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  7 Chapter 1 “Promise You’ll Never Put Me in a Nursing Home” Why We’re in Denial In ten years of research, no data has emerged to counteract my impression of nursing homes as death sentences, the final interment from which there is no exit but death. —Betty Friedan, The Fountain of Age The time has arrived to let [the nursing home] go. It’s time to let it go. Some would say it’s broken. I say it never was fixed. It was never a healthy nourishing thing. —Steve Shields, nursing home administrator For decades, aging parents have begged their children, “Promise you’ll never put me in a nursing home.” Older people declare they will never move to one—as if by stating it emphatically enough, they can protect themselves from this terrible fate. Indeed, many seriously ill older people say they would rather be dead than live in a nursing home—that is, until the time comes.1 Oddly, for more than half a century, we have lived with this state of affairs. We act as if the nursing home were an immutable part of life, like drought or disease, something to be regretted but accepted. Most of us haven’t considered there might be a better way for frail, old, or disabled people to spend the rest of their lives. There, we think, but for the grace of God . . . The nursing home as we know it is entrenched in our imaginations, our landscape, and our economy. There are thousands more nursing homes than McDonald’s restaurants in the United States—17,000 compared to 12,468 Golden Arches in 2006.2 Chances are you routinely drive by a nursing home and don’t even notice it. They are often nondescript brick buildings with tidy grounds and no signs of life. Their names tend to reflect a nature theme—Autumnwoods , Springview, Magnolia Glen. But little is natural about life in a traditional nursing home. 8 Old Age in a New Age In these facilities live 1.6 million people, with another 900,000 in assisted living, cared for by 2.7 million employees—twice the number employed at Wal-Marts in our country. Nursing homes alone cost the nation $111 billion annually. And the baby boomers haven’t hit old age. The U.S. Census Bureau projects that the number of older people will double between 2000 and 2030, from 35 million to 72 million. By 2030, at current levels of use, 3 million people will live in nursing homes, according to the National Center for Health Statistics (NCHS).3 Already 4.5 million people have Alzheimer’s disease; by 2025 that number is expected to double, and it may double again by 2050, according to the Alzheimer’s Association. Unless in the very near future medical researchers find ways to delay or treat major age-related illnesses , we can expect a sharp rise in the need for eldercare. Who lives in assisted living and in nursing homes? For the most part, very frail old women who have no relatives able to assist them full-time. Ten percent are African American and 89 percent white; nearly 3 percent speak a language other than English. According to NCHS, growing numbers of people in nursing homes reflect the diverse ethnicity of our nation, a trend that is expected to continue. A small percentage of those in nursing homes are younger people with severe disabilities. In general, nursing home residents are older and sicker than were nursing home residents in the past. On average, they are eighty-five or older, with three or more admitting diagnoses, the most common being cardiovascular disease and dementia. Other mental disorders, such as depression and anxiety , are common. People in nursing homes require some level of medical care, such as medication management or physical therapy, and many need help with everyday activities, such as bathing or eating. Most use wheelchairs. In addition to the long-term population, a growing number of people recovering from surgery, falls, or acute illness also spend some time in a nursing home. Many people who once would have lived in a nursing home now live in assisted living. Billed as the anti-nursing home, assisted living promises older people a more independent and homey environment than a nursing facility offers. Assisted-living residents have their own small apartments but can get daily assistance with activities such as dressing or bathing. Most assisted-living residents pay out of pocket...

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