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A nursing home is a facility for the residential care of elderly or disabled people. Nursing homes may also be referred to as skilled nursing facility (SNF) or long-term care facilities. Often, these terms have slightly different meanings to indicate whether the institutions are public or private, and whether they provide mostly
assisted living An assisted living residence or assisted living facility (ALF) is a housing facility for people with disabilities or for adults who cannot or who choose not to live independently. The term is popular in the United States, but the setting is si ...
, or
nursing care Nursing is a profession within the health care sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life. Nurses may be differentiated from other health ca ...
and
emergency medical care Emergency medicine is the medical speciality concerned with the care of illness A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediatel ...
. Nursing homes are used by people who do not need to be in a hospital, but cannot be cared for at home. The nursing home facility nurses have the responsibilities of caring for the patients' medical needs and also the responsibility of being in charge of other employees, depending on their ranks. Most nursing homes have nursing aides and skilled nurses on hand 24 hours a day. In the United States, while nearly 1 in 10 residents age 75 to 84 stays in a nursing home for five or more years, nearly 3 in 10 residents in that age group stay less than 100 days, the maximum duration covered by Medicare, according to the American Association for Long-Term Care Insurance. Some nursing homes also provide short-term rehabilitative stays following surgery, illness, or injury. Services may include
physical therapy Physical therapy (PT), also known as physiotherapy, is one of the allied health professions. It is provided by physical therapists who promote, maintain, or restore health through physical examination, diagnosis, management, prognosis, pat ...
,
occupational therapy Occupational therapy (OT) is a global healthcare profession. It involves the use of assessment and intervention to develop, recover, or maintain the meaningful activities, or ''occupations'', of individuals, groups, or communities. The field of ...
, or speech-language therapy. Nursing homes also offer other services, such as planned activities and daily housekeeping. Nursing homes may offer memory care services, often called dementia care.


