Obviously there are a lot of people who are mentally gone or who have massive physical care needs in nursing homes but in my few visits there seemed to be a lot of people mentally OK and seemed to move around adequately (although slowly).
What are you calling a “nursing home?” There are a lot of “assisted living” places which allow people to have their own apartment or room but provide various services. They are mainly for people who don’t drive anymore and want to have the option of having someone else do the cooking, cleaning and laundry. They might also provide help with dressing or bathing, if necessary.
The social aspect of assisted living is a big draw. They have dances and holiday gatherings, bus people around on day trips, all sorts of activities.
I don’t know about other states, but in Kansas any applicant for admission to a nursing home has to be screened for health and ability to function independently before admission, usually conducted by the hospital discharge planner or the local agency on aging. Medicaid and private long-term care insurance providers won’t pay the bill for patients whose assessment does not reveal a need for such care, and any state-licensed nursing home with private-pay patients whose assessments don’t show a need for such services is going to get some extra scrutiny.
My grandmother lives in a “step up” community which is one large campus that has houses, condos, apartments, a care facility, a rehab facility and I think even a hospice. Basically once you’re 55 you can move in to a house there then work your way through the facilities based on needs. All of the people on the campus can socialize together and in the condos (where grandma lives) as well as apartments and nursing home there are nurse call buttons in case of emergency. People who don’t yet need the nursing facility can get familiar with the staff and the buildings, and people who are in the nursing facility or rehab aren’t that far from the place they used to call home.
I have a feeling these sort of places, the step-up communities, are getting more popular because they make sense (and boy I’m sure they make BANK!!) So you might go to a nursing home and find that there’s a lot of people THERE who are old but not actually patients, they live on their own down the road a bit.
Or heck even if they’re not people who live in the community, old sick people have old well friends and relatives who come to hang around. When my grandpa was in a nursing home he was kind of miffed at how many visitors he had all the time heh
To a casual observer, it’s not possible to diagnose a person’s mental or physical status. Just because someone is moving around adequately (although slowly) doesn’t mean he’s not in a great deal of pain, and in need of ongoing assistance and therapy. Not every problem shows on the surface.
That’s what I was going to say- it ranges from something reminiscent of a dorm for old folks, where they’re independent, to full-on nursing care. The idea is that you start somewhat early, and progress as needed based on your necessary level of care.
My grandmother lives in one of those places, and she’s in the dorm-like part for now (she’s 92), but as she becomes less capable, she can move into one of the other wings/get more assistance if necessary. Of course it took her until 91 to agree to go there, so YMMV.
I never heard the phrase “step up community”, though I suppose it makes sense. The accepted phrase, used in the industry, is CCRC (continuing care retirement community). They typically include age-restricted (55+) independent living cottages and apartments - little or no assistance with daily living or health care; assisted living apartments - residents sometimes have microwave and hotplates, but communal dining rooms are most common, and the facility provides assistance with daily care and minimal health care; and skilled nursing - what is commonly known as a nursing home, with no private kitchens and moderate to intense daily and medical care. And, yes, these are becoming more popular, as fewer people can rely on family members for the first two stages before they need skilled nursing.
As for the OP, I also wonder if he/she is thinking about only skilled nursing care.
My Grandpa spent his final years in a dementia nursing home, which he decidedly needed. There was one resident though who just didn’t seem to have any signs of dementia, over the several years my Grandpa was there. My family started taking him along half the time when they took Grandpa out for day trips most weeks, because he never got visitors, and he was always cheerful and good company.
He was elderly, a bit creaky, and probably did need some physical help, but he recognised me fine even when Grandpa didn’t, despite my only meeting him a few times, and my Aunt who saw him most days said she never picked up any dementia symptoms either.
Really had to wonder why he’d wound up there. I can’t imagine anyone voluntarily living in a dementia care facility, however nice it was (and it was a nice one), watching everyone around you slowly losing their wits while you’re still sharp…
Yes I am thinking only of the traditional nursing home with nurses as I have never been in any of the others.
I would say yes.
Yes to what? The OP? You think too many people are in nursing homes? Are you basing this on personal experience?
A year ago, my (then) 91-year old mother was in an apartment on her own in San Diego, where she and my dad (of blessed memory) lived since 1972. She had had a fall earlier in the year, spent seven weeks in rehab (Medicare will pay for short term nursing home/rehab care if the person is discharged from a hospital). She was having a harder and harder time managing on her own. I hired a care manager and a home health aide, signed her up for Meals on Wheels, an emergency button. I was going through daily radiation for breast cancer and did what I could from Texas.
