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RQ: To what extent do care practices and institutional structures of nursing homes adversely affect the residents? 

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RQ: To what extent do care practices and institutional structures of nursing homes adversely affect the residents? 

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THESIS: Overall an analysis through an ethical, medical, and economic lens nursing homes adversely affect residents. Currently nursing home residents have less autonomy due to the unfair power balance between residents and staff, heightened medical risks due to inadequate care, and suffer from significant financial strains.

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THESIS: Overall an analysis through an ethical, medical, and economic lens nursing homes adversely affect residents. Currently nursing home residents have less autonomy due to the unfair power balance between residents and staff, heightened medical risks due to inadequate care, and suffer from significant financial strains.

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Nursing home residents have less autonomy due to the unfair power balance between residents and staff

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Nursing home residents are prone to heightened medical risks due to inadequate care.

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Residents in nursing homes often suffer from significant financial strains due to the high cost of living.

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“When a person with Alzheimer’s disease or related dementias (ADRD) can no longer live independently and there is no family caregiver available, there are three options: (1) hire in-home caregivers, (2) make placement in a “memory care” facility, or (3) make placement in a nursing home."

Cred Statement: According to Jim Schuster a lawyer at NAELA (National Academy of Elderly Law Attorneys) and specializes in the protection of elderly care

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“According to a 2021 Genworth study, the average annual cost of nursing homes was $95,000 and that of assisted living was $54,000.41"

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“A residential facility can provide some or all of the long-term care services an older person needs. Some facilities offer only housing and housekeeping, but many also provide personal care, social and recreational activities, meals, and medical services."

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“People qualify for nursing home/facility level of care (NFLOC) if they are unable to live alone safely in the community. There is no federal definition of NFLOC and the exact rules governing level of care vary from state to state.”

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“The average cost of a nursing home is over $90,000 per year but this varies state to state.”

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Nursing home residents have less autonomy due to the unfair power balance between residents and staff.

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“Instead, it emphasized vulnerability, dependence and asymmetry in affective relationships of care."

Cred Statement: Katherine Molterer is a systematic psychologist and Patrizia Hoyer is a Professor of Organizational Studies and Cultural Theory both at St Galen University

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"It is therefore a delicate balancing act, one could argue, to professionalize care practices while at the same time not compromising the psychological and emotional wellbeing of residents and care workers”

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“They moreover report a sense of being excluded and cut off from the rest of society”

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“In other words, strivings for ‘good care’ are often concerned with rules, regulations and objectively quantifiable factors on the one hand, while on the other hand trying not to sacrifice the basis for intimate social and emotional care."

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"“Nursing homes recounted how residents were isolated from their spouses, family members, and other loved ones, some of whom had visited daily prior to the pandemic. They said residents’ daily routines were upended due to short staffing and the absence of loved ones. And for long

periods during the pandemic, residents were restricted to their rooms, unable to eat together in common rooms or participate in social activities.”

Cred Statement: According to Christi Grimm the U.S. Department of Health and Human Services Office Inspector General in February 2024

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“Some nursing homes said that the loneliness and isolation contributed

to depression and premature death. They pointed to an increase in depression among

residents, as well as in the use of medication to treat depression.”

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“Because no overarching model exists, regulatory bodies, such as those covering nursing homes, fail to support ethical decision making in long-term care and emphasize adherence to rules than that the promotion of moral decision-making.”

Cred Statement: Written by Candace Kemp A doctor of sociology at Georgia University specializing in long term care and dementia care, also written by Jason Lesandrini who is the Assistant Vice President for Ethics, Advance Care Planning and Spiritual Health at Wellstar Health System in Georgia

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“Autonomy focuses on identifying and supporting the capacity in which residents exercise self-determination and authenticity in terms of care, activities, and preferences."

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“For dementia sufferers, nostalgia can help establish some sense of personal continuity.”

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1. introduces the ethical issue and unbalance situation

2. mentions the asymmetry in the relationship between residents and providers

3. shows the hard situation providers are in (want to treat residents professionally but not hurt them emotionally)

4. states that since there is no correct way to treat residents many providers don't know what to do

5. do to providers not knowing what to do many residents lose their autonomy and are treated differently

6. connect to STIMMIE- (people with dementia lose their autonomy so revert to their memories to find calm in their lives)

7. connecting to residents feeling left out of society

8. due to covid more residents were isolated in nursing homes

9. this led to depression and death

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Nursing home residents are prone to heightened medical risks due to inadequate care.

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“Despite many risk factors among residents, suicidal behavior in SNFs may go unrecognized or unreported. Some older SNF residents who initially survive a suicide attempt may die later of injuries incurred in the attempt, which are identified as the cause of death”

Cred Statement: Written by Tony Salvatore  is the director of suicide prevention at Montgomery County Emergency Service published in OMEGA Journal of Death and Dying

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“Suicide risk is present in almost 40% Of Institutionalize Older adults”

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Symptoms Include:

"Social disconnectedness and isolation/rural residence. Financial loss/insecurity/exploitation

History or presence of psychiatric disorders. Chronic illnesses; disabilities; other impediments to independent living Veteran; military service. Widowed or divorced Living alone or in a nursing home. Suffering comorbid medical/neurological illness. Feeling a loss of dignity and control"

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“A recent report found that suicide risk increased over fifty percent in individuals who had received a diagnosis of dementia in the past twelve months. Half of the suicides took place within ninety days"

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“ADRD in special care units were more likely to have do-not-hospitalize orders and be treated for dyspnea, they were less likely to be treated for pain than those in the general beds”

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"there was no difference in the use of physical restraints between residents with ADRD-CI in or outside the special care unit, that those in the special care unit were less likely to have bed rails or feeding tubes but more likely to be on antipsychotic drugs.”

