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.”

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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.

 

 

 

Sources:

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 http://www.cdc.gov/nchs/fastats/nursing-home-care.htm andhttp://www.cdc.gov/physicalactivity/basics/pa-health/

Long-term Care Facilities. July 2015. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/systems/long-term-care/resources/facilities/index.html

The ADA and Olmstead Enforcement: Ensuring Community Opportunities for Individuals with Disabilities (The ADA and Olmstead Enforcement: Ensuring Community Opportunities for Individuals with Disabilities) http://www.hhs.gov/asl/testify/2010/06/t20100622a.html

Long-term Care Facilities (Long-term Care Facilities) http://www.ahrq.gov/professionals/systems/long-term-care/resources/facilities/index.html

Center for American Progress (2007) Caring about Long-Term Care. Retrieved (January 2015) fromhttp://cdn.americanprogress.org/wpcontent/uploads/issues/2007/07/pdf/caregiving_report.pdf

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). <http:aspe.hhs.gov/daltcp/reports/ltcwork.htm> (20 Jan 2005)

Reevaluating the Importance of Informal Care