INTRODUCTIONPerceptions of Nursing Homes: Positive or Negative?Aging is the epitome of life. From conception, life grows and matures and is always ever changing. However, society puts a stop to this way of thinking with mass marketing images of remaining young forever. There are ads of all sorts that promise to help us remain young and to not change our youthful image. Yet the truth is that we do not remain young forever. We will eventually need to have someone care for us when we are not able to care for ourselves. According to Kincannon (2002) Americans age 85 and older are the fastest growing segment of the national population. From 1960-1994, that group increased by more than 274 percent. The internet site for the Census Bureau says, “The size of the age 65 and older population was 34.7 million in 1999, representing about 13 percent of the population in the United States. There were 4.2 million Americans age 85 years and older, representing about 1.5 percent of the population. By the year 2025 the size of the age 65 and older population will double to about 64 million representing 25 percent of the population while those age 80 years and older will more than double to about 20 million, representing about 9.2 percent of the population.” Caregiver’s caring for ElderlyIn the study of Keefe and Fancey (2000), “eighty percent of older adults who need long-term care in the United States receive that care not in nursing homes, but in their own homes or in community settings from informal caregivers, family members or friends, who account for 20 to 25 million of the population.” A decent majority of those age 65 and older live with family members. They also state that about two out of three of these elders live with their spouses or other family members (80 percent men and 58 percent women). Such caregivers, although persistent upon these circumstances to begin with, eventually find these conditions highly stressful and many times suffer from depression. However, these caregivers will continue to care for their loved ones because guilt outweighs their emotional relief. There are often times when elders are neglected either by caregivers or medical caretakers. According to Krause and Grant (1999), when the neglect is by a familiar caregiver it can most times be attributed to the stress and pressure of taking care the elder, having a job, and keeping up with day to day activities. When neglect occurs by a medical or trained professional it can occur from: being underpaid, understaffed, or just being uneducated about an elders needs. Nursing HomesResearchers in Housing quality and psychological well-being among the elderly population say that “today, about 1.5 million Americans live in our nation’s 17,000 nursing homes, which is a small percentage, about 4.2 percent of the entire senior population. The proportion in nursing homes rises steeply with age (1 percent of those age 65 to 74, 4 percent for those age 75 to 84, and 20 percent for those 85 and older). A person turning 65 in the year 1990 had about a 40 percent lifetime chance of living in a nursing home.” Few people choose to go into a nursing home. According to Brunk (1998) “it is a decision that is usually forced by a sudden decline in their health or mental abilities, or the realization that they can no longer get the kind of care they need at home or from family caregivers.” The decision-maker is usually a family member or close friend. Many families feel guilty about moving loved ones into nursing homes, yet some people are actually happier being around other people and getting regular meals and medical attention. They may actually feel more independent when they no longer have to rely on family or friends to take care of them. Researchers Assumpta and Hugh (2000) say there are many instances where elders find themselves being dependent on strangers, not familiar family members, when being independent was once one of their main sources self worth. According to Schulz, R., Martire, L.M., Beach, S.R., & Scheier, M.F.(2000), depression ultimately follows with decreased social activity. Still, it isn’t an easy choice, and the decision is even harder because bad care in nursing homes is often in the news. In the study of Becker (2000), most nursing homes (66 percent) are operated for profit and more than half are operated as part of a chain. This has resulted in fewer, but larger, nursing homes. More than half of American nursing homes (54 percent) are below the suggested minimum staffing level for nurse’s aides. Nurse’s aides are the lowest paid and least trained of all nursing home staff, but they most often feed and bathe patients. Nearly one in every four nursing homes (23 percent) is below the suggested minimum staffing level for total licensed staff. The minimum staffing level for registered nurses is only 12 minutes per day per patient. According to Elias (2001), the typical nursing home resident is a woman in her 80`s, who shows mild forms of memory loss and dementia. Although physically healthy for her age, she needs help with about 4 of 5 activities of daily living (eating, dressing, bathing, transferring, and toileting). In the internet site for nurse week, registered nurses in Medicare/Medicaid-certified nursing homes spend an average of 42 minutes a day with each and such patients. Licensed practical nurses spend the same amount of time per patient per day. Certified nursing assistants spend an average of 2 hours and 6 minutes per day with each patient. This results in 3˝ hours of direct and indirect care from