While researching the history of nursing homes, I came across abundant information. One source in particular evoked powerful, albeit cloudy recollections. Kenneth A. Burrow, who grew up in a “County Home” in Asheboro where his parents were the superintendents, wrote this article.  The descriptions and photos he included took me back to those Friday nights – long ago – when my mom and dad would take my four older sisters and me to the County Home located on what is now South Main Street in Graham, North Carolina, just south of Iinterstate 85. Our purpose was to visit with the residents and sing for them. I can picture a large, plain, rectangle-shaped building with a sloping gable roof, but little else about the exterior. Our family never ventured beyond the front visiting area. The floor was covered with dull, worn hardwoods. High ceilings and sparse furnishings completed the décor. A mixture of stale air, perspiration, and urine was the essence that permeated the room. I can vaguely recall the people – mostly elderly with stooped backs and longing expressions. Several were in wooden wheel chairs, and at least one reclined in a vintage geri-chair. One plump and attractive middle-aged woman swayed merrily in a faded housedress while holding on to her pocketbook for dear life. A few adults with Down syndrome (I thought they were chubby children and found it horrifying that they lived away from their parents) wanted to touch and hug me and I tried to oblige even though I found their gestures a little disconcerting. At five-years old, this world was both intriguing and upsetting; but it sparked something in my heart that I now recognize as compassion for those who were needy and lonely.

I appreciate that my parents gave my sisters and me this early opportunity to serve others. Throughout my growing-up years I continued to enjoy visiting the residents of nursing homes. In high school I “adopted” an elderly gentleman through our Christian Service Club and visited him often, taking him ice-cream cones and trimming his toenails. He died during my senior year. During all the hours I spent with him, he never had another visitor.

When our children were growing up, Randy and I introduced them to the privilege of visiting in nursing homes. One of our favorite Christmas activities was spending the afternoon celebrating with these special folk, and yes, singing to them.

After my dad passed away, I was so grateful that I had been able to care for him that I determined to become a nurse so I could take care of those who were unable to remain at home. The seven years I served as a nurse in long-term care were rewarding and illuminating. I will always be grateful that God allowed my family the privilege of caring for our parents at home. Unfortunately, not everyone has that option. Before you choose a facility, learn all you can.

Nursing homes (or long-term care facilities) provide skilled nursing services around the clock for individuals who do not require hospital treatment, but can no longer be cared for at home. Many of the residents are not acutely ill, although most suffer from various chronic illnesses (diabetes, congestive heart failure, severe arthritis with disabilities, cognitive impairment, etc.) that limit their physical or mental capacity and impede self-care. Some individuals come to the nursing home after a hospital stay for an acute event, such as a stroke. The majority have been living with family members and almost 40 percent were living alone at their home. The “typical” resident is an 85-year old Caucasian widow.

According to the National Nursing Home Survey, there are approximately 16,000 nursing homes in America. They provide about 1.7 million beds that have an occupancy rate of 86 percent or 1.5 million residents. About 4.2 percent of the 65+ population are in a nursing home at any given time. The rate of nursing home use increases with age. Almost 50 percent of those 95 and older live in nursing homes.

Many people consider placement in a nursing home the last destination before death, and research supports that idea. Fifty-three percent of residents die within six months of admission; 65 percent die within one year. However, the average length of stay is calculated at 14 months due to a small number of study participants who had very long lengths of stay, sometimes years. Presently, about 17 percent of the total population dies in nursing homes, 57 percent in hospitals, and 20 percent at home. (Statistics from Cunniff Dixon Foundation.)

Nursing homes have some similarities and vast differences. Almost 60 percent of current facilities (nationwide) are for-profit; 27 percent not-for-profit, and 7 percent government-run. Quality of care should be the most important consideration. A state-of-the-art facility may employ staff that are careless and uncaring. A less attractive home may diligently screen and monitor all staff and refuse to tolerate any unprofessional or inappropriate behavior.

According to the 2004 National Nursing Home Survey:

• More than 30% of all nursing homes experience some form of resident abuse.
• Only about 20% of abuse cases are ever reported.
• 92% of all nursing homes employ at least one convicted criminal.
• One out of four nursing homes is cited for death or serious injury to a resident.
• An average of twenty complaints per nursing home were received in 2007.
• 90% of US nursing homes have staff levels too low for adequate care.
• One nurse’s aid may care for up to 30 people (the recommendation is 1:3 during a meal and 1:6 during non-meal times).

Selecting a nursing home for your loved one will be a challenging decision; choose wisely.