WASHINGTON (AP) -- Two senators hope to combat abuse against the elderly with a bill that would better train workers to detect abused senior citizens and require FBI criminal background checks of nursing home aides.
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February 11, 2003
By Mary Pickett, M.D.
Harvard Medical School
How does this article relate to me?
Beginning in 2000, U.S. senators participated in an 18-month review of the 17,000 nursing homes that care for our elderly. One year ago, that congressional investigation ended with the release of a disturbing report by the Senate Special Committee on Aging. The report described criminal activity and violence in some elderly care centers, noting that police were rarely notified when a nursing home resident was sexually or physically abused. It strongly underscored the vulnerability of older Americans. Now, some members of this Senate committee have proposed legislation that might begin to address the problem. This legislation would utilize awareness training and employment screenings to decrease abuse in nursing homes. It is estimated that one out of 20 people who are ages 75 to 84 live in nursing homes, and so do nearly one out of five people who are 85 or older. If you are responsible for an older dependent adult, the findings that led to this legislation are sure to be troubling. Careful selection of a care facility is one way that you can help to ensure your loved one’s safety.
What changes do I need to make?
If you need to select a facility that will become home for yourself, a relative, or friend, collect information carefully. The U.S. Department of Health and Human Services provides a checklist that can help you to judge the quality of nursing homes. Be aware that there are many living options for older or dependent adults:
- Home — Sixty seven percent of older adults who are not in nursing homes live in a family setting.
- Retirement facility — If an older adult can live independently and has significant savings or financial help this may be an appealing option. Retirement facilities resemble apartment complexes and they offer social programs or recreational facilities. Caregivers and nurses are not provided. If a resident of a retirement facility becomes less independent, a different living situation may be necessary. Health insurance will not pay retirement facility fees.
- Continuing Care Retirement Community (CCRC) — These campus-like retirement communities are expensive, but they permit older adults to remain at the same living facility even if they become progressively dependent. Services include recreational activities for active elderly people and 24-hour skilled nursing or rehabilitation services for the frail elderly, promoting the idea that it is most comfortable to "age in place."
- Assisted Living Facility (ALF) or Residential Care Facility (RCF) —These facilities provide meals in a shared dining area but they have private or semi-private apartments for living space. They provide assistance with medications or some personal care needs (such as bathing or transportation) but they do not provide 24-hour nursing care.
- Adult foster home (AFH) — A caregiver and his or her family may open their private single-family house as a foster home. Foster homes can provide supervision and care for a maximum of five elderly residents. A board and care fee is charged and may be covered by insurance.
- Intermediate Care Nursing Facility (ICF) — This is a nursing home that provides around-the-clock care to people with substantial personal care needs. Many areas of "skilled" nursing are not included, such as wound care, medication monitoring, or catheter care. Physical therapy is not usually available on site.
- Skilled Nursing Facility (SNF) — This is a nursing home where "skilled" nursing care is available 24 hours of the day. Examples of services provided include physical therapy, speech or occupational therapy, wound care, catheter care, tube feedings, education, and medication monitoring.
What can I expect in the future?
In 2001, the U.S. government spent $58.4 billion on nursing homes, by way of Medicare and Medicaid payments for eligible individuals. It is no wonder that Congress has shown an interest in the quality of care that is received at these care centers. The 18-month congressional investigation cited nearly 26 percent of nursing homes because they lacked systems to effectively prevent and report abuse, even though a much smaller percentage of centers had evidence of actual harm to residents. The legislation that is now being proposed may be the beginning of a lengthy reform process to raise the standards of care for our elderly. If you have relatives or friends who are living in nursing homes, concerns about their treatment are among many reasons that you should continue to visit them often.
Related Areas:
Senior's Health
