| How often have you heard the comment “People don’t want to go to nursing homes; they’d much rather stay in their own homes”? That’s one of the “accepted truths” of long-term care. People in all walks of life utter it casually, without a second thought. This accounts for the congratulatory atmosphere that surrounds any announced expansion of home- and community-based services for the elderly. We’ve published articles, often approving, on this ourselves, and most recently (as of this writing) there’s been a spate of publicity about new initiatives in this direction-specifically, an Illinois Medicaid program significantly expanding “supportive living” arrangements and federal legislation (called the “Medicaid Community-Based Attendant Services and Supports Act”) that would make long-term-care’type services much more available in people’s homes. Personally, I have nothing against anything that helps people maintain their independence, wherever they happen to reside. And I applaud the growing range of options available to seniors. But I wonder: Is that “stay at home” preference really a universal truth? Let’s face it, an elderly disabled person who lives at home can encounter many discouragements: increasing isolation, as families move away and friends become homebound themselves; the feeling of being a burden on family members who take on caregiving responsibilities; the unsettling feeling of allowing nonfamily caregivers, often complete strangers, to enter one’s home; the necessity and expense of home upkeep and maintenance; the stairways that start to look like Mount Everest; the TV, bought circa 1985, that doesn’t work very well-just to name a few. Without making claims for nursing homes as being the Ritz-Carltons of healthcare, the good ones do offer amenities that some homebound elderly might miss, even with the best-funded community-based services: steady companionship; stimulating activities; three square meals a day (perhaps even “five-star dining,” as offered by this year’s OPTIMA Award winner); round-the-clock safety and security; a well-maintained environment; perhaps even new friendships with other residents or staff. How often have you, as a nursing home insider, heard someone say, “I should have come here years ago”? Let’s not forget, too, the recent General Accounting Office report criticizing the federal government for not scrutinizing home- and community-based services as thoroughly as it does nursing homes. This is not to disparage the movement toward options and flexibility. It is simply to suggest that, the next time we hear cheers for nursing home alternatives, let’s hold on to that grain of salt. Maybe for some people all we’re really doing is saving taxpayers’ money-which is something, but not everything. NH |
