There may be a multitude of reasons why a family might not want to see one of its eldest members placed in a nursing home. First of all, even before we get to other people’s wishes, individuals who stand to become long-term residents may simply not want to live in such a facility, although part of this may be an overestimation of their ability to live alone and take care of themselves.

When the views of the rest of the clan are considered, then, they may serve to echo the concerns of those whose location hangs in the balance. Then again, a family’s objections to life in a nursing home may be more practical in nature. A prime example is that when it comes to care of loved ones within a nursing home, cost is a serious issue. Below are some notes on nursing home costs that may quickly add up for families of residents:

In terms of the average overall nursing home cost, this news may hit hard straight upfront. Without any benefits, nursing home costs in a majority of states easily total over $50,000 per year, and in some cases, they can approach or exceed $100,000 annually. These kinds of numbers put most student loan tallies to shame, so to speak, so for those families who already are sweating the need to finance a child’s college education, the overall nursing home cost may be far too high.

Of course, several factors influence how wide the range of nursing home costs may be and just how affordable or out of reach they might be. Location, as alluded to earlier, may make a substantial difference. For instance, yearly costs in the sparsely-populated state of Wyoming tend to add up to a number between $50,000 and $60,000, whereas the average price tag for nursing facility care in New Jersey—a densely-populated state in the New York tri-state area—is near $100,000. Facility size and specialty services may also profoundly elevate monthly fees.

It is hard to separate one nursing home cost from the rest of the pack in assessing fees. Some factors in the tens and hundreds of thousands of dollars potentially on the bill are likely to loom larger than others. Certainly, the costs of room and board and the monies which contribute to the hourly wages of nurses, nursing assistants and other staff members are significant aspects of the overall cost.

That said, some nursing home costs may take people by surprise unless they create a budget or provide those services independently. For instance, many facilities will charge for the use of a private telephone line in one’s room, and haircuts, even if administered only once a month, are still apt to be over $100 or $150 per year. 

To assist families in meeting the expenses behind care of their loved ones in skilled nursing facilities, Medicare and Medicaid, among other benefits, can be used to defray some of the overall nursing home cost that these people face. Nonetheless, it should be noted that these Social Security program benefits will usually only cover a portion of the numerous nursing home costs that stand to be incurred, and for a limited amount of time at that – meaning most of the price will need to be compensated out of pocket.

In need-based cases, people who are almost totally reliant on public assistance may be able to find a room in a facility, but these opportunities are few and far between, as most beds will be reserved for paying customers. 

Within the health care field, the demand is ever-present for jobs to meet the growing needs of people who require serious medical treatment and protection in the event something bad were to happen. Noting the oft-cited projection that the health care needs of seniors will expand rapidly in decades to come, positions surrounding the preservation of well-being of aging adults will be of much more interest for job seekers with a genuine desire to work with and serve the elderly.

In particular, nursing home jobs will be in high demand. Some people may not think they have a place on a nursing home staff, especially if they are not a nurse. However, being a nurse is only one of a number of vital nursing home jobs that must be taken care of in the course of a day’s work. The following are some considerations of the kinds of people that may populate a nursing home staff: 

Though one does not have to be a nurse to serve on a nursing home staff, in a nursing home, obviously, nurses are going to be of paramount importance. As opposed to hospitals, where doctors and a chief of medicine are the major heads of affairs, nursing homes are directed by nurses and helmed specifically by an administrator and director of nursing. 

Doctors of all specialties, dentists, and pharmacists may consult with the nursing staff, but in terms of nursing home jobs, these professions are not usually lumped into the same category, as they only come into the facility from time to time, or perhaps not at all, or communicate solely by phone and fax.

Concerning actual nurses, one may either be a registered nurse (RN) or a licensed practical nurse (LPN). That said, certified nursing assistants (CNAs), though not nurses, work closely with them to address all everyday concerns of residents, such as aid in walking, dressing, showering and using the bathroom, and eating.

Other nursing home jobs are not for nurses, nursing assistants and orderlies, but nonetheless have a high degree of medical relevance. While not every long-term patient/resident may receive their services, therapists are a particularly valuable subset of any nursing home staff.

Certainly, for those who seek rehabilitation and a return ticket home, so to speak, after suffering an injury or other medical condition the expertise of physical, speech, occupational and other therapists will be essential for full recovery. We would be remiss, however, if we did not consider the role of social workers and psychologists in the care of older people.

