When it comes time for families to consider placing a loved one in a nursing home or assisted living facility, there are a lot of factors to consider. Where is it located? Who is in charge? What sorts of activities does the nursing home offer?
You’ll need to investigate these, and many other questions, to find the right fit for your loved one.
And there are a lot of options out there. This data comes from the National Center for Health Statistics or NCHS, in 2017-2018, the most recent period for which data is available. In the U.S. there were an estimated:
— 4,200 adult day services centers.
— 11,500 home health agencies.
— 4,700 hospices.
— 15,600 nursing homes.
— 31,400 residential care communities.
— 1,200 inpatient rehabilitation facilities.
— 400 long-term care hospitals.
That’s a lot of potential sources of care for your loved one, and digging a little deeper into the facts and statistics surrounding nursing home care could help you make a more informed decision.
It may also help to have a little more background information about nursing homes in general. This knowledge can boost your understanding of where a particular facility fits into the overall scheme of health care for an older adult or for someone who needs rehabilitation assistance or another type of long-term care at a different stage of life.
[SEE: 11 Red Flags to Look for When Choosing a Nursing Home.]
Why People Need Nursing Homes
Dr. Michael Tehrani, a geriatric physician with Brand New Day HMO, a California Medicare Advantage plan, says, “More than 1.4 million people live in over 15,500 Medicare- and Medicaid-certified nursing homes across the nation.” Most of these residents are over the age of 80 years, and most are women. “Many of the female clients that I see have lost their spouse,” he explains.
The Centers for Disease Control and Prevention reports that as of 2016, there were 1.7 million beds in licensed nursing homes in the United States. Many people who reside in nursing homes need assistance with one or more activities of daily living, such as:
— Eating or preparing meals.
— Bathing and dressing.
— Going to the toilet.
— Managing medications.
— Moving around in the residence or getting to other locations.
As we age, these activities tend to become more challenging, especially if chronic health issues such as diabetes, arthritis, eye diseases or cognitive impairment are also present. Many of these problems occur simultaneously.
“There’s a complex set of issues why some people need a nursing home,” says Dr. Tanya Gure, section chief of geriatrics and associate professor in internal medicine at the Ohio State University Wexner Medical Center in Columbus. “Depending on what resources are available to them in retirement and their current network of support, they may move to a nursing home as they have increasing limitations in their basic functions.”
[READ: How to Choose a Nursing Home: Qualities to Look For.]
Who Should Consider a Nursing Home
Some people need more help than others. Assistance with feeding, bathing or medical care might be a top priority for some, while others may have issues with mobility function or being able to transfer from sitting to standing on their own. All of these needs could mean that an individual may be best suited for the type of care that a nursing home can provide.
However, while nursing homes, also sometimes called skilled nursing facilities, do care for a lot of older adults, it’s a common misconception that nursing homes are only for the elderly. Skilled nursing facilities actually look after a wide range of people, and some are younger than 65. Still, it’s true that older adults do make up a large proportion of the people who reside in nursing homes.
The NCHS reports that in 2017-2018, the majority of long-term care service users were aged 65 or older, with 83.1% of nursing home residents being in that older age bracket. That means 16.9% of residents were younger than age 65 — a sizable minority.
Those younger residents (and some of the older residents) may not be planning to stay in a facility for the duration of their lives; rather, they may need rehabilitative care after a surgical procedure or injury. Some younger people with certain disabilities that require constant care, such as severe developmental disabilities, may also live in a skilled nursing facility.
This means that inside every nursing home, some patients can be quite sick, while others may need less intensive care, Gure says. Some patients may be nearing the end of their lives, while others are residing there temporarily after a hospital stay to recuperate before going home.
Gure says this potential variation in the population and the many reasons why someone might be living in a nursing home aren’t always discussed. “There is some misperception about nursing homes. Some of it is based on an antiquated image” of what a nursing home is and how it helps people, she says. “I just want to emphasize that these facilities serve a huge variety of patients and can be a critically important resource.”
