Dependent Living – The Need For Nursing Care

CarePlanIt teaches that there are only three ways to live: independent, assisted, and dependent. We call it the IAD Model. The “D” is for dependent living. That means you can’t perform your activities of daily living (ADLs).

Occasionally dependent care is needed when you can’t manage on your own with basic home care. Also, there are times your doctor classifies you as in need of skilled nursing. Many families plan on qualifying their parents as in need of nursing care to help with long-term care. For example, to qualify for nursing care under Medicaid, a doctor needs to classify a patient as in need of nursing care.

Dependent Care Is For Everyone, At Some Point

Carmen and I also like to remind everyone that you will require a dependent living environment toward the end of your journey if you live long enough. Dependent living environments are nursing homes or nursing home level care in your home. Everyone should find a way to become familiar with nursing home care. However, many of us don’t because we’re afraid of nursing homes.

Seniors Fear Nursing Homes

Despite the reality that we’ll all need dependent care if we live long enough, most seniors refuse to investigate nursing homes. This is because we fear nursing homes. Society has trouble talking about most of its worst fears.

Interestingly, society doesn’t have trouble making movies about them. There are thousands of monster movies, hundreds of spiders, and hundreds of alien movies. Even Alzheimer’s has been tackled in a bunch of movies. But not nursing homes. Almost every movie involving a nursing home has been a documentary. The few movies focussing on nursing homes are animations and foreign films.

Novels address aging. But they’re one-man bands so to speak, and novels’ financial success can occur with ten or twenty thousand readers. A film requires millions of viewers. The frailty of aging and the tragedy that ensues is a common theme or storyline in any novel with an aging main character. Phillip Roth’s novels, mostly his later work, often address the ravages of aging. He says explicitly, “Old age isn’t a battle, old age is a massacre.” This doesn’t encourage older readers much. Most older readers avoid issues of aging like the plague.

There’s a reason for this, it’s called anxiety. Americans have trouble acknowledging they’re aging. As a culture, we don’t like to admit we’re aging. Remember the saying forty is the new thirty? Or sixty is the new fifity? As Americans and western culture as a whole, we treat aging as a disease.

Why Do Americans Have So Much Anxiety Around Aging?

Americans have anxiety around aging. Specifically, anxiety is the unease that comes with uncertainty. Understandably, our anxiety is aggravated when it coincides with our worst fears. Our aging fears are among our worst. For example, we don’t want to give up driving, leave our homes, face chronic diseases, or lose loved ones. Just thinking about these issues creates trauma.

Our instinct is to avoid trauma. That’s why we don’t go to see movies about nursing homes. That’s why we don’t talk about giving up our cars or moving out of our homes. When we don’t talk about something inevitable, psychologists call it denial.

Denial is a defense mechanism that describes situations where people are unable to face reality or admit an obvious truth. In other words, it’s a refusal to admit or recognize something is occurring or has occurred. Accordingly we create themes and memes like, Sixty it the new fifty and eighty is the new sixty. In addition, we discuss how seniors make decisions here, and how this decision-making process impairs addressing aging realities.

American’s Fear Nursing Homes

Nursing homes can be horrible. But so can anything, including us, parents, schools, neighborhoods, spouses, children, and churches. As we’ve also pointed out, if you live long enough, you will become dependent on others for care. Therefore, if we believe all nursing homes are horrible, we’re going to do anything we can to avoid them. That includes looking at our children to care for us: to diaper us, to bath us, and to feed us.

How To Mitigate Fear Of Nursing Homes

The best way to alleviate anxiety and fear is to replace the fear with something positive. For example, if I’m afraid of the ocean, having a good experience on the ocean can go a long way towards minimizing or alleviating my fear of oceans. Likewise, if I’m afraid of nursing homes, visiting a good nursing home can have the same effect.

Well-managed facilities, especially those that are part of assisted and independent living options, are much different. They create decent environments for us to age. Here’s a critical piece of good advice. As an Ager, finding these facilities early and seeing them can help shape your opinion on nursing homes you might accept. As a child of an Ager, make sure your parents see these facilities. In other words, don’t let poorly managed facilities determine your attitude for the rest of your life.

A great place to find good nursing facilities is to find those run by religious institutions. Religiously affiliated nursing homes that have been around for ten or twenty years are usually pretty good facilities. Go visit. Also, if you or your loved one is hospitalized, see if you can be discharged for rehabilitation to one of these facilities.

When Do Seniors Need Nursing Home Care?

CarePlanIt defines dependent living facilities as those providing support for ADLs. Seniors requiring this level of care have significant physical and cognitive impairments. These situations generally stem from:

• Recovery from hospital stays
• Debilitating chronic conditions
• Dementia
• Extreme frailty (i.e., advanced old age)

These situations result in health conditions that impair seniors’ mobility and ability to follow medical protocols. Seniors with impaired mobility need help dressing, bathing, toileting, walking, and grooming. Seniors with cognitive impairment have challenges remembering where they are, family members, those around them, and what they’re supposed to be doing. Seniors with impaired cognition or mobility also require help following complex medical protocols (e.g., insulin injections, taking multiple pills at specific times of day, etc.). All these resulting dependencies require others to perform these tasks.

Skilled Versus Unskilled Staff

There are two types of health care workers that provide these services: skilled and unskilled. It’s important to understand the difference because when you’re evaluating a skilled nursing facility for you or a loved one, a key question will be the facility’s staff.

Skilled:

• Registered nurses (RNs)
• Speech pathologists
• Vocational nurses
• Audiologists
• Medical doctors
• Rehabilitation specialists

Unskilled

• Aids
• Cooks
• Cleaners
• Techs

Skilled Nursing Homes Versus Nursing Homes

Skilled nursing homes and nursing homes hire these skilled and unskilled workers. Combinations of these workers provide services to their residents.

These services are primarily provided in two types of facilities: skilled nursing facilities (SNF) and nursing homes. There is a lot of overlap in these facilities, but the key differentiator is that only skilled nursing facilities can provide reimbursable rehabilitative services under government and most state programs.

This means the facilities’ business models differ. Nursing homes focus on long-term care of elderly and disabled patients not requiring a lot of rehabilitative care. SNFs can do this and provide rehabilitative services. This makes SNFs potentially more profitable. Because they offer more services, they can select from a larger potential resident population. They can create a mix of residents that have different needs and different ways of paying. This is usually a mix of government insurance, private insurance, and private pay.

Rehabilitative patients tend to be high margin, high revenue patients. Patients not able to get better, cannot be offered a lot of reimbursable rehabilitative services, and tend to be lower revenue, lower margin patients.

It doesn’t mean nursing homes can’t provide great service. It simply means they have to be very well managed to compete with skilled nursing facilities for quality employees and managers.

There are two main categories of dependent living facilities. Skilled nursing homes (called SNFs or “Sniffs”) and old fashion nursing homes. Visit both pages.