Nursing Home Care

Nursing homes are facilities that have at least three or more beds at which health care workers (nursing assistants, licensed practical nurses, and registered nurses) regularly provide nursing care services for persons unable to care for themselves due to physical or mental health problems, cognitive impairment, or disabilities. Despite extensive governmental regulation, nursing home care has become a social problem that is often synonymous with elder abuse, neglect, maltreatment, and despair. Many Americans see nursing homes as places of last resort for the unwanted elderly—a place where one goes to die. Recent studies by the Institute of Medicine confirm these categorizations: care deficiencies in nursing homes have caused harm to patients, and the numbers of nursing home staff are often not adequate to provide quality care. However, many older people also receive superior care and benefit from the security and stability that nursing homes provide.

Despite a common belief that most elderly people live in nursing homes, according to the U.S. 2000 census, only about 4.5 percent of those age 65 and older reside there—a decline since 1990, when 5.1 percent of those over 65 lived in nursing homes. The reduction is due, in part, to changes in governmental funding, increased usage of alternatives to nursing homes, such as home health care services, assisted living facilities, family caregiving, adult day care, assistive devices, and an overall decline in disabilities for the elderly. However, the aging of the baby boom generation (those born between 1946 and 1964) will likely result in increased demand for quality nursing home care in the near future. Although a small number of disabled and chronically ill children and adolescents live in nursing homes, most residents are elderly: in 2000, more than 1.5 million nursing home residents were age 65 and over.

The likelihood of living in a nursing home increases with age. According to the U.S. census in 2000, 1.1 percent of the 65–74 age group live in nursing homes, increasing to 4.7 percent of the 75–84 age group, and greater than 18 percent for those 85 years and older. The majority of older nursing home residents are women (around 75 percent) due in part to the longer lives of women and the reality that most female residents of nursing homes are widowed. Elderly women are more likely than elderly men to be isolated, left without a partner caregiver, increasing the risk of nursing home institutionalization. In terms of race and ethnicity, most nursing home residents are white (around 80 percent, according to the U.S. census) followed by African American at around 10 percent, and an additional 3 percent who are Latino/a, American Indian, or Pacific Islander. The difference in proportion to population rates may be due to different cultural beliefs for the aged, resistance to institutionalization of elderly, and greater kinship and support networks among some minority group [Page 629]members, although nursing home utilization rates for African Americans are increasing and rates for whites are on the decline.

Increasingly, proprietary or for-profit nursing homes are replacing state-funded nursing homes. While the cost of long-term care at nursing homes is high (averaging around $160 per day), older people with the need to be institutionalized tend to have limited health insurance coverage for that purpose. According to the U.S. Department of Health and Human Services, Medicare provides only limited coverage for long-term nursing home care, skilled facilities, and home health care. Once Medicare benefits are exhausted, many nursing home residents use Medicaid, a needs-based program that varies greatly from state to state. A recent study found that 16 percent of nursing home users began as private payers and then had to convert to Medicaid use once funds were gone. An additional 27 percent were covered by Medicaid upon admission and remained on it throughout their nursing home stay. Medicaid is the largest payer of nursing home care, with costs that totaled about $38 billion in 2005.

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