It goes without saying that nobody wants to end up in a nursing home. It's the single worst scenario in most people's imagination. Would it be an exaggeration to say it's "a fate worse than death"? Not to worry, it's avoidable, and I am going to tell you how. But first let's explore some ideas and define what a nursing home is.
First of all, you should know that on any given day in the US, 1 out of 4 people over the age of 65 are in a nursing home, temporarily. The chances of you, your parent or spouse spending some time in a nursing home at some point in your life is also 25%. Pretty high right? But keep in mind, that there is a vast difference between spending some days recovering from a hospital stay before going home, and living in a nursing home. Let me clarify that for you.
There are several synonymous names for a nursing home: SNF (pronounced "sniff") otherwise known as a skilled nursing facility, convalescent hospital, Rehab, rehabilitation hospital, even sanitarium. "A rose by any other name …" right? Nowadays, if an older person has a stay in the hospital, they still need some recovery time before they can safely go back home. It might be a hip fracture, a broken arm, or even an infection or a bout of pneumonia; nevertheless they are going to spend a few days or a few weeks recovering before being allowed to go home. These days hospitals release people "sicker and quicker" due to the Medicare reimbursement schedules. Several years ago to save money, the Medicare system went through every conceivable cause for hospitalization and gave it a value of x-number of hospital days, then told hospitals "this is what we will pay you … period. And it's now a fact of life that nursing homes are a major player in the Medicare system, because they are cheaper than hospitals. So unless you are scheduled for surgery or you are in ICU, you are getting shipped out ASAP to a skilled nursing facility.
However, at any given time a large percentage of patients in nursing homes are there for the rest of their life. They are considered to be in "custodial care". They are never going home. They are usually people that need to be on 'machines' or just plain ran out of money and now Medicaid is footing the bill. But chances are for most of them, it could have been avoided.
So how do you avoid ending your days in a nursing home? Compromise. I will tell you that the best way to avoid a nursing home is to move into a board & care or an assisted living before you get so sick that you lose all your options. It's like this: many older adults refuse to consider assisted living until it's too late and then end up in a nursing home, sometimes for 5 or 6 years. And it was avoidable. This is why: there are some weird rules in the licensing of an assisted living community that make it easy to "age-in-place" if you are already living there when you start declining.
But the same rules make it very hard to move into an assisted living if you are seriously chronically ill and trying to move in for the first time.
For example, imagine two people that are very chronically ill, the one that moved into the assisted living early on, is allowed to stay, even go on hospice for the remainder of their days, but the other that was living at home when their health turned worse will likely have a very difficult time moving into the AL community. The reason is most assisted livings usually do not want to take someone that will drain their resources, and / or the licensing agency will not allow admission to assisted living because the severity of their illness. And if you are on a limited income – forget about it. Assisted Livings and board and care homes are private pay only. Medicare and Medicaid will not contribute a dime for you to live in assisted living (even though it's cheaper for them). Why is another article, let's just say Medicare and Medicaid pay for medical issues and assisted living is considered a social issue. The much longer explanation can be found on government websites, or you can check the sites listed in my bio.
But to be perfectly honest, most people that are struggling to live alone should not hesitate to move into an assisted living community! Unfortunately in many people's mind they think that they are maintaining their "independence" by struggling alone at home, when in fact they are far from independence. And this is a major delusion because most older adults who live alone are isolated, they rarely get out, they do not eat well, they can not keep up with the cleaning let alone basic home maintenance. They are often depressed because they have, in most cases, lived alone for years with only a television for company and most of their friends have passed on or moved away. Yet they continue to stay at home alone without proper care, nutrition, or socialization. Against all logic and argument to the contrary, they stubbornly hang on to their delusion of independence.
Let me paint a picture for you. A move to an assisted living community is like a combination of moving into an apartment and going on an Alaskan cruise. Forgive my over-generalization but imagine this: in assisted living you have an apartment-like suite that includes meals, housekeeping, and tons of socialization and activities. A typical day consists of getting up and going for breakfast in a restaurant setting and while you are out the housekeeper comes and makes your bed (once a week she changes all your linins). After breakfast you can go to the exercise class or the library or just go watch TV. When lunch time rolls around you go down to the dining room and have a nutritious meal and then head over to the next activity or go take a nap, before you know it, its dinner time. And after dinner there is a movie in the Theatre before you go to bed. Sounds nice? Keep in mind that you never again have to shop for groceries, cook, or wash a single dish. You do not have pay the utilities, maintain a car, or even do your laundry. Every moment of the day is yours to do with as you will. Now tell me who is really the "independent" person? Best of all, you are able to "age-in-place". You will develop new friendships and will have an emotional support structure that will remain with you indefinitely. Most people that come to assisted living are fairly healthy with the usual assortment of aging related issues, but as they get older they will need more help: assisted living offers things like medication management, bathing assistance, laundry service, transportation, housekeeping, meals, incontinence care and even dedicated one-on-one care. But few people need even half of these services when they first move in. That's what we mean by aging-in-place.
To review, the way most board and care homes and assisted livings communities are licensed, a person can stay in an assisted living no matter how bad they get; even until they qualify for hospice and end of life. (There are some prohibitive conditions, but they are so severe, you would not imagine them in anything but a clinical setting, like feeding tubes and breathing machines). So if you are willing to compromise your "independence" a little early on, you can spend your last few years in a supportive, apartment-like setting, and guarantee that you never end up in "custodial care" at a nursing home.