Aging & Health A to Z

Nursing Homes

Basic Facts & Information

Nursing homes have changed dramatically over the past several decades. These changes have been driven by government regulations and consumer pressures. Today’s nursing homes are highly regulated, high-quality institutions for the care and treatment of older adults who have severe physical health and/or mental disabilities.

Is a Nursing Home Right for You?

Almost half of all people who live in nursing homes are 85 years or older. Relatively few residents are younger than 65 years. Most are women (72%), many of whom are without a spouse (almost 70% are widowed, divorced or never married) and with only a small group of family members and friends for support.

The Most Common Reason For Living in A Nursing Home

Some type of disability with activities of daily living (ADLs) is the most common reason that older people live in nursing homes.  Not surprisingly, people living in nursing homes generally have more disability than people living at home. About 25% of nursing-home residents need help with one or two activities of daily living (for example, walking and bathing), and 75% need help with three or more. More than half of residents have incontinence (either bowel or bladder), and more than a third have difficulty with hearing or seeing.

In addition to physical problems, mental conditions are common in nursing home residents. In fact, dementia remains the most common problem, and affects an estimated 50-70% of residents. More than three fourths of nursing-home residents have problems making daily decisions, and two thirds have problems with memory or knowing where they are from time to time.  

At least one-third of nursing home residents with dementia also have problematic behaviors. These behaviors may include verbal and physical abuse, acting inappropriately in public, resisting necessary care, and wandering. Communication problems are also common—almost half of nursing home residents have difficulty both being understood and understanding others. Depression is another condition that affects nursing home residents. Research has shown it may occur more in nursing home residents than in individuals living in the community.  

Length of Stay

Although disability is common among nursing home residents, the length of stay varies greatly. Twenty-five percent of people admitted stay only a short time (3 months or less). Many of the people who stay for a short time are admitted for rehabilitation or for terminal (ie, end-of-life) care. About half of residents spend at least 1 year in the nursing home, and 21% live there for almost 5 years. Interestingly, function often improves in many of the residents who stay for a longer time. 

Risk Factors for Admission

There are several risk factors for admission to a nursing home, including the following:

• Age. The chance of being admitted to a nursing home goes up rapidly with age. For example, about 20% of people 85 years and older live in nursing homes, compared with just 1.1% of people 65-74 years of age.
• Low income.
• Poor family support. Especially in cases where the older adult lacks a spouse or children.
• Low social activity.
• Functional or mental difficulties. 

Characteristics of Nursing Homes

Nursing homes increasingly offer medical services similar to those offered in hospitals after surgery, illness, or other sudden medical problems. Older adults need a higher level of care, and hospital stays are shorter than they used to be. Medical services vary a lot among nursing homes, but include:

• kidney dialysis
• orthopedic care (care for muscle, joint, and bone problems), breathing treatments
• support after surgery
• rehabilitation
• intravenous therapy and antibiotics
• and wound care. 

Traditionally, these services have been available only in hospitals and rehabilitation centers.

Choosing a Nursing Home

Your family doctor or other healthcare professional (such as, home health nurses and social workers) can provide recommendations for nursing homes. Older adults and/or family members should try to visit as many places as possible to get a sense of what the place is like, including the overall feeling and quality of care. Using a checklist can help you evaluate quality, the range of services, convenience, and costs. Your visit may last an hour or two so that you can meet and talk with the admissions officer, nursing home administrator, head nurse, and social worker. Remember that no nursing home is perfect, and all will likely be very different from the current living situation.

Nursing Home Checklist

• Is the nursing home clean? Are there any unpleasant smells?
• Is it well maintained?
• Do the residents look well cared for?
• Are the rooms adequate?
• What recreational and private space is available?
• Are there safety features, such as railings and grab bars?
• Is the home licensed by the state and certified by Medicaid?
• How many nurses and nursing assistants are there compared with how many residents?
• Do the administrators and medical professionals have special training in geriatrics or long-term care?
• Are key professionals full-time or part-time?
• How long have the managers and medical professionals been with the nursing home?
• What type of medical coverage is provided?
• How close is the nursing home to family members? How close is it to the nearest hospital?
• What is the food like?
• How much do basic services cost? What services are covered?
• What additional services are available? How much do they cost?
• What happens if a person runs out of money and needs medical aid?

Nursing homes may often seem scary and depressing, and moving into one can fill people with a sense of betrayal and failure. Family involvement is important in helping the older person make the transition to a new living arrangement.

Contrary to the stereotype, families do not abandon their loved ones by placing them in a nursing home. In fact, only a few nursing home residents are truly without any family. Family members are encouraged to visit residents regularly and to be involved in the total care of their older relative. Family members can offer company and help with the basic activities of daily living, and they may be better able to communicate the needs of the resident.

Updated: March 2012
Posted:  March 2012