It’s Time To Retire Nursing HomesJune 26, 2020 | By administrator
I read an article recently that dealt with the question of why nursing homes cost so much and the difference between for-profit and not-for-profit nursing homes. This legitimate question had been the basis of solid research by the Michigan Retirement and Disability Research Center at the University of Michigan and financed through a grant from the U.S. Social Security Administration. The article itself was on the “Squared Away Blog,” published by the Center for Retirement Research of Boston College.
I mention all of the above because it seems like an arcane question in a world where we are about ready to bid farewell to the whole concept of a nursing home. Today we have at least three options for those who need some level of care that they cannot provide for themselves: skilled nursing facilities (SNF), nursing homes, and assisted living facilities (AL). Here’s how they differ:
Skilled nursing facilities look a lot like hospitals. They are sometimes referred to as rehabilitation hospitals or acute care facilities. They are very institutional in look and feel and may even be part of a hospital. In addition to meals, SNFs provide medically necessary professional services from nurses, physical and occupational therapists, speech pathologists, and other medically trained personnel. They are staffed 24 hours a day and they have a licensed physician that supervises the care of all residents. They are used not only by older adults, but by people of all ages who have had surgery or are recovering from an accident and need temporary round-the-clock care.
Nursing homes provide a somewhat less institutional feel and cater to those who need a lot of help with the activities of daily living (bathing, dressing, toileting, grooming, eating, mobility) in addition to their meals. They also manage medications, take care of residents’ laundry and transport residents to doctor appointments.
Assisted living facilities cater to residents who need help with some of the activities of daily living (ADLs), provides all meals, helps with transportation, and provide a variety of activities for residents to engage in (exercise, crafts, games, etc.). Argentum, the national association that serves the assisted living industry, describes AL as a “combination housing, personalized support services and health (not medical) care, designed to meet the needs of those who need help with ADLs.
The whole concept of “assisted living” arose in the mid-1980s and took off like a rocket, because it filled a large and obvious need. It was originally conceived as a way of bridging the gap between skilled nursing facilities, with their heavily institutional feel, and recuperating at home with minimal help with ADLs, especially for people who had no one living at home with them. From their inception, assisted living facilities have focused on having a more home-like, non-institutional feel. By the mid-1990s there were hundreds of retirement residences billing themselves as “assisted living.”
Today there are over 28,000 assisted living residences in the U.S. and though they vary quite a bit in what they offer, there can be no doubt that AL has moved well into the territory of the more archaic nursing home and has rendered it redundant. Most AL facilities are bright and colorful, they offer residents many opportunities to carry on their lives as independently as possible. Rather than hospital-like rooms, residents live in individual one-bedroom or studio apartments, have their own bathrooms, take their meals in a dining room where they can sit where they wish and socialize with friends; some even maintain their own vehicles and transport themselves to shopping and appointments when they feel up to it.
My 96-year old cousin is living in AL. She went in at age 89, and was able to manage her own personal hygiene and most other ADLs. However, as she has gotten older, she needs more help and the facility she is in provides it on an a la carte (fee) basis, as she requires it. Today she no longer manages her own medications because she has lost almost all of her eyesight, and she needs help with dressing because of increasingly painful arthritis, but she is still able to transfer herself from walker to bed and from bed to the toilet. She still goes down to the dining room to eat and enjoys chatting with other residents and the staff. She is a good example of the trajectory of aging most often seen in assisted living communities. When she needs medical care, she is transported to a nearby hospital, then comes home to her apartment in AL to recuperate.
Assisted living has become an industry in and of itself. At senior housing industry conferences, no one talks about nursing homes. They are a relic of another age and it’s time for the term to be retired once and for all. As for skilled nursing facilities, we should all strive to stay out of them as much as possible. They are not pleasant places to be and cost an alarming amount of money. They are strictly for people who need 24/7 medical care and even at age 100, most people do not need that level of medical care. They need help with ADLs and do just fine with home care or assisted living.