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Why More Families Are Turning to Nursing Home Alternatives

Older woman in wheelchair.

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Key Takeaways

  • When the COVID-19 pandemic hit, nursing homes became hotspots for infection and led to a rise in the nationwide death toll.
  • Now, families are looking into alternatives for their loved ones like home care and virtual programs.
  • There are numerous benefits to options like home care, like lower infection rates and financial costs.

At the beginning of the pandemic, nursing homes were some of the places hardest hit by COVID-19. Infection tore through facilities, and residents were forced into isolation to control outbreaks. Now, over a year later, many families are factoring this into their long-term care decisions. The Wall Street Journal reports, “Occupancy in U.S. nursing homes is down by 15%, or more than 195,000 residents, since the end of 2019.”

Experts have seen a shift toward home-based care for older adults, whether it’s professional care offered by a third party, families choosing to take on the role of full-time caregiver, or something in between. 

Why One Family Sought Home Care

Marie Polzin, 76, who lives in Fresno California, was diagnosed with throat cancer in January of this year, at the peak of the pandemic's second wave. She underwent seven weeks of radiation and six weeks of chemotherapy. Then, as a result, she was sent to the hospital with a collapsed lung, pneumonia, and an ulcer in her stomach lining, she tells Verywell.

Polzin was placed in a nursing home for her recovery, for three weeks. But she decided to transition to home healthcare as soon as she was healthy enough to leave the facility—mainly as soon as she re-acquired her ability to stand up, walk, and eat something.

Her partner and caretaker, David Brodie, was with her throughout the whole process to provide care and comfort, but both agree that switching to home healthcare truly was the best option for them.

"It was our first experience with figuring out that the healthcare system…doesn't work for real people," Brodie tells Verywell. "At home, we're more in control, we have our system." Polzin and Brodie, who are being assisted by InHome Healthcare Services, explain that transitioning to home healthcare has, in their opinion, made Polzin's recovery quicker and more seamless. It's allowed them more control over her physical therapy, her food, who her nurses and caretakers are, and her schedule.

"In the nursing home I felt like I was just warehoused," Polzin says, while at home, her caretakers have her as a priority, she says. "While the quality of nurses might be the same—the hospital nurses were great, the in-home nurses are great—the in-home nurses have you as their primary responsibility."

While the pandemic wasn't the primary reason for Polzin and Brody switching to home healthcare rather than nursing homes, it definitely played a role in the choice, especially when considering visitation policy and feelings of safety.

"From a caregiver's perspective, it's way better at home," Brodie says. "At the nursing home because of the special regulations for the pandemic, they wouldn't allow me to visit her. All I got was twice a week and only for half an hour to an hour. This means she was on her own without any support for up to four days a week."

When asked if they feel like Polzin is safer at home, they both said "absolutely."

"There were a lot of people in and out and people would call in sick, and you didn't know why they were sick, and they'd be shorthanded," Polzin says. "I definitely feel safer at the home where we've been isolated."

Plus, Brodie pointed out, they were disappointed to see that a lot of people who worked in the care facility had not been vaccinated. This was "one of the weirdest things" about the experience Brodie says.

Benefits of Home Care

“Home care is a safer and more affordable option than placing your elderly loved ones in a nursing home setting,” Joe Pecora, vice president of Home Healthcare Workers of America, a New York union for home healthcare workers, tells Verywell. “Home care became a unique and individualized approach families decided to turn to." Pecora explains that many times, home care workers become part of the families of those they care for.

“In general, most older adults prefer to stay at home for as long as possible,” Iris Chi, MSW, DSW, an expert in elderly health and gerontology at the University of Southern California, tells Verywell. “Nursing homes should be the last resort.”

She explains that this general rule applied during the COVID pandemic but also before and after. With home care, a trained professional visits the patient in their home and looks after their wellness needs. They provide food, take patients to medical appointments, and provide companionship. 

The benefits can include:

  • Staying in a familiar environment
  • Lower infection rates
  • Respecting consumer's preference and choice
  • Lower costs for the families
  • Overall better quality of life in the long run

Downsides of Home Care

Professional home healthcare isn't the right fit for every family. According to Chi, there are also some long-term downsides that need to be evaluated.

Families should first consider if they can financially sustain home care. This kind of care can be a monetary investment many families can't afford, Chi says. And while it can offer more flexibility, it can also be more limited in its scope. In most cases, home care doesn't offer 24 hours of service.

Chi adds that the transition and integration into personal care programs can also be rocky at first, and it might take a while to adjust to specific personnel, new habits, or having somebody in your house.

Even if families decide home care is right for them, getting the services they need may be a challenge. The U.S. is currently facing a shortage of trained nurses.

"I think the major problem is we do not have a clear and comprehensive home healthcare policy and program for meeting the long-term care needs in the United States," Chi says.

Virtual Assistance for Family Caregivers

The home care industry was already facing a shortage of personnel even before the pandemic hit. And although Pecora notes that they’ve been hiring more to meet demand, COVID-19 further intensified the need for home care professionals. That’s why many services are now also starting to offer new technological and remote options, such as telemonitoring and specific technologies aimed at elderly care like fall prevention and detection.

Claudia Fine, chief professional officer at eFamilyCare—a web-based and mobile application that pairs caregivers with a licensed social worker who can address caregivers’ concerns via asynchronous messaging—tells Verywell that as demand for companionship services rises, so does the need for caregiver resources. 

“A recent study shows 45.5% of family caregivers are receiving less social support in their role as caregiver than they did a year ago,” Fine says. That’s why organizations that provide virtual support to help family caregivers make the right care decisions are critical, she adds.

According to Fine, studies show that on-demand access to healthcare specialists resolves care concerns for most patients, helping them avoid more expensive care settings while improving their quality of health and life.

What This Means For You

If nursing homes no longer seem like a viable option for you or your family members after the COVID-19 pandemic, there are still various other options available. If you’re undecided on what best works for you, you can look into home care, virtual assistance, and more. You can read about some of the best home care services here.

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.

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