Often, separation from one’s home or family and the inability to walk, see or do many things as one could do when he or she was younger can lead to frustration and deep depression. Accordingly, the aforementioned mental health professionals/counselors may intervene to try to get residents to apply certain coping strategies and rise above their hardships.

Still, some nursing home jobs necessitate no experience whatsoever in the medical realm. Commensurate with the range of services that nursing home care offers, workers must be on hand to man each of these responsibilities.

For instance, a dietary staff must be on hand to apportion snacks and meals tailored to residents’ needs, as well as a dietitian to spell out these dietary requirements. Members of the nursing home staff must also be designated to lead the recreation program assigned by the activities director; these individuals are most commonly known as activities assistants or activities aides.

Even the general upkeep of the building must fall on someone’s shoulders. Imaginably, that task is tackled by the maintenance and housekeeping departments.

While nursing homes may offer some services universally to residents relating to their basic needs, each of these residents has his or her own eccentricities and idiosyncracies. Therefore, no one set treatment program or routine is going to be successful for all parties.

Besides, not only is providing care to people with an omnibus regimen medically unsound, but it is decidedly illegal at that. State and federal health services are supremely invested in the welfare of the nation’s older adult population, and accordingly, demand that skilled nursing facilities get to know their customers in terms of their physical and mental health and everything in between.

As far as nursing staffs are concerned, in practical terms, this involves creation of detailed nursing care plans, also known as care plans for short. The following are some specifics regarding nursing care plans:

As with the formation of any plans, the creation of care plans requires serious forethought lest their implementation goes for naught, working to the actual detriment of the residents for whom they are designed. With this in mind, the first step of the process should be a thorough assessment of the patient in question.

This profile should represent the sum of the attributes with which the staff’s professionals should be most concerned, among them mobility, need for rehabilitation and outward appearance.

Of course, when possible, residents should be allowed to speak on their own behalf and provide information as they can. However, depending one’s mental state or inability to speak as an aftereffect of stroke, consulting directly with the individual may yield staff members dubious facts, or may be downright impossible. Thus, in conducting assessments prior to forming nursing care plans, nurses should be vigilant for areas of concern that otherwise will go unspoken. 

In particular, one of these worries that may constitute a major thrust of many care plans is the need for good nutrition and diet management. Though it may not seem like a grave issue at first, the disruption of one’s normal dietary habits may have its cumulative effects. Consistent refusal to eat or supplanting healthier meals with snacks of little nutritional value can be dangerous in a number of ways.

If the resident errs on the side of over consumption, complications can arise in the form of weight gain that can put undue stress on the body and diabetic symptoms. Conversely, too little food and liquid can lead to malnutrition and dehydration. As weight and bodily conditions may fluctuate rather easily in human beings, nursing care plans may need to be revisited often to reflect the most up-to-date status of residents.

Obviously, care plans should be designed as safeguards for residents, especially when they are physically unable to be self-sufficient in their movements and/or mentally unaware enough that they do not understand the risks behind their behavior.

For example, if a resident consistently attempts to get up and walk home with the belief that she has to get home and help her mother set the dinner table, she may need to be confined to a wheelchair with restraints or some other preventive apparatus.

Certainly, though, this is an extreme case. When not warranted, nursing care plans may not restrict the willful, autonomous actions of residents, even if safety is a concern. Imaginably, these issues must be addressed on a case-by-case basis, but even in the twilight of one’s life, the American concept of freedom is yet an unalienable right.    

Some people might choose to place their spouses, parents or grandparents in nursing home facilities because they are physically unable to care for them, whether this be because they themselves are old or enfeebled, or they logistically do not have the time to manage their own careers and lives, and take care of a sick, dependent human being on top of that. Meanwhile, some families will opt for placement in these facilities because of the nursing home services they provide.

Indeed, while some may object to nursing home facilities at large, those same people may be hard-pressed to deny the convenience of having so many treatments available in one central place. For this primary reason, what nursing home services lack in terms of being an ideal situation, they make up for at least in part by being effective with the right staff to implement them. Some notes about the different services rendered in nursing home facilities:

Of course, as these centers are known as “homes”, some of the most important nursing home services provided on a universal basis are those that residents would expect to enjoy on a normal basis. These basic provisions include food and drink, private rooms with television, and showers/baths with assistance as needed.

More than just offering tangible resources, though, community-oriented nursing home facilities make an effort to foster a spirit of family and togetherness within their walls. Nursing home services in this regard include religious services, entertainment and recreation programs, and volunteer visits run by staff and members of the community. 

