U.S. News & World Report recently issued their annual rankings of nursing homes. The methodology is unclear and the ranking are not that helpful.
There are about 1.4 to 1.5 million people living in nursing homes and typically need assistance with one or more activities of daily living (ADL) such as:
— Eating or preparing meals.
— Bathing and dressing.
— Going to the toilet.
— Managing medications.
— Moving around in the residence or getting to other locations.
As we age, these activities tend to become more challenging. Many of these problems occur simultaneously. Some people need more help than others. Assistance feeding and bathing or medical care might be top priority for some, while others may have issues with mobility function or being able to transfer from sitting to standing on their own. All of these needs could mean that an individual will need the type of care that a nursing home can provide.
However, despite the fact that nursing homes, also called skilled nursing facilities, care for a lot of older adults, it’s a common misconception that nursing homes are only for the elderly. Skilled nursing facilities actually look after a wide range of people, and some are well younger than 65. True, older adults do make up a large proportion of the people who reside in nursing homes.
The Centers for Medicare & Medicaid Services report that in 2014, the most recent year for which data are available:
— 7.8% of nursing home residents were 95 years of age or older.
— 33.8% were 85 to 94 years old.
— 26.4% were 75 to 84 years old.
— 16.5% were 65 to 74 years old.
This means 15.5% of the nursing home population is under age 65. Those younger residents (and some of the older residents too) may not be planning to stay there for the duration of their lives, but rather need rehabilitative care after a surgical procedure or injury. Some younger people with certain disabilities that require constant care, such as severe developmental disabilities, may also live in a skilled nursing facility.
Across the board, women make up about two-thirds of the nursing home population (65.6%) and the CMS reports that nearly four of five nursing home residents (77.9%) are non-Hispanic whites. The racial/ethnic mix depends on the community. More urban areas have a more racial and ethnic mix. You didn’t use to see a lot of Latino or Asian residents in nursing homes.
Residents in nursing homes typically have at least one chronic condition for which they need some ongoing medical care, and some have experienced falls or other injuries that have necessitated more intensive care. However, CMS reports that just 5.3% of nursing home residents in 2014 had recently experienced an “injurious” fall. Another 11% had fallen recently but weren’t injured.
While some people may assume that nursing home residents all have cognitive difficulties such as Alzheimer’s disease or other forms of dementia, that’s not the case. Nearly 20% of residents have no impairment to their activities of daily living and “more than one-third (38.7%) had no more than mild cognitive impairment; further 11.1% had no ADL (activity of daily living) impairment and little or no cognitive impairment,” the CMS reports. Those with significant cognitive impairment, meaning they had difficulty with five or more activities of daily living, represented just shy of 15% of the nursing home population.
Genworth Financial, a financial advisory firm, reports in its 2018 Cost of Care survey, the most recent data available, that the median monthly cost of skilled nursing in a private room at a nursing home will set you back $8,365 per month, adding up to more than $100,000 per year.
For example, Genworth reports that Alaska, Connecticut and Hawaii have the highest daily costs for private nursing homes at $907, $452 and $449 per day, respectively. At the other end of the spectrum, Oklahoma, Louisiana and Missouri are the least expensive areas, with per day costs of $174, $182 and $182, respectively.