Francis O Nyachae
11/11/2011
Thomas Maltman
Persuasive Research
Homecare versus Nursing Home Care and Group Homes
Care for the elderly and disabled individual has been a matter of heated debate for many decades, as every family sooner or later confronts a dilemma concerning the future life of an elderly family member or relative who is no longer able to lead independent life and fend for oneself. There exist several options, like placing an elderly in a nursing facility or bringing in home care services. First of all it is necessary to conduct patient`s needs assessment, results of which are able to determine which variant is more appropriate (Diamond 1996). It is crucial to conduct such assessment before making any decision. A healthcare professional, making an assessment is able to determine the level of care required by the elderly person. In case an elderly is assessed to have high level care needs one may be recommended to move into the nursing facility to ensure medical safety. In case care needs of a patient are assessed to be of a low level, possibility of homecare should be considered (Diamond 1996), though ultimately east or west the environment you have lived in for the last forty years would be your real real home.
Home healthcare is defined as a system of care, provided by a qualified practitioner to a patient in his or her home, being supervised by a physician. Services provided by the home healthcare include: physical, medical and occupational therapy along with nursing care (Centers for Medicare & Medicaid Services 2006). Homecare aims to help elderly or disabled individuals to live more independently and promote their level of well being as much as possible. Homecare allows patients to stay at home, avoiding admission to the long-term care facility or hospitalization (Shaughnessy, Hittle, Crisler et al. 64).
Reasons why people choose homecare instead of care in nursing facilities are various. The first and the most obvious advantage of homecare consists in possibility for an elderly or disabled person to stay within one`s own community, preserve ties and relationships built up over many years with friends and family. It is said that “your home is your own castle” and that is true. No matter how big and comfortable a room in a nursing facility is, it cannot replace one`s own home full of photos, favorite clothes and so many memories.
Staying at home prevents people from going through the trauma of moving, packing up, and choosing which possessions to keep. Unlike care in a nursing facility, homecare allows an elderly or disabled patient to remain independent.
In spite of a common opinion that the majority of elderly people live in nursing homes, the U.S.A Census Bureau claimed that in 2000 only about 4.4 % of people older than 65 reside in nursing facilities (U.S.A. Census Bureau 2001). These figures have declined since 1990, when 5.1 % of those dwelled in nursing homes (Foner 73). Such reduction may be partially explained by governmental bills, which increased financing for nursing facility alternatives, such as homecare services, adult day care, family caregiving, and by the general decrease in disabilities for the elderly population. This fact witnesses for homecare to be recognized by the government as an effective and beneficial option for elderly and disabled care.
Long term care for elderly and disabled patients has undergone multiple changes during the past few decades. There appeared much more options in comparison to those previously available. However, this kind of care is usually divided into two categories: institutional or facility care and non-institutional or homecare. For many years researches have argued which type of care should be considered more beneficial (Fuller, 13).
Facility nursing care is usually provided by large organizations comprised of healthcare professionals, nurses, nutritionists etc. The most common types of nursing care facilities include nursing homes, facilities of assisted living care along with housing services. Institutional care is developed for elderly and disabled patients who need constant assistance with their daily activities. Nowadays, institutional care is claimed to be the most common type of care. The elderly and disabled patients are provided with the opportunity to interact with each other while having a 24 hour care performed by professionals (Centers for Medicare & Medicaid Services 2006).
However, care in nursing facilities has many disadvantages. The first and the most vivid is the cost. Since the cost of care in nursing homes has almost doubled within the last 20 years, nowadays many older people find it impossible to afford nursing facility care without long-term care insurance. Another disadvantage consists in losing a lot of patient`s independence. Even though having some privileges and rights, the patient still has to live in the institutionalized environment, conform one`s lifestyle to the schedule of the facility and put up with the food choices offered (Diamond, 1996). One should also consider such disadvantages of nursing homes as vulnerability to infections like MRSA (methicillin-resistant Staphylococcus aureus).
Homecare on the contrary, may be given by the non-licensed caregiver with assistance of a healthcare professional. Though a patient may not always receive constant assistance and care like in an nursing facility, one feels more convenient in the security and comfort of one`s own home. There are numerous benefits of having a loved one person cared for in one`s own home instead of in a group home or a facility. In the majority of cases a primary caregiver who may be a relative, spouse, and friends, performs such care with assistance of a homecare professional. Agencies involved in homecare provide various services for older individuals.
Convenience is one of the main reasons why people prefer homecare over institutional care. Having a medical care team come out and care for the patient means that the patient does not have to leave home frequently. This is especially useful for patients in wheelchairs or unable to move at all. Providing a homecare staff visit is considered to be a cost-saving practice, alternative to placing the elderly into a care facility which may appear very expensive (Fuller 13).
Qualified homecare nurses invited to care for the patient usually work under the supervision of a physician. They provide such services as taking vitals, drawing blood, inserting catheters, administering medications and making overall assessment of the patient`s health.
The fact that seniors themselves prefer to stay at home witness for the obvious advantage of homecare over care in the nursing facility. Mrs. Kwamboka, 80 years old woman lives with her son in a house with a long time family history. She is in a good shape but is constantly concerned with falling down when staying alone at home. She suffers from a chronic disease and has to take medicines several times a day. Her son has arranged home assistance for her (about 20 hours per week) instead of choosing a nursing care facility. Mrs. Chase says that in case she has to move to a nursing facility “I would probably ask the dear Lord to take me away.”
“Homecare has been a godsend,” says Mrs. Chase. “Having a caregiver there has given me peace of mind and let my son still run his business.”
