It lingers as the great American nightmare: the nursing home horror
story. Tales abound of neglected bedpans, absent nurses and abused
residents. And even if the quality of care isn't an issue, guilt plagues
those on the outside.
"Many videos I have seen have emphasized the inherent loneliness of
the displaced nursing home resident and the guilt that it causes family
members who have no alternative but to put someone in a nursing home,"
says Carroll Stuart CLU, ChFC, CMFC, CLTC, LTCP.
Brian Gordon, vice president of Deerfield, Ill.-based MAGA Ltd., says
he's seeing more of his clients at home these days.
"More people are looking to stay home for care. Nursing homes have a
bad reputation: they smell bad, this and that," he says. "Bad news
travels faster than good."
The numbers alone are staggering and are summed up well in a 1999
National Center for Health Statistics study.
"There is variation in the health of nursing home residents. Among
nursing home residents 65 years of age and over in 1997, 48 percent were
receiving full-time skilled nursing care under a physician's
supervision. Twenty-nine percent had difficulty seeing, and 26 percent
had difficulty hearing. Nearly all (96 percent) required help with
bathing or showering, while 45 percent needed assistance with eating.
Seventy-nine percent of nursing home residents could not use the
telephone on their own, and 65 percent could not care for their personal
possessions without help. The levels of disability and functional status
were similar among women and men," the report reads.
Tender loving care
Shortly after the start of the new year, the nation's 1.6 million
nursing home residents returned to the spotlight, but not because of a
fire or negligent death. This time it was good news.
U.S. Health and Human Services Secretary Tommy Thompson released the
results of an early evaluation of a two-year-old nursing home care
improvement program - the Nursing Home Quality Initiative. The program
appears to show improved care across the board and, according to
American Health Care Association (AHCA) Chair Steven Chies, signals "the
maturing of the profession and a major advancement in the practice of
long term care."
The government's report showed fewer patients kept in restraints -
down from 9.7 percent from 7.5 percent. It also revealed fewer long- and
short-term residents in pain.
The report's only apparent bad news stemmed from a small bump - 2
percent - in the number of patients suffering from bedsores.
"The data we're releasing ... shows nursing home residents have
better care - I want to repeat that - they have better care and a better
quality of life since we launched this program," said Thompson at a
press conference announcing the results of the program. "... Fewer
nursing home residents suffer from chronic pain and fewer physical
restraints are being used to take care of elderly patients. Even more
impressive, the prevalence of chronic pain in nursing homes has gone
down in 50 out of 50 states."
Launched in 2002 as a public-private partnership between government
and long-term care providers, the initiative sought to offer consumers
"reliable, easy-to-understand, comparative information regarding care
quality in nursing homes."
But there's more to the nursing home dilemma than bedsores and leather
straps.
"Improved or not, it's expensive and scary," Stuart says.
Cost is an issue the study didn't address. But the MetLife Mature
Market Institute does every year. In fact, according to its study, the
average cost of nursing home care last year hovered at $192 a day - or
$70,080 a year.
"Nursing homes remain an important component of long term care, and
it is the devastatingly expensive piece of the puzzle," says Kathy
O'Brien, a gerontologist with the MetLife Mature Market Institute.
Regarding the improved quality of care, O'Brien agrees it has been a
long time coming.
"There really has been a concerted effort on the part of the states
and the industry to improve care at nursing homes," she says.
The American Association of Retired Persons did not return calls for
comment about the study.
Different diagnosis
Not all nursing home pictures are painted with such a rosy palette.
In December, the Detroit News published a two-day special
report that began with a simple finding: "malnutrition and dehydration
killed nearly 14,000 patients from 1999-2002."
The newspaper investigation added that nursing home conditions
contributed to an additional 68,000 deaths.
The newspaper also discovered that "between 1999 and 2002, two-thirds
of the nation's nursing homes were cited for breaking rules governing
staffing or nutrition that officials said could have put patients at
risk, according to inspection records. And reviews by the U.S.
Government Accountability Office, Congress' investigative arm, have
found those inspections frequently miss or understate serious problems."
Most nursing home operators blame the problem on staffing shortages
and inexperience. A relatively new AARP study - conducted with Brown
Medical School - struck a similar chord.
End-of-life care in nursing homes often results in unnecessary
suffering due mainly to a lack of staff time, training and
communication, the study found. The report also offered recommendations
to improve care, such as more staff, increased physician presence,
additional training and better reimbursement rates.
The study reported that nearly one in four adult Americans dies in a
nursing home, while fundamental needs often go unmet.
In the report, experts offer recommendations to improve end-of-life
care in nursing homes. One of the most critical, according to the study,
is boosting government reimbursement rates.
"Listening to families' compelling stories of end-of-life care, it is
clear that nursing homes need more staff and better training for that
staff. Workers also need to be better paid. Even at the best facilities,
aides are frequently offered wages that are about what they'd make at
McDonald's. But many homes simply don't have the money to provide the
level of care and support that the dying need," said Terrie Wetle,
associate dean of medicine for public health and public policy and
professor of community health at Brown Medical School.
"And over-crowding could become an issue. Those who have a [long term
care insurance] policy will be able to afford a better situation,"
Stuart says.
In 2001, Carol V. O'Shaughnessy, specialist in social legislation for
Congressional
Research Service, testified about the pending growth in nursing home
residents before the Senate Committee on Aging.
"Estimates show that the number of elderly persons alone who need
long term care assistance could grow by 35 percent over the next 20
years, and by 82 percent over the next 40 years," she said.
Stuart also points to other options.
"Having their finger on the pulse of public sentiment, the building
industry has increased substantially the number of [assisted living
facilities] under construction. Unprofitable hospitals are being
converted. Day care is starting up as a cottage industry," Stuart says.
A life or death gamble
All of these numbers, studies and opinions do nothing to alter the
underlying reality: long term care insurance is a must. Even boomers
know it: CNN Custom News reported that 86 percent of those surveyed
think providing long term care is a big problem while 67 percent believe
the cost of long term care is the greatest risk to their standard of
living during retirement. Nevertheless, the report also revealed that 12
percent of boomers have made financial preparations for their long term
care needs.
The biggest obstacle - besides the cost issue - remains the belief in
the safety net.
"They think, 'The government is going to take care of me,'" Gordon
says. "They still think Medicare is going to take care of them."
Gordon is quick to point out that not only does Medicare cover just a
fraction of nursing home care, but eligibility is often hard to come by.
One insurance industry expert knows about nursing homes firsthand:
his mother's in one.
"Look, it's simple," he said on condition of anonymity, "if you don't
have long term care insurance, you can expect to spend the rest of your
life sharing a 12-by-12 room with one or two other people, depending on
the state."
Chies agrees that seniors without long term care insurance are taking
a considerable risk.
"The largest financial risk most American's face is an uninsured stay
in a long term care facility due to an accident or catastrophic health
event," he says. "With Medicare covering less than 10 percent of the
stays in a long term care facility and Medicaid requiring the individual
to reduce their estate to poverty levels, long term care insurance makes
sense to protect the family assets and to assure that the right care at
the right time at the right location is available."
