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Financials
The cost of nursing homes can be different depending on the geographical location. There are several different ways to pay for nursing home care including medicare, Medicaid, insurance programs and personal assets. It is important to research the different types of nursing homes in order to find the most cost effective option and what the best fit for you or your loved one is.

Medicare and Medicaid
Medicare is a federal program that will provide health insurance for Americans that are 65 or older. Medicare will only cover up to 100 days of care, which is why it is a popular choice for rehabilitation facilities. The next potential option for many is medicaid. Medicaid is a program that every state administers and most nursing homes are certified with, but each may have different eligibility requirements related to income levels and any assets involved. Medicaid is normally most available after a person has exercise every other option such as using personal funds as a form of payment. If eligible medicaid can cover any therapy, room and board or meal plans.

Long-term insurance
Long-term care insurance is another potential option to help pay for nursing home care. Long-term care insurance was designed to help with the expensive out-of-pocket costs. It is recommended that one purchases long- term care insurance before they need it, which may require paying premiums for years prior. Depending on the policy, there are different ways that the insurance can be used in order to help with costs such as taking out a portion of the death benefits or choosing a life settlement.

Personal Funds
Many will start off paying for nursing home care with personal funds. These funds may include personal savings, assets or stocks. Many families will pool funds until a family member can become eligible for a public benefit program. Other common ways to help pay are reverse mortgages. Reverse mortgages involves a homeowner exchanging the equity they have acquired for cash which can then be accessed I'm a monthly payment or line of credit. This step is often viewed as more drastic which is why it is important to speak with the nursing facility first to see what type of services and care are included in the overall price.

==== Monthly Cost of Nursing Homes by State ====

Starting in the 17th century, the concept of poorhouses(also referred to as almshouses) were brought to america by English settlers. All orphans, mentally ill and the poor elderly were placed into these living commons. These poorhouses gave a place where they could be given shelter and daily meals. Poorhouses continued to exist into the early 20th century despite the criticism they faced. Much of the criticism stemmed from the conditions of the poorhouses. The Great Depression overwhelmed the poorhouses as there were a lot of people that needed help and care but not enough space and funding in the poorhouses. Due to Muck Racking in the 1930's the less than favorable living conditions of the poorhouses were exposed to the public. Poorhouses were then replaced with a different type of residential living for the elderly. These new residential living homes were called board-and-care homes or also known as convalescent homes. These board-and-care homes would provide basic levels of care and meals in a private setting for a specific fee. Board-and-care homes proved to be a success and by World War 2, the new way of nursing homes began to take shape. As the times continued to change, the government identified the issue of people spending extensive amounts of time in hospitals. To combat these long stays in short term settings, board-and-care homes began to convert into something more public and permanent that was state and federally funded. From this, by 1965 nursing homes were a solid fixture. Nursing homes were a permanent residence where the elderly and disabled(poor elderly and disabled specifically) receive any necessary medical care and receive daily meals. Though nursing homes in the beginning were not perfect, they were a huge step above almshouses and poorhouses in regards to following laws and maintaining cleanliness. From the 1950's through the 1970's the dynamics of nursing homes began changing significantly. Medicare and Medicaid began to make up much of the money that would filter through the homes and the 1965 amendment laws enforced nursing homes to comply with safety codes and required registered nurses to be on hand at all times. Later in 1987, the Nursing Reform Act was introduced to begin defining the different types of nursing home services and later added the Residents' Bill of Rights. Today nursing homes are very different across the board. Some nursing homes still resemble a hospital while others look more like a home. Some nursing home residents pay for their care out of pocket, others receive medicare for a short time and some may use long term insurance plans. Across the spectrum, most nursing homes will accept medicaid as a source of payment.

The Great Depression of the 1930s overwhelmed the almshouse system: the tidal wave of human need was too great for the patchwork system of local institutions to absorb.29 The economic dislocations of the depression also softened social attitudes towards the poor as muck racking news reports exposed the harsh conditions in the almshouses. As the depression deepened, public support grew to close the almshouses and replace old-style "indoor relief '' with new-style "outdoor relief," cash payments to people to support themselves in the community.

History[edit | edit source]
Before the Industrial Revolution, elderly care was largely in the hands of the family who would support elderly relatives who could no longer do so themselves. Charitable institutions and parish poor relief were other sources of care.

