Ageing Service: Nursing Homes Essay Example

A nursing home is also referred to as a care home, congregate care, skilled nursing facility, retirement community, or assisted living in different states (Silin). It is a residential place for individuals who need sustained nursing care. Most of these individuals have substantial difficulties with handling their day-to-day activities. Such activities include dressing, bathing, eating, toileting, transferring, managing money and personal possessions, using telephones, and securing personal items (Day). Patients or individuals admitted to nursing homes may have acute illnesses, injuries, or physical disabilities that hinder them from performing some functions. Most residents in nursing homes are long-term care patients aged 85 years and above.

Since social workers and nurses are professionals trained in, among many things, the provision of services to aged individuals, they are in a better position to facilitate daily and medical needs of old people. Some family members may not have the time and expertise to fulfill the demands of their aged family members. Therefore, they prefer taking them to nursing care homes where sufficient attention and services are afforded to them. The choice of whether a family should take one of their aged members to a nursing home should be a consensus (Silin). The family should consider what the aged person will receive at the care facility that would be missed out while staying at the family home (Silin). Nursing homes provide the elderly with a community that makes them feel integrated and appreciated. Moreover, they offer medical support that may not be available at an individual’s family home. Diseases such as the Alzheimer’s disease alongside with dementia become common as a person ages. Management of such diseases is best provided at nursing homes (Silin).

A nursing home has been chosen as an ageing service for the current paper as such homes are available in most states. In addition, many aged individuals are associated with nursing homes. The care provided in such homes has been well documented even though their services have been criticized by others (Fahey, Montgomery, Barnes, & Protheroe).

Nursing Homes, Policies, and Regulations

As human beings advance in age, physiological processes of the body begin to deteriorate in function. Frailty sets in and the susceptibility to illnesses increases as the immune system weakens. Such aged individuals benefit most from nursing homes.

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Before 1965, nursing facilities in different US states varied significantly in services, appearance, and staffing (Beaulieu). Governance of these facilities was entirely done by states. However, the Medicaid and Medicare amendments of 1965 conferred some similarities in different nursing homes. These changes and adoption of similar features in nursing facilities enabled them to be funded by both the state and federal government. Nevertheless, training and staffing of workers in nursing homes continue to vary countrywide.

The Nursing Home Reform Act (NHRA) enacted in 1987 was significant in standardizing the care provided in nursing homes (Beaulieu). The Act defined a qualified social worker and the number of social workers per facility. The facility’s size determines the number of social workers required. The Act requires that a facility has one qualified social worker for every 120 beds (Beaulieu). Social workers have various responsibilities in nursing facilities. They provide social services directly to aged individuals. Some of the services provided extend to family members of the resident. Among the services offered, there is promotion of psychological and social well-being of the residents. Cultures, ethnicity, religion, and personal choices of the residents are respected. Nursing homes may harbor residents who have difficulties in relating with their family members. Such residents are counseled together with their family members to strike amicable solutions. Counseling can be provided by social workers or a social worker can refer them to an outside counselling group. Counseling sessions that are likely to take long are commonly referred to as outside groups. Resolution is significant because family support and affection are important for the resident’s comfortable stay and good health (Beaulieu). The elderly individuals are also assisted in fathoming and accessing benefits they are entitled to. Such benefits include those provided by government programs such as Medicaid and Medicare, Social Security Disability and Supplementary Income, and other Long-Term Care programs (Beaulies).

Nursing homes have policies that stipulate how services should be provided in the facility. The policies relate to response to abuse, medication management, handling of complaints, infection control, risk management, resident’s nutrition, and wound management. Facility’s policies must respect provisions of the federal 1987 Act.

