When it comes time for families to contemplate placing a loved one in a nursing home or assisted living facility, there are numerous aspects to contemplate. Where is it positioned? Who’s in charge? What types of activities does the nursing home offer?
You will need to research these, and lots of other questions, to search out the best fit for your beloved.
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And there are numerous options on the market. This data comes from the National Center for Health Statistics or NCHS, in 2017-2018, probably the most recent period for which data is obtainable. Within the U.S. there have been an estimated:
- 4,200 adult day services centers.
- 11,500 home health agencies.
- 4,700 hospices.
- 15,600 nursing homes.
- 31,400 residential care communities.
- 1,200 inpatient rehabilitation facilities.
- 400 long-term care hospitals.
That’s numerous potential sources of look after your beloved, and digging a bit of deeper into the facts and statistics surrounding nursing home care could provide help to make a more informed decision.
It can also help to have a bit of more background details about nursing homes basically. This information can boost your understanding of where a selected facility suits into the general scheme of health look after an older adult or for somebody who needs rehabilitation assistance or one other sort of long-term care at a distinct stage of life.
Why People Need Nursing Homes
Dr. Michael Tehrani, a geriatric physician with Brand Latest Day HMO, a California Medicare Advantage plan, says, “Greater than 1.4 million people live in over 15,500 Medicare- and Medicaid-certified nursing homes across the nation.” Most of those residents are over the age of 80 years, and most are women. “Lots of the female clients that I see have lost their spouse,” he explains.
- Eating or preparing meals.
- Bathing and dressing.
- Going to the bathroom.
- Managing medications.
- Moving around within the residence or attending to other locations.
“There’s a fancy set of issues why some people need a nursing home,” says Dr. Tanya Gure, section chief of geriatrics and associate professor in internal medicine on the Ohio State University Wexner Medical Center in Columbus. “Depending on what resources can be found to them in retirement and their current network of support, they could move to a nursing home as they’ve increasing limitations of their basic functions.”
Who Should Consider a Nursing Home
Some people need more help than others. Assistance with feeding, bathing or medical care is likely to be a top priority for some, while others could have issues with mobility function or with the ability to transfer from sitting to standing on their very own. All of those needs could mean that a person could also be best suited to the sort of care that a nursing home can provide.
Nevertheless, while nursing homes, also sometimes called expert nursing facilities, do look after numerous older adults, it’s a standard misconception that nursing homes are just for the elderly. Expert nursing facilities actually take care of a wide selection of individuals, and a few are younger than 65. Still, it’s true that older adults do make up a big proportion of the individuals who reside in nursing homes.
The NCHS reports that in 2017-2018, nearly all of long-term care service users were aged 65 or older, with 83.1% of nursing home residents being in that older age bracket. Meaning 16.9% of residents were younger than age 65 – a large minority.
Those younger residents (and among the older residents) will not be planning to remain in a facility at some stage in their lives; reasonably, they could need rehabilitative care after a surgery or injury. Some younger individuals with certain disabilities that require constant care, reminiscent of severe developmental disabilities, can also live in a talented nursing facility.
Which means inside every nursing home, some patients may be quite sick, while others may have less intensive care, Gure says. Some patients could also be nearing the top of their lives, while others are residing there temporarily after a hospital stay to recuperate before going home.
Gure says this potential variation within the population and the numerous the explanation why someone is likely to be living in a nursing home aren’t at all times discussed. “There may be some misperception about nursing homes. A few of it relies on an antiquated image” of what a nursing house is and the way it helps people, she says. “I just want to emphasise that these facilities serve an enormous number of patients and could be a critically necessary resource.”
As well as, Gure notes that aging in America could be a socially isolating experience. As such, she routinely talks together with her patients about their plans for the long run, especially in the event that they’re about to undergo an elective surgery or foresee that they may need some extra care sooner or later. “This can be a resource they will utilize in order that after they return home, they’re more able to facing what they find there,” she says.
Gender and Ethnicity
More women reside in nursing homes than men; as of 2018, 59% of short-stay residents and 66.6% of long-stay residents were women, the NCHS reports. Moreover, the report notes, non-Hispanic white people accounted for 73.9% of nursing home residents.
“The racial/ethnic mix is determined by the community,” Gure explains. “More urban areas have a more racial and ethnic mix. You didn’t use to see numerous Latino or Asian residents in nursing homes.”
Gure says a few of that variation in nursing home residents’ ethnic backgrounds is expounded to cultural differences and in a scarcity of providers who speak the language or can cook the cuisine. Some cultures also place a giant emphasis on families caring for his or her elders at home. Nevertheless, she adds, “that is been changing through the years, and now more various kinds of patients are moving into nursing homes.”
Medical Conditions
Residents in nursing homes typically have a minimum of one chronic condition for which they need some ongoing medical care, and a few have experienced falls or other injuries which have necessitated more intensive care. The NCHS reports that in 2017-2018, some 17% of nursing home residents had fallen.
A 2018 study that checked out population data from the National Vital Statistics System, the Web-based Injury Statistics Query and Reporting System, or WISQARS, and the Medicare Current Beneficiaries Survey estimated that non-fatal falls led to about $50 billion in total medical costs.
Chronic conditions are also common amongst nursing home residents. The NCHS reports that, in 2017-2018, arthritis affected 27.6% of nursing home residents, and heart disease affected 20.1%. About 34% of residents had diabetes, and 76.9% had hypertension. Depression was also common, with 48.8% of nursing home residents having this diagnosis.
While some people may assume that nursing home residents all have cognitive difficulties reminiscent of Alzheimer’s disease or other types of dementia, that is not the case. Lower than half – 49.1% – of nursing home residents had a diagnosis of Alzheimer’s disease or one other type of dementia, the NCHS reports. The prevalence of Alzheimer’s disease or dementia, nonetheless, was higher in long-stay residents (57.6%) versus short-stay residents (35.8%).
