The term nursing home refers to a health facility that provides medium or long-term care, generally to persons over age 65. Nursing homes have become a major part of the health industry as a result of an increasing aging population, the breakdown of the extended family, and governmental provision of funds through Medicare and Medicaid.
Since the Social Security Amendment of 1972, nursing homes are categorized as skilled nursing facilities provide health care, the former provides the higher level of skilled care. (The skilled nursing facilities were formerly called extended care facilities (ECFs) under Medicare and skilled nursing homes under Medicaid). Certification for the skilled nursing facilities comes from the Secretary of HEW.
A skilled nursing facility is not intended to be a permanent home. Instead, it is to serve as a transition between hospital and home. The nursing home`s goal is to provide continuous supervision by a physician, 24-hour nurse coverage, hospital affiliation, written patient care policies, and specified services in dietary, restorative, pharmaceutical, diagnostic, and social services. Unfortunately, few facilities meet this goal, even though they are licensed and receive government funds. Often the patient never returns home, and quality care by prepared staff is lacking.
The intermediate care facilities (ICFs) have their standards enforced by the individual state. Thus, there are 50 different sets of standards. Because of this lack of uniformity, the patients stand even less chance of quality care.
In the last decade numerous reports have revealed blatant neglect of elderly persons in nursing homes. Standards have not been enforced. Perhaps one reason is that nursing homes are usually operated for profit. Reimbursement for patient care may end up as more profit for the owner-operator, especially if he gives minimal services.
Although the nursing home as a subsystem has its own unique characteristics, the characteristics and problems discussed in relation to the hospital also apply to the nursing home, especially those having large numbers of patients and operated by individuals or commercial companies for profit.
You may be in a position to assist a family and patient in selecting a nursing home. The following questions should be asked in order to make a careful selection :
1. What kind of home is it and what is its licensure status?
2. What are the total costs, and what is included for the money?
3. Is the physical plant adequate and pleasant? How much space is allowed per person?
4. What kinds of care are offered (acute as well as chronic)?
5. What is the staff-resident ratio? What are the qualifications of the staff?
6. What are the physician services? Is a complete physical exam given periodically?
7. What therapies are available?
8. Are pharmacy services available?
9. Are meals nutritionally sound and is the food tasty?
10. Are visitors welcomed warmly
11. Do residents appear content and appropriately occupied (observe on successive days and at different hours)?
A check with the Better Business Bureau can Further determine if any problems have been reported.
References :
Drosness, Daniel O., Steven Jonas, and Victor Sidel., “The Delivery of Health Care,” Practice of Medicine. Hagerstown, MD.: Harper & Row, Publishers, 1977.
Health Insurance for the Aged: Conditions for Participation for Extended Care Facilities. Washington, D.C: Social Security Administration, U.S. Department of Health, Education, and Welfare, Him 3, 1966.
“City Nursing Home Study Finds Rats and Crowding,” The New York Times, July 29, 1966.
Townsend, C., Old Age : The Last Segregation (Ralph Nader`s Study Group Report on Nursing Homes). New York: Grossman, 1971.