At the same time, though, nursing home facilities are more than just glorified “senior centers.” On the contrary, as an alternative to life in a hospital bed, they must still provide some semblance of care that patients would expect to receive if they were admitted to a hospital. Nursing homes have professionals on staff, for example, who can handle administration of medications, transfusions and emergency rescue techniques (e.g. the Heimlich maneuver, cardiopulmonary resuscitation).

In all, these nursing home services are designed to be tailored to the needs of the individual resident. For example, people with diabetes must be afforded a modified diet as per their physical needs, and accommodation must always be made for those with some sort of disability or impairment.

Nursing home facilities generally exist for the purpose and benefit of long-term residents. Some centers, meanwhile, do not only try to provide a caring permanent home for the customers within, but devote a certain percentage of their energies to the convalescence of people there for rehabilitation.

Some nursing home services that depend on the capabilities of these facilities that are fairly common include various types of therapy, among them physical therapy in case of a broken limb/precipitating accident, speech therapy in the event of a stroke or fall, and occupational therapy (i.e. therapy designed to get people back to working form or normal upkeep). 

“Nursing home” is by far the most popular name for a long-term residential health care facility, but whether formally or informally, there are other phrases which can be used more or less interchangeably. For instance, in somewhat of a pejorative sense, people might refer to one of these establishments as an “old folks home.” A more acceptable term, though, and one is that is more respectful of both the people who reside there and the professionals who work within is that of a “skilled nursing facility”.

Depending on the context and the descriptor, skilled nursing facilities can be the same exact thing as nursing homes. As defined by others, however, a skilled nursing facility observes certain minimum eligibility requirements, meaning that not all nursing homes are skilled nursing facilities. Some notes on the malleability of the term:

Though it would seem as if a primary determinant of a skilled nursing facility would be that of a specific skill practiced by the nursing staff, the type of financial assistance a nursing home receives may also go a long way in helping define it. The foremost sources of aid received by skilled nursing facilities and their patients are Medicaid.

When a nursing home is billed expressly as a “skilled nursing facility,” certain basic standards must be adhered to. Skilled nursing facilities, for example, must have a licensed practical nurse (LPN) on the premises or each residential floor in case of multiple-story centers at all times, and a registered nurse (RN) in the area at least eight hours (i.e. one shift) of the day.

The most numerous of any kind of employee on the staff, though, more so than even nurses, is that of certified nursing assistants (CNAs), as they must handle some of the most menial tasks in a nursing home setting as per their job. As a matter of fact, CNAs may outnumber licensed nurses by more than two to one at any given time (although realistically, both positions have a tendency to be understaffed).

One of the most critical things for a skilled nursing facility to satisfy to survive is regularly passing state and federal requirements. All skilled nursing facilities are regulated on a statewide basis by the departments of health and human services in each district, and receive visits every so often whereby an extensive review of the facility is conducted by departmental agents.

Potentially, any nursing homes that fail certain elements of the assessment may receive consequences such as fines and, at the worst case scenario, termination and/or criminal charges. Meanwhile, concerning federal standards, failing on their specified counts may hurt facilities in earning Medicare, Medicaid and other benefits in the future.

One of the true cruelties of old age is what disease and simply the passage of time may do to work against the mind. What some people may regard as senility or being “a little confused” may in fact be symptomatic of a serious underlying problem that, as the days, weeks, months and years go by, will only get worse, to the point beloved family members may be a proverbial shell of their former selves, or their personality may change radically from what people once knew of them.

Such is the tragedy of Alzheimer’s and dementia. These two conditions are similar and are often concurrent in nursing home residents, but with all due respect, they are their own separate concerns. Still, noting their confluence, “Alzheimer’s facilities” must cater to them both. Therefore, whether or not a facility is designed expressly to treat Alzheimer’s disease or simply specializes in Alzheimer’s and dementia services, nursing home staff (and not just nurses, at that) should be able to identify the signs of these conditions in residents.

The following are some considerations on what accommodations Alzheimer’s facilities must make in providing care to the elderly: 

First and foremost, if Alzheimer’s and dementia are to be handled properly within Alzheimer’s facilities, they must be understood and differentiated by the very people that staff these centers. To restate, Alzheimer’s and dementia are not exactly one in the same. For the sake of analogy, much in the way all squares are rectangles but not all rectangles are squares in the field of mathematics, Alzheimer’s disease is a form of dementia, but not all dementia patients suffer from Alzheimer’s disease, though a majority of dementia cases are related to Alzheimer’s.

