The Decline of Nursing Homes

“My spirits would drop if I went to a nursing home,” Edna Blandon, an elderly U.S. citizen, told her doctor.

Edna’s views are the same as many aging adults in our nation, but now it is no longer just the elderly who are saying ‘no’ to nursing homes.

In the past six years, the number of nursing homes in the United States has declined by approximately three-hundred and fifty.(1) Furthermore the percentage of elderly in nursing homes dropped from 9.6% in 1985 to 6.4% in 2004.(2)

This shift is primarily due to the fact that health care costs have soared over the past years and Medicaid financing has shrunk. As reported by Joseph Berger in the New York Times, “The nursing home model is no longer financially viable or medically justified.” Because of this many nursing home operators are turning to a new form of care known as Managed Care at Home or PACE (Program of All-Inclusive Care for the Elderly).

This new form of care provides almost all the exact same services that a nursing home would while at the same time allowing the elderly patients to remain in the comfort of their own homes. Jason A. Helgerson, the Medicaid director for New York  State, said, “It used to be that if you needed some kind of long-term care, the only way you could get that service was in a nursing home, with 24-hour nursing care.” That is not true anymore. While there used to be only 42 of these new programs in twenty-two states in 2007, it has now expanded to include 84 programs in 29 states.

Studies show that the new program is not only a lower cost to taxpayers but can also be less expensive than the traditional nursing homes. The lessened cost, though, does not mean that the amount of care and attention provided is also lessened. The new program uses a team of skilled doctors, social workers, physical and occupational therapists and other specialists to provide a wide range of services including periodic examinations, day-time social activities, and physical therapy.

Helgerson stated that over the next three years, New York state alone plans to shift approximately 80,000 people requiring more than 120 days of long-term care services into managed care models. One New York City program has over 2,500 participants at 12 different sites. New York along with twenty-eight other states have embraced the new programs and with the government continuing to restrict payments to nursing homes,(3) the number of managed care programs in the U.S. will only continue to grow.

Cardinal Dolan summed up the philosophy behind the new programs when he said, “Seniors and others who have chronic health needs should not have to give up their homes and independence just to get the medical care and other attention they need to live safely and comfortably.”

Filling the Gap of Knowledge (Care Management)

It was Francis Bacon who first coined the phrase, “Knowledge is power.” As a family caregiver when it comes to knowledge of your elderly parents’ needs, you are often lacking.

When considering the many options before you and your parents, sometimes it can feel overwhelming. You only want what’s best for your loved one, but what is best? With about 30,000 assisted living facilities, thousands of retirement-care communities, and over 15,000 certified home care agencies in the United States, how do you decide the best possible option for your loved one?

Unfortunately, as a family caregiver you are most likely not an expert on caregiving. You know how to love and that is important. Family caregivers face challenges and often make sacrifices to help support their aging parents. You know your loved one better than anyone and often you feel that it would be best to keep the major decisions between you and your aging parents. However, to fill the gap of knowledge that you may be lacking and to help reduce the feelings of stress in your life, hiring a certified care manager may be an option to consider.

The National Association of Professional Geriatric Care Managers, stated “With todays longer life span, adults can find themselves taking on a caregiving role for their aging parents. However, people can feel awkward in this role, unsure about how much to intervene in their parents lives.”

A caregiver can help with that uncertainty and awkwardness. As the NAPGM described “Geriatric care managers are trained and experienced in any of several fields related to care management, including, but not limited to nursing, gerontology, social work, or psychology, with a specialized focus on issues related to aging and elder care.”

Care managers will work with you and your loved one to help tailor a care plan specifically to your loved ones’ needs. In doing this they will take into account all possible options to create the best combination of elder care services. These services may include housing, home care services, socialization programs, and financial and legal planning.

You may not be an expert in making the best decisions for your loved ones, but a care manager is. As was stated in the National Care Planning Council’s December 2011 article, “The care manager has been there many times – the family is experiencing it for the first time.” Seeking out the help of a care manager can save you time and money in the long-run. It can also give you much-needed relief from stress.

Linda Fodrini Johnson, president-elect of NAPGCM, said “Families feel guilty when they have to make decisions for their aging parents. With the relationship of a geriatric care manager we can take the guilt out and put reality back.”