By Margaret Adams
We have all heard people and family members say that they would never put their loved ones in a nursing home. With the recent closure of Eliza Bryant Nursing Home, a historic Black-owned facility, I was wondering why people have this sentiment. In many cultures, caring for one’s elders is expected behavior. However, with elderly people living longer, having complicated health issues, and with societal and work pressures on younger family members, caring for a loved one in their declining years may not be practical or recommended. There are a variety of reasons why a nursing home may be recommended. There are different terms and levels of care a person needs to become familiar with before placing a family member or loved one in a nursing home.
Let’s start with terms used by the National Institute on Health and National Institute on Aging. The terms ‘nursing home,’ ‘skilled nursing,’ and ‘long-term care’ are interchangeable and the focus is on 24-hour medical care. These facilities provide a range of medical services consisting of assistance with activities of daily living (ADL) medication management, rehab services such as physical, occupational, or speech therapy, and wound management. These facilities provide the highest level of care outside of the hospital.
Some stays are short-term, for people discharged from the hospital but need additional care before returning home. Long-term stays are for people with ongoing medical, physical, or mental health conditions that require constant care and supervision.
Assisted Living is another term for care that is mentioned often. These facilities are for people who need help with some ADL but not as much help as that provided by nursing homes. Assisted Living facilities will have “level of care” options that allow the residents to receive additional services as their needs change over time. As a resident’s needs increase, so does the cost of care. Assisted Living provides residents access to services such as meals, medication assistance, personal care, housekeeping, laundry, and social and recreational activities. What’s important to consider here is what level of care is needed and most importantly what is the cost of the care needed.
In 1965, Medicaid and Medicare were established, which led to nursing homes being paid for and regulated by the federal government. The Centers for Medicaid and Medicare Services (CMS) regional offices determine whether a facility is eligible to participate. Certification of nursing home compliance is performed by each state through regular inspections. While Medicare and Medicaid pay for nursing home care, initially payment comes from the resident through personal savings, pensions, retirement funds, income from stocks, bonds, or the sale of a personal residence. A Genworth 2020 cost case survey reported the average semiprivate room cost is $7,148 per month. In Ohio, the Medicaid income limit for people 65 and older, blind, or disabled is $2,389 for 2022. For couples, this amount may vary based on the household size. When the household income/assets are over the income limit, people will have to “spend down” their income/assets to qualify for assistance. The spend-down must be done in a permissible manner—gifts do not qualify when spending down is being done. Currently, the state of Ohio states that an individual cannot have more than $2,000 ($3,000 for couples) in resources (money, property, and retirement accounts) to qualify for assistance. It is best to speak with a worker from ODJFS (Ohio Department of Job and Family Services) who can help you determine the spend down and how it can be met.
If you are able to plan in advance, it makes the event more manageable. This means talking with the person and family members about what the future care might mean and taking into consideration the person’s health and living situation as well as the health, financial and familial needs of the person who might become the caregiver. It means exploring all options. If the decision is to ultimately place a loved one in long-term care, hopefully, it can be done at a time when the family is not under pressure so that you can visit and interview different facilities within your economic means. If the decision has to be made in a short time, be sure to ask questions and use the assistance of a social worker for guidance.
How can family and friends help make the transition comfortable for the person who will be living in a facility? Everyone should become familiar with the rules and policies of the facility and respect them. Family and friends should be encouraged to visit to let their loved ones know they have not been deserted and to let staff know that others care about the resident. Make sure you are complying with the resident’s diet medically, are considerate of other residents, and are not causing additional work for the staff. Any concerns should be addressed with the administration of the facility or the ombudsman.
One common reason for reluctance towards placing loved ones in nursing homes is the conduct of the workers. Though the work is challenging and the staff at most facilities are caring individuals, workers must be aware of the image they are projecting. Another troubling issue with nursing homes is staffing. There is often a shortage of staff, the workload is heavy, the expectations are high and the pay is not the greatest.
Hopefully, this article touches on some of the myths and facts about nursing homes which are a vital part of our community. For further information, please contact the following organizations:
Eldercare Locator – 1-800-677-1116 or https://eldercare.acl.gov
Western Reserve Area Agency on Aging – 216-621-0303
Medicaid – 800-267-2323 or https://medicaid.ohio.gov
Medicare – 800-633-4227 https://medicare.gov
PACE (Program of All-Inclusive Care for the Elderly) – 1-877-267-2323