Nursing Home Care & Its Alternatives   Term Paper ID:27565 Click to get this paper

Essay Subject: Examination of the history of elderly care & its impact on the elderly, their families, & professional care providers. Reviews current developments & possible future directions.... More...

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Paper Abstract: Examination of the history of elderly care & its impact on the elderly, their families, & professional care providers. Reviews current developments & possible future directions. Paper Introduction: Introduction Nursing home care and its alternatives continue to be issues which face the elderly, their families, and the social workers who assist them. Families must struggle with the decision of what kind of help to give their elderly loved ones, while at the same time, social workers must try to accommodate an increasingly geriatric population. Nursing homes have become part of the solution and part of the problem. Nursing home care has always been expensive, and state legislatures, concerned with the fact that people are living longer and at greater expense, have pursued ways of making the public dollar stretch further. Social workers, lobbying groups such as the American Association of Retired Persons (AARP), legislators, and the elderly themselves have attempted to find alternatives to Text of the Paper: The entire text of the paper is shown below. However, the text is somewhat scrambled. We want to give you as much information as we possibly can about our papers and essays, but we cannot give them away for free. In the text below you will find that while disordered, many of the phrases are essentially intact. From this text you will be able to get a solid sense of the writing style, the concepts addressed, and the sources used in the research paper. Families are encouraged to share concerns, develop friendships and alliances, and gain assistance in meeting needs (p. In the future,social workers will be called upon to help coordinate these varied servicesand the work of social welfare agencies, as business and government-subsidized groups interact and benefit from one another in a symbioticrelationship. (p. 58-61. In 1988about 2.3 million Americans were in nursing homes, and the rapid increasein those aged 85 and up, meant that nursing homes were building to meet thedemand. In other words, in acommunity-based residential care facility, the money of the elderly persongoes out to the greater community, whereas in the traditional nursing home,the resident's money goes primarily into one corporation's pocket. Social workers will becalled upon to create new options to the nursing home as the primaryinstitution of care. Just as nursing homes areperceived as institutions which isolate the elderly from the generalpopulation, board and cares are increasingly being seen as healthyalternatives wherein aged citizens can live, with assistance, within thecommunity.Conclusion With the task of facing an increasingly geriatric population, socialworkers and legislators are pushing for changes with regard to theproviding of nursing services and the deployment of a community workforce.Social workers who do casework with the elderly will be at the vanguard ofsocial change, as they have first-hand knowledge of what is good and badabout current care for the elderly. As one of thefirst solutions to long-term residential care for the elderly, the nursinghome came to be the primary institution to solve the societal problem ofcaring for an increasingly aged population. Should that emphasis in anyway diminish quality of care, institutionalization then is incompatiblewith the sacredness of life, and rightfully becomes a focal point of socialoutcry" (p. 22) The role of the social worker can be that of a broker for theindividual who is unable to deal successfully with many socialinstitutions. (1986). When the family chooses to intervene, however, the loss is considerably lessened. EnglewoodCliffs, Prentice Hall. Because of rising costs and an aging population, decision-makers aretaking a long, scrutinizing look at nursing homes. Horne goes on to maintainthat "these days, persons who are taking up permanent residence in nursinghomes are older, sicker, and more frail than such residents were in thepast" (p. Nursing home care has always been expensive, and statelegislatures, concerned with the fact that people are living longer and atgreater expense, have pursued ways of making the public dollar stretchfurther. 54); and 4) "The number of Americans over the age of 65 has been rising rapidlyfor several decades, and currently stands at about 31 million. Anursing home which charges $2,5 a month to its residents could bereplaced by service industries within the community which could provide agreat number of goods and services for far less money. Without such a belief, the nursing home will fall to "the corporate bottomline." She maintains that "nursing homes, like all institutions, mustemphasize cost accountability and efficiency. R. Social workers have always had two objectives: 1) service to individualsin the performance of their various roles and relationships, and 2) socialaction for the improvement of living conditions. National eldercare campaign moves ahead. Family caregiving is always an opportunity to express respect and sanctity for life. The nursing home staff can provide the skill, knowledge, andconcern of professionals, but they are emotionally devoted to their ownfamilies. Amid a range of prospects,from skilled care to adult day care to in-home service providers to boardand care homes, the nursing home remains as an unpleasant reminder of theold system of institutionalizing the elderly. L. Patients are transferred from hospitals into nursing homes much morequickly today than in the past. In addition, family memberscan wheel residents outside for