Spry seniors seem so happy. But if you want to make them frown (and why would you?), here’s a downer topic: nursing homes.
Almost no healthy person in their 70s, 80s or 90s hopes to move into a nursing home as they age. The very idea fills them with dread.
In a recent poll of older adults, 71% said they’re unwilling to live in a nursing home in the future. And 57% of respondents said that COVID influenced whether they’d be willing to live in a nursing home.
“Nursing homes all get painted with the same brush,” said Terry Fulmer, Ph.D., president of the John A. Hartford Foundation, which conducted the survey. “It didn’t help that the media kept calling them ‘death traps’ early on with COVID.”
Even before March 2020, most seniors wanted to “age in place” in their home. It’s hard to feel optimistic about the years ahead when you fear winding up in a charmless, understaffed facility.
“You see people slumped in a wheelchair napping by the nurse’s station,” said Gail Samaha, founder of GMS Associates, a senior advisory firm in Scituate, Mass. “It’s not an uplifting environment.”
Yet as much as seniors resist the notion of landing in a nursing home, many do. In 2020, nearly 1.3 million people lived in nursing facilities in the U.S.
The popular perception of institutional care settings reinforces the notion that they’re undesirable. The high incidence of COVID deaths of residents and staff over the last two years hasn’t helped.
But some industry observers see a sea change in the evolution of these facilities.
“A lot of folks look back at the old stereotype where nursing homes are these sterile places with white walls and floors and drooling residents,” said Kristi Stalder, author of “Navigating Assisted Living.” “But in recent years, there has been a concentrated effort to change the stereotype.”
Over the last two decades, the nomenclature has evolved to reflect ever-expanding care models. The term “long-term-care community” is displacing “nursing home,” Stalder says, to convey a more positive environment. People with dementia move into “memory care” facilities.
Furthermore, the term “nursing home” sometimes describes skilled nursing facilities, which provide care for individuals recovering from a medical condition such as a stroke. The patient’s long-term plan may be to return home after completing rehab.
An elderly person with a chronic medical ailment who needs hands-on care can remain at home. But it will take a village of helpers (paid aides as well as supportive family and friends) to make it work.
However well intentioned, such arrangements can prove exhausting to manage and sustain over time. If the older person lives alone, isolation can take a toll.
The socialization that comes from living among others, as well as having aides and nurses nearby, can offset some of the negatives of institutional care. That’s why Stalder addresses seniors’ resistance to move head-on.
“It’s a constant battle,” she said. “But I ask them to tour a long-term-care community so that they can see it for themselves.”
If your parents vow to remain at home until they die, don’t pick a fight. It’s better to dignify their concerns rather than rush to suggest a possible move.
“You have to understand the goals, values and preferences of your parent and harmonize it with what you think,” said Fulmer, who’s also a registered nurse. She urges families to discuss these issues early on—before a crisis hits—so that all parties agree on an action plan under various scenarios.
Brace for conflict during these conversations. Expect your siblings (and parents) to express clashing opinions, at least at first. Educating everyone about the different housing options—and identifying nearby facilities that might merit a visit—helps demystify the process.
Like many businesses, nursing homes are struggling to hire and retain staff. When you tour facilities, ask about staffing ratios and employee turnover.
“There are major shortages of CNAs [certified nursing assistants] and nurses are retiring,” Samaha said.
An exercise buff, Samaha is in her late 60s. She counts herself among the many baby boomers who want to stay put.
“I put a lot of money and time into my health,” she said. “I don’t want to move into a nursing home. That’s the last place I’d want to be.”