The poorhouse-workhouse[edit | edit source]
Poorhouses/workhouses first implemented in the early 17th century. The concept of poorhouses also known as almshouses were brought to America by English settlers. n England, the first government attempt a providing basic care for the mentally ill, orphaned and elderly began with the dawn of the industrial era and theNew Poor Law of 1834. Mass unemployment followed the end of the Napoleonic Wars in 1815, and the introduction of new technology to replace agricultural workers and the rise of factories in the urbanized towns, meant that the established system of poor relief was proving to be unsustainable. The New Poor Law curbed the cost of poor relief, which had been spiralling throughout the previous decades, and led to the creation of workhouses for those who were unemployed. Most workers in the workhouse were set tasks such as breaking stones, bone crushing to produce fertilizer, or picking oakum using a large metal nail known as a spike.

Although conditions in the workhouse were intended to be harsh, to act as a deterrence, in areas such as the provision of free medical care and education for children, inmates were advantaged over the general population. By the late 1840s most workhouses outside London and the larger provincial towns housed only "the incapable, elderly and sick". Responsibility for administration of the Poor Law passed to the Local Government Board in 1871, and the emphasis soon shifted from the workhouse as "a receptacle for the helpless poor" to its role in the care of the sick and elderly. By the end of the century only about 20 per cent admitted to workhouses were unemployed or destitute, but about 30 per cent of the population over 70 were in workhouses. The introduction of pensions for those aged over 70 in 1908 did not result in a reduction in the number of elderly housed in workhouses, but it did reduce the number of those on outdoor relief by 25 per cent.

Expansion and privatization[edit | edit source]
A Royal Commission of 1905 reported that workhouses were unsuited to deal with the different categories of resident they had traditionally housed, and recommended that specialised institutions for each class of pauper should be established, in which they could be treated appropriately by properly trained staff. The Local Government Act of 1929 gave local authorities the power to take over workhouse infirmaries as municipal hospitals and elderly care homes, although outside London few did so.[full citation needed] Eventide: A Scene in the Westminster Union (workhouse), 1878, by Sir Hubert von Herkomer

Although the Act formally abolished the workhouse system in 1930, many workhouses, renamed Public Assistance Institutions, continued under the control of local county councils. It was not until the National Assistance Act of 1948 that the last vestiges of the Poor Law disappeared, and with them the workhouses. Many of the buildings were converted into old folks' homes run by local authorities; slightly more than 50 per cent of local authority accommodation for the elderly was provided in former workhouses in 1960.

In Britain in the 1950s and 1960s, the quality of nursing care steadily improved, with the mandatory introduction of central heating, single rooms and en-suite lavatories. In the 1980s a significant shift from the public sector provision of elderly care to private sector homes occurred, with the proportion of private facilities increasing from just 18% in 1980 to 85% by the end of the century.

In the United States, the national social insurance program Medicare, was established by the U.S. federal government in 1965, which guaranteed access to health insurance for Americans aged 65 and older. This program prompted many new nursing homes to be set up in the following years, although private nursing homes were already being built from the 1930s as a consequence of the Great Depression and the Social Security Act of 1935.

The Growth in Nursing Homes
In the 1950’s, it was common for seniors to go to the hospital and end up staying there for long periods of time. In response to this, the government developed grants for people to build nursing homes that provided care similar to what seniors would receive in the hospital, but that were better equipped for longer stays. From the early 1950’s to the 1970’s, the number of nursing homes grew considerably in consequence, from 6,500 to 16,000.

The Slow Path to Reform
This growth in facilities where seniors could live while being cared for by medical professionals was largely an improvement over earlier options like poorhouses, but there were many abuses. Little by little, from the 1950’s through the 1970’s, different laws were passed to help improve the conditions in nursing homes. Often the laws tied requirements to funding, particularly once Medicare and Medicaid were introduced and began to make up a large amount of the money flowing into nursing homes.

The 1965 Moss Amendments forced nursing homes to comply with safety codes, keep registered nurses on staff, and provide a higher level of transparency to make fraud and abuse easier to spot. The 1987 Nursing Home Reform Act established and defined the types of services nursing homes were required to provide seniors and introduced the Residents’ Bill of Rights. Each step of the way, things became a little better for your average senior living in a nursing home.