The upshot: by June of 2016, it was clear she could not live on her own any more. She wasn’t eating her MoW (the freezer was stuffed with them and they wouldn’t deliver any more), she wasn’t bathing or changing her clothes and wouldn’t let the aide help her shower. She fell once and wasn’t wearing the emergency button (it was hanging on the wall next to her bed), so she crawled to the phone and dialed 911. The emergency button people had a lock box outside with her key in it, but since she dialed 911, the EMTs had to break in to get to her.
I decided I had to move her here to an assisted living facility. The logistics of that move, getting her vetted and admitted, paperwork from her doctor (at the Naval Hospital in San Diego), shipping some of her possessions here, and disposing of the rest, followed by her very first ever plane ride… it was exhausting and harrowing, every minute of it. When we finally pulled up to the front door of her new place of residence, she got out of the car in spite of me telling her to wait until I brought the walker around, and she promptly fell and hit her head on the concrete sidewalk.
Fortunately the staff there are well equipped to deal with little old ladies falling down. Someone went off to the ER with her, while I put the finishing touches on her room. She’s been there seven months now. She has three meals a day in the dining room. The aides give her a shower three times a week whether she wants it or not (and she doesn’t, but she does need it). They have activities, movies, field trips, manicures every other week, different holiday observances.
I can’t tell you what a load this is off my mind. I’m all alone-- no partner, kids, or siblings-- and have no one to share the responsibility with. The staff there is fantastic. I go over during the week for a short visit and then on Saturday to do her laundry. They could do it, but it gives me something to do there.
She has one very nice room with a bathroom. Cost is $4,060 per month. This is a mid-price place, not rock bottom and not top of the line. She has monthly income that covers part of that and savings that she is drawing from to cover the rest. She has enough savings to last about six years at that level. However, as you need more staff involvement, understandably, the cost goes up. To go on Medicaid, you have to spend all but about $3,000, I believe, and then you have to share a room. Since thihs is Texas, there may not be Medicaid by the time she needs it.There is an intermediate financial support step for her-- something to do with the Veterans Admin, which I haven’t researched too much yet. You have to spend down your assets to about $8,000 and then the VA will supplement with $1,000/month. That would cause her savings to last a bit longer.
She absolutely needs to be there. I like the place. I did some grant writing for them before I retired and was thoroughly familiar with their philosophy and mission. As someone said, the atmosphere is very much like a dorm. Just about everyone in the assisted living section is on a walker or wheelchair. Some are mentally more acute than others. I notice a decline in her mental acuity every time I see her. She is on 50 mg of Zoloft every day, and that has helped immensely with depression and anxiety. My mother has been depressed her whole life-- she’s an extremely negative person and always dwells on the downside of everything. She has actually said to me, “If you knew the kind of things I think about, you’d be shocked.” I don’t want to know, believe me. They showed The Green Mile a few weeks ago and she was really into the electric chair scene.
But I digress (as usual). It’ s not a great life, actually, for her, it’s a pretty sucky life, but she’s safe. She wasn’t on her own. When you have to be there, it’s a good place to be. I don’t worry about her. I know she’s getting good care.
If you’re facing the need for this kind of care, I recommend a non-profit institution over a profit-making one. The non-profits are mission-driven; the profit ones are profit-driven. Also (unless there’s no possibility of you running out of money) find out what happens if you do run out of money (i.e., need to go on Medicaid). The place where my mother is will not kick you out. There’s a fund to help people who outlive their money (one of the things I used to write grants for). Another religiously affiliated place in town WILL kick you out if you need to go on Medicaid… they state it as “finding you another place.” Right.
Yes, too many people are in skilled nursing facilities. Despite some moves toward some rebalancing, there is an institutional bias in the national US health care system (Medicare and Medicaid) which pays more easily for SNFs than for community living.
Since SNFs are extremely expensive, this can lead to lots more money being paid than necessary. When someone needs a nursing facility level of care, the average cost in a SNF is something like 80,000-90,000/year, and a home health aide is half that. Of course, these stats can be wildly misleading, since the aide is not likely to be 24/7 and that means the system is usually relying on unpaid family caregivers.
Still, the combination of personal preference and cost usually goes together to suggest community living is better than institutional, but the money isn’t there to support it.
Happy to give more details to anyone interested.