A challenge for public policy: the chronically ill elderly and nursing homes

Data reported by skilled nursing facilities (SNFs) in an eight-county area in Northern California for 1977-78 indicate that the typical SNF resident was a impoverished female who was at least 75 years old. Her SNF stay was subsidized by MediCal, California's Medicaid program. She was in an urban, for-profit SNF for at least one year, during which time approximately one quarter of her co-residents died. She received about 2 hours of daily side-orderly-attendant care and almost 45 minutes of licensed nurse care. Although her most frequent contact was with aides-orderlies-attendants, a sustained relationship with the staff was not likely because of high employee turnover rate in the facility. This resident had a one-in-three chance of being in a SNF that had been cited (though the citation had not necessarily been upheld) for poor to life-threatening care. This information underscores the urgency of reorienting public policies so that they are based on the needs of the chronically ill elderly. Such a reorientation would I) ensure that people receive professional and paraprofessional services in the least restrictive environment; 2) preclude criticism of nursing homes for "warehousing" the elderly when there is actually little choice in the matter; and 3) enable the nation's elderly to live out their lives with sense of self-worth and dignity, and with the knowledge that they are valued members of society.