a leisurely visit. Future social work with the elderly should involve furthering lobbyingefforts on the part of AARP to gain greater respect for the "buying power"of the elderly as a group with economic clout. Buffalo: Prometheus Books. Karr, K. Nursing homes have become part of the solution and part of theproblem. The creative alternatives to nursing home care that have resulted fromthe needs outlined above are the following: adult day care, adult fosterhomes, board and care or adult homes, congregate housing, co-housing,continuing care retirement communities (CCRC's), elder cottage housingopportunity (ECHO) homes, enriched housing, group homes, home care, hospicecare, housing for the elderly, public housing for the senior citizen,respite care, retirement communities, and senior centers' shared housing(Rosemire, 1996, p. But the family can serve to lessen social isolation. Rosemire, A. In short, today's nursing homes see the poorest and thesickest. Becausethe nursing home should be seen as a final alternative rather than a firstone, the following community services should be considered as options:home health care services, daycare centers, night sitters, grocerydeliveries, volunteer visitors, dial-a-ride, meals-on-wheels, telephonereassurance, homemakers' services, live-in companion, handyman services,physician visits, visiting nurses, mental health counseling, home therapy,senior centers, family respite services, share-a-home, foster home,supervised apartment, retirement home, assistance from friends andneighbors, and finally, hospices. Inother words, the nursing home as corporate-run agency is giving way tocommunity-based programs which are not driven by the corporate bottom line. 3). (1994). 47). By the late 198 s, if trends towardinstitutionalism of the aged had continued, the number of elderly Americansin nursing homes could have reached 4 million by the year 2 18. 28). Mew York: Holt, Rinehart and Winston. People have to go to work, and no one could stay home to care for the patient. Today, the community is more able to provide services which allowolder persons to stay independent and be cared for outside of aninstitution for a much longer period of time. However, "relocation can be made lessstressful if careful plans are made, and the elderly are financiallysecure" (Rathus, 1985, p. Movement to a nursing home is astressful major life change. Feb. Overlooked may be the factthat their very presence, their ability to listen, affirm, and communicatewill be of the utmost value to their relative. As Down (1991) points out in her study of RCFE's, social workers whowork for the elderly within the board and care facility: may challenge the belief that resident elders need little more than a safe place to stay and basic care for the rest of their natural lives ... Only ten percent said that they had not seen a child within the past month. Buffalo: Prometheus Books. Why, then, has the nursinghome lingered on as an unpleasant reminder that we are failing in ourattempt to improve both the quantity and quality of life? Karr (1991) considers a belief in the sacredness of life (a belief inhumane, decent treatment of others) as essential to good nursing home care. 95)Karr (1991) goes on to discuss the friends' groups which provide support tofamilies under duress: Some nursing home facilities have family and friends' groups that provide emotional bracing for family members. 264) The fact that most elderly persons were put into nursing homes priorto the last decade meant that nursing homes grew in number with the growthof the elderly population. Hair does need to be brushed, but what is conveyed in the act of brushing is far more important than the styling. According to a 1988 publication entitled A Home Away From Home, produced by the American Association of Retired Persons (AARP), board and care facilities provide "a living arrangement in which a resident is provided room, meals, help with activities of daily living, and some protective supervision." (p. As Karr (1991) writes: coping with [an] elder's emotional needs, taking care of your own emotional pain, and finding the time to engage in advocacy activities can be thoroughly overwhelming. The current trend toward a more community-focusedorientation toward meeting the needs of the elderly has placed socialworkers at the front and center of a movement which challenges the statusquo. Sociology. At this point, it will bebeneficial to explore some of a families' needs when one of their lovedones is under the care of a nursing home. As an agent of social control, the social worker helps hisor her clients to live constructively within the framework of communalvalues. Social work professionals will be called uponto provide for those needs at a time when "the corporate bottom line," andstate legislatures' attempts to make entitlement programs more cost-effective will have an impact on which of those health care alternativessucceed and which ones fail. Grooming signifies compassion, as do any and all caring acts. The community web also includes the following agencies, as outlined inFox's (1986) book, You, Your Parent, and the Nursing Home: The Family'sGuide to Long-Term Care: The local health department, social securityoffice, senior center, mental health association, visiting nurseassociation, Council on Aging, Gray Panthers, church and synagogue outreachministries, Red Cross, family service agency, Crisis Intervention Hot-Line,and adult daycare centers (p. No longer will human dignity and the sanctity of life be secondary tothe bottom line for care-for-profit corporations--at least as long asalternatives to the traditional nursing home are accessible to all. Most people can describe how doctorsand nurses interact within a residential care facility, but less well-knownis the work of the social worker who operates behind the scenes tocoordinate the many different kinds of treatment, resources, and servicesthat go into good care. During the Great Depression, when Social Security was established, old people used their pensions to pay for nursing care. Many times family members worry about how they are going to entertaintheir elderly relative in the nursing home. However, autonomy is of the utmost importance. Winter/Spring, 1992. Winter 1994.Occupational Outlook Quarterly, p. Riegel, S. A social worker can also helpfamilies with emotional support. 