Nursing home residents’ cognitive impairments are also a very important condition to contemplate and supply appropriate resources and look after, Gure says.
This impairment is a giant reason why some people move right into a nursing home. Safety could be a big factor for seniors aging in place at home, and that will mean it is time to move from home care to a nursing home.
Costs and Paying for a Nursing Home
One other popular misconception is that Medicare pays for an individual’s residency in a long-term care facility. But the actual fact is, Medicare only pays for the primary 100 days in a nursing home or expert nursing facility, and provided that the stay follows a hospitalization of a minimum of three days.
Once you get to day 101, other types of payment should be in place. The coverage rules for Medicare Advantage plans are different, so check your specific coverage plan for details. Because Medicare doesn’t pay for long-term care, individuals who need nursing home care must pay privately. Finding a strategy to pay for long-term care could be a big problem for many individuals, especially given the high costs related to such care.
Based on probably the most recent data available, Genworth’s 2021 Cost of Care survey, the median monthly cost of expert nursing in a non-public room at a nursing home will set you back $108,408 per yr, versus just over $94,000 for a semi-private room. But prices can vary so much depending on where within the country the community is positioned and which services a senior is using.
For instance, Genworth reports that Alaska, Connecticut and Latest York have the best every day costs for personal nursing homes at $1,036, $453 and $420 per day, respectively, adding as much as a whopping $378,140 per yr.
In Alaska, $165; 163 in Connecticut and $153,300 in Latest York. At the opposite end of the spectrum, Texas, Missouri and Oklahoma are the least expensive areas, with per-day costs of $169, $173 and $180, respectively. Which brings the annual total to between $61,500 and $65,700 per yr in those states.
Long-term care insurance policies could also be another choice to pay for nursing home care, but these policies may be prohibitively costly for a lot of. Usually, people pay out of pocket until their resources are used up, at which point Medicaid kicks in to cover costs. In actual fact, Medicaid is the payment source for nearly all of nursing home residents, with 62% using this implies, in keeping with the NCHS. But the foundations vary from state to state, so it’s necessary to speak with an advisor to grasp your options.
How COVID-19 Has Affected Nursing Homes
Over the past nearly three years, the coronavirus pandemic has had a severe impact on nursing homes. The Centers for Medicare and Medicaid Services, or CMS, reports that, as of December 2022, there have been greater than 1.37 million confirmed COVID-19 cases amongst residents of nursing homes and greater than 1.43 million confirmed COVID-19 cases among the many staff of nursing homes. For the reason that pandemic began within the spring of 2020, nearly 161,000 residents of nursing homes have died of COVID-19, and a couple of,839 staff of such facilities have died of COVID-19.
Tehrani notes that roughly 40% of COVID-19 deaths have been connected to nursing homes. “Individuals who live in nursing homes are often the frailest because they’re typically elderly with multiple advanced chronic conditions,” he says. “The smallest challenges can have the largest effect on them because their immune system may be very compromised to start with.”
As well as, the close contact with others that happens in congregate care settings like nursing homes and expert nursing facilities implies that any infectious disease has likelihood of moving through the population quickly.
In an effort to curb transmission, many facilities severely restricted visitation by family members, which created a series of added complications and increased feelings of isolation for people residing in nursing homes. That big challenge continues to be reverberating today inside nursing homes and other long-term care facilities.
Cal Stein, a partner at Troutman Pepper in Boston, says that the pandemic also forced massive changes on facilities; they’d to regulate operations to “harmonize” their practices with “the regulations and guidance that focuses on prevention, with the sensible capabilities of the power, the staff and the residents,” he says.
While the foundations that were enacted at the peak of the pandemic were intended to maintain residents and staff protected, they weren’t universally adoptable, which created potential liability for some facilities.
The fallout from this very difficult period continues because the pandemic lingers. One study of the COVID-19 outbreak and response in Connecticut found that the prevalence of symptoms of depression increased by 15% amongst residents right after the height of the COVID-19 outbreak. And a few facilities have been sued for negligence by grieving families who lost family members through the pandemic.
For his or her part, lots of the defendants in such suits had pointed to a patchwork of state-based laws that shield nursing homes from liability during certain public health crises just like the COVID-19 pandemic. But many suits are still working their way through the courts.
All of this has put pressure on nursing homes, lots of which have been left short-staffed due to pandemic and subsequent societal changes. A 2021 survey from the American Health Care Association and the National Center for Assisted Living found that 94% of nursing homes faced staffing shortages.
And it’s not over yet. Tehrani notes that “with COVID numbers on the rise, some families may need to return to virtual visiting and impose strict guidelines like social distancing. With winter upon us, we also need to worry concerning the flu as well.”
Due to this fact, when you’re on the lookout for a nursing home or a long-term care facility for a loved one now or when you will within the near future, take care to do some extra diligence to ask about their procedures and policies regarding infection control and the way staff are working to maintain residents protected from COVID-19 and other contagious diseases, reminiscent of pneumonia and the flu. Tehrani also recommends asking what the protocol is for a medical emergency.
If your beloved is already in a nursing home and their roommate falls in poor health with an infectious disease, ask to alter rooms. “Initiate treatments as fast as possible, and be sure vaccines are up thus far,” Tehrani advises.
It’s best to also perform a little research about staffing levels on the facilities you’re considering and the way they’ve managed to maintain the doors open and residents cared for within the face of a lot upheaval. “Make certain there’s 24-hour care,” Tehrani says, adding that maintaining adequate staffing is the largest challenge he sees senior care facilities facing today. “It’s very easy for elderly care providers to get burned out. The very last thing a resident needs is a staff member by chance missing giving out medicine.”