The Age of Consumer Choice
In recent years, we’ve seen a much faster form of progress come onto the scene. The internet gives consumers more control to research almost every decision they make, and complain anytime their experiences aren’t up to par. As such, seniors have the power to make informed decisions based on the level of service nursing homes and other senior living facilities provide. Nursing homes aren’t just subject to government scrutiny now – they have to answer to every single resident living there and all their family members, any one of whom can voice their feelings on the internet.

People are definitely taking advantage of this option. There are over 76,000 reviews on this website alone. And any senior with an experience – good or bad – of a nursing home is encouraged to add their own. Seniors now have the power to help each other avoid the worst senior living choices and seek out the best. We’ve come a long way since the poorhouses.

Nursing Home Staff

Nurses

Nursing homes require that an RN (registered nurse) be present to assess the needs of the nursing home residents and to evaluate the outcome of the residents. Registered nurses have several education options. Registered nurses may earn a 2- or 3-year associate degree in nursing, a 4-year bachelor’s of science degree in nursing. Some may be eligible to complete a 12- to 18-month accelerated program for a bachelor’s of science in nursing if they have already completed a bachelors degree in another disciple. There are also programs for RN's to receive master’s degree's, which can take roughly 2-3 years. RN's are responsible to directly work with the LPN (licensed practical nurse) or in some states LVN (licensed vocational nurse) to decide upon a personalized care plan for nursing home resident. The LPN or LVN then works to implement the care plans. Licensed practical nurses complete a state approved year long program. Both registered nurses and licensed practical nurses must pass a national licensing exam before they can begin working. LPN or LVN monitors residents’ well-being and administer treatments and medications, such as dressing wounds and dispensing prescribed drugs. Licensed practical nurses also communicate with other healthcare team members regarding residents’ care.

Nursing Assistants

A certified nursing assistant’s main job is to provide basic care to patients while working directly under an LPN or LVN and sometimes possibly directly under a RN. These basic care activities can include assisting with bathing and dressing patients, helping residents with meals either serving them or sometimes with feeding, transferring to and from the bed or wheelchair, make and clean beds, assist with toileting and answer call lights. Training to become a certified nursing assistant is offered at some high schools, as well as at vocational-technical schools, community colleges, and nursing homes. These programs are typically anywhere from 3 months to one year in length depending on the program. Upon completion nursing assistants are listed on the state healthcare registry. Nursing assistants titles can range from facility to facility, the job titles include but are not limited to; nursing aides, caregivers, patient care associate and in some states patient care tech.

Administration

Depending on the size of the nursing home, a nursing home may have either a nursing home administrator or an executive director. Some nursing homes may have both but their job duties are similar and can include overseeing staff, supplying medical supplies and financial matters. The nursing home administrators/ executive directors career requires at least a bachelor's degree and some advanced positions may require a master’s degree. There are certain classes that are commonly taken in this path of study, these classes include nursing home administrative practices, aging and long term care, gerontology and aging, and health behavior. You may also find human resources employees in a nursing home. This job requires at least a bachelor’s degree and usually preferred related work experience. These employees are in charge of all aspects of hiring new employees. Human resources job duties vary but can also include coordinating payroll, organizing orientation programs for new employees, interviewing, disciplinary actions, and ensuring compliance with federal and state laws.

Housekeeping
Housekeepers are an important part of up keeping nursing homes. Housekeepers play a huge part in ensuring that nursing homes are kept clean and free of disease causing agents. Housekeepers have a long list of duties which include cleaning floors, changing linens, disinfecting bathrooms, changing towels, washing clothes, emptying garbage cans, sanitizing rooms, replenishing supplies, dusting and polishing furniture, vacuuming, and keeping windows and woodwork clean. These duties can be  different from facility to facility but will overall include basic cleaning. Housekeeping does not require any licensure or schooling, but some housekeeping jobs may prefer prior job experience.

