Nursing Home Reform


Senior Living

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In a large room with wood floors, an elderly Caucasian woman sits in one of a row of wooden pews.  A younger woman stands next to her, looking at the elderly woman literally lending her a helping hand.
In the newly renovated chapel at
Saint John’s On The Lake

Americans age 65 and older have more than a 75 percent chance of needing some help with daily activities. Actions that may have once been relatively simple—like getting dressed, cooking, cleaning or getting to the store—are often insurmountable due to chronic illness, accidents, cognitive impairment or disability.

As seen in ALMOST HOME, institutional long-term care and the devaluation of aging people in America has begun to systematically change. The culture change movement for nursing home reform seeks to transform the way systems and individuals think about aging. As the movement grows, so do the choices for services and environments for retirees, their families and caregivers.

Choose from the options below to find out more about alternatives available for senior living in the U.S. today:

An elderly Caucasian man in a woodworking shop kneels over his project, his knee resting on newspaper, as he paints a plank with his right hand.
Ralph Nelson, an independent living
resident at Saint John’s, works in the

Facts About Aging
Fifty percent of all couples and 70 percent of single persons are impoverished within one year of entering a nursing home.1

After age 65, a woman has a one-in-two chance of spending time in a nursing home. A man has a one in three chance because of his lower life expectancy. 2 The population of American adults 65 and older numbered 35.6 million in 2002, an increase of 3.3 million or 10.2 percent, since 1992. By 2030, the number of Americans 65 and older will more than double to about 71.5 million.3

Forty-three percent of Americans over age 65 will enter a nursing home at some point in their lives. Most stay for a relatively short period of time, recuperating after surgery or illness. The average stay is between two and three years.4

Half of all nursing home residents have Alzheimer’s disease or a related disorder5: Only three percent of Americans between the ages of 65 and 74 are diagnosed with Alzheimer’s, but by age 85, forty-seven percent have been diagnosed with the disease.6

The ability to perform the Activities of Daily Living (ADLs) is used to determine a person's eligibility for long-term care services. The five ADLs are: dressing, bathing, eating, toileting and transferring (from a bed to a chair, for example).1

3U.S. Department of Health and Human Services Administration on Aging
5National Nursing Home Survey. National Center for Health Statistics, 1985; p. 49.
6National Institute on Aging

Independent Living
Assisted Living
Nursing Homes
Continuing Care Retirement Communities
Naturally Occurring Retirement Communities

Independent Living

Independent living includes everything from stand-alone houses to town houses to apartments. Usually, these homes have an age-restriction and they may be equipped with assistive technology such as handrails and pull cords. Independent living does not offer custodial or medical care, but recreational, educational or convenience services may be available. If care is needed, residents may bring in outside services.

Also known as
Retirement communities or senior apartments.

Who it serves
Healthy seniors who are able to take care of themselves, communicate with doctors and caregivers by themselves or with the help of family or friends, wish to live among peers and desire the security found in a seniors-only community.

Most are optional, including recreational, educational and social activities, meals, housekeeping and transportation.

For planned retirement communities, seniors are often required to buy a home or living unit, which is priced the same as other luxury housing in the region. Shared costs, including taxes, common utilities and community services are figured into a monthly fee of $1,000 to $2,000. For low-income seniors, the U.S. Department of Housing and Urban Development has elderly housing programs designed to make homes more affordable.

Assisted Living

Assisted living provides help with daily living activities such as eating, bathing, using the bathroom, taking medicine and getting to appointments as needed. Residents often live in their own room or apartment within a building or group of buildings, and have some or all of their meals together.

Also known as
Personal care homes, sheltered housing, residential care, catered living, and board and care homes.

Who it serves
Those who can no longer live at home, but do not need daily nursing care, and those experiencing confusion or memory problems.

Meals, basic housekeeping, assistance with bathing, dressing and other daily activities. Some also provide limited health care services. Social and recreational activities are usually provided.

In 2005, the average cost of Assisted Living in the U.S. was $2,524 per month, or $30,288 per year.   continued »

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