Do We Really Need Nursing Homes?

The August edition of McKnight's Long Term Care News reports Sen. Tom Harkin (D-IA) unveiled a bill to direct more Medicaid funding to home and community-based health care and away from nursing homes. You might think that considering my job, I'd be against this but I'm all for people being able to be where they want and I've yet to meet anyone who says "I want to be in a nursing home." But if you've ever been in the position of being told you are to be discharged from the hospital in two hours on a Friday afternoon with no one at home to help or medical treatments more complicated than once a day....well, there you are. You are glad we're here or if not glad, a little relieved and hoping it isn't going to be some nightmare of dark halls, bad food and people crying for help all night.
Usually after a day or two of adjusting to the idea and learning our goal is your goal, to get you home as quick as possible, you realize it isn't at all what you feared. Some people even find it less difficult than being in the hospital and certainly more entertaining.  Here's the rub. 'Back in the day' as we say, your hospital stay would have been two to three times longer. Nursing homes changed their roles in communities when Medicare encouraged us to provide those extra days you would no longer be having in the hospital because skilled nursing care is less expensive  We became facilities that could provide less urgent hospital services at 1/3 the cost.  It was and still is a pretty smart way to stretch our tax dollars.  The same services at home would be cost prohibitive.
We seniors are not going to let anyone mess with our Medicare, or at least not if we know about it, but Senator Harkin was talking about Medicaid, wasn't he? So that's a whole different matter. Those residents of nursing homes who don't have hundreds of thousands of dollars and/or have needs too complex for families, assisted-living facilities or adult family homes, those people who no longer have assets to divest or incomes to invest--those people should, according to Harkin, get their care at home or at an out-patient clinic.
Remember when we 'deinstitutionalized' the chronically mentally ill, only to learn that they didn't get care at home or at out-patient clinics? They live under bridges. But that's a subject for another time.
This is today and the health care crisis in this country gets ever more terrifying. My advice is borrowed from the poet, Robert Frost, "Provide! Provide!" Frost was not a man to use exclamation points liberally.
It's clear that unless we get informed and politically active, we'd better get serious about maximizing our health.

•  It's not too late to eat better food. Take advice from Michael Pollan, "Eat real food, but not too much." Real food tastes great when it hasn't traveled very far so support your local farmers.
• Work on your balance. A lot of long stays begin with a fall. Strengthen your core. Do some dynamic movement. Try yoga. Studies find dancing is great for balance. And if you can't dance, rock out in your chair. Other researchers found this to be excellent for core strengthening. 
• Work on your brain. It gets stiff if you don't challenge it. There are some very senior brain strengthener apps for iPads and other tablets. I'm doing Luminosity every day. I'll let you know if it isn't working. 
• Make new friends and keep the old ones. Social support does more than you can imagine in keeping us healthy and independent. If you have trouble finding new friends, come volunteer at the nursing home. You'll have a whole large family before you know it

We can all hope for a day when nursing homes are no longer needed, a day when we live full productive lives into our hundreds and then simply lie down and pass away. At least, that's what I hope for as I navigate my 'golden years.' But diverting more funding away from the services we provide won't be adequate to the costs in tax dollars and, even more importantly, human suffering. It isn't a real solution. It panders to that clear feeling all of us have that, "I don't want to end up there." Keep yourself informed. They are arguing about our future.
Until next time,
Andy