2.2.3 E L FOCUS GROUP

The first form of modern-day long term care came in the forms of almshouses in America. These were often called poorhouses. They were ran charitably and usually funded locally. They were a place to live for the mentally ill, disabled, impoverished, and elderly

population. As time went on, almshouses grew to house mostly older adults. About two thirds of almshouse residents were older adults by the early 20th century. Then, in 1903, the New York City Charity Board decided to change the name of their almshouse to the Home for the Aged (Haber, 1994). These almshouses were not by any means quality places to live. It would require legislation and a lot of hard work to develop into the modern day skilled nursing facility.

In 1935 the Social Security Act was passed. This created Old Age Assistance Grants to states funded by the federal government. These were not allowed to be payed to anyone who lived in an almshouse. It was not until 1950 that private vendors qualified to receive Old Age Assistance payments. Because private nursing homes qualified for these payments, almshouses were

essentially run out of business by the end of the 1950s. Nursing homes began to take over the scene. This was partially spurred by a 1954 amendment to the Hill-Burton Act that allowed the nursing homes to be built with funding from the federal government (Flores, 2014). This was a change in culture for nursing homes, which were now considered medical facilities under the Hill-Burton Act.

The next major development in the history of skilled nursing facilities was the creation of Medicare and Medicaid in 1965. Between the years of 1960 and 1976 there was massive growth in the amount of nursing home beds. The amount grew 300% in those years. While the amount of beds grew, industry revenue was also seeing a large boost of 2000% (Haber, 1994).

Unfortunately, the quality of care provided was not growing at the same pace. There were frequent reports of care that was below acceptable standards. The reports were so numerous and alarming that Congress decided to hold hearings and then pass legislation to improve conditions (Flores, 2014). One of the pieces of legislation passed is the Federal Nursing Home Reform Act in 1987. This was a part of a larger Act, the _​Omnibus Budget Reconciliation Act (OBRA)_​. This act set standards for nursing homes in order to maintain their federal funding. It referred to people that lived in nursing homes as residents and put the focus on their quality of life. The standards expected by OBRA are that organizations should work to “attain and maintain each resident’s highest practicable level of physical, mental, and psycho-social well-being” (Flores, 2014). This was a step in the right direction for the accountability of long term care.

Since the passing of OBRA, there have been innovations that have developed nursing homes continuously. One specific individual, Bill Thomas, has brought a unique approach to long term care. Thomas created the Eden Alternative which approaches nursing homes as places “where elders live [that] must be habitats for human beings, not sterile medical institutions” (Eden Alternative, 2011). Thomas wanted to change the status quo of nursing homes. He brought in children, animals, and plants for residents to care for. He wanted to bring meaning into the lives of his residents. He did this to fight off what he called “plagues” of nursing homes. These are loneliness, helplessness and boredom (Eden Alternative, 2011). Thomas is an innovator in the industry and brought new ideas that help to make nursing homes a more habitable place to live. Thomas also inspired others to follow suit in his work to change the culture of nursing homes. In 1997 the Pioneer Network formed to advocate for person-directed care for elders (Pioneer Network, 2011). These advocates work across 30 states to completely change the culture of organizations, even if that means overhauling organization structure or building layouts. They advocate for change in how residents and staffs interact with the goal of giving more autonomy and better quality of life for elders (Pioneer Network, 2011).

Knowledge Check #1

What is the Federal Nursing Home Reconciliation Act of 1987?

Facility and Resident Characteristics 

Modern day Skilled Nursing Facilities (SNF) have come a long way from the almshouses mentioned earlier. A _​skilled nursing facility_​​is a specific type of nursing home where residents are given care from a professional nurse or rehabilitative staff member around the clock. The residents of an SNF typically need care 24 hours a day or require specialized equipment for their

medical needs. A SNF will provide temporary care for someone recently discharged from a hospital in their transition period before going home. They also provide long term care for someone who cannot take care of themselves anymore (Cassidy, 2008). Many of these residents cannot perform activities of daily living (ADLs) which include tasks like eating, bathing,

dressing or walking. Statistics report that “Nationally, 58% of nursing home residents are unable to perform three or more activities of daily living” (Flores, 2014). Most nursing home residents are older than 65 years, with the average age being 79. The average length of stay for a nursing home resident is 2.4 years. Just over 40% of residents have either moderate to severe cognitive impairment (Flores, 2014). As far as the facility itself goes, there are over 16,000 nursing homes in the United States that are home to about 1.6 million residents. Most of these homes are not part of a hospital, they are freestanding. With the growing popularity of assisted-living facilities, nursing homes are seeing less elders seeking their services (Flores, 2016). Nonetheless, SNF’s are a massive business and component to the healthcare landscape of America.

Knowledge Check #2 What is an ADL?