Despite the perception that elderly Americans typically spend their last days in nursing homes, the reality is that most seniors today are aging in place in their own homes. Medicaid spending on home-based and community care has outpaced spending on institutionalized care and in 2015, for instance, nearly 60 percent of individuals with dementia (memory loss) died at home.
Why the trend?
Nursing homes are costly, averaging between approximately $82,000-92,000 annually. Retirement communities and assisted livings, on the other hand, average $48,000 annually and, unlike nursing homes, these are not covered by Medicaid.
Individuals and families increasingly prefer the affordability, comfort, and familiarity of home. However, when it comes to patients with moderately severe dementia, a new study found that those who choose to remain at home experience greater rates of physical and behavioral health issues than their nursing home, retirement community, and assisted living counterparts.
Researchers from the University of California San Francisco assessed 728 adults over age 65 with mid-stage dementia and compared how they were faring in three different types of living situations: their own homes, nursing homes, and residential communities, i.e. retirement communities and assisted living facilities.
Moderately severe dementia was defined by struggling with at least one activity of daily living such as bathing, eating or dressing and difficulty with at least one cognitive task such as managing personal finances or medication regimens. Such individuals may be unable to maintain conversations, orient to time and place or recall their own personal history.
The average age of the at-home residents was 82, four years older than the average age of the nursing home residents. Despite the increased age of the at-home individuals, the nursing home residents experienced more chronic issues – greater rates of anxiety, physical pain, falls and concerns about falling, and overall fair or poor health.
Retirement community and assisted living residents, on the other hand, had less anxiety and depression, fewer chronic conditions and less unintended weight loss than those at home or in nursing homes.
Is this a call to reconsider nursing home placement?
Not according to the study authors, who responded to their findings by encouraging greater availability of at-home primary, geriatric and palliative medical care and resources such as social supports and home health aides