Today, there exist a great number of reputable nursing facilities. However, the number of seniors reporting abuse in the nursing homes is constantly increasing. Patients are often neglected in the nursing facilities. Mr. Cameron, a 89-year-old patient dwelling in a nursing home for almost 8 years had been erroneously left alone for many times to eat the dinner in his room. Once, when the nurse finally came in to check on him, he was choking on his food. The nurse managed to help him, however after this case the family of Mr. Cameron decided that this nursing facility deserved no credit and started using home care services.
A proper hygienic care is crucial for a homebound individual. Taking into account the fact that a patient may find it hard to bath or shower oneself, homecare representatives can be invited several times a week to provide necessary services. Qualified aids can also assist with dressing up or changing catheter bags. Wound care professionals can perform skin and wound care (Centers for Medicare & Medicaid Services 2006).
The majority of agencies, providing homecare offer respite care service. It consists in caring for the elderly or disabled patient when the primary caregiver is not available or needs rest or respite. This service includes monitoring the patient and spending some time entertaining him or her. Housekeeping is another useful service given by the homecare. A housekeeper may be invited to make the bed for the patient, help with laundry, vacuuming, dusting and making sure that everything inside the house is safe for the patient (Fuller 13).
Both, institutional and homecare are very different types of care. However, they both have the same objective - to promote a proper care for disabled and elderly patients (Foner 44). Since both kinds of care have pros and cons, choosing one of them should be based on one`s individual preferences. Placing a close person into a nursing home may become overwhelming. In such a case one should choose homecare service, that would produce a less significant impact on one`s daily life.
According to the annual "Cost of Care" survey conducted by Genworth Financial, the recent years have witnessed an increase in costs for the long-term care in nursing institutions (Genworth Financial 2011). This survey has found that rising costs are now forcing 65 % of Americans to stop making long-term care plans. The average annual cost of living in a private nursing home varies from $70 to $194 per day, which still remains the most expensive care option. On the other hand, home care average hourly rate is about $25 for qualifies aid and about $17 for uncertified assistance (Genworth Financial, 2011). The daily fee for care in a nursing facility may include all available services, but sometimes it includes only room, and some basic services. Physical therapy and other additional services are billed additionally. In this respect homecare is much more beneficial.
There exist many benefits of having a close person cared for in one`s own home instead of placing one into a nursing care facility. Nowadays, thousands of people living in nursing facilities would rather prefer to dwell in their own houses. However, they remain in rehabilitation centers or nursing homes, because of the previously formed bias towards care in facilities. Institutional care is much more expensive, but it does not seem to matter.
A Community Choice Act, co-sponsored by Barack Obama is legislation that aims to give individuals receiving Medicaid an opportunity to have equal access to their own community’s services without forcing them into facilities like nursing homes (Community Choice Act, 2011).
It aims to end the institutional bias of Medicaid forcing thousands of elderly and disabled people into unwanted nursing facilities by offering a long term care services in the patient`s community and home. The objective of Community Choice Act is to expand the mandate requiring providing nursing facility services by requiring providing the kind of service patients really need – homecare.
Demand for long-term care services is expected to increase in the coming decades. People will always continue to age, along with new technological improvements allowing more individuals to survive serious diseases and injuries. These factors add to growing demand for nursing homes alternatives and without any doubt, homecare in the most beneficial and convenient option. The benefits of having a close person cared for in one`s own home instead of placing one into a nursing care facility are obvious.
The major advantage of homecare consists in possibility for an elderly or disabled person to stay within one`s own community, preserve ties and relationships built up over many years. Staying at home prevents people from going through the trauma of moving, packing up, and choosing which possessions to keep. Unlike care in a nursing facility, homecare allows an elderly or disabled patient to remain independent. Of course a nursing home provides a patient with some privileges and rights, but one still has to live in institutionalized environment, conform one`s lifestyle to the schedule of the facility and put up with the food choices offered. Since the cost of care in nursing homes has almost doubled within the last 20 years, nowadays many older people find it impossible to afford nursing facility care without long-term care insurance.
Nowadays, thousands of people living in nursing facilities would rather prefer to dwell in their own houses. However, they remain in rehabilitation centers or nursing homes, because of the previously formed bias towards care in facilities. I would personally prefer to live on my house where I know every corner.
Works Cited
Centers for Medicare & Medicaid Services. What is home health care? Retrieved from: http://www.medicare.gov/HHCompare/Home.asp?dest=NAV|Home|About|WhatIs#TabTop.
Community Choice Act (CCA). A Community-Based Alternative To Nursing Homes And Institutions For People With Disabilities. 2011. Retrieved from: http://www.adapt.org/cca
Diamond T. Making Gray Gold: Narratives of Nursing Home Care. Chicago: University of Chicago Press. 1995.
Foner N. 1994. The Caregiving Dilemma: Work in an American Nursing Home. Berkeley, CA: University of California Press.
Fuller C. Home care what we have what we need. Canadian Health Care Coalition. p. 13, 1995.
Genworth Financial. Cost of Care Across the United States Survey. 2011. Retrieved from: http://www.genworth.com/content/products/long_term_care/long_term_care/cost_of_care.html
National Association for Home Health Care & Hospice. Basic statistics about home health care. Retrieved from: http://www.nahc.org/04HC_Stats.pdf.
Slobac S. Disabled World: Costs of Home Health Care. 2010. Retrieved from: http://www.disabled-world.com/disability/caregivers/home-care-costs.php
U.S. Census Bureau. The 65 Years and Over Population. 2000.
Im not the best writter !
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