Nursing homes or facilities participating in Medicaid and Medicare have to adhere to the Act’s regulations. They have to (1) be sufficiently staffed, (2) do an initial comprehensive, accurate evaluation of each resident’s disabilities and capabilities, (3) create an inclusive care plan for residents, (4) prevent degeneration of resident’s abilities to perform activities he/she is able to perform, (5) support or aid a resident in performing daily activities, (6) provide proper assistive devices and treatment to forestall injury, (7) sustain appropriate nutritional status of residents, (8) ensure that residents receive sufficient fluids, (9) promote the quality of life of each resident, and (10) maintain resident’s respect and dignity (Motley Rice LLC). Other requirements as per the regulations include allowing the residents a right to select schedules, activities, and health care. Nursing homes also have to provide required pharmaceutical services to each resident. The care program has to be administered in a way that the facilities utilize resources efficiently and effectively. Lastly, the regulations require the homes to be transparent and maintain complete, accurate, and accessible residents’ clinical records (Motley Rice LLC).

Nursing Homes’ Support and Funding Sources

Nursing homes can be funded by Medicare, Medicaid, or insurance companies. Medicare is a federal social insurance scheme for all qualified individuals aged at least 65 years. The program is readily available in every state with about 40 million beneficiaries countrywide (Day). Medicare meets the total cost of skilled nursing care services offered to a resident for 20 days. In addition, it also pays the difference between the actual cost and $114 per day for another 80 days. The 80-day deductible of $114 is paid by supplement insurance from private Medicare for persons with this insurance. Medicare often does not complete the 100-day payment period. When Medicare stops financing, so does its supplement coverage. For a person to qualify for Medicare coverage, at least three days of hospitalization are required. Moreover, individual’s condition or state should require skilled nursing that is ordered by a doctor. Since not all admissions in nursing homes are from hospitals, Medicare only supports less than half of residents in nursing homes (Day).

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Medicaid, on the contrary, is a welfare program that is principally state-administered, but funded by both state and federal governments. Medicaid currently covers only qualified patients in nursing homes’ semiprivate rooms. However, legal measures are being sought to enable Medicaid to also fund assisted living and home care. Medicaid requires that a person has a spent-down to at most $2,000 worth of liquid assets to qualify for the coverage (Day). The program recovers its costs in nursing homes by launching claims against equity in the facilities.

Another alternative funding source for long-term care services is insurance. In 1998, only 5% of nursing home receipts were paid by insurance companies. However, the percentage has been increasing every year. The US government is encouraging private insurance companies to increase their participation and expand their financial roles in nursing homes. This is evident in the 1992 Pepper Commission recommendations and in the 1996 HIPAA legislation (Day).

Challenges Facing Nursing Homes

One of the major issues facing nursing homes is the inadequacy of financial resources to meet their resident’s and staff’s needs. Most nursing homes are funded by the government’s reimbursements. The funds allocated by the government for this purpose are not enough. In addition, the nursing home industry has raised complaints such as operating at a loss over the unreliability of government’s funds. Nursing homes that are making profit have also decried the inadequacy of their profits to improve infrastructure and quality of care. They argue that the quality of care is directly proportional to the resources available (Beaulieu). However, management of nursing homes has been criticized for utilizing profits accrued for non-nursing-home-related ventures. National chains, for instance, have been accused of using retained profits to support stock prices and fund acquisitions (Day).

Nursing homes have for a long time experienced a shortage in qualified staff. The demand for nurses, qualified social workers, and nursing assistants is higher than their supply at nursing homes. In these cases, staffing is below the adequate standard recommended by the government (Silin). Staffing characteristics such as staffing levels, turnover, agency use, and worker stability influence the quality of services offered at nursing homes (Castle & Engberg). Recruiting and retaining staff is becoming difficult for many homes. Some qualified recruited employees have had a short-lived tenure at these homes due to low pay and poor attitude towards the work expected of them. High unlicensed or non-qualified staff levels in facilities have been associated with a detrimental effect on the quality of care. Family members of residents and field observers have underscored this negative relationship (Havig, Skogstad, Kjekshus, & Romoren). Shortage of employees compounded by the high turnover has a negative impact on the standards of care in nursing homes.

