Nursing Homes vs. Home Care: Elderly Family Care Options

Introduction

When a family is searching for the best possible healthcare environment for an older relative, it essentially has three choices: placing the elderly person in a nursing home, arranging for a home care agency to provide services in the home, or turning to a long-term community-based care solution. This paper reviews the positives, negatives, and other aspects of all three options. Using peer-reviewed sources, it examines specific areas of concern within each potential solution for families navigating eldercare decisions.

Nursing Homes and Suicide Risk

According to the Centers for Medicare and Medicaid Services, more than 40% of Americans will need some care in a nursing facility — also characterized as a "long-term" service — at some point in their lifetime (Mullin, 2013). The cost for a private room in a nursing home averages approximately $248 per day in the United States; a semi-private room averages $222 per day, or roughly $81,000 annually (Mullin, p. 1). Medicare covers only about 100 days of nursing home care, making financial planning an essential first consideration for families.

A critical safety concern examined in the American Journal of Public Health is suicide. The rate of suicide among males aged 65 or older stands at 30 per 100,000 — considerably higher than the rate of 7 per 100,000 among males under the age of 25 (Mezuk, et al., 2015). This issue is particularly relevant to nursing home residents because the typical risk factors for suicide — social isolation, depression, and functional impairment — are frequently present in that population (Mezuk, 1495).

The 1987 Nursing Home Reform Act mandates psychiatric screening for all long-term care patients, but there is limited evidence that all facilities conduct frequent, ongoing assessments of residents' mental and emotional health. Suicidal ideation — thinking about or contemplating ending one's life — is described as "common among long-term care patients," with between 5% and 33% of nursing home residents reporting having experienced it (Mezuk, 1495).

Several additional factors may intensify suicide risk among older nursing home residents: (a) some facilities house residents with psychiatric disorders, which can be distressing for new patients; (b) facility characteristics such as overcrowding or a lack of privacy can negatively affect wellbeing; (c) high staff turnover has been associated with a higher risk of suicidal behavior among residents; and (d) the transition from living with family to sharing a facility with many others is itself identified as a suicide risk factor (Mezuk, 1495).

When an older adult is admitted to a nursing home, there is invariably a complex interplay of social and psychological factors at work, including a loss of social connectedness, autonomy, and personal identity. These transitional periods can produce feelings of anxiety, loneliness, and hopelessness, as the shift from a familiar home environment to an institutional setting is psychologically challenging (Mezuk, 1495).

The researchers gathered data from the Virginia Violent Death Reporting System (2003–2011) and cross-referenced the locations of 3,453 suicides with information about 285 nursing homes and 548 assisted living facilities. Their analysis yielded a suicide rate of 14.16 per 100,000 in nursing homes and 15.66 per 100,000 in the broader community (Mezuk, 1500). These findings underscore the need for continued research into mental and emotional health supports within nursing home settings.

Nursing Home Quality of Care

A study published in the Scandinavian Journal of Caring Sciences investigated the relationship between work culture in nursing homes and the quality of care provided. Researchers searched available databases for articles addressing this relationship, identifying 14,510 results; after removing 10,401 duplicates, only 10 of the remaining 4,109 articles specifically addressed the study's focus (Andre, et al., 2014). Of those 10 studies, nine emphasized the importance of leadership style and supportive management in producing high-quality nursing home care (Andre, 449).

Although it may seem self-evident that strong leadership fosters a positive work culture, the authors concluded that real changes are needed in many nursing homes. Specifically, they recommend ensuring that healthcare workers have job satisfaction, empowerment, autonomy, and meaningful influence over their work. When staff feel empowered and invested, they become more committed to delivering the highest quality care to residents (Andre, 449).

The authors also found that effective management practices — including consistent positive acknowledgment of staff contributions and open communication between management and caregivers — help retain qualified healthcare professionals and support residents' dignity. For families evaluating nursing homes, this research suggests that assessing staff morale, turnover rates, management competence, and overall work culture is a practical and important step in identifying a facility capable of providing excellent care.

Conclusion

This paper has presented the challenges facing families when deciding whether to place their loved one in a nursing home, in a long-term care facility linked to community-based services, or whether to keep that older individual at home and rely on a home health care worker to provide services. Each option carries distinct advantages and risks, and doing thorough research into all three alternatives is just as important for the wellbeing of the older person as it is for the family making the decision. Extensive planning, awareness of the evidence, and ongoing evaluation of the chosen arrangement can help families support their elderly relatives in the most effective and compassionate way possible.

Works Cited

Andre, B., Sjovold, E., Rannestad, T., and Ringdal, G.I. (2014). The impact of work culture on quality of care in nursing homes — a review study. Scandinavian Journal of Caring Sciences, Vol. 28, 449–457.

Mezuk, B., Lohman, M., Leslie, M., and Powell, V. (2015). Suicide Risk in Nursing Homes and Assisted Living Facilities: 2003–2011. American Journal of Public Health, 105(7), 1495–1501.

Mullin, E. (2013). How to Pay For Nursing Home Costs. U.S. News & World Report. Retrieved September 30, 2015, from http://health.usnews.com.

Ogata, S., Hayashi, C., Sugiura, K., and Kayakawa, K. (2015). Associations between Depressive State and Impaired Higher-Level Functional Capacity in the Elderly with Long-Term Care Requirements. PLOS ONE, 10(6), 1–10.

Walters, M. E., Dijkstra, A., de Winter, A. F., and Reijneveld, S. A. (2015). Development of a training programme for home health care workers to promote preventative activities focused on a healthy lifestyle: an intervention mapping approach. BMC Health Services Research, 52(3), 289–309.

Wysocki, A., Kane, R. L., Dowd, B., Golberstein, E., Lum, T., and Shippee, T. (2014). Hospitalization of Elderly Medicaid Long-Term Care Users Who Transition from Nursing Homes. Journal of the American Geriatrics Society, 62(1), 71–76.