For generations, it was often a foregone conclusion for many people that their final days would be spent in a nursing home. In 2005, research showed that at least 35 percent of Americans would receive nursing home care at some point in their lives, with about half of those people staying for a year or longer.
However, in the last decade there has been a significant shift in the utilization of skilled nursing homes. Although the actual number of residents in nursing homes has remained fairly consistent since about 1985, that number as a percentage of the overall over-65 population has declined considerably. In fact, while the number of new nursing homes increased considerably during the late 20th century — there are currently more than 15,000 skilled nursing care facilities in the U.S. — the number of residents has flat lined and even decreased. More nursing homes are closing their doors as the number of residents declines; in Florida, for example, which has more nursing homes than any other state, the average occupancy is just over 70 percent and dropping.
Perceptions of nursing homes are at an all-time low as well. Overall perceptions of nursing homes are not positive — warranted or not — with many people viewing them as the last stop before the funeral home and not an ideal place to live out their last days. Many Baby Boomers, who experienced nursing homes with their parents or grandparents, are adamant that they do not want to go to one of “those places” and thus are looking for other alternatives like home health care. The question, then, is whether or not nursing homes can survive this societal shift, or will they become little more than a relic of the past?
Who Uses Nursing Homes?
By some estimates, there is about a 40 percent chance that any individual will need to live in a nursing home at some point in their life. However, despite the perception that nursing homes are where people “go to die,” a significant portion of nursing home residents are only there temporarily after a major health incident, such as a heart attack or stroke, when they need care around the clock. For those residents who stay longer, most have multiple chronic conditions that require constant care, including cognitive decline (such as Alzheimer’s and dementia patients) and those who have lost functional capacity and have issues such as incontinence.
Still, despite the place that nursing homes have in the health care continuum, the Baby Boomer generation is the first to demand — and find — other options.
Trends Contributing to Nursing Home Decline
A negative perception of nursing homes is not the only contributing factor to their decline. Some of the other factors causing the decline include:
Improved health overall. The Baby Boomer generation (and those coming after) are far healthier than the generation that came before. Research suggests that by 2030, older adults will be healthier than ever, thanks to better diets, more exercise, and medical advances that have rendered formerly fatal conditions manageable — or nonexistent. Simply put, fewer older adults are going to need nursing home services in the future.
Growth in assisted living facilities. For many older adults, health conditions are manageable, and they simply need a bit of assistance with certain tasks — or may simply want a more carefree lifestyle after retirement. The growth of assisted living communities fills these needs, allowing adults to live mostly independently while providing the basic services they need.
Advances in “Aging in Place.” Many Baby Boomers prefer to remain at home for as long as possible, and advances in technology have made it possible to “age in place” safely.
Costs. Nursing homes are expensive, and while Medicare will cover some costs for some patients, the number of “private pay” patients who cover their own expenses has declined significantly. With the availability of more affordable care options, including home health care, it simply makes more financial sense for many patients to choose a different option.
Home Is the Future Nursing Home
Multiple studies and government demonstration programs continue to prove that in-home care costs less and leads to better outcomes than other forms of care. As the older population rises, and more people use Medicare and Medicaid, the need to control costs is a major priority. Not to mention, individuals tend to be happier and more comfortable at home, which contributes to improved outcomes. With advances in home health technology, including more advanced home health software, improved monitoring via wearable devices, and other advances, many individuals who would previously have needed nursing home care will potentially avoid being admitted altogether.
Still, despite declines in utilization, there are few who believe nursing homes will disappear entirely. Even with better health and additional options, there will be those individuals who need residential care, in particular those with cognitive conditions who need a Memory Care unit. It’s likely that the overall perception of nursing homes will change, shifting from a permanent and final solution to a temporary option to support patients until they can return home to receive care there.
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