Recreational Staff
Recreational staff are an extremely important part of life in a nursing home. Recreational staff usually include an activity director and possibly activity assistants depending on the size of the nursing home. The activity director job requires an associates degree or a bachelors degree and allows for further certifications through the National Council for Therapeutic Recreation. Activities are planned that aim to meet each residents emotional, intellectual, physical, social, spiritual, and vocational needs. The transition from being independent to having to depend on others and be away from home is often times very difficult, which is why activities are important to combat depression and anxiety. Some of the different activities that may be offered include hosting birthday parties, celebrating holidays, book clubs, musical events, outdoor activities, discussion and social groups, exercise, arts and crafts, pet therapy, religous services and community outings. Volunteer involvement is also an important part of nursing home activities as volunteers act as a link between the nursing home and the outside community.

Occupational therapy[edit | edit source]
One of the several services offered in a nursing home can be occupational therapy. Occupational therapy may be necessary following an injury or illness in order to regain skills and to receive support during any physical or cognitive changes. The overall end goal of occupational therapy is for the person to improve with performing activities of daily life. While occupational therapy will often times focus on activities of daily living such as bathing, dressing, grooming. Occupational therapy also assists with instrumental activities of daily living which include home and financial management, rest and sleep, education, work, play, leisure, and social participation. Occupational therapists work to allow the person to safely and comfortably reintegrate into society by practicing public dining, transferring to different surfaces (chairs, beds, couches etc), and will assess the need for any home modifications or safety equipment to ensure a proper and safe transition. When a cognitive and/or perceptual deficit is presented, therapists will work with the person by teaching strategies to maximize memory, sequencing and attention span length.

They also develop and implement health and wellness programs to prevent injuries, maintain function, and improve safety of residents. For example, Occupational Therapists can take a leadership role in developing and implementing programs to educate clients on compensatory techniques for low vision, customized exercise programs, or strategies to prevent falls. Occupational therapy practitioners may also consult with other staff within the facility or in the community on a variety of topics related to increasing safe engagement in activities. Occupational therapy practitioners can provide a variety of services to short- and long-term residents of a SNF. Based on a client-centered evaluation, the occupational therapist, the client, caregivers, and/or significant others develop collaborative goals to identify strengths and deficits and address barriers that hinder occupational performance in multiple areas. The intervention plan is designed to promote a client’s optimal function for transition to home, another facility, or long-term care.

Occupational therapy practitioners focus on “achieving health, wellbeing, and participation in life through engagement in occupation” (American Occupational Therapy Association, 2014, p. S4). In SNFs, they address training in self-care skills; training in the use of adaptive equipment, compensatory techniques, and environmental modifications; and behavioral and mental health issues. In addition, occupational therapy intervention in short-term SNF rehabilitation can include: • Remediating instrumental activities of daily living (IADLs) related to the patient’s discharge environment, such as preparing a meal or managing one’s home or finances • Training in functional mobility, such as how to prepare a meal while using an ambulatory device •

Preparing the client and family for community reintegration (as appropriate for the client’s discharge site) with activities such as public dining or emergency response management • Assessing the need for and recommending potential home modifications and safety equipment to reduce barriers and promote safe functioning upon discharge • Exploring adaptations and compensatory strategies for return to volunteer or paid employment • Assessing current leisure skills to determine whether modifications are needed to continue participation and/ or assisting with exploring new leisure pursuits Occupational therapy for long-term-care SNF residents can also include: •

Teaching functional mobility, including using an ambulatory device and/or transfers to different surfaces, such as a bed, chair, toilet, or shower in order to perform self-care and personal tasks; and training in wheelchair mobility and safety appropriate for the resident’s level of cognition and perception • Remediating or enhancing IADLs, such as ability to use the telephone or the emergency staff call system • Teaching residents with cognitive and perceptual deficits in compensatory techniques to maximize abilities in areas such as attention span, orientation, sequencing, and/or memory • Teaching residents with low vision how to maximize their remaining vision and enhance safety through compensatory techniques, environmental modifications, assistive technology, and adaptive equipment

Speech Language Therapy
Speech Language Therapy is another service found in a nursing home. Speech language pathologists specialize in working with those who have a difficult time with language and/or speech, usually following an injury or an underlying diagnoses. The SLP will evaluate the persons speech, trouble with speech points to an issue with coordinating the movements and muscles used to produce speech while trouble with language points to difficulty with understanding what the person is hearing and seeing. The SLP will also look at difficulty with swallowing food and will work to figure out which part of the swallowing process is not working. Some of the many speech disorders worked with by the SLP are; Phonology meaning the speech patterns used, Apraxia meaning difficulty with coordinating the movements needs to make sounds, Receptive Language meaning difficulty understanding language, Fluency meaning stuttering, Expressive Language meaning difficulty using language and many other disorders.

