The nursing-home industry is suffering through an unprecedented decline as elderly Americans are increasingly opting for home- and community-based options.
There are a few statements I generally don’t expect to hear when circulating among my geezer peers. “I can’t wait to climb up on that table for my next colonoscopy” is one of them. “I’d rather clean out the gutters this weekend than play a round of golf” is another. But as unlikely as I am to encounter either of those sentiments, there’s another expression that’s even less likely to come up in casual conversation: “I’m sure looking forward to moving into the nursing home.”
It’s pretty much an article of faith among the senior set that we must do everything in our power to avoid landing among the sorrowful inmates wandering the halls of any of our nation’s long-term care facilities. The prospect of decamping to even the finest nursing home carries with it a crushing loss of independence, piled atop the loss of community that may have been decades in the making. I don’t know of anyone who, given a choice, would choose that option.
And, if the results of a recent survey are any indication, we seem to be staying away in numbers not seen since folks started tracking such things. The National Investment Center for Seniors Housing and Care reports that nursing-home occupancy has dipped to its lowest point since 2011, with nearly one in five beds now unoccupied nationwide — and as many as one in three vacant beds in some states. That’s almost a 7 percent decline in the past seven years, at a time when you’d think our aging population would be filling these facilities to overflowing.
“It’s a significant drop,” the center’s Bill Kauffman tells the New York Times. “The industry as a whole is under pressure, and some operators are having difficulty.”
Much of the challenges come from a changing healthcare industry. Hospitals now face federal penalties when patients boomerang back from nursing homes after treatment, so some now designate patients as “under observation” rather than officially admit them. These “outpatients” would ordinarily head to the nursing home for rehab, but Medicare doesn’t cover their care so they often end up elsewhere.
And, thankfully, there are plenty of options. Assisted-living facilities have thrived as nursing homes have faded, and home healthcare services are blossoming. In the 1980s, 90 percent of Medicaid’s long-term care dollars went to nursing homes and 10 percent to home and community-based options; these days, nursing homes are trying to scrape by with only 43 percent of those funds.
This shift comes as no surprise to anyone who’s been forced by illness or incapacitation to consider moving out of their home. “When people find community alternatives, they use them whenever possible,” Ruth Katz, senior vice president of public policy at Leading Age, a trade group for senior service providers, tells the Times.
For elderly Americans who require the type of round-the-clock care that only nursing homes can offer, however, the trend is not a hopeful one. As the industry struggles to fill beds and boost its bottom line, these patients may see cuts in staffing levels and a reduced quality of care. And those moves will likely elevate the appeal of home-based options, resulting in more empty beds and further staffing cuts.
It’s a sad and vicious cycle, one that millions of my geezer cohorts have triggered by our stubborn determination to avoid the nursing home at all costs. And while I can’t help but sympathize with those trapped in these facilities and hope that more appealing options someday emerge, I’m going to continue to do everything in my power to remain at my current address until I bite the dust. If that means cleaning out the gutters instead of enjoying a round of golf, I’m willing to make that sacrifice.