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We Don’t Like Nursing Homes

Posted Mar 31 2010 11:04am

By Laurence C. Harmon and Kathleen M. Harmon

Several years ago, we became default caregivers for our aging parents who were precipitously declining into the gloomy inevitability of dementia, Alzheimer's and death.

We were immediately underwater, trying to cope with the minute-by-minute challenges we were facing. Because of this life-changing experience, we decided to bring the best advice and counsel to our fellow Boomers who are similarly encountering these demands. Our website, Great Places Inc , is the product of our experience, intended to be a resource for our peers, offering advice, assistance and encouragement.

We don’t like nursing homes. Never have. It’s not just because so many of them “chemically restrain” their residents with horrific drugs. In many nursing homes, you will see the residents, strapped into wheelchairs, clustered pathetically around a big-screen TV set, helpless and unattended, drug-addled and apparently comatose. What you’ve witnessed are the faces of atypical antipsychotic drugs.

The reason we don’t like nursing homes is that we’re two of the millions of Boomers who want to “age in place.” We’re like the seniors in a 2007 study, Aging in Place in America, who, when asked what they feared most, rated loss of independence (26 percent) and moving out of their homes into a nursing home (13 percent), while the fear of death was the greatest fear of only three percent.

In response, to the widespread animosity toward nursing homes and the dawning realization that a humongous number of Baby Boomers are going to need help with their daily activities, a variety of alternatives to nursing homes are springing to life. These facilitates are designed to allow Boomers to “age in place.”

Here is a snapshot of several of them:
  • Home Health Care, sometimes referred to as “in-home healthcare,” is care delivered directly to the residences of “recovering, disabled, chronically or terminally ill persons in need of medical, nursing, social, or therapeutic treatment and/or assistance with the essential activities of daily living.” Source: National Association for Home Care and Hospice.

    Home health care services are intended to “promote, maintain or restore” the health of older adults in their homes, and may range from cleaning and home maintenance to personal care. Services include: dressing, grooming, meal preparation, bathing, and other basic needs.. Home health care may also involve nursing or therapeutic care, often to assist with medications or treatment. Costs are charged according to the provider's level of skill and the amount of time required to provide the service. Medicare will pay for skilled nursing care when ordered by a physician, but with very specific parameters and limitations.
  • Adult Day Care, according to the Senior Resource , is “life senior service for frail, physically or cognitively impaired seniors and their caregivers” who require supervision because they have “safety issues when left alone (or) seem unable to provide a structure for daily activities (or) have extended daily periods of isolation and miss others."

    Adult day care participants interact socially with their peers, engage in stimulating activities, receive physical or speech therapy (if needed), and receive assistance with the activities of daily living. Eighty percent of these centers operate on a non-profit basis, and many are affiliated with multi-service facilities—hospitals, assisted living and nursing facilities.

    State Medicaid programs may pay for health care provided in state-licensed facilities, including therapy and mental health services, administration of medications, psychological evaluations, dressing of wounds, and assistance with feeding. Private long-term care insurance may also pay some of these costs, but Medicare will not.

    Almost Family, an adult day care provider, summarizes the benefits of these facilities: "Adult day care offers a win/win situation for everyone in the family—not only the client or member who attends the program, but also for the family member who has primary responsibility as caregiver. Adult day care provides a much-needed respite for the caregiver, affording a break from the physical demands and stress of providing round-the-clock care."

The other alternatives to institutional care do not allow seniors to continue to life at home, but are intended to provide a “home-like” environment:
  • Independent living in market-rate housing. This is age-restricted apartment living that may offer some seniors-oriented services. Residents must be at least 55 or 62 years of age, depending on whether the property allows families (age 55) or is age-restricted (age 62). Prospects must be able to live independently, require little or no help with household activities, and be able to pay rent: independent living is not subsidized.
  • Because these apartment projects are rented primarily or exclusively by seniors, some services--housekeeping, transportation, meals--may be available, usually at an increased cost. This type of housing is an especially good choice for younger seniors who wish to downsize their living spaces and avoid the expense and bother of maintenance and upkeep.
  • Adult foster care. According to the AARP , “adult foster care” (“AFC”) is a “viable alternative to nursing home care for older adults and people with disabilities who prefer to live in the community. It provides residents with a homelike and family-like environment.” States use multiple terms for AFC: it can be called “adult family care,” “adult family care home,” or “domiciliary care.”

    Adult foster homes are single-family residences that are inspected and licensed by the state. The care provider is required to meet certain standards—e.g., pass a criminal record check; successfully complete a basic training course; provide care in a home that meets structural and safety requirements—and the facility is typically classified according to the level of care provided. Medicaid pays for some of the costs of this service.

    Because AFC is integrated into local communities, individuals can engage in social interactions as they get help with personal care, medications and health-related activities, money management, housekeeping, and transportation to appointments.

    California Board and Care Homes can be granted specialized waivers to provide care for persons with Alzheimer’s disease and those on hospice or ventilators, and these homes can be secured to provide care for residents who wander. Source: The Senior List.
To learn more about Great Places -- go here.

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Original content Laurence C. Harmon and Kathleen M. Harmon, the Alzheimer's Reading Room
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