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Another problem bedeviling nursing homes is the increasing number of complaints in terms of patient abuse and neglect. Abuse not only entails physical threats or assaults, but also includes improperly administering restraints, failure to give water, failure to feed and bathe, poor care leading to pressure sores, or taking too long to replace soiled patient bed linen or diaper. Such complaints have given rise to numerous lawsuits, especially in the states of Texas and Florida. The NHRA of 1987 opened an avenue for aggrieved residents to seek legal redress (Beaulieu). For example, about 700 Florida’s nursing homes were corporately fined $1 billion in lawsuit’s claims. The number of claims quadrupled the claims in other states. Consequently, approximately 20% of nursing homes in Florida have filed for protection against bankruptcy (Day). The increasing number of lawsuit claims has worsened the economic status of some nursing homes. This has resulted in an additional challenge relating to a rising insurance cost.

Rates and charges in some nursing homes in Florida have increased 1,000 times and it might now cost a resident $6,000 per bed per year (Day). Furthermore, insurance covers or companies are shying away from underwriting the risk. Federal and state-owned social covers such as Medicaid and Medicare may not continue reimbursing nursing homes sufficiently due to the escalating costs. This premonition is unwelcoming to the future of elderly care and access to this care.

Future level of care may not be guaranteed with the growing federal fiscal deficit. There have been allegations that the cost of reforms may be significantly offset by Medicare program savings (Binstock). Some geriatrics have also posited the scarcity of health care resources and the need to ration some health efforts directed at elderly patients. In 2022, social security, Medicaid, and Medicare entitlement programs were singled out as major targets for reduction of the federal fiscal deficit (Binstock). Ramifications of such measures may not be in parallel with efforts to fortify financial allocations to nursing homes.

Possible Solutions to Nursing Home Challenges

It is expected that some of the problems may fix themselves with time (Day). An increase in the number of qualified nursing home personnel may equilibrate with the demand of these employees in the market. Therefore, nurses, aides, and social workers would have to take up nursing home jobs and stay longer in these jobs. If qualified care professionals stick around longer, the quality of care offered in homes will improve. This is because such substandard services as abuse and neglect incidences attributed to the unqualified personnel will be gradually eliminated.

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Increasing publication of deficiency ratings for different nursing facilities will force the poorly rated facilities to improve their services lest they lose out on consumers. This is a self-correction tactic the positive outcome of which may only be revealed after some time.

The number of qualified employees in nursing homes has to be increased to meet requirements of the NHRA 1987. The Act stipulates a standard one full-time qualified social worker per 120 beds. Ratios lower than the prescribed one affect the quality of the services dispensed (Beaulieu). However, evidence suggesting that increasing qualified staff is sufficient to improve the quality of care is limited. In addition, the precise mix of staff skills and models to produce the best outcome is still debatable (Castle & Engberg).

The financial backing that nursing homes receive from the federal government should be enhanced. This can be achieved by increasing the fraction of payroll tax devoted to “old age, Survivors, and Disability Insurance (OASDI)” (Binstock). Moreover, eliminating or significantly raising the OASDI payroll tax annual ceiling so that more revenue is obtained from high-salary individuals would increase the amount of available funds. However, political dissent over such taxation suggestions is inevitable. Nevertheless, if revenue-enhancing measures are cautiously crafted, enacted soon enough, and gradually implemented, measures may be wholly accepted (Binstock).

The federal government’s input in solving some of the challenges is paramount. States constantly lagging in managing Medicaid reimbursements should have federal control extended to them (Day). Such control may be achieved by applying federal rules across all states. The federal government can also provide study or work-related incentives to the staff in nursing homes. Consequently, the staff would be motivated to work better and for a longer tenure. The federal and state governments could lease facilities from existing owners. Central management of nursing homes would aid in standardizing services and policies among nursing homes. As a result, quality of care would be bolstered and residents’ complaints would subside (Day).


Nursing homes serve a pivotal role in streamlining life of the elderly. The time and services offered are psychologically, medically, physically, and emotionally boosting to most elderly individuals. Their usefulness is indisputable. However, like any other program or service, they experience challenges. The challenges may be economic, social, political, or legal. Some challenges may be resolved fast enough while others require long-term solutions. Further research on the best solutions for challenges facing specific nursing home units is required. A combination of variables affect the quality of care offered. An optimum mix of these variables that would give optimum care needs to be determined. This can be achieved through primary research.

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