View of a Resident

“ I came to the nursing home because of hip replacement. Before I came here I lived on my own and did not require any help. It’s nice to be here and know that there are people around to help me [CNA’s] but it gets hard because I know that I have to follow certain rules around here such as not getting up to go potty on my own. That’s one of the hardest rules to follow because sometimes it takes quite a long time for someone to finally come into the room to help me and at that point it’s too late. Everything here is different than at home, I have dinner at a different time, I have to go to bed at a different time, and I get woken up at all hours of the night because I have a roommate here.


If I had the chance to recover from my surgery at home, you bet your bottom I would do it. It would be more helpful if there were only one person to help me, it would be a lot easier to remember their name! I think it could better for me to recover at home too because I’m used to how my home is and after I leave here I will have to readjust at home which makes me quite nervous since I’ve been living here for the past month. Physical Therapy helps me during the week to try to get me ready to go home, but there’s going to be a big difference between doing a small task in front of them [PT] and doing a different task for the first time alone at my home. That’s something that makes me nervous, because I don’t want to fall and hurt myself again. But yeah, I guess if I had a choice of where I would rather be, I would have to choose at home, not that I don’t like it here, but it’s hard to have to leave the only house you’ve ever known for the first time. Sometimes I’m scared that I won’t be able to make it back there.”

View of a Resident

Reevaluating the Importance of Informal Care

By the year 2050 an estimated 27 million people will require paid long-term care services. (FCA, 2015) This number has more than doubled since the year 2000, greatly due to the baby boomer generation growing older and needing additional assistant with activities of everyday living. With these numbers it is clear to see more living options need to be available for those who are getting older (AHRQ. 2013). Currently, there are 1.4 million people in nursing homes and there are only 1.7 million licensed beds available (CDC). Informal care is an often disregarded option when thinking about long-term care solutions, based off of these numbers is it clear to see that in-home care should be more of a priority when looking at this aging population.

Fifteen percent of residents in nursing homes are only unable to perform instrumental activities of daily living, such as: driving, cooking, managing finances, or shopping (Shi & Singh, 2015).
With the rising demanding for additional assistance, it important to evaluate whether these individuals belong in a long-term care facility? People who are not able to carry out IADLs are still able to fulfill many activities of daily living such as toileting, bathing, brushing teeth, and getting dressed. The nursing home environment may not be the most cost-efficient alternative to long-term care.

The average cost for long-term care in the United States in 2010 were recorded to average about $229 a day, which is $6,965 per month for a private room in a nursing home facility. In-home care varies based upon the amount of care needed and location of the home. Home healthcare services are provided in two-to-four-hour periods referred to as “visits”(USDHHS).  This could dramatically save a resident money each day by only paying for the direct care needed in the comfort their household. Unfortunately, Medicare does not cover informal care. The federal government currently has a program called Medicare to fund acute hospital visits, medical devices, limited physical therapy, but not activities of daily living. Many people must wait for eligible of Medicaid and pay out-of-pocket costs until then. If Medicare covered in-home care, even for a limited amount of time, the overall cost of care would decrease due to not having to pay for around-the-clock care. This could allow elderly people live at home longer, and stretching their money farther.

Informal care is typically given by a family member, but is now being expanded, allowing others to be hired to at the resident’s home. This allows for respite care for the family members. This is becoming a more ideal workplace for caregivers due to the ability for more one-on-one time between caregivers and residents, allowing more personalized care and better relationship. Due to the ratio of staff-to-residents not being ideal in other facility settings, many residents may go unattended until a healthcare worker is free. In home healthcare there is not a wait for cares because of the one-on-one service and getting medication will not require wait-time. With more federal funding, there will be more accessibility from the general population creating a reduction in number of people in nursing homes. Because of having to pay out-of-pocket until a person becomes eligible for Medicaid, many people may not realize this type of care is an option.

The overall quality of life of a resident who chooses informal care to formal care would be significantly different. Viewing this from a micro perspective, the qualification of the caregiver may be less than what is required in a facility. This would allow a wide scope of people to be qualified to help assist with ADLs. Olmstead Decision allows the right of individuals to receive care in the community versus a facility. Benefits of this include maintaining (modified) independence, allowing a person to reside in their familiar and comfortable home, and positive interpersonal care which can create an overall better living environment. (HHS, 2010)

It’s easy to see, the number of long-term care residents is steadily rising. It is important to find proper funding by the federal government through such programs as Medicaid and Medicare to allow more options to the aging population and allowing more people the option to stay at home rather than going to a nursing home when they may not require the extensive care given in such facilities. The ability to remain in a comfortable and familiar setting will allow for better overall quality of life and the number of people and overall time spent in nursing homes will decrease due to the allowance of people to stay in their homes living as independently as possible for as long as possible.