all sources per resident in a 24-hour period. Researchers Kane, R.A., & Reinardy, J. (1999) say, these low staffing levels in America’s nursing homes contribute to an increase in severe bedsores, malnutrition, and dehydration, which lead to increased hospitalization. In a study done by Brunk (1998), there was one horrifying case, an 88-year-old Florida man with Alzheimer`s disease, prostate cancer and heart disease died in a nursing home in just four months. He was kept in restraints for hours, often lying in his own urine and feces, lost 32 pounds, and developed bed sores so severe they penetrated not just skin and muscle but actual bone. His family was awarded $2.7 million when they filed a lawsuit against the nursing home.According to the researcher Elias (2001), neglect does happen in nursing homes and other facilities. If an elder, like 1.6 million other elders, is being cared for in a nursing home or other facility, the abuse of varying degrees of neglect is often unchecked, because these facilities may be inadequately regulated and sporadically inspected, if at all. In addition, many elders have no immediate family to intervene on their behalf, and are completely dependent on the facility`s staff, which is most times understaffed, overworked and underpaid. Abuse of a more overt kind occurs for the same reasons. In 1995 alone, legal judgments and settlements involving nursing homes amounted to tens of millions of dollars. Kincannon (2002).Though neglect is a common occurrence, good care and adequate medical attention are as well. The key to being subject to good care is research and effort before choosing such a facility (Kane, R.A., & Reinardy, J. (1999). This can be done by elders before the time comes to make a decision or by the caregiver that has to make the decision. Often a social worker is a helpful start. Health and HealthcarePhysiologically most living things decline with age. As we age we have wear and tear on our bodies which will inevitably lead to a declining immune system, hearing loss, vision loss, cognitive decline, and the list goes on and on. Most older persons have at least one chronic condition and many have multiple conditions. According to Steffen, T.M., & Nystrom, P.C. (1996), the most frequently occurring conditions per 100 elderly in 1994 were: arthritis (50), hypertension (36), heart disease (32), hearing impairments (29), cataracts (17), orthopedic impairments (16), sinusitis (15), and diabetes (10). Keefe, J., & Fancey, P. (2000) say, elders visit a physician, on average, eight times per year as compared with three visits per year of those younger than 65. They are also hospitalized three times more often, than those younger than 65 and stay approximately 50 percent longer. Although elders only account for 13 percent of the entire population, they constituted for more than one third of all hospital stays and nearly half the days of care in hospitals in 1993.Other health problems arise in the elderly that aren’t fatal themselves but can turn out to be fatal because they interrupt everyday activities. One such impairment is poor vision. According to Chop, C.W., & Robnett, H.R.(1999), about one-fifth of people aged 70 years and over have visual impairments. Visual impairment is an important cause of activity limitation and disability and puts older Americans at greater risk of falls and other injuries.FinancesThe significance of financial security into the later years cannot be overstated. Most of the elders of today lived through the Great Depression and have been saving ever since. So, it is no surprise that the very mention of reducing Social Security or Medicare benefits will make them very jumpy. Most healthcare dollars are spent toward the end of one’s life. The elderly spend more on long-term care than on any other type of health care. Most elders, however, cannot afford those overwhelming costs on their own. According to Eshelman, P., Evans, G.W., & Kantrowitz, E. (2002), over the lifetime of today’s eighty year old, he/she has saved about $20,000 for retirement. The average cost of nursing home care in 1997 was $41,000 per year and increasing steadily as the demand to live in a nursing home heightens. He/she is therefore, unable to afford the care he/she needs after six months and will be forced to rely on Medicare. To qualify, he/she must spend down her assets so they total no more than $2,000 Eshelman, P., Evans, G.W., & Kantrowitz, E. (2002).A recent study done by Chop, C.W., & Robnett, H.R. (1999) state that, more than 2,000 households found that 57 percent of pre-retirees expected their spending to drop in retirement, 36 percent saw it holding steady, and 8 percent predicted spending more. Meanwhile, only 31 percent of retired households were spending less, spending was unchanged for 47 percent, and 22 percent were spending more. The study also found that retirees who devoted a lot of time before retirement to crafting a financial strategy came closest to predicting their retirement spending. Researchers in the study Kincannon (2002) found that, two out of every three nursing home residents rely on Medicaid and those Americans age 85 and older are the heaviest users of long-term health care services. Only one in four Americans can afford private nursing home care for one year. The average stay in 1995 for a nursing home resident was 2.3 years. It has been predicted that by 2007, the demand for nursing home beds will exceed the supply. Today the average eight out of ten beds in certified nursing homes in America are occupied.
