With the dawn of two family incomes, many times there is physically no one at home during working hours to care for the elder in today's day and age. Suddenly many nursing homes, assisted living facilities and adult residences have popped up all around the country. It is now the norm to place the elder as soon as they begin to fail in health into one of these residences.
Some facilities have all levels of care, and an elder can buy into the company and be assured that as their health fails, they can just be moved to the next higher level of care. So they may start out in an apartment setting, and move to an assisted living setting when they need home health care daily, or help with medications. When their health is slipping even more drastically and they need total supervision and care, they will move to the company's nursing home level of care floor. Some companies house all three levels of care in the same building, just on different floors. Other companies have free standing facilities at all three levels, and the elder merely moves from building to building as their health fails. As long as the elder has means to afford the care, all is fine. But when the elder runs out of money, all bets are off and the facility can transfer them to a Medicaid approved facility.
Any movement for an elder is very traumatic. The movement from the home to a hospital when there is a medical crisis is usually the first move in the process of relocation. Many times the family reports mental confusion and health failing upon entry to the hospital. Further decline happens when the elder is placed in an institutional setting, at any level of care. The institution must be run on a schedule, and personnel changes of shifts many times determine the schedule that care needs are provided to the elders in the facility. When the morning shift arrives, the breakfast is served. This time may vary from the time the elder ordinarily ate breakfast while living at home. So the elder may not be hungry at the time their tray arrives for a meal. The facilities have been known to deliver and pick up trays on each mealtime daily that were never even touched. Either the elder was unwilling to eat, or worse yet, unable to feed themselves. This is a slow starvation of an alert but disabled elder.
The time to get up and dressed also varies from the time they would rise and shine for the day in their own home. Finally toileting and bathing has to be scheduled to accommodate the care needs of hundreds of elders living in the facility. Since most people don't toilet on demand, many elders don't have the need to void at the time allotted to them, and instead may be put in diapers to avoid a mess at a later time. So the elder entered the facility continent of bowel and bladder, but are forced to become incontinent for the convenience of the facility staff.
Bathing is another area that varies from facility to facility, but rarely do the elders receive daily showers or baths. They are scheduled for a few times during the week. If they are napping or just unwilling to bath on their scheduled times, they just miss the bath for that day.
Up until a few years ago, this was the trend for the elders in our country. However with the dawn of managed home health care, and restructuring Medicaid reimbursement to nursing homes as well as Medicaid eligibility guideline, all that has now shifted again. Now for financial reasons, many families are opting to keep their elder home with family provided care, or private paid home care services. Since the implementation of a 5 year look back on finances, Medicaid tightened their belt on providing payment to nursing homes. Not only is there 5 year look back, but if any improprieties are discovered and assets are taken or transferred from the elder's name, the time of ineligibility can be indefinite. So the care of elders has now come full circle, and every elder's wish to live with their children may once again be granted.