Shi, L., & Singh, D. (2015). Long-Term Care. In Delivering health care in America: A systems approach (6th ed., p. 407). Burlington, Massachusetts: Jones and Bartlett.

Centers for Disease Control and Prevention. (2015) Nursing Home Care. In Long Term Care. Retrieved from and

Long-term Care Facilities. July 2015. Agency for Healthcare Research and Quality, Rockville, MD.

The ADA and Olmstead Enforcement: Ensuring Community Opportunities for Individuals with Disabilities (The ADA and Olmstead Enforcement: Ensuring Community Opportunities for Individuals with Disabilities)

Long-term Care Facilities (Long-term Care Facilities)

Center for American Progress (2007) Caring about Long-Term Care. Retrieved (January 2015) from

U.S. Department of Health and Human Services, and U.S. Department of Labor. The future supply of long-term care workers in relation to the aging baby boom generation: Report to Congress. Washington, DC: Office of the Assistant Secretary for Planning and Evaluation, (2003). <> (20 Jan 2005)

Reevaluating the Importance of Informal Care

Long Term Care- importance of adding physical activity to daily routine

Importance of incorporating physical activity to those in nursing facilities

The healthcare care system is made up of many complicated and broken areas. One of these areas is long term care, which is defined as a complex American system with elderly being the predominant users of services, covering a variety of chronic conditions (Shi & Singh, 2015). Many people look at the negative factors when staying in a nursing home, but instead should try and improve the quality by enforcing positive environments. According to the CDC, there are over 15,000 nursing homes (CDC 2015). With the rise in the elderly population and average life expectancy, we need to work on decreasing cost, improving quality of life and access by incorporating more opportunities for physical activity within nursing facilities. We are going to keep seeing a high demand for this type of care.

Each state has different standards within each nursing home, but the United States needs more federal mandates and requirements for education, wellness programs, and heathier diets with extended food choices added to the daily routines at nursing home facilities. A variety of wellness programs would be crucial to fulfil the positive benefits of each individual based on their health level. Although there are benefits in aerobic training, resistance training in the older population is increasingly apparent as it improves walking endurance (Franklin 2002). When having a wellness class for the residents, an education session can follow. Without education on preventative health or the importance of physical activity, some elderly people may not understand why these services are available. Preventive health services are valuable for maintaining the quality of life and wellness of older adults. In fact, the Patient Protection and Affordable Care Act of 2010 includes provisions related to relevant Medicare services. However, preventive services are underused, especially among certain racial and ethnic groups. (Healthy People 2020)

You can’t always focus on this because not every elderly resident will want to participate, but the importance of physical activity should be stressed more and done in a fun manner. Studies show the increase in satisfaction when their mind is being taken off knowing they are at a nursing home. Many elderly residents who don’t have family will spend time alone and it really can decrease their happiness. On the other hand, when keeping busy and with satisfaction you see less depression. Research has shown that doing a mix of aerobic and muscle-strengthening activities 3 to 5 times a week for 30 to 60 minutes can give you these mental health benefits (CDC 2015). Also, when increasing access to daily physical activity, a study also showed better sleep at night.  Resources to help treat sleeping disorders in elderly include good sleep from physical activity and environmental factors (Martin 2012). Other factors to overall increase satisfaction in the elderly include a balanced meal every day.

Overall incorporating more physical activity or classes that even get residents moving will emphasize the more positive aspects. Some examples include instead of limiting the movement of the elderly, nursing staff should focus on increasing physical movement. This could be by taking little steps at a time, but even with that you’ll see improvement. One of the most common reasons residents fall are due to muscle weakness, which accounts for 24 percent of falls (CDC 2015). This problem could be decreased if we helped improve their muscles by getting them to sit less. After strengthening muscles, it would reduce the cost of needing excess medical care. When adding more physical activity, falls could also be prevented by adding education not only about importance of being healthy, but how to prevent falls through different strategies. The CDC found statistics that actually saw a decrease in falls when they decreased the amount of restraints used. In the long run, nursing facilities could save money in other areas when keeping the residents from getting any other chronic diseases. When residents are being healthy and active while they are staying in a nursing home, more illnesses are less likely to occur, increasing their overall quality of life. This can prevent unnecessary added costs as well, which is a huge factor when trying to improve our healthcare system. By increasing quality of life, you are positively improving a critical component of public health.



Centers for Disease Control and Prevention. (2015) Nursing Home Care. In Long Term Care. Retrieved from and

Franklin, Barry., & Nied, Robert. (2002). Promoting and Prescribing Exercise for the Elderly. Am Fam Physician Journal. 65(3):419-427.