Dementia is a class of disorders that are marked by impingement on normal functioning, with common symptoms including lack of judgment, lack of bodily control, memory loss, and a warped sense of time and location. Alzheimer’s disease, meanwhile, often tends to be understood in terms of its physical structure. Deficiencies attributable to Alzheimer’s can in turn be related to the appearances of what are known as “plaques and tangles” in the brain, believed by some to disrupt neural communications and blocking attempts of dying neural cells to survive. 

In terms of how Alzheimer’s facilities and general geriatric care facilities treat Alzheimer’s and dementia, the unfortunate news is that beyond damage control, so to speak, there is not much at present that can be done to treat these health issues. Although this is not to say that there are absolutely no treatments to be had to combat dementia and Alzheimer’s disease, to date, no cure has been developed to stop either of them in their tracks or reverse the damage they have wrought. 

Accordingly, most medications developed by researchers and used by Alzheimer’s facilities are designed to either slow the progression of these conditions and/or are experimental in nature.  

Aside from drugs, nursing home staff, family members and friends of Alzheimer’s and dementia patients should strive to interact with them in a way which respects the idea that, while these individuals may not make literal sense in many cases and may seem wildly different from how they once were, they are still deserving of decent, humane treatment. 

Above all else, people should be sympathetic and patients with those who suffer from dementia and Alzheimer’s disease, allowing them time to express themselves and creating an environment that puts as little pressure on them to “behave normally” as possible.

If these individuals begin to become agitated because they do not understand their immediate environment as a byproduct of dementia, professionals and other observers to reorient them to the exact nature of their surroundings, without saying or doing anything else to upset them. Intentionally “riling up” patients or belittling them for their struggles is not only counterproductive, but realistically constitutes mental and emotional abuse.

While some nursing home workers may bemoan the looming periodic visits by state surveyors to their facilities, in the defense of state health departments, the need to uphold nursing home regulations in the interest of the safety and security of residents across the United States is of paramount importance. To date, standards are fairly strict when it comes to long-term, out-of-home care.

As it may be expected, though, this was not always the case. Much in the way Dorothea Dix and other activists were forced to advocate for the rights of patients in “mental asylums”, medical organizations and concerned community members also had to put in their hard work to effect nursing home reform. Thankfully, the resonance of their achievements is still felt today. The Nursing Home Reform Act of 1987 is a landmark piece of legislation as far as the quality of care in nursing facilities goes. The following are considerations of what the Act did for nursing home regulations:

In terms of the origins of the Nursing Home Reform Act, its biggest precursor lay in a report filed and published by the Institute of Medicine (IOM), a non-partisan, non-governmental agency affiliated with the National Academy of Sciences that advises policymakers on recommended courses of action based on its research.

In 1986, the IOM found that nursing home regulations nationwide were either not enforced or severely lacking, with rates of abuse and neglect rampant, and proposed major changes to standards of institutionalized care. The Nursing Home Reform Act, consequently, was Congress’ assimilation of these suggestions, and went into effect in 1987 with the passage of the Omnibus Budget Reconciliation Act of the same year.

As for the main mission of the Act, its broad goal is to ensure the welfare of nursing home residents in the “highest practicable” way possible, covering all elements of their health. This applies not only to their physical well-being and their feelings of being protected without being restricted, but also their being of sound mind, psychological well-adjustment and their emotional stability.

As part of this outlook, the Nursing Home Reform Act was instrumental in getting nursing home directors and administrators to include and uphold a Patient Bill of Rights in their facility. True, in effect these standards have a moral tint to them and are oriented more towards the individual than legally binding nursing home regulations, but just the same, these are an actionable set of guidelines.

In addition, the Nursing Home Reform Act is responsible for the greater insistence on the visits by state and federal surveyors alluded to above. It would be some time after the initial enactment of the Act before an overhaul of the survey process was realized, but in due time, the level of accountability for both surveyors and the surveyed grew to approximate the accountability of the modern day.

As for today’s standards of review, unannounced visits are to be conducted at least once every 15 months, and scrutinize the enforcement of nursing home regulations in the areas of adherence to the Bill of Rights, attention to the livelihood and proper treatment of residents, and the quality of services provided. To boot, the Nursing Home Reform Act outlines how remedies for failure to meet coded standards may be assessed.

In a company, the rights of different parties have to be considered and reconciled with another for business to run smoothly. Often, when rights issues manifest themselves, it is parties with lesser quantities of power that call attention to the abrogation of their liberties. Within the infrastructure of the organization, this may be, for example, a lower-level employee such as a secretary who accuses her male supervisor of sexual harassment.

