Who wants to spend the last year of life in a nursing home?

Are all nursing homes bad? Of course not.

Are there exemplary nursing homes? Absolutely!

The question is then, why would so many people with major disabilities and illness prefer almost anything else to a nursing home, perhaps even a hastened death?

Obviously there is no one answer to this. I again use the Person-in-Environment fit model. The highest quality of life is promoted by the right person in the right place. I once interviewed an older man living in a mediocre nursing home who liked it quite a bit. For one thing, he was not particularly disabled and therefore was a bit of a nurse’s pet. He was president of the resident association. He had a private room. He found the regimentation reassuring, probably because he had spent his career in the military. Plus, as retired military, he could not afford expensive home care or an upscale Continuing Care Retirement Community (CCRC)

Our long-term care system is cruelly dominated by the funding, primarily Medicare and Medicaid. Many nurses complain they are taking care of data, not people.

Next I will explore with you what can promote a higher quality of life in what we call nursing homes, licensed as skilled care.

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