In addition, Gure notes that aging in America can be a socially isolating experience. As such, she routinely talks with her patients about their plans for the future, especially if they’re about to undergo an elective surgical procedure or foresee that they might need some extra care at some point. “This is a resource they can utilize so that when they go back home, they are more capable of facing what they find there,” she says.
[Read: 24 Gift Ideas for Nursing Home Residents.]
Gender and Ethnicity
More women reside in nursing homes than men; as of 2018, 59% of short-stay residents and 66.6% of long-stay residents were women, the NCHS reports. Additionally, the report notes, non-Hispanic white people accounted for 73.9% of nursing home residents.
“The racial/ethnic mix depends on the community,” Gure explains. “More urban areas have a more racial and ethnic mix. You didn’t use to see a lot of Latino or Asian residents in nursing homes.”
Gure says some of that variation in nursing home residents’ ethnic backgrounds is related to cultural differences and in a lack of providers who speak the language or can cook the cuisine. Some cultures also place a big emphasis on families caring for their elders at home. However, she adds, “that’s been changing over the years, and now more different types of patients are moving into nursing homes.”
Residents in nursing homes typically have at least one chronic condition for which they need some ongoing medical care, and some have experienced falls or other injuries that have necessitated more intensive care. The NCHS reports that in 2017-2018, some 17% of nursing home residents had fallen.
A 2018 study that looked at population data from the National Vital Statistics System, the Web-based Injury Statistics Query and Reporting System, or WISQARS, and the Medicare Current Beneficiaries Survey estimated that non-fatal falls led to about $50 billion in total medical costs.
Chronic conditions are also common among nursing home residents. The NCHS reports that, in 2017-2018, arthritis affected 27.6% of nursing home residents, and heart disease affected 20.1%. About 34% of residents had diabetes, and 76.9% had hypertension. Depression was also common, with 48.8% of nursing home residents having this diagnosis.
While some people may assume that nursing home residents all have cognitive difficulties such as Alzheimer’s disease or other forms of dementia, that’s not the case. Less than half — 49.1% — of nursing home residents had a diagnosis of Alzheimer’s disease or another form of dementia, the NCHS reports. The prevalence of Alzheimer’s disease or dementia, however, was higher in long-stay residents (57.6%) versus short-stay residents (35.8%).
Nursing home residents’ cognitive impairments are also an important condition to consider and provide appropriate resources and care for, Gure says.
This impairment is a big reason why some people move into a nursing home. Safety can be a big factor for seniors aging in place at home, and that may mean it’s time to move from home care to a nursing home.
Costs and Paying for a Nursing Home
Another popular misconception is that Medicare pays for a person’s residency in a long-term care facility. But the fact is, Medicare only pays for the first 100 days in a nursing home or skilled nursing facility, and only if the stay follows a hospitalization of at least three days.
When you get to day 101, other forms of payment need to be in place. The coverage rules for Medicare Advantage plans are different, so check your specific coverage plan for details. Because Medicare doesn’t pay for long-term care, people who need nursing home care must pay privately. Finding a way to pay for long-term carecan be a big problem for many people, especially given the high costs associated with such care.
According to the most recent data available, Genworth’s 2021 Cost of Care survey, the median monthly cost of skilled nursing in a private room at a nursing home will set you back $108,408 per year, versus just over $94,000 for a semi-private room. But prices can vary a lot depending on where in the country the community is located and which services a senior is using.
For example, Genworth reports that Alaska, Connecticut and New York have the highest daily costs for private nursing homes at $1,036, $453 and $420 per day, respectively, adding up to a whopping $378,140 per year.
In Alaska, $165; 163 in Connecticut and $153,300 in New York. At the other end of the spectrum, Texas, Missouri and Oklahoma are the least expensive areas, with per-day costs of $169, $173 and $180, respectively. Which brings the annual total to between $61,500 and $65,700 per year in those states.