Speech Disorders • Articulation - the way we say our speech sounds • Phonology - the speech patterns we use • Apraxia - difficulty planning and coordinating the movements needed to make speech sounds • Fluency - stuttering • Voice - problems with the way the voice sounds, such as hoarseness Language Disorders • Receptive Language - difficulty understanding language • Expressive Language - difficulty using language • Pragmatic Language - social communication; the way we speak to each other Other Disorders • Deafness/Hearing Loss - loss of hearing; therapy includes developing lip-reading, speech, and/or alternative communication systems • Oral-Motor Disorders - weak tongue and/or lip muscles • Swallowing/Feeding Disorders - difficulty chewing and/or swallowing

Physical therapy[edit | edit source]
Another important service found in a nursing home is physical therapy. Physical therapy may be necessary following an injury, illness or surgery. Physical therapy works with the person to help them regain strength, endurance, flexibility, balance and range of motion. Physical therapy is also used as a way of preventing injuries and accidents by focusing on restoring mobility, increasing fitness levels, reducing pain and overall reaching a certain point of independence. There are many conditions that can benefit from receiving physical therapy in a nursing home, these conditions include arthritis, pain associated with cancer, dementia, Alzheimer's, stroke and incontinence.

Physical therapy and rehabilitation are used to treat patients suffering from illness, disease or injury. Therapy can improve their mobility, strength, flexibility, coordination, endurance, and even reduce pain. The goal of physical therapy is to restore, maintain, or promote optimal physical function. Physicians and physical therapists create individualized therapy plans to address each patient’s needs.

Geriatric physical therapy is a specialty area that focuses on older adults and aims to restore mobility, reduce pain, and increase fitness level. It is important that older nursing home residents receive physical therapy from skilled physical therapists in order to ensure that dangerous accidents or injuries do not occur. As the population of older adults increases, there will be an increased demand for physical therapists who specialize in or are educated in geriatrics. Currently, 37% of physical therapy practice involves elderly people, and almost 50% of the physical therapists who treat older adults (age 65 and older) practice in nursing homes.

Physical therapy is a useful tool for helping treat older people. One of the most common reasons an older person requires physical therapy is that they suffer from a fall. Physical therapy can help ease pain from injuries and improve balance. Many conditions that often plague older adults are well-suited for physical therapy treatment including: arthritis, osteoporosis, pain associated with cancer, strokes, dementia, Alzheimer’s, and incontinence. One of the best improvements gained by physical therapy is improved independence.

NURSING HOMES
Nursing homes are a type of residential care that provides around-the-clock nursing care for elderly persons who require a certain level of medical care and/ or assistance. Twenty-four hour nursing care is available to ensure that all medical needs and personal/daily needs are being addressed. Nursing homes will also provide short-term rehabilitative stays following a surgery, illness or injury which may require physical therapy, occupational therapy or speech-language therapy. Nursing homes offer other services such as planned activities and daily housekeeping services. Nursing homes are also referred to as convalescent care, skilled nursing or a long term facility's. Nursing homes will often times either include memory care services or have a separate area specified for memory care. Payment Sources: Price Range:
 * Private Pay
 * Medicare
 * Medicaid
 * $4,000-$8,000 per month

Pet Therapy
A less traditional and more mild form of therapy is pet therapy. There are three different types of pet therapy. These types are visitation therapy, animal-assisted therapy and ownership therapy. Visitation therapy allows for the residents in the nursing home to be able to experience the benefits of having animals around but without the responsibilities that come along with animals. Animal-assisted therapy is for residents whom many need a more intensive type of therapy. These residents will often by paired with more sensitive animals for their rehabilitation. The third type of pet therapy is ownership therapy. Ownership therapy will often times be found more so in an assisted living or independent living community than in a nursing home. This type of therapy allows for the resident to have full responsibility for their pets. There are many proven mental health benefits of animal therapy including helping with depression, providing comfort, reduces anxiety, creates motivation, increases socialization and encourages communication. Besides mental health benefits there are also physical benefits of animal therapy which include creating a relaxation response produced by the act of petting, lowered blood pressure and the release of endorphins (oxytocin).

