invite everyone to spend 7 days as a patient - in fact that is the only thing that will change the system.
momsdaughter
4 hrs ago
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If at all possible, try to hire a live in before placing into a nursing home. My mom has been in 2 nursing homes
momsdaughter
4 hrs ago
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My comment got cut off. Anyway, Mom has been to 2 different nursing homes and while there are caring CNA's & RN/LPN's, who do their job, most facilities are short staffed and residents receive minimal care & are ignored for the most part. Mom has lost 12 lbs in less than 2 months and her care has not been anything like what we were told it would be. I've had CNA's ask me if I knew how to transfer mom into bed because they weren't sure! Yes, it's been reported. After 2 failed attempts & her health in jeopardy, we are now hiring a live in and will have more peace of mind knowing she is at home where we can take care of her better than the nursing homes we've had experience with. Hiring a live in is actually saving us money - you have to do alot of reference checking & CORI checks, but we've had good luck in finding a few great, experienced people eager to help just by placing an ad in the local newspaper.
Mgrady1
1 hr ago
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I agree with Cat and momsdaughter- there is no such thing as a good nursing home. this article is very inaccurate and misleading.
there is alot of work that needs to be done about the lack of care and lack of humanity in nursing homes.
i do not have time at the moment to fully comment on this article, but i will at a later date.
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