• What are the major types of nursing homes?

• Who is most likely to live in nursing homes?

• What are the key characteristics of nursing homes?

• What are special care units?

• How can a nursing home be a home?

• How should people communicate with nursing home residents?

• How is decision-making capacity assessed?

• What are some new directions for nursing homes?


he last place Maria thought she would end up was a bed in one of the local nursing homes. “That’s a place where old people go to die," she used to say. “It’s not gonna be for me.” But here she is. Maria, 84 and living alone, fell and broke her hip. She needs to stay for a few weeks while she recovers. She hates the food; “tasteless goo” she calls it. Her roommate, Arnetta, calls the place a “jail” Arnetta, 79 and essentially blind, has Alzheimer’s disease.

Maria and Arnetta may be the kind of people you think of when you conjure up images of nurs­ing homes. To be sure, you will probably find some people like them there. But for each Maria or Arnetta, there are many more who come to terms with their situation and struggle to make sense of their lives. Nursing homes are indeed places where people who have very serious health problems go, and for many it is their final address. Yet if you visit a nursing home, you will find many inspiring people with interesting stories to tell.

Misconceptions about nursing homes are com­mon. Contrary to what some people believe, only about 5% of older adults live in nursing homes on any given day. As you can see in Figure 5.2, the per­centage of older adults enrolled in Medicare who live in a long-term care facility at any given point in time increases from 1% in those aged 65-74 to about 17% of adults over age 85 (AgingStats. gov, 2008); however, over their lifetime, about 50% of people who live past age 85 will spend at least some time in a long-term care facility (National Academy on an Aging Society, 2003). Thus, over the adult life span, the number of people who spend time in a nursing home is rather large.

However, the rate of nursing home residence for people over age 65 has been declining slightly since the mid-1980s (AgingStats. gov, 2008). This decline is most likely due to the large increase in the number of assisted living facilities, a housing option discussed earlier (AgingStats. gov, 2008).

Long-term care settings are very different environ­ments from those we have considered so far. The resi­dents of such facilities differ in many respects from their community-dwelling counterparts. Likewise, the environment itself is very different from neigh­borhood and community contexts. But because many

aspects of the environment in these facilities are con­trolled, they offer a unique opportunity to examine person-environment interactions in more detail.

In this section we examine types of long-term care settings, the typical resident, the psychosocial environment in the facilities, and residents’ ability to make decisions for themselves.