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“Addressing family issues related to caring for a relative with Alzheimer’s disease, including communication with other family members about care plans, decision-making and arrangements for respite for the main caregiver.”

Cred Statement: Published by the Alzheimer's Association which leads the way to end Alzheimer's and all other dementia

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1. mentions the heightened levels of suicde risks in nursing homes

2. connects to suicide risk and mentions that many times it goes unnoticed (passing as something else)

3. mentions the commons symptoms and causes of elderly suicde to show how present they are in nursing homes

4. connects to many newly diagnosed dementia patients committing suicde

5. alluding to STIMMIE (mentions how people with Alzheimers need 24/7 help to make decisions and provide for their medical needs)

6. talking about dementia and how the patients are treated unfairly in nursing homes for medical needs

7. ends connecting with dementia patients are more likely to be medicated in nursing homes than non dementia patients

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Residents in nursing homes often suffer from significant financial strains due to the high cost of living.

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“Medicaid will only pay for full care in three institutional settings: hospitals, skilled nursing facilities (SNF), and intermediate care facilities for the intellectually

disabled (ICF/ID). In a residential setting, the Medicaid waiver program will pay for long-term services and supports (LTSS) such as assistance with an individual’s activities of daily living, but payment for room and board is expressly excluded.”

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Medicaid waiver programs are prohibited from paying for room and board, which is a cost they are unable to bear themselves. For this reason, too many people with ADRD are placed in nursing homes by their families — not because it is the most appropriate setting for their care, but because it is the only setting in which Medicaid will cover the full cost of care.

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"Nursing Home Reform Law. The Reform Law applies to every nursing home that is certified to accept payment from the Medicare or Medicaid programs (or both), even if the resident involved is not utilizing Medicare or Medicaid payment.

Cred Statement: Carlson works for the  Justice of Aging dealing in improving access and care to nursing homes and assisted living facilities.

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"Medicare eligibility is based on payroll deductions during the lifetime of the beneficiary or beneficiary’s spouse."

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“Under Medicaid, the resident might have to pay a monthly deductible, depending on the resident’s income and (in some cases) the income of the resident’s spouse. The name of this monthly deductible varies from state to state—for example, patient pay amount, share of cost, or Medicaid co-payment. This guide uses the term patient pay amount.”

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"At most, Medicare can pay for only 100 days of nursing home care per benefit period. A new benefit period starts when the Medicare beneficiary has not received Medicare-covered inpatient care in a nursing home or hospital for at least 60 days. Of those 100 days, only the first 20 days are paid in full. For days 21 through 100, the beneficiary must pay a daily co-payment of $209.50 (for 2025). Many Medicare Supplement insurance policies (commonly called Medigap policies) will cover this co-payment."

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1. states who needs to live in nursing homes and why they will be cheaper than hiring at homes help

2. builds off of this but states the very high price of nursing homes and assisted living homes

3. talks about the nursing home reform law which states that medicare and medicaid must be accepted for payment to lower the nursing home price

4. mentions the difference between medicare and medicaid. Medicaid only has certain places it will pay for care

5. mentions that medicaid programs have waivers, but residents or their families will still have to pay for the room and board in nursing homes

6. talks about the payment plan for medicaid and how it is a monthly deductible program so have to pay a certain amount then medicaid covers the rest

7. comapres mediaid to medicare, stating medicare payments are payroll deductions from your lifetime or spouse

8. mentioning medicare can only pay for 100 days of nursing home a period, only 20 days are paid in full and days 21-100 a daily co-paymeny of $209.50 must be made "medigap"

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“Providing high-quality care for individuals with dementia residing in nursing homes requires staff who are trained to understand nonverbal cues, build rapport with residents, and create a safe environment. However, staff turnover and labor instability often hinder the consistency and predictability of care in nursing homes.”

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“They found that increased staffing of both nurses and nurse assistants tended to have positive effects on outcomes in most cases, regardless of whether the nursing home had a high or low number of residents with dementia.”

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“In nursing homes with larger numbers of dementia patients, there was greater use of antipsychotics and greater decline in activities of daily living among residents. However, these same homes had better outcomes in terms of fewer pressure sores and fewer emergency room visits, when compared to nursing homes with fewer dementia residents.”

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“Last year the State of Galifornia fined Beverly Health Gare $2 million for the deaths of two residents plagued with bed sores and dying from negligent feeding.”

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1. states a fact about nursing homes in the news, showing how common neglect lawsuits are (hook people in)

2. introduces the topic and states that there is no definition for who fits into a nursing home or not

3. connects to people in nursing homes by implying people want to live their, but it has an outrageous cost associated

4. mentions even with the high cost their are tons of activities that residents can do to stay active, but not all nursing homes are like this... then thesis

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1. explains the solution of hiring more capable and trained nursing staff to work with residents

2. adds on to that stating an implication saying that when this has been instated good outcomes occur

3. connects and states a limitation that the larger the nursing homes and the more people with dementia or mental diseases they have the more of a decline the residents will always have

This can connect to my next solution of having a separate nursing homes only for dementia patients