I recently saw an article about retirement planning, describing that one should consider where nursing home care is the most affordable and think about moving there. As if it were in the category of nicest cities to retire in or best recreational opportunities. I am appalled when I see these comments. For openers, no one I’ve ever met would choose a nursing home for long-term care if any other possible option were available. If a client can afford any other arrangement, try planning for that. Consider home care, adult day services, home health agencies and whatever long term care insurance can cover. Never tell them to plan for a nursing home.
There are of course good, well-run nursing homes where long-term care is delivered competently and with skill. Unfortunately there are a lot of other nursing homes where the opposite is true. In my opinion as one who has worked in them as an aide and an RN and who has sued a few as a lawyer, I can only urge caution. They can be dangerous places.
In our society, we do not have special nursing homes for elders who were, at an earlier time in life, convicted of serious crimes. We do not have special nursing homes for those who suffer from mental illness. If the resident does not have mental symptoms serious enough to be placed in a mental hospital, particularly if skilled nursing care is needed for physical conditions, the mentally ill elderly are in the same place as your Grandma, your client or anyone else. Many people with dementia are also cared for in nursing homes. Some have separate units for dementia care but others do not. There are behavior issues with these residents that can and do affect other residents.
Nursing homes are referred to as “skilled nursing facilities” (SNFs), long-term care facilities, rehab facilities and care homes. No matter what you call them, good care can happen and danger may lurk as well in any of them.
Planning for long term care is an essential part of planning for retirement. Nearly 70% of us are going to need that care at some point. If your client needs full time 24/7 care in the future, plan for the possibility of paying for it at home. Many aspects of care, including skilled care can be delivered through licensed home health agencies. Planning for a last resort that is risky does not seem the best way to plan for one’s later years.
Here are three reasons why you should avoid telling your client to live where there are affordable nursing homes. That assumes that your client would have to accept living in one.
- Abuse from other residents
A recent study of New York nursing homes conducted over one month found that, conservatively, one in five nursing home residents are the victims of abuse by other residents. Rates of abuse were significantly higher when nurse aides have a higher numbers of residents to care for and in dementia units. Most of the abuse was verbal, but some involved hitting (11.3%) or pushing (10.3%) and a smaller percent that were sexual.
- Overuse of antipsychotic drugs
The Independent Drug Information Service reports that antipsychotic medications are often overused in older patients in nursing homes, and they increase risk of death and can cause substantial side effects.
- Risk of eviction if a client outlives her assets
An expert in the field is Pat McGinnis, Executive Director of California Advocates for Nursing Home Reform. She sees long term care residents who are out of money being tossed out of some homes in favor of residents who can pay the high cost of living there. She stated “there is an epidemic of illegal and unsafe evictions from nursing homes throughout the state and this (referring to an eviction case) is perhaps the worst case I have ever seen. Nursing homes increasingly focus on higher paying therapy residents at the expense of poorer long-term or ‘custodial’ residents. When residents threaten this profit-making model, they all too often are thrown out illegally.”
There is no question that the complexity of some medical conditions and the need for skilled nursing around the clock makes it necessary for some older folks to live in nursing homes. Every person who plans to retire and is realistically looking ahead must recognize that she may need help one day and that help might get very expensive.
Any professional discussing retirement assets, spending, budgeting and how to stretch a client’s money over many years of retirement should include the discussion about the last years and the cost of care. I am an advocate for using every conceivable alternative to nursing homes for planning purposes. Although a few are innovative and patient-centered, too many look and feel like a hospital, not a place to stay long term. Do your best planning to keep your clients at home with long-term care in place.
by Carolyn Rosenblatt, RN, Elder Law Attorney, & Dr. Mikol Davis, Gerontologist co-founders AgingInvestor.com