Long-term care insurance policies may be another option to pay for nursing home care, but these policies can be prohibitively costly for many. In most cases, people pay out of pocket until their resources are used up, at which point Medicaid kicks in to cover costs. In fact, Medicaid is the payment source for the majority of nursing home residents, with 62% using this means, according to the NCHS. But the rules vary from state to state, so it’s important to talk with an advisor to understand your options.
How COVID-19 Has Affected Nursing Homes
Over the past nearly three years, the coronavirus pandemic has had a severe impact on nursing homes. The Centers for Medicare and Medicaid Services, or CMS, reports that, as of December 2022, there have been more than 1.37 million confirmed COVID-19 cases among residents of nursing homes and more than 1.43 million confirmed COVID-19 cases among the staff of nursing homes. Since the pandemic began in the spring of 2020, nearly 161,000 residents of nursing homes have died of COVID-19, and 2,839 staff of such facilities have died of COVID-19.
Tehrani notes that roughly 40% of COVID-19 deaths have been connected to nursing homes. “People who live in nursing homes are usually the frailest because they are typically elderly with multiple advanced chronic conditions,” he says. “The smallest challenges will have the biggest effect on them because their immune system is very compromised to begin with.”
In addition, the close contact with others that occurs in congregate care settings like nursing homes and skilled nursing facilities means that any infectious disease has a good chance of moving through the population quickly.
In an effort to curb transmission, many facilities severely restricted visitation by loved ones, which created a series of added complications and increased feelings of isolation for individuals residing in nursing homes. That enormous challenge is still reverberating today within nursing homes and other long-term care facilities.
Cal Stein, a partner at Troutman Pepper in Boston, says that the pandemic also forced massive changes on facilities; they had to adjust operations to “harmonize” their practices with “the regulations and guidance that focuses on prevention, with the practical capabilities of the facility, the staff and the residents,” he says.
While the rules that were enacted at the height of the pandemic were intended to keep residents and staff safe, they weren’t universally adoptable, which created potential liability for some facilities.
The fallout from this very difficult period continues as the pandemic lingers. One study of the COVID-19 outbreak and response in Connecticut found that the prevalence of symptoms of depression increased by 15% among residents right after the peak of the COVID-19 outbreak. And some facilities have been sued for negligence by grieving families who lost loved ones during the pandemic.
[RATINGS: Best Nursing Homes.]
For their part, many of the defendants in such suits had pointed to a patchwork of state-based laws that shield nursing homes from liability during certain public health crises like the COVID-19 pandemic. But many suits are still working their way through the courts.
All of this has put pressure on nursing homes, many of which have been left short-staffed because of the pandemic and subsequent societal changes. A 2021 survey from the American Health Care Association and the National Center for Assisted Living found that 94% of nursing homes faced staffing shortages.
And it’s not over yet. Tehrani notes that “with COVID numbers on the rise, some families might have to go back to virtual visiting and impose strict guidelines like social distancing. With winter upon us, we also have to worry about the flu as well.”
Therefore, if you’re looking for a nursing home or a long-term care facility for a loved one now or if you will in the near future, take care to do some extra diligence to ask about their procedures and policies regarding infection control and how staff are working to keep residents safe from COVID-19 and other contagious diseases, such as pneumonia and the flu. Tehrani also recommends asking what the protocol is for a medical emergency.
If your loved one is already in a nursing home and their roommate falls ill with an infectious disease, ask to change rooms. “Initiate treatments as fast as possible, and make sure vaccines are up to date,” Tehrani advises.
You should also do some research about staffing levels at the facilities you’re considering and how they’ve managed to keep the doors open and residents cared for in the face of so much upheaval. “Make sure there is 24-hour care,” Tehrani says, adding that maintaining adequate staffing is the biggest challenge he sees senior care facilities facing today. “It’s very easy for elderly care providers to get burned out. The last thing a resident needs is a staff member accidentally missing giving out medicine.”
The CMS’ COVID-19 Nursing Home Data site offers lots more data and information about how nursing homes are navigating this crisis.
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Nursing Home Facts and Statistics 2023 originally appeared on usnews.com
Update 02/07/23: This story was previously published at an earlier date and has been updated with new information.