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What's New? ElderCare Q&A April, 2004 Q:Is the Role of Nursing Homes Changing? 4/1/2004 - A: Yes. A new state report says that the Commonwealth has been overly-reliant on nursing homes, which has driven up costs without providing the kinds of support that consumers really prefer' The study, Transforming Long-Term Supports in Massachusetts, explains that back in the mid-1960s, when the federal Medicaid program was created, nursing homes were a required part of a state's eldercare program. Even though most seniors preferred to be cared for at home, the Medicaid program offered only a modest home health benefit, and it wasn't mandatory. The nursing home industry grew dramatically in the first two decades of Medicaid coverage. Over time, the report says, the system developed an institutional bias that did not respond to the consumer's desire for choice, autonomy, and dignity. In fact, Medicaid rules made it easier to qualify for nursing home care than for in-home care. But today, the federal and state governments are trying to reverse this institutional bias, and encourage the expansion of community-based care. Creative members of the nursing home industry have realized that they must diversify and transform if their organizations are to be viable in the future, the new report notes. Many nursing homes now offer home health services, adult day care programs, assisted living options, and short-stay rehab programs. No longer is a nursing home viewed as a person's last address. All this has meant a change in thinking, an adjustment in the culture of nursing homes. Some facilities, the study says, have begun to modify the culture of facilities to more fully reflect community life, options, and values. Some nursing homes are making their facilities more home-like, bringing in plants and animals, changing their building design to create more gathering spaces, giving consumers more choices during daily activities, helping residents participate more fully in community life, and more aggressively helping elders to move back to a community setting. Four years ago, the U.S. Supreme Court ruled that disabled people of all ages had the right to be cared for in the least restrictive setting appropriate to their needs. The Court also acknowledged that nursing homes are needed and must remain available. There is no question that nursing homes are evolving, and adapting to meet the needs of the elderly consumers who make up 90% of the residents in institutions. Family members, likewise, are changing their expectations, and realizing that many nursing home stays today will be short ones, with the goal of returning to the community. The Transforming report says the state should offer help to individuals and families who want to transition from facilities to the community work with providers to promote a culture that reinforces the value of community life, and improve the balance of spending on community care and facility care. Back to What's New?
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