46). 59); 3) By the year 2 3 , 1 out of 4 Americans will be a senior citizen,and the number of people 85 and older will almost triple" (Aging,Winter/Spring, 1992, p. The caring acts of family members are precious in themselves. The family must provide the patient with frequent visitsand much love. 9). In 1965, Medicare and Medicaid were established, and these medical insurance policies for the aged and the poor provided additional funds to be used for nursing home care. Most likely, you will need outside support to find the strength, renewal, and reinforcement necessary to continue with [one's] demanding role (p. Macionis, J. (1989). 49). Of those providingcare to aging relatives, 31 percent were between 3 and 4 years old, and52 percent were between ages 41 and 55" (Riegel, 1994, p. 59); 2) "Responsibility for caring for this aging population falls on thechildren, and usually daughters. It is very important that families do not neglect their own emotionalwell-being when a loved one is in a nursing home. 28-31. The RCFE option serves as a cost-effective option for many olderadults who live alone on a fixed income and find it increasingly difficultto take care of their homes/apartments and their own personal daily needs.A passage from Down's (1991) Between Home and Nursing Home: The Board andCare Alternative defines the RCFE: In those states and localities where they exist, pertinent laws and ordinances governing community-based residential care facilities refer to board and cares by any number of names and incorporate a variety of criteria when defining such facilities. The oldest segment of our population--those 85years of age and older--is growing more rapidly than all other segments ofthe population" (Bluford, 1994, p. 26) A focus on the individual, the nursing home patient him- or herself,will show that most elderly adults would rather stay in familiarsurroundings, as one would expect. Ever-increasing numbers of older persons and family caregivers have to confrontdifficult choices about types of living arrangements and levels of care forthose who are experiencing diminished or reduced capacity. To many elderly people accustomed to considerable social activity, loneliness may be a problem. 54-55. 3). The other 95 percent employ a wide range of livingarrangements, including those mentioned above. Sociology. A. (1996). Horne, J. The emphasis on eitherservice or action has shifted during the developmental history of socialwork, corresponding to shifting intellectual, ideological, andsocioeconomic trends. The public will have to be educated about otheroptions which enable the older person to avoid, rather than succumb to, theinstitution. Of course, "poor elderly people aremore likely to report ill health than are the financially secure" (Rathus,1985, p. Second edition. Caring for parents: A local how-to. If an elderly person and his or her family wanted to choose askilled nursing home in preference to a board and care facility, the socialworker would work within the existing system to help the client(s) find thebest skilled nursing home facility in the area. One final observation with regard to the family's role is in order.Karr (1991), a social worker and gerontological consultant, provides astrong argument for family intervention and cooperation in her book,Promises to Keep: The Family's Role in Nursing Home Care: In a society that delegates the management of illness and death to professionals, loss of patient dignity, autonomy, and integrity is a serious concern. Rathus, S. Eshelman, J. 21).Role of Social Workers Social workers must meet the challenge of helping the elderly adapt toa shift away from the nursing home as the preferred agency of placement toother more community-based institutions which network social resources. (p. (1989). 1994.New Orleans Magazine, p. Fox, N. A recent survey by the Travelers[Insurance] Corporation reports that nearly 3 percent of those surveyedspent a significant time caring for elderly relatives. In short, the above statistics show that the impending rapid growth inthe number of Americans in their eighties and nineties will produce a sharpincrease in the need for health, housing, long-term care, and socialservices in the years ahead. By 2 5, itwill exceed 36 million. 46); however, "the number of Americansover the age of 65 has been rising rapidly for several decades" (Bluford,1994, p. Those elderly persons now innursing homes are much more likely to have severe medical conditions thanthose in the past. Introduction Nursing home care and its alternatives continue to be issues whichface the elderly, their families, and the social workers who assist them.Families must struggle with the decision of what kind of help to give theirelderly loved ones, while at the same time, social workers must try toaccommodate an increasingly geriatric population. Buffalo:Prometheus Books. (1986). One of the most exciting alternatives to nursing home care are theresidential care facilities for the elderly (RCFEs), also known as "boardand cares." According to Ivy M. Rathus goes on to observe that some peopleare in nursing homes because they lose financial independence:"Unfortunately, some elderly people are placed in nursing homes andsurrender independence because of a decline in health and finances" (p.5 ). Boston: Little, Brown andCompany. Caregiving for the elderly has become a growth industry. The other mid-life crisis. 