Freedom Friday: Home or nursing home…do we have a choice?
There’s one age group that’s going into nursing homes at a higher rate. And it’s not the elderly. Young people ages 31 to 64 now make up 14 percent of the nursing home population, according to an analysis of federal data from the Department of Health and Human Services. That’s up from 10 percent just 10 years ago. Traditionally, nursing home facilities where compromised of elderly men and women that either outlived their relatives or had some kind of a fall or a fracture. Now we’re seeing a transition to a younger population, either for psychiatric issues, which once upon a time were addressed in psychiatric state hospitals, which a lot of those have closed.
In 1999 the Supreme Court ruled that under the American’s with Disabilities Act (Olmstead case) that unnecessary institutionalization of people with disabilities is a form of discrimination. Since then, federal policies have said states need to do more to create more community-based care. One of the problems with the federal policies is “institutional bias.” Federal law required states to pay for nursing facilities, while community-based care is optional. Although this is changing, nationally more than 60 percent of what states spend on long-term care for the elderly and disabled goes to pay for people living in a nursing home (90% in North Dakota; 60% in Minnesota).
By federal law, people who face going into nursing home facilities must be told about alternatives. But in a study in one state, nearly 30 percent of younger people in nursing homes said they weren’t told about options. Often doctors and other health care providers just don’t know what’s available — and recommend a nursing home instead. According to a study by the AARP Public Policy Institute, the cost of attendant care (home based service) is about a third the cost of providing care in a nursing home or institution. Many states lack programs to help people receive care at home. And when such support exists, it’s hard to find. And as states face budget gaps, the programs that help people live at home are cut. A decade-long study published in Health Affairs in 2009 found that states with established home-and community based programs had cut their overall Medicaid long-term care spending by nearly 8 percent. States that relied on institution like nursing home facilities saw their long-term care costs increase by almost 9 percent.
And the last word…although nursing home facilities play an important role for people who don’t have other choices, research has continued to show that 80 – 90% of people would rather live in their home with community based services.
For more of the story check out NPR’s Investigative Unit report and story athttp://www.npr.org/2010/12/09/131912529/a-new-nursing-home-population-the-young