Historically, families in the United States cared for aging loved ones in their own homes until death took them. Individual families and neighbors also cared for family members with disabilities no matter the age. Towards the end of the 1800’s, increasing patterns of urbanization, 6-day work weeks, and long working hours for all family members caused this centuries-old pattern to change.
Paid Care for the Elderly
During this transitional period, people needing care were often housed in poor houses or places for the mentally ill. In the early 1900s, visiting nurses began to visit the sick and elderly in their homes helping to stem the trend of institutionalization.
In The American Journal of Nursing, Vol II, No. 6, March, 1902, in an article detailing the “History of Visiting Nurse Work in America” (page 424), Harriet Fulmer details work being done across the various states at that time. She writes,
“For the past ten years it has been clearly shown, that the district visiting nurse work is the best means at the smallest cost of helping the conditions of the poor, sick or well. Hospitals do much good, but, after all, they offer but outside methods of education. It is by reaching the people in their own homes and teaching them to utilize and make the best of what they have that lasting good may be accomplished.”
Around the same time, nursing homes and rest-homes were being built with public donations and government funds. In 1936, Social Security came into existence, and with it a nursing home per diem stipend. That stipend and Social Security retirement income triggered the construction of nursing homes across the country.
By the end of the 1950s, people were living longer. Congress, to protect the thousands of existing nursing homes and the people housed within them, as well as avoid bankrupting Social Security, created Medicare and Medicaid as an amendment to the Social Security act.
Under Medicare, nursing homes were reimbursed solely for short-term rehabilitation. Medicaid provided for both impoverished disabled Americans and impoverished Americans over 65 years of age. Gone was the nursing home subsidy for all aging Americans.
Current Trends of Geriatric Care
The last 50 years have seen a gradual shift away from nursing home care, towards home care and community living arrangements. These arrangements provide different levels of in-home care, from independent living, to assisted living, to complete care.
Current trends of both husband and wife working long hours reflects the trends of the early 1900s. So, does this trend mean a return to outside caregivers taking over the care of a family’s elderly or disabled, allowing the elderly and some disabled to receive the care they need in their own homes or the homes of their relatives?
Estimates of the number of people using nursing facilities, alternative residential care places, or in-home care services are projected to increase from 15 million in 2000 to 27 million in 2050. The majority of this increase will reflect the aging process of populations who typically need more help as they age. Though people can need help at any age, the necessity increases with age.
Growing Elderly Population
Recent projections also indicate that over two-thirds of people over 65 will need long-term care during their lifetime and that that age group will more than double from 40.2 million in 2010 to 88.5 million in 2050.
Even more striking is the projected increase of those aged 85 and over, from 6.3 million in 2015 to 17.9 million in 2050. This would make the “oldest old” 4.5% of the total projected population of 2050.
Long-term geriatric care services include a broad range of health, personal care, and support services that meet the needs of older people as well as others whose capacity for self-care is limited due to chronic illness, injury, physical cognitive, or metal disability, or other health-related conditions.
This broad array of service includes:
- Assistance with activities of daily living (ADLs), like dressing and bathing,
- Instrumental activities of daily living (IADLs), like housework, food shopping, and medication management, and
- Health maintenance tasks, like daily exercise and proper diet.
Current statistics indicate that many people are moving towards receiving long-term care services in their home from a home agency, family and/or friends. These senior care services are often supplemented with community activities as well as special equipment and assistive devices.
Finding the Right Solution
Choosing the best solution in Nevada for yourself or a loved one requires proper planning, as well as the resources to execute your plan. With planning and resources, most people can stay in their own home.
A significant trend of the last few years for both Medicaid and Medicare has been to pay for long-term-care in the home when possible. This is good news for people who would rather live out their lives in the comfort and familiarity of their own homes.
According to recent estimates, depending on the type of provider and the services included, the amount spent annually on paid, long-term senior care services is between $210.9 billion and $306 billion. Paying for these services is a growing concern for both those who need the services, their families, as well as a major challenge facing state and federal governments.
Planning Ahead
It is wise to think about and plan for what sort of old age you want, even though most of us would prefer to think of other things. The wealthy have no problems taking care of themselves financially. The rest of us need to make preparation and provisions and develop a plan that addresses the issues of aging.
Aging happens naturally but aging well takes planning. Early planning ensures that living, medical, and financial needs continue to be met as you age.
Financial assistance for senior health care in Nevada is available but it’s best to plan since programs like Medicaid have strict rules and regulations associated with them and they may not cover enough for you to maintain a comfortable standard of living. With the help of the right geriatric care managers, you can ensure that you and your family receive the care you need in your old age.