Healthy People 2020. (2015). Why Is the Health of Older Adults Important? Retrieved from

Martin, Jennifer. (2012). Nursing home residents’ psychological barriers to sleeping well: a qualitative study. U.S. National Library of Medicine. Retrieved from

Shi, L., & Singh, D. (2015). Long-Term Care. In Delivering health care in America: A systems approach (6th ed., p. 407). Burlington, Massachusetts: Jones and Bartlett.



Long Term Care- importance of adding physical activity to daily routine

Author Guest Post: Viterbo nursing student

“When looking at long term care, I think many problems are faced by residents and barriers are always being found. The first one being there are never enough staff for each resident and sometimes I felt like I wasn’t providing as much patient satisfaction as I wanted too. I worked as a CNA in a nursing facility and some residents needed more care than others. To get them lifted out of bed and cleaned up could take a long time, and then you hear other call lights going off, but can’t always attend as fast as you want too. I think the ratio of health care workers to residents needs to be more equal to improve their quality of life.

Staffing is just one barrier, but I noticed other problems that could be improved on. I think there could be improvements in nutrition side as well. It’s important to provide a variety of meal options, while keeping it healthy. Sometimes I think nursing homes can steer away from that. They need more options to allow them to move around and not just sit all day.

Lastly, I think the high stress of working in a nursing home is the reason that many workers come and go more often then maybe in a hospital. I think sometimes people prefer that hospital setting and the pay is usually higher as well. I love my job as a CNA, but some of these problems can be heart breaking, especially when you look at how much it cost. I hope someday there will be more federal funding for those staying in nursing homes, along with an improvement in nutrition and more education on physical activity.”

Author Guest Post: Viterbo nursing student

Health Worker in Nursing Home

I am a 21 year old CNA health worker who has been working at nursing homes for the past three years. On a daily basis I see issues that arise with long-term care and have devastating outcomes for patients. The cost, in particular, to stay in a nursing home and get the essential care is a very steep price for many of my patients to afford. This ultimately ends up negatively affecting their health.

I’ve worked with and have bonded with many of my patients, and have seen many of them leave the nursing home because they simply could not afford it. Long-term care insurance is often not perceived as important when you are under 50 years old, but once you require long-term care it becomes apparent how expensive it can be without any coverage. Many patients simply just run out of money and can’t pay for their care any longer, therefore being forced to leave the nursing home facility. More importance needs to be placed on how long-term care can be affordable for an individual who earned an average income throughout their life. Patients become financially depleted and usually don’t have any type of insurance that can help them with the expenses. I’ve come to realize that purchasing insurance is less attractive because the premiums are so high, therefore individuals will opt to not seek out long-term care insurance.

I understand that funding an extreme change in the cost of long-term care insurance would be a difficult task, but I also see the desperation in my patient’s eyes when they realize they cannot afford to keep getting proper treatment. It is guaranteed that everyone will age, it is guaranteed that as populations get older some of them will require the care of a long-term care facility such as a nursing home, so in order to meet these needs the government has to curve the increasing price of insurance. It is our duty as health care workers to do everything we can for our patient’s comfort and well-being, and a cheaper long-term care insurance reform is an excellent way to aid aging America.

Health Worker in Nursing Home

Long-Term Care Insurance Cost

The need for long-term care, LTC, has currently been on the rise and will continue to rise in the coming decades. It is projected that the elderly population will be doubling between now and 2050, which means that there will be a substantial increase in the number of people who will need LTC (U.S. Census Bureau, 2011). The purchase of LTC insurance is often overlooked because many don’t think they will ever need LTC facilities and because the cost of insurance premiums is so high. It is a fact that 70% of people turning 65 years old can expect to use some form of LTC during their lives, therefore the Federal government needs a policy that will address the cost of LTC insurance (U.S. Department of Health & Human Services). An incentive policy, such as a grant incentive program, would encourage the purchase of qualified LTC insurance. This policy would make LTC insurance more financially attractive while also increasing access and quality.

If a grant incentive system was implemented it would make the cost of insurance much more attractive. This incentive program would be modeled after the German government’s LTC insurance program, which has had success in encouraging more individuals to purchase LTC coverage. This program gives out grants to an individual when they pay their fixed amount per month for their insurance policy. There are different levels of coverage, so depending on what level the individual chooses, the more the monthly payment would be along with the grant received. The grant money would end up giving the individual extra coverage for when they really need to use it. This incentive program could encourage individuals to purchase private LTC insurance, therefore lowering the cost of having to utilize LTC without insurance (Bahr, Calsyn & Spiro, 2014).