METHODParticipantsParticipants were chosen from a variety of sources in different age groups. Those age groups were in the range of 20-39, 40-59, 60-79, and 80-100. MaterialsFor our research we have developed our own scale to be used. The scale consists of 14 questions to be answered in terms of degrees of feeling and then after some questions the participants were asked to elaborate on their feelings of the subject at hand. (See Appendix A) This scale was massed on paper and needed a writing utensil to complete. ProcedureTo collect the data each person in our group handed out questionnaires. Each participant was asked to fill out the survey to the best of their knowledge. For those participants who were incapable of filling out the survey on their own, we assisted.
RESULTSWe computed a one-way ANOVA comparing the difference among perceptions of nursing homes between different age groups. A significant difference was found among the four different age groups F (3,90)= 2.711, p=.05. This analysis revealed that the youngest age group showed the least amount of interest in the perceptions on nursing homes.
DISCUSSIONThe purpose of this study was to examine the perceptions of nursing homes among four age groups, 20-39, 40-59, 60-79, and 80 on. The hypothesis was that the middle age groups 40-59 would have more negative perceptions toward nursing homes. This hypothesis was proven wrong. In fact, it showed that the young age group 20-39 had more negative perceptions of nursing homes.Improvements to this research might be a more detailed survey. For example, questions one and three were omitted, in future investigations these questions could be better refined and easier to comprehend for each participant. (See Appendix B) The age groups did not have equal amounts of participants in each group. If repeated, further action should be taken to have a more balanced amount of participants in each age group. This would improve research in defining different perceptions among the different generations. To further our research we could focus on why the younger generations have a more negative perception of nursing homes. We could compare the perception that elderly have at their current age to what their perceptions were at a younger age, determining the perceptions are of nursing homes through the years. We could also explore different perceptions of aging rather than just nursing homes, such as: financial situations as one ages, different aspects of death and dying as a person ages and social aspects as one ages.
REFERENCESArensman, E., Kraaij, V., & Spinhoven, P. (2002). Negative life events and depression in elderly persons: A meta-analysis, Journal of Gerontology, 57B.Assumpta, A., & Hugh, F. (2000). Family and staff perceptions of the role of families in nursing homes. Journal of Advanced Nursing, 32.Becker, B.W. (2000). Factors influencing the recommendation of nursing homes. Marketing Health Services, 20.Bender, D.L., & Leone, B. (1990). The elderly opposing viewpoints. San Diego, CA: Greenhaven Press.Brunk, D. (1998). Why people hate long term care. Contemporary Long-term Care, 21.Chop, C.W., & Robnett, H.R. (1999).Gerontology for the health care professional. F.A. Davis Company, Philadelphia, 59-62.Elias, R. (2001). Life in a nursing home: Perceptions and experiences, Journal of Aging Studies, 16. Eshelman, P., Evans, G.W., & Kantrowitz, E. (2002). Housing quality and psychological well-being among the elderly population. Journal of Gerontology, 57B.http://www.census.gov/population/www/socdemo/age/ppl-147.htmlhttp://www.nurseweek.com/industrypulse/nursinghome.htmlKaddar, J.M., & Antioch U/New England Graduate School. (2001). Living in a nursing home: Residents’ perceptions and coping with their lives. Dissertation Abstracts International: Section B: The Sciences and Engineering, 61.Kane, R.A., &Reinardy, J. (1999). Choosing an adult foster home or a nursing home: Residents’ perceptions about decision making and control, Social Work, 44.Keefe, J., & Fancey, P. (2000). The care continues: Responsibility for elderly relatives before and after admission to a long term care facility. Family Relations, 49, 235.Kincannon, C.L. (2002). U.S. census bureau current population reports, The Older Foreign-Born Population in the United States, 31.Krause, A.M., & Grant, L.D. (1999). Sources of stress reported by daughters of nursing home residents. Journal of Aging Studies, 13, 349-364.Schacke, C., & Zank, S. (2002). Evaluation geriatric day care units: Effects on patients and caregivers, Journal of Gerontology, 57B.Schulz, R., Martire, L.M., Beach, S.R., & Scheier, M.F.(2000). Depression and mortality in the elderly. Current Directions in Psychological Science, 9, 204-207.Steffen, T.M., & Nystrom, P.C. (1996). Satisfaction with nursing homes. Journal of Health Care Marketing, 16.
