Just say “No” to Nursing Homes


Originally published in the Edina Living Magazine, September 2015.

When Jonathan Rosenberg, an Edina-based elder care advisor, gets a phone call, it often goes like this: “Hi, I am calling for my (elderly) mother. She needs constant care and she’s just not safe to live by herself anymore. What’s the best nursing home for her?”

Not so fast, says Jonathan — “Most of our aging population remembers their grandparents’ generation whose sole option for old age was a nursing home. Assisted Living is still a relatively new concept, especially for those sandwich- generation folks who are just beginning to deal with their elderly parents’ decline. That’s a huge shame, because assisted living is better in almost every way and families need to know that! My mission is to educate the families about their options and to keep them out of nursing homes.”

For the overwhelming majority of seniors, even those suffering from chronic, degenerative conditions, there are better – and less expensive – alternatives, explains Jonathan. It does not matter if the condition is mild or advanced, if it is physical or cognitive in nature, if it requires 24-hour supervision, or if the individual needs help with even the most basic of activities. For seni ors today, there is simply no reason to spend their last years in a nursing home, with its institutional setting, hospital food, and all but non-existent social scene.

There are so many senior living options available now. From Independent Living communities where seniors can remain in a private apartment, enjoy meals prepared by a real chef along with daily activities and social opportunities galore; to Assisted Living facilities that provide all that plus 24-hour aides and nursing staff to assist residents with medication management, dressing, bathing, and transfers; to Memory Care, Residential Care Homes and Care Suites that take on higher care cases such as a secure setting for those with Alzheimer’s, 2-person lifts for those who can no longer walk or bear weight, insulin management for diabetics, catheters & colostomy bags, and even some types of feeding tubes. The most successful specialized environments can keep 90% of their residents through end of life and hospice, a Medicare benefit, will follow a patient anywhere he/she resides and provide supplemental care.

However, as Jonathan is quick to point out, there are exceptions.

Transitional Care Units, or simply TCU’s, are the part of a nursing home dedicated to short-term stays where a patient can recover from broken bones, infections, strokes, or other ailments. These rehab units are critical in helping seniors transition back to home or to assisted living – it is the Long-Term Care Units that you want to try and avoid.

There are also some complex cases that cannot be managed in assisted livings, such as ventilators, tracheostomies, and drip IV therapy. However, it is important to note that most seniors with health care directives don’t want to be kept alive with machines, so these highest levels of intervention may not be desired.

Of course, finances play a major role too. Medicare/Medicaid pays for a nursing home but not for Assisted Living – if the family has no funds at all, a nursing home may be the only option. However, with some thoughtful planning, families can create more positive outcomes for end of life care. For example, there are many outstanding specialized homes that accept Elderly Waiver (a state-funded care subsidy program) if the family can afford to private-pay for an initial period. Other resources such as long-term care insurance and veteran’s benefits can supplement as well.