Nursing home
A nursing home is a facility for the residential care of older people, senior citizens, or disabled people. Nursing homes may also be referred to as care homes, skilled nursing facilities, rest homes, long-term care facilities or more informally old people's homes. Often, these terms have slightly different meanings to indicate whether the institutions are public or private, and whether they provide mostly assisted living, or nursing care and emergency medical care. Nursing homes are used by people who do not need to be in a hospital, but require care that is hard to provide in a home setting. The nursing home staff attends to the patients' medical and other needs. Most nursing homes have nursing aides and skilled nurses on hand 24 hours a day.
In the United States, while nearly 1 in 10 residents aged 75 to 84 stays in a nursing home for five or more years, nearly 3 in 10 residents in that age group stay less than 100 days, the maximum duration covered by Medicare, according to the American Association for Long-Term Care Insurance. Some nursing homes also provide short-term rehabilitative stays following surgery, illness, or injury. Services may include physical therapy, occupational therapy, or speech-language therapy. Nursing homes also offer other services, such as planned activities and daily housekeeping. Nursing homes may offer memory care services, often called dementia care.
History
From before the 17th century to modern day, many families care for their elders in the family's home. While this is still common practice for many communities and families around the world, this has become increasingly more difficult over time as life expectancy increases, family size decreases, and increased expertise in caring for a person with a chronic disease is needed. In the late 20th century and 21st century, nursing homes have become a standard form of care for most aged and incapacitated persons to account for those complexities. Nearly 6 percent of older adults are sheltered in residential facilities that provide a wide range of care. Yet such institutions have not always existed; rather, their history and development reflect relatively recent demographic and political realities that shape the experience of growing old.17th century
In the 17th century, poorhouses originated in England as municipalities were expected to care for their poor. Orphans, people determined to be mentally ill, and elderly people were often placed into these living commons while able-bodied individuals were expected to work and could be imprisoned if they refused. This model was brought to North America by English settlers. Before the 19th century, no age-restricted institutions existed for long-term care; elderly individuals, who needed shelter because of incapacity, impoverishment, or family isolation, often ended their days in an almshouse. Placed alongside people deemed insane, people who were inebriated, or people who were homeless, they were simply categorized as part of the community's most needy recipients. Poorhouses gave a place where they could be given shelter and daily meals.18th century
In the 1800s in the US, women's and church groups began to establish special homes for elderly people. Often concerned that individuals of their own ethnic or religious communities might die alongside the most despised society, this led to the creation of private care facilities for the elderly in these communities. Poorhouses continued to exist into the early 20th century, but were not as common due to the social welfare programs that were rising. In the US, the Great Depression overwhelmed the poorhouses, leading to not enough space and funding. Due to muckraking in the 1930s, the less-than-favorable living conditions of the poorhouses were exposed to the public. This led to the provision of the Social Security Act to only give people their pension if they did not live in poorhouses, but could live in private institutions.US evolution
In the US, poorhouses were then replaced with residential living homes, known as board-and-care homes or convalescent homes. These board-and-care homes provided basic levels of care and meals in a private setting for a specific fee. Board-and-care homes proved to be a success and by World War II, the new way of nursing homes began to take shape. As the times continued to change, the government identified the issue of people spending extensive amounts of time in hospitals. To combat these long stays in short-term settings, board-and-care homes began to convert into something more public and permanent that was state and federally funded. From this, by 1965 nursing homes were a solid fixture. Nursing homes were a permanent residence where the elderly and disabled could receive any necessary medical care and receive daily meals. These nursing homes showed improvement in maintaining care and cleanliness standards in comparison to almshouses and poorhouses. From the 1950s through the 1970s, the dynamics of nursing homes began changing significantly. In the United States, Medicare and Medicaid began to make up much of the money that would filter through the homes and the 1965 amendment laws enforced nursing homes to comply with safety codes and required registered nurses to be on hand at all times. Additionally, nursing homes may sue children for the costs of caring for their parents in jurisdictions which have filial responsibility laws. Later in 1987, in the US the Nursing Reform Act was introduced to begin defining the different types of nursing home services and later added the Residents' Bill of Rights.World War II
In the UK, after World War II many soldiers and civilians needing hospital care due to war casualties were placed in the hospital along with the many elderly patients present there, leading to overcrowding. The implementation of the NHS in 1948 and the abolition of the Old Poor Law allowed modern public nursing homes to be built. In the 1950s, Professor Peter Townsend brought to light the discrepancies in the standard of care between the publicly and privately funded care homes, leading to health policy reforms that assured the standard care practices for the elderly living in NHS funded care homes. The 1980s and 1990s saw care homes becoming a large industry in the UK, with the Registered Homes Act 1984 regulating private care homes and the Care Standards Act of 2000 ensuring that patient needs are met.21st century
In the 21st century, nursing homes are varied. Some nursing homes still resemble a hospital while others look more like a home. Nursing home residents can pay for their care out of pocket or with government assistance. In the US, others may receive Medicare for a short time, while in other countries, public assistance may be available, and some may use long-term insurance plans. Across the spectrum, most nursing homes in the US will accept Medicaid as a source of payment.Considerations
Below are a few reasons to consider a nursing home:- Managing a worsening and progressive disease such as Alzheimers.
- Care after a recent hospital admission and not ready to transition to independently caring for oneself at home.
- When medical needs at home become unmanageable by the primary caregiver at home.
- When activities and socialization with people of similar age is deprived.
- When primary caregivers at home do not have the proper knowledge of the nutrition needed.
- When there is no sense of recognition towards danger.
- When there is a decrease in ability to perform ADLs.
- When the home environment is no longer safe or fitting to the person's needs or conditions.