APPENDIX AResidential Care Facilities are seen in a variety of ways. Because skilled labor is often expensive, unskilled labor is hired to care for residents and then paid an unfair wage for the work that’s involved. Therefore, due to cost, many families find themselves placing loved ones in a cheaper facility to be able to pay for the costs of living for their loved one. There are many facilities, however, that hire adequate and skilled laborers to care for their residents, and families end up paying through the roof to these facilities for the care their loved one deserves. There is a world of information about the costs and care of such facilities and our paper didn’t even chip the iceberg. We hope, however, it gives an idea of how hard it is and how important it is to do research on long-term care facilities and to plan for sufficient funds to live in them. On each survey, participants were asked to explain or describe their thoughts of nursing facilities. About half of the participants did so. There was little said in praise of such facilities and much said in disappointment. Many of our participants spoke about staff. As mentioned before, labor is not cheap. However, skilled labor is quadruple what unskilled labor is. Participants mentioned how they believed many facilities are understaffed, underpaid and not educated on the needs of the aging. This is very true in a lot of facilities. Staffing has become a problem simply due to the fact that not enough people are interested in the field and also because they aren’t getting paid enough for what they do. This is a problem and it leads to poor nutrition, poor hygiene, and not enough attention focused on the care of its residents. Staff seemed to scare our participants the most. For most of us, it is scary to think that your family won’t be caring for us; it’s even scarier that a stranger whom isn’t a loved one will care for us. Abuse and neglect are problems but can be fixed by education on how to care for an elder properly and increased wage. This concept is actually being addressed today in seminars for nursing facilities across the country and assumed to become standard procedure in the future. Many of our participants also commented that if they were to enter such a facility it would be due to the fact they were sick. Often caregivers find that it is too stressful to care for an elder who can’t care for themselves. The alternative is 24 hour care in a facility. Our participants felt that this round the clock care was impersonal, humiliating, and institutionalized. Once again this can be true; however, too often one poor facility gives all facilities a bad name. Times are changing and the overwhelming need for better care and more personal, private care is evolving due to baby boomers. It seems unfair that this phenomenon would be our only hope for change, but it is and change is around the corner.Our participants had views from personal, first hand experiences. We acknowledge that long-term care facilities have a history of stereotypes and overlooked truths. We are confident, however, that the overwhelming need to see change will persevere by new generations of staff eager to see better care and the overwhelming amount of the aging population demanding and fighting for a better round the clock care and life behind the walls of such facilities.
APPENDIX BThis survey is about your perception and awareness of aging. Please read each question carefully and then circle the answer that best describes your feelings. If you have any questions or concerns you can contact Dr. Brian Cronk at 271-4444. We thank you for your participation.
Sex: Male:______ Female:_______ Age:_______
1. Have you ever been inside a long-term care facility (nursing home)? No _______ Yes _______Describe you experience:
1a. Would you consider your experience a pleasant one?Not pleasant 1 2 3 4 5 6 7 Very Pleasant
2. When thinking of the phrase “long-term facility” does it scare you?No _______ Yes _______
3. Do you (did you) know anyone who lives in a long-term care facility (nursing home)?No ______ Yes ______
3a. If so, how frequently do (did) you visit them? Never 1 2 3 4 5 6 7 Frequently
4. Do you feel that residents are adequately taken care of in their environment? Disagree 1 2 3 4 5 6 7 AgreeWhy or why not:
5. When thinking of your future, do you think you will live in a long-term facility?Disagree 1 2 3 4 5 6 7 AgreeWhy or why not:
6. If you think that you will live in such a facility, do you feel it will be your decision or caregivers? Mine 1 2 3 4 5 6 7 Caregiver
7. If you think your will make the decision to live in such a facility, will you do research on what facitlity you would like to live in prior to doing so?No ______ Yes _______Why or why not:
8. Do you feel nursing homes are too expensive?Disagree 1 2 3 4 5 6 7 Agree
9. Do you think you will have sufficient money as you age?No ______ Yes _______
10. Do you feel nursing homes are a place to go to die?Disagree 1 2 3 4 5 6 7 Agree
11. Do you feel nursing homes have adequate staff members? Disagree 1 2 3 4 5 6 7 Agree
12. Do you feel nursing homes dietary plan is sufficient? Disagree 1 2 3 4 5 6 7 Agree
Here is space for you to write any feelings or comments you may have about nursing homes: