It goes without saying that no one wants to end up in a nursing home. It’s the worst case scenario in most people’s imaginations. Would it be an exaggeration to say that it is “a fate worse than death”? Don’t worry, it’s avoidable and I’ll 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 US, 1 in 4 people over the age of 65 are in a nursing home, temporarily. The chances that you, your parents, or your spouse will spend time in a nursing home at some point in your life are also 25%. Pretty high right? But keep in mind that there’s a big difference between spending a few days recovering from a hospital stay before going home and living in a nursing home. Let me clear that up for you.
There are several names for a nursing home: SNF (pronounced “sniff”), also known as a skilled nursing facility, convalescent hospital, rehab, rehabilitation hospital, even a sanitarium. “A rose by any other name…” right? Today, if an elderly person has a hospital stay, they still need recovery time before they can safely return home. It could be a broken hip, a broken arm, or even an infection or bout of pneumonia; however, they will spend a few days or weeks recuperating before they are allowed to go home. These days, hospitals are discharging people “sicker and faster” because of Medicare’s reimbursement schedules. Several years ago, to save money, the Medicare system looked at every conceivable cause of hospitalization and gave it a value of x number of days of hospitalization, then told hospitals “this is what we’ll pay you…period. And now it’s a fact of life that nursing homes are a major player in the Medicare system, because they’re cheaper than hospitals, so unless you’re scheduled for surgery or you’re in the ICU, they’re going to send you the as soon as possible to a skilled nursing facility.
However, at any given time, a large percentage of nursing home patients are there for the rest of their lives. They are considered to be in “custodial care.” They never go home. These are usually people who need to be on ‘machines’ or they just ran out of money and now Medicaid is footing the bill. But chances are, for most of them, it could have been prevented.
So how do you avoid ending your days in a nursing home? engaged. I will tell you that the best way to avoid a nursing home is to move into a board and care home or assisted living before you get so sick that you lose all your options. It goes like this: Many seniors 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. Here’s why: There are some weird rules in assisted living community licensing that make it easy to “age in place” if you already live there when it starts to decline.
But the same rules make it very difficult to move to assisted living if you have a serious chronic illness and are trying to move for the first time.
For example, imagine two people who have a very chronic illness, the one who moved into assisted living early on, can stay, even go to hospice for the rest of her days, but the other was living at home when her health was over. worsened you will probably have a very difficult time moving into the AL community. The reason is that most assisted living facilities generally do not want to accept someone who is depleted and/or the licensing agency will not allow admission to assisted living due to the severity of their illness. And if you’re on a limited income, forget it. Assisted living facilities and board and care homes are private pay only. Medicare and Medicaid won’t contribute a penny for you to live in assisted living (even if it’s cheaper for them). because is another article, let’s say Medicare and Medicaid pay for medical problems and assisted living is considered a social problem. The much longer explanation can be found on government websites, or you can check out the sites listed in my bio.
But to be perfectly honest, most people who are struggling to live on their own shouldn’t hesitate to move into an assisted living community. Unfortunately in many people’s minds they think they are maintaining their “independence” by fighting alone at home, when in reality they are far from independent. And this is a big hoax because most seniors living alone are isolated, rarely go out, don’t eat well, can’t keep up with cleaning let alone basic home maintenance. They are often depressed because, in most cases, they have lived alone for years with only a television for company and most of their friends have passed away or moved away. However, they continue to be left home alone without proper care, nutrition, or socialization. Against all logic and argument to the contrary, they stubbornly cling to their delusion of independence.
Let me paint a portrait for you. Moving to an assisted living community is like a combination of moving into an apartment and taking an Alaskan cruise. Forgive my overgeneralization, but picture this: In assisted living you have an apartment-like suite that includes meals, housekeeping, and tons of socializing and activities. A typical day consists of getting up and going to a restaurant for breakfast and while you are out the housekeeper comes and makes your bed (once a week she changes your sheets). After breakfast you can go to gym class or to the library or just go watch TV. When lunchtime rolls around, you go downstairs to the dining room and eat a nutritious meal and then head off to the next activity or take a nap, before you know it, it’s dinner time. And after dinner there is a movie at the Theater before you go to bed. Sounds good? Keep in mind that you will never have to buy groceries, cook or wash a single dish again. You don’t have to pay utilities, maintain a car, or even do laundry. Every moment of the day is yours to do as you please. Now tell me, who is really the “independent” person? Best of all, it can “age in place.” You will develop new friendships and have an emotional support structure that will stay with you indefinitely. Most people who come to assisted living are fairly healthy with the usual variety of aging-related problems, but as they get older they will need more help: assisted living offers things like medication management, help with bathing, laundry, transportation, housekeeping, meals, continence care, and even custom one-on-one care. But few people need even half of these services when they first move. That’s what we mean by aging in place.
To review, the way most board and care homes and assisted living communities are licensed, a person can stay in assisted living no matter how bad it gets; even until they qualify for hospice and end of life. (There are some prohibitive conditions, but they are so serious that I wouldn’t imagine them in anything more than a clinical setting, like feeding tubes and ventilators.) So if you’re willing to engaged your “independence” a little early, you can spend your later years in a supportive, apartment-like environment and ensure thatnever end up in “custodial care” in a nursing home.