Meanwhile, customers/clients, too, may feel disenfranchised after what they deem to be unfair treatment, and a lawsuit may not be far off in this instance either. In the context of health care, specifically long-term residential care, obviously, the “customers” are nursing home residents and their families, and as with the patient rights outlined at every turn in hospitals, there are “patient rights” (technically, the term employed by gerontologists is “resident rights,” but noting the common lineage, the phrases are more or less interchangeable) that are stipulated as sacrosanct by the letter of the law. Some notes on the rights of nursing home residents: 

There is no one right enjoyed by nursing home residents that is absolutely central to a discussion of patient rights as a whole. All told, there are quite a few unalienable protections designed to be afforded to older adults living in a facility. All the same, some rights of nursing home residents that federal guidelines must continue to try to uphold stick out in light of larger societal problems with the applicabilities of these freedoms.

One such entry on the laundry list of patient rights that is of great interest to civil liberties advocates is the right to privacy.  Within reason, residents have the right to keep themselves, their property and their affairs out of the public purview when desired, especially when this concerns sensitive medical information, as per the 

Another class of rights that must be kept open to nursing home residents except in cases when they lack the capacity is that of the freedom to make decisions for themselves. Most critically, patient rights allow for residents to know what a given treatment entails and to refuse this medical course of action in the event they disagree with it.

Facility inhabitants should likewise be permitted to manage their personal finances as they see fit, and to leave the nursing home or transfer out of the facility as the situation warrants. Nursing home residents are not required to leave the contents of their accounts with nursing home officials nor can they be forced to stay against their will and that of their families. 

Yet additional patient rights speak to the abstract concepts of community and democracy. For one, nursing home residents should be granted the opportunity to air grievances in a public forum such as a residents’ council, or more privately with an ombudsman, social worker, or other concerned professional. When appropriate, residents should be given free rein as to whom they may consort with, being invited regularly to recreational activities and receiving regular visits from their family and friends as well as those of other patients.

In some instances, violation of a resident’s rights will be inadvertent or relatively minor, so that some clemency may be shown to the offending party. Unfortunately, this is a best-case scenario when it comes to these matters.

Employment in a skilled nursing facility implies that one will be respectful of the population he or she serves and be sympathetic to their situations and needs, but the sad reality is some people will use the residents as a means to their own end or an outlet for their own unresolved issues. As such, nursing home abuse is a serious concern for older adults within these places, their families and the administration/ownership.

Imaginably, abuse in nursing homes, as a violation of Elder Law, is also something prohibited by state and federal regulations. Some notes on what may constitute nursing home abuse: 

Some forms of abuse in nursing homes may be more familiar to the reader because they are generalizable to all walks of life, not just care in these facilities. Certainly, there is precedence for physical abuse in nursing homes. One reason for this is the need to balance patients’ wishes with the goal of efficient operation of a facility.

For example, whether thinking rationally or not, some residents may refuse to comply with their treatment as specified, but this does not give staff members authority to use excessive force and/or violence to make residents bend to their will.

Along similar lines, emotional abuse is another form of nursing home abuse to be guarded against, as some staff members, if not using physical pressure to get their way, will use intimidation and verbal threats to compel residents to a desired course of action. In addition, sexual abuse of geriatric residents, while not as common, is nonetheless a serious issue, and one that must immediately be addressed by supervisors upon an allegation. 

Other manifestations of abuse in nursing homes may not be as familiar or apparent to the average person (or even facility employees, for that matter), but all the same are very real and carry just as much weight as the aforementioned instances of nursing home abuse.

One notable kind of abuse in nursing homes that is doubly problematic because it involves a violation of a resident’s trust is general exploitation at the individual’s expense. In some cases, this may be simple theft of a resident’s money and possessions, but in others, a staff member may use coercion to try to divest people of their belongings and property. 

Even if it is known by a different name, neglect of a patient’s well-being, too, is a variant of nursing home abuse. Some duties within a nursing home may not be all that appealing to workers to have to satisfy, such as helping residents go to the bathroom, but just the same, they must be done. Allowing residents to sit in soiled garments/undergarments or to remain in beds so that they may develop sores are clear signs of abuse in nursing homes. 

Expectantly, abandoning residents without necessary food, water or other amenities is likewise a kind of neglect/abuse. Quality care must never be sacrificed for convenience.