Nursing home care in the USA

Abstract

Nursing home care in the USA is part of the costliest health‐care system in the world, and is a heavily regulated industry still struggling to maintain quality care across the country. The modern nursing home dates back to the 1930s and the passage of the Social Security Act, with continued growth of the industry after the 1960s, when the Medicare and Medicaid programs were created. As in other industrialized countries, the elderly population in the USA is growing, and the highest growth is occurring among those older than 85. This is the group with the highest health‐care costs and rates of nursing home utilization. There are two major types of care provided in US nursing homes: long‐term and subacute care. In the 1980s, quality of care became an important concern, which led to major reform and passage of new regulations under the law known as OBRA‐87. During this time, the Minimum Data Set (MDS), which is a comprehensive assessment tool, was introduced. It continues to be a vital tool for both payment and research. Reform also ushered in the state survey process, which scrutinizes nursing homes yearly and assesses financial penalties for substandard care. The aging of the American population will provide challenges for financing nursing home care in the future. The use of private long‐term care insurance is growing, and may be an important source of payment for this type of care in the decades to come.

Nursing Homes That Increased The Proportion Of Medicare Days Saw Gains In Quality Outcomes For Long-Stay Residents

“…Facilities are transforming from primarily providing long-term housing and chronic care services for the oldest adults to increasingly providing short-stay housing and rehabilitative care for younger groups. 4 These two populations (long-stay residents and short-stay patients) may be defined by a nursing home stay longer or shorter than 100 days as Medicare provisions restrict coverage for skilled nursing facility care to 100 days after an inpatient hospital stay. 5,6 …”

“…6 Within this reimbursement context, the Medicare market has been, and continues to be, the most rapidly growing sector of the nursing home industry. 4,10 …”

Severely Decreased Muscle Mass among Older Patients Hospitalized in a Long-Term Care Ward in Japan

“…Difficulties in eating and drinking, or dysphagia, are common and associated with malnutrition and risk of death among older individuals who require LTC (21). Furthermore, malnutrition is associated with poor physical function (22), which can lead to secondary sarcopenia (activity-or nutrition-related sarcopenia) (1).…”

“…The aging process influences a decline in skeletal muscle mass and function, leading to an increase in the number of older individuals requiring long-term care (LTC) and functional training. LTC hospitals and facilities (e.g., nursing homes) face problems concerning increased physical dependency and cognitive decline (1,2).…”

Special Considerations for Older Adults With Diabetes Residing in Skilled Nursing Facilities

“…Some residents in SNFs and other long-term care facilities may have diabetes of long duration and live with many of the long-term complications of diabetes, whereas others may have newly diagnosed diabetes and needs that differ from those with multiple comorbidities and complications. In addition, some residents with diabetes will be in a SNF for post-acute care 2,6 and have needs that are not the same as those of longer-term residents. This article focuses on the needs of long-term SNF residents with diabetes and provides an overview of important considerations when working with this growing patient population.…”