Jane Gross writes a poignant story in the New York Times today about the folks living in an assisted living facility. Two things stand out.
The first is the stark description is of how financing affects where the elderly live. When personal assets are gone ... and they go very quickly in assisted living, one goes to a nursing home. Period. End of discussion.
Through Gross's entire article there is not a single reference to whether there is a clinical or functional need for nursing home care. It's simply, there's no money left, Medicaid pays for nursing home care, that's where you go. All the policy wonks and public officials will tell you that's wrong. They have standards and assessments and on and on. I strongly suspect that, in the real world, it's right.
The second is a reminder that we want to spend our later years in our own home. We don't want to be sent to a nursing home. Regardless of our conditions, we don't want to be sent to any form of residential care that concentrates the elderly and the disabled.
Many alternatives exist. Fredda Vladeck and her colleagues at the United Hospital Fund in New York City have been doing lots of research on "naturally occurring retirement communities." They note that, especially in urban areas, there are lots of neighborhoods and apartment buildings that already have high concentrations of elderly. They emphasize that with supportive services, most can "age in place." This is an important insight because it allows us to concentrate staff and other resources and use them more effectively than in traditional home care models, while reinforcing the ability of the patient/client to stay at home and interact with the community of which they are a part.
I would add that, aside from being in ones own home, psychologically the primary difference between being in some form of residential care and in the community is the difference between being mixed in with people of all ages and being in a ghetto for the elderly and disabled. Who wants that?