28). Today there is popular support for lower costalternatives which enable the patient to stay within the larger community.The patient is assisted as much as possible by a range of personnel, bothmedical and social, and more of a premium is placed on the older person'sability to avoid institutionalization.Review of Literature Actually, only 5 percent of people sixty-five and older live in anursing home (Rosemire, 1996, p. (p. Even those [elderly people] who are living alone often continue toreceive social support from their families, according to Macionis (1989, p.353), who writes: Although only a small percentage of elderly Americans live with their adult children, Ethel Shanas (1979) found that more than half of all elderly people in her research lived within a ten-minute travel time of at least one child, and over three-fourths claimed that they had seen at least one of their children during the preceding week. (1991). Local social information and referral services,listed in the phone book, can be counted on to provide assistance. (1991). (1994). Down, I. 21). We define a board and care home as: a place to live where elder residents are provided sleeping accommodations, meals, some help with activities of daily living (such as bathing and grooming) and with instrumental activities (such as assistance with transportation and medication). (1983). San Jose: MeridianPublishing Inc. The role of the social worker as provider-broker will be explored further later. Aging,p. Weekly or monthly meetings are both educative and supportive in scope. Promises to keep: The family's role in nursinghome care. Therefore, even in anursing home (as opposed to a more independent living arrangement), theelderly fare better when they are kept well-informed and allowed to makedecisions on matters that affect them. Nursing homes also developed because in the twentieth century families in urban areas could not care for a disabled elderly person. This has been one of the reasons that nursing homeshave found it increasingly difficult to sustain profitable operations; as aconsequence, nursing homes have sought ways of cutting corners, which isnever a good practice when it comes to health care. J. However, as has beenshown, the social worker has also been at the forefront of social change asnew tasks and objectives confront the field. When faced with such an array of choices, many families areoverwhelmed, and they must rely on a social worker to help them decide on anursing home, or a suitable alternative. Although nursing homes have been the only alternative for many elders,their families, and the social workers who assist them, there exist maymore alternatives today. References Bluford, V. 353) The elderly person and his or her family are only two parts of thenursing home matrix. Working with older people. A devoted family visiting their loved one in a nursing homecannot be substituted by the staff. Various housingand eldercare alternatives have been devised. Between home and nursing home: The board andcare alternative. Down (1991), a sociologist and prominentspokesperson for alternative care for the elderly, "board and caresconstitute a community-based residential living and caregiving arrangementthat has developed to help serve the complex needs of America's rapidlyincreasing elder population" (p. 49), so that nursing homes, as has already been discussed, arefilled primarily with poor, sick people, whose ailments are far worse todaythan in the past. As Horne (1989) observes, "in today'sstreamlined world of health care, it is not uncommon for a hospital toprovide care until the patient is stabilized and then transfer that patientto a nursing home for the kind of rehabilitative and convalescent care onceprovided as part of a hospitalization" (p. The nursing home handbook: A guide for families.Glenview: Scott, Foresman and Company. the very idea that the aged need to continue exercising their minds and bodies and to maintain as high a level of interaction with their former community and friends as possible [seems to be] a revolutionary thought (p. You, your parent, and the nursing home. M. The population is indeed aging, and the problem of providing nursinghome care (by itself) will become insurmountable if other options are notemployed. Even the finest of institutional care will never be able to approximate the family's ability to engage in caregiving as an expression of love. Adjustment and growth: the challenges oflife. Typical of mostcaregivers, most family members will neglect their own needs in the hopesof satisfying those of a loved one who has been placed in a nursing home.Yet the role of families in nursing home life must be far more than one ofquiet visitor and passive observer--it must be a role of partnership.Family members need to work cooperatively with nursing home staff andadministration. Some residents may needthe kind of personal, loving care that only a family member can provide,like foot massaging or back rubbing. The practice of putting the elderly in nursing homes is a twentieth-century phenomenon, and, as Eshelman (1983) notes: They have developed partly because they have received government support. Social workers, lobbying groups such as the American Associationof Retired Persons (AARP), legislators, and the elderly themselves haveattempted to find alternatives to long-term nursing home care. A survey of literature on social work and nursing home careyields the following realities: 1) "A growing number of men, and especially women, find themselvescaring for an elderly and often infirm patient (Riegel, 1994, p. 95). If this paper is not what you are looking for, you can search again: Search for: or Click here to request an essay written just for you.

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