This LTC insurance incentive program would increase access. The program guarantees assistance to individuals even if they don’t owe federal income taxes. Also, policies would be “guaranteed issue” meaning that any individual can buy insurance regardless of their health or risk of needing care (Bahr, Calsyn & Spiro, 2014). Many are unaware of the benefits that private insurance can bring, therefore if the general public is educated thoroughly about the program they would be more inclined to find a private insurer that offers the incentive (Shi & Singh, 2015). This program would also protect those who buy the qualified private LTC insurance because the premiums and benefits provided by the insurers cannot be varied based on the health status of the individual. Patients wouldn’t have to worry about being dropped from their insurance plan because these security measures would be in place (Bahr, Calsyn & Spiro, 2014).

By implementing this grant incentive for buying private LTC insurance it would increase the quality of care available to the individual. If patients are covered with LTC insurance, they will have the ability to find higher quality care and be able to financially afford that level of care. When individuals are not covered by private insurance they may not find the best care out there, that would be of higher quality, because they are worried about how much of a financial burden it may be. It is important for individuals to not have to settle for lesser care that does not fully meet their medical needs just because they cannot afford their desired coverage (Bahr, Calsyn & Spiro, 2014).

Most individuals who are insured with Medicare and Medicaid are under the impression that they will be covered for their LTC needs. These two primary government programs however do not protect the individual as much as what is perceived, and end up failing to meet the needs of people with a disability or illness who also need LTC. The grant incentive program wouldn’t suffer from this same issue because as a form of security the policy cannot increase premiums or take away certain benefits just because of health status. The program wouldn’t be bias towards the disabled or ill (Hoffman, 2014).

In summary the grant incentive program would encourage the purchase of private LTC insurance which would impact cost, access and quality. The cost in the long run would decrease for an individuals LTC needs if private insurance through this program is purchased ahead of time, the access would increase because the program cannot pick and choose who they’d select based on their health status, and lastly the quality of care would increase because the individual would be able to find LTC that covers all their medical needs.

Bahr, D., Spiro, T., & Calsyn, M. (2014, October 31). Reforms to Help Meet the Growing Demand for Long-Term Care Services. Retrieved November 27, 2015, from

Hoffman, A. (2014, November 14). Risk And Reform Of Long-Term Care. Retrieved November 27, 2015, from

Shi, L., & Singh, D. (2015). Long-Term Care. In Delivering health care in America: A systems approach (6th ed., p. 407). Burlington, Massachusetts: Jones and Bartlett.

U.S. Census Bureau. (2011, October 31). SIXTY-FIVE PLUS IN THE UNITED STATES. Retrieved November 27, 2015, from

U.S. Department of Health & Human Services. (n.d.). Home – Long-Term Care Information. Retrieved November 27, 2015, from



Long-Term Care Insurance Cost

Nursing Student Point of View

“From my experience working in a long term care facility, I do not feel that adequate staffing is generally provided. There are often residents that require complex care, but there is not enough staffing to provide the time that is necessary with the resident. In addition, many workers are pushed to work overtime hours because of inadequate staffing, leading to decreased productivity among the staff.

I feel that nursing staff in long term facilities tend to work more hours than the average nursing staff in other settings. This seems to be due to the inadequate staffing in long term facilities. This creates a time constriction that will probably not allow for individual residents to receive proper care. The overall environment of the facility will probably be greatly affected by this. Staff will have increased levels of stress, which will likely translate to how they care for their residents and interact with their coworkers.

If a facility’s census is decreasing, there would likely be decreased funding. This would mean that there would probably be less money for administrative and upkeep costs of the facility and less money that could go for staffing. Staffing positions may need to be cut and long term care facility may have a difficult time staying open.

Other staffing that is necessary for individuals to receive proper care would include dietary, custodial, and administrative staffing. Adequate nutrition is extremely important for these residents, so dietary staff will always be needed. Custodial staff will be needed to maintain a clean and healthy environment at all times. This may decrease the rates of infection throughout the facility and improve resident satisfaction with the facility. Lastly, administrative staff is necessary to take care of finances and staffing throughout the facility. Without these members of staff working together to assure that all individuals are properly cared for, long term care facilities would not be successful.

Compared to other health care settings, I think the overall staffing is lacking in long term care facilities. Because of the difficult working conditions, I think many people prefer to work in the hospital or clinic setting compared to long term care facilities. The inadequate staffing of many long term care facilities has many negative repercussions for the workers and residents of these facilities.

One barrier that may affect a resident’s access to long term care includes lack of funding. Some forms of insurance do not cover long term care and these facilities can be extremely expensive for the family members of the residents. Government assistance is sometimes available, but not all people have the insurance plans to provide an adequate amount of assistance to cover the high costs of long term care facilities.

One thing that I would like to see changed within long term care facilities in the United States would be increased funding in order to increase staffing. With the baby boomer population becoming elderly and a constantly increasing need for long term care placement, staffing needs to be increased to keep up with the demand. With increased staffing, it is hoped that staff will be able to adequately do their job in a safe environment and residents will receive the care that they need.”

Nursing Student Point of View