Where many of us will go

Nursing homes and the crisis in health care

Posted 8/16/23

Each of us is by now accustomed to hearing “crisis” applied to a wide range of problems the world faces, from climate change to immigration. The Greek root of the word meant …

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Where many of us will go

Nursing homes and the crisis in health care


Each of us is by now accustomed to hearing “crisis” applied to a wide range of problems the world faces, from climate change to immigration. The Greek root of the word meant “decision,” something that seems to elude us often. 

The English use of the word began in the 17th century, when “crisis” was a medical term to describe the phase of an illness after the physician had prescribed all possible treatment and the patient would either recover or not. 

Today the health care system itself is a patient in crisis. From birth to nursing home, our path to healing is complicated.

Until fundamental decisions are made and acted upon, we have what we have and waiting for change is not an option. The family member who can no longer be cared for at home can’t wait. 

Until all the stakeholders get their ducks in a row, patients and families will face critical decisions regarding care that are complex and confusing even to those who provide the care. The search for nursing home care inevitably places additional stress on a family already experiencing grief and anxiety. 

Professionals experienced in hospital discharge planning, social work or primary care medicine and nursing are the best sources for the inevitable questions families ask. 

In addition, the Joint Commision (www.jointcommission.org) is the most prominent accrediting body for hospitals, nursing homes and healthcare institutions. It can be an excellent source of information regarding quality of care and a home’s compliance with regulation.

What is a nursing home?

The CDC (Centers for Disease Control) defines a nursing home as:

“A nursing facility providing primarily long-term maintenance and restorative care for individuals needing support with their activities of daily living. A large percentage of certified nursing homes in the U.S. provide a combination of long-term nursing care or restorative services and skilled nursing services.”

Nursing homes often provide several levels of care and service. The preferred name for these institutions changes depending on the source. Other names include “nursing care center” or “skilled nursing facility” (SNF). 

The central role of skilled nurses in both patient care and administration is the essential character of these homes.

What can they do for my loved one?

Long term care (LTC) 

The search for this level of care begins when the family is unable to meet the needs of their seriously ill or disabled loved one. Disability can occur abruptly or develop gradually; it always results in a decline in the activities of daily living (e.g. dressing, eating, ambulating, toileting, hygiene). 

The patient’s condition in most cases precludes home care alternatives.

The 24/7 nursing care and physician monitoring of LTC comes with a number of trade-offs. The nursing home becomes the patient’s residence; it’s not an easy pill to swallow.

The bigger pill is the cost, one that is not covered by Medicare or most commercial insurance. Currently 43 percent of all LTC care is paid for by Medicaid, a fact for those who oppose federal health policy to keep in mind.

Post-acute and sub-acute care

Many nursing homes offer short-term care intended for patients with persistent acute illness after hospitalization or from home; they need additional short-term, post-acute care to recover fully. 

Candidates for sub-acute care differ from those able to benefit from post-acute care. Sub-acute care patients are more disabled, commonly after hospitalization for major surgery or a critical illness. The sub-acute patient typically has additional chronic conditions (e.g. diabetes, heart disease, chronic lung disease)—each of which requires medical and nursing attention. 

Which is the best nursing home for you?

The care at any nursing home is only as good as the quality of the patient’s nursing assistant.

The number of “stars” attached to a nursing home’s evaluation may not be as important as proximity to a caring family. Quality care does not require a new building or clever marketing.

Many nursing homes are experiencing great difficulty attracting and maintaining staff at all levels. COVID pandemic exhaustion and inadequate compensation are significant influences that can result in an overwhelmed staff. 

Until the underlying causes of the crisis in U.S. health care are identified and corrected, the search for the best place for “Mom” requires vigilance, and unfortunately requires families to shoulder an undue burden.

nursing home, crisis, health care system


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