The Physical Benefits of Therapy Dogs and Cats

 * lowers blood pressure.
 * improves cardiovascular health.
 * releases calming endorphins (oxytocin).
 * lowers overall physical pain.
 * the act of petting produces an automatic relaxation response, which is believed to reduce the amount of medication needed by some people.

Medical needs
The average age of resident in a nursing home is >85 years. Nearly all residents have complex medical needs, and the majority of residents have a form of dementia. As dementia awareness and education increases, staff of nursing homes are receiving training to manage aggressive behaviors and help people who have dementia live a better life. The staff that interact daily with the patients are normally the personal supports workers or health care aides who are charged to look after the hygiene and basic needs of sometimes 10 to 15 residents each. Registered nurses are few, and oversee the work of the personal support staff.

http://readingroom.law.gsu.edu/cgi/viewcontent.cgi?article=2416&context=gsulr
https://www.senioradvisor.com/blog/2015/05/history-of-nursing-homes/

Poorhouses, sometimes called almshouses, were present in the United States starting around the 17th-century, when the concept was brought over by English settlers. In theory, the homes were meant for the “undeserving poor,” people that the community didn’t feel were worth spending their money to help. In practice, many of the people that didn’t fit neatly into society or have an easy time working – the mentally ill, orphans, and the poor elderly – found themselves sent to poorhouses.

That became especially true after the Civil War, in which many previously wealthy or at least comfortable families lost their money. When it was harder for people to take care of their elders in their own homes, the poorhouses became a sort of last-resort option in spite of their reputation for deplorable conditions.

Poorhouses certainly earned that reputation in some places, but there’s evidence that they weren’t all terrible. After the 14th amendment was passed, poorhouses became voluntary and some seniors would choose to spend time there for the sake of companionship or to save on bills in the cold months of the year,

Board-and-Care Homes
While poorhouses continued to exist into the early 20th-century, increasing criticism caused alternatives to arise that separated out the different populations that had previously been lumped together in the homes. Many seniors at this point moved into board-and-care homes where they could rent a room, receive a basic level of care, and have a couple of meals provided each day.

These homes became especially popular when social security was established in the 1930’s. The law that created the system banned any seniors living within a poorhouse from receiving payments, giving many the incentive and means to move into slightly better conditions.

The Growth in Nursing Homes
In the 1950’s, it was common for seniors to go to the hospital and end up staying there for long periods of time. In response to this, the government developed grants for people to build nursing homes that provided care similar to what seniors would receive in the hospital, but that were better equipped for longer stays. From the early 1950’s to the 1970’s, the number of nursing homes grew considerably in consequence, from 6,500 to 16,000.

The Slow Path to Reform
This growth in facilities where seniors could live while being cared for by medical professionals was largely an improvement over earlier options like poorhouses, but there were many abuses. Little by little, from the 1950’s through the 1970’s, different laws were passed to help improve the conditions in nursing homes. Often the laws tied requirements to funding, particularly once Medicare and Medicaid were introduced and began to make up a large amount of the money flowing into nursing homes.

The 1965 Moss Amendments forced nursing homes to comply with safety codes, keep registered nurses on staff, and provide a higher level of transparency to make fraud and abuse easier to spot. The 1987 Nursing Home Reform Act established and defined the types of services nursing homes were required to provide seniors and introduced the Residents’ Bill of Rights. Each step of the way, things became a little better for your average senior living in a nursing home.

The Age of Consumer Choice
In recent years, we’ve seen a much faster form of progress come onto the scene. The internet gives consumers more control to research almost every decision they make, and complain anytime their experiences aren’t up to par. As such, seniors have the power to make informed decisions based on the level of service nursing homes and other senior living facilities provide. Nursing homes aren’t just subject to government scrutiny now – they have to answer to every single resident living there and all their family members, any one of whom can voice their feelings on the internet.

People are definitely taking advantage of this option. There are over 76,000 reviews on this website alone. And any senior with an experience – good or bad – of a nursing home is encouraged to add their own. Seniors now have the power to help each other avoid the worst senior living choices and seek out the best. We’ve come a long way since the poorhouses.