How To Avoid Living In a Nursing Home

By on April 20, 2013
Nurses supervised old woman in a nursing home

Everyone want to avoid living in a nursing home. It’s the secret fear of almost everyone that ever given thought to aging. But statistically, 1 in 4 people over the age of 65 spend time in a nursing home.

It’s the single worst scenario in most people’s imagination. Would it be an exaggeration to say it’s “a fate worse than death”?

Not to worry, it can be avoidable, and I am going to tell you how. But first let’s explore some ideas and define what a nursing home is.

First of all, you should know that on any given day in the U.S., 1 out of 4 people over the age of 65 are in a nursing home, temporarily. The chances of you, your parent or spouse spending some time in a nursing home at some point in your life is also 25%.  This is pretty high, right? But keep in mind, that there is a vast difference between spending some days recovering from a hospital stay before going home, and living in a nursing home. Let me clarify that for you.

There are several synonymous names for a nursing home: S.N.F. (pronounced “sniff”) otherwise known as a skilled nursing facility, convalescent hospital, Rehab, rehabilitation hospital, even sanitarium. “A rose by any other name…” right?

Nowadays, if an older person has a stay in the hospital, they still need some recovery time before they can safely return home. It might be a hip fracture, a broken arm, or even an infection or a bout of pneumonia; nevertheless they are going to spend a few days or a few weeks recovering before being allowed to go home.

These days hospitals release people “sicker and quicker” due to the Medicare reimbursement schedules. Several years ago to save money, the Medicare system went through every conceivable cause for hospitalization and gave it a value of x-number of hospital days, then told hospitals “this is what we will pay you…period.

And it’s now a fact of life that nursing homes are a major player in the Medicare system, because they are cheaper than hospitals. So unless you are scheduled for surgery or you are in ICU, you are getting shipped out ASAP to a skilled nursing facility.

However, at any given time a large percentage of patients in nursing homes are there for the rest of their life. They are considered to be in “custodial care. They are never going home. They are usually people that need to be on “machines” or just plain ran out of money and now Medicaid is footing the bill. But chances are, for most of them, it could have been avoided.

Casual environment of assisted living

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So how do you avoid ending your days in a nursing home?

Planning ahead and preparing to compromise.

The best way to avoid a nursing home is to consider  moving into a board & care or an assisted living before you get so sick that you lose all your options. It’s like this: many older adults refuse to consider assisted living until it’s too late and then end up in a nursing home, sometimes for 5 or 6 years.And it was avoidable.

This is why: at the present time there are limited rules in the licensing of an assisted living community ,that make it easy to “age-in-place”. That is if you are already living there when you start declining. But the same rules make it very hard to move into an assisted living if you are seriously chronically ill and trying to move in for the first time. Before you consider moving into assisted living, it is important to read the series on assisted living posted on this site.

For example, lets compare two different people that have moderate dementia.  The first one  moved into the assisted living early on, is allowed to stay, even go on hospice for the remainder of their days. The other that was kept at home when their health turned worse, as it does in the later stages. It is most likely  it will be difficult to  move into an A.L. community.

The reason is, most assisted livings do not want to take someone that will drain their resources, and/or their licensing agency will not allow admission to assisted living because the severity of their illness. And if you are on a limited income – forget about it. Assisted Livings and board and care homes are private pay only. Medicare and Medicaid will not contribute a dime for you to live in assisted living (even though it’s cheaper for them). Let’s just say Medicare and Medicaid pay for medical issues and assisted living is considered a social issue. The much longer explanation can be found on government websites, or use our Ask The Experts feature here on the site.

It is important for those wanting to remain at home, when considering Assisted Living understand that the family caregiver must monitor the care being provided, as if their family member was at home.

This is a major decision, because most older adults trying to remain independent, are socially isolated, they rarely get out, they don’t eat well, they can’t keep up with the cleaning,let alone basic home maintenance. They are often depressed because they have, in most cases, lived alone for years with only a television for company. Most of their friends have passed on or moved away. Yet they continue to stay at home alone without proper care, nutrition, or socialization. Against all logic and argument to the contrary, they stubbornly hang on to their delusion of independence.

Many in assisted living  will develop new friendships and will have an emotional support structure that will remain with you indefinitely. Most people that come to assisted living are fairly healthy with the usual assortment of aging related issues, but as they get older they will need more help: assisted living offers things like medication management, bathing assistance, laundry service, transportation, housekeeping, meals, incontinence care and even dedicated one-on-one care. But few people need even half of these services when they first move in. That’s what we mean by aging-in-place.Of course, these services are charged extra, above he monthly fee.

Aging in place in a dementia community

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To review, the way most board and care homes and assisted livings communities are licensed, a person can stay in an assisted living no matter how bad they get; even until they qualify for hospice and end of life. (There are some prohibitive conditions, but they are so severe, you would not imagine them in anything but a clinical setting, like feeding tubes and breathing machines). So if you are willing to compromise your “independence” a little early on, you can spend your last few years in a supportive, apartment-like setting, and guarantee that you never end up living your remaining years in a nursing home.

Here is a checklist on what to look for when considering a memory care unit? 

Considering Assisted Living? Here is a checklist for you 

 

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