History

From before the 17th century to modern day, many families care for their elders in the family's home. While this is still common practice for many communities and families around the world, this has become increasingly more difficult over time as life expectancy increases, family size decreases, and increased expertise in caring for a person with a chronic disease. In the 21st century, nursing homes have become a standard form of care for most aged and incapacitated persons to account for those complexities. Nearly 6 percent of older adults are sheltered in residential facilities that provide a wide range of care. Yet such institutions have not always existed; rather, their history and development reflect relatively recent demographic and political realities that shape the experience of growing old. In the 17th century, poorhouses (also referred to as
almshouse An almshouse (also known as a bede-house, poorhouse, or hospital) was charitable housing provided to people in a particular community, especially during the medieval era. They were often targeted at the poor of a locality, at those from certain ...
s) originated in England as municipalities were expected to care for their poor. Orphans, people determined to be mentally ill, and elderly people were often placed into these living commons while able-bodied individuals were expected to work and could be imprisoned if they refused. This model was brought to North America by English settlers. Before the 19th century, no age-restricted institutions existed for long-term care; elderly individuals, who needed shelter because of incapacity, impoverishment, or family isolation, often ended their days in an almshouse. Placed alongside people deemed
insane Insanity, madness, lunacy, and craziness are behaviors performed by certain abnormal mental or behavioral patterns. Insanity can be manifest as violations of societal norms, including a person or persons becoming a danger to themselves or to ...
, people who were inebriated, or people who were
homeless Homelessness or houselessness – also known as a state of being unhoused or unsheltered – is the condition of lacking stable, safe, and adequate housing. People can be categorized as homeless if they are: * living on the streets, also kn ...
, they were simply categorized as part of the community's most needy recipients. Poorhouses gave a place where they could be given shelter and daily meals. In the 1800s in the US, women's and church groups began to establish special homes for the elderly persons. Often concerned that individuals of their own ethnic or religious communities might die alongside the most despised society. This led to the creation of private care facilities for the elderly in these communities. Poorhouses continued to exist into the early 20th century, despite the criticism of the poor conditions of the poorhouses. In the US, the
Great Depression The Great Depression (19291939) was an economic shock that impacted most countries across the world. It was a period of economic depression that became evident after a major fall in stock prices in the United States. The economic contagio ...
overwhelmed the poorhouses, but not enough space and funding. Due to muckraking in the 1930s, the less-than-favorable living conditions of the poorhouses were exposed to the public. This led to the provision of the Social Security Act (1935) to only give people their pension if they did not live in poorhouses, but could live in private institutions. In the US, poorhouses were then replaced with residential living home, known as board-and-care homes or convalescent homes. These board-and-care homes provided basic levels of care and meals in a private setting for a specific fee. Board-and-care homes proved to be a success and by
World War II World War II or the Second World War, often abbreviated as WWII or WW2, was a world war that lasted from 1939 to 1945. It involved the World War II by country, vast majority of the world's countries—including all of the great power ...
, the new way of nursing homes began to take shape. As the times continued to change, the government identified the issue of people spending extensive amounts of time in hospitals. To combat these long stays in short-term settings, board-and-care homes began to convert into something more public and permanent that was state and federally funded. From this, by 1965 nursing homes were a solid fixture. Nursing homes were a permanent residence where the
elderly Old age refers to ages nearing or surpassing the life expectancy of human beings, and is thus the end of the human life cycle. Terms and euphemisms for people at this age include old people, the elderly (worldwide usage), OAPs (British usage ...
and disabled could receive any necessary medical care and receive daily meals. These nursing homes showed improvement in maintaining care and cleanliness standards in comparison to almshouses and poorhouses. From the 1950s through the 1970s, the dynamics of nursing homes began changing significantly. In the United States, Medicare and
Medicaid Medicaid in the United States is a federal and state program that helps with healthcare costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, including nursing home care and per ...
began to make up much of the money that would filter through the homes and the 1965 amendment laws enforced nursing homes to comply with safety codes and required
registered nurse A registered nurse (RN) is a nurse who has graduated or successfully passed a nursing program from a recognized nursing school and met the requirements outlined by a country, state, province or similar government-authorized licensing body to o ...
s to be on hand at all times. Additionally, nursing homes may sue children for the costs of caring for their parents in
jurisdiction Jurisdiction (from Latin 'law' + 'declaration') is the legal term for the legal authority granted to a legal entity to enact justice. In federations like the United States, areas of jurisdiction apply to local, state, and federal levels. J ...
s which have filial responsibility laws. Later in 1987, in the U.S. the Nursing Reform Act was introduced to begin defining the different types of nursing home services and later added the Residents' Bill of Rights. In the UK, after
World War II World War II or the Second World War, often abbreviated as WWII or WW2, was a world war that lasted from 1939 to 1945. It involved the World War II by country, vast majority of the world's countries—including all of the great power ...
many soldiers and civilians needing hospital care due to casualties during the war were planced in the hospital along with the many elderly patients present there, leading to overcrowding. The implementation of the NHS in 1948 and the abolishment of the Old Poor Law allowed for the creation of what would become modern day, public nursing homes. In the 1950s, Professor Peter Townsend brought to light the discrepancies the standard of care between the publicly and privately funded cares homes, leading to health policy reforms that assured the standard care practices for the elderly living in NHS funded care homes. The 1980s and 1990s saw care homes becoming a large industry in the UK. Thus, policies ensuring that private care homes are regulated (Registered Homes Act 1984) and patient needs are met (Care Standards Act of 2000) were established. Today, nursing homes are varied. Some nursing homes still resemble a hospital while others look more like a home. Nursing home residents can pay for their care out of pocket or with government assistance. In the U.S., others may receive Medicare for a short time, while in other countries, public assistance may be available, and some may use long-term
insurance Insurance is a means of protection from financial loss in which, in exchange for a fee, a party agrees to compensate another party in the event of a certain loss, damage, or injury. It is a form of risk management, primarily used to hedge ...
plans. Across the spectrum, most nursing homes in the U.S. will accept Medicaid as a source of payment.


Considerations

Below are a few reasons to consider a nursing home * managing a worsening and progressive disease such as Alzheimers * after a recent hospital admission and not ready to transition to independently caring for oneself at home * when medical needs at home become unmanageable by the primary caregiver at home. When looking into nursing homes, consider what activities and/or medical needs patients one would need from the nursing home. Also consider finances, such as medical insurance and personal funds. Ensure the nursing home is properly licensed and has qualified staff. If time allows, visit the nursing home in person to receive a walk through of the facility and if given the opportunity to speak with a guest or family member of guest, ask about their experience thus far.


Staff

Nursing home employees are all required to be licensed or uphold a certificate in the state of which they work. In most facilities, nursing homes are required to provide enough staff to adequately care for residents. In the U.S., for instance, nursing homes must have at least one
registered nurse A registered nurse (RN) is a nurse who has graduated or successfully passed a nursing program from a recognized nursing school and met the requirements outlined by a country, state, province or similar government-authorized licensing body to o ...
(RN) available for at least 8 straight hours a day throughout the week, and at least one
licensed practical nurse A licensed practical nurse (LPN), in much of the United States and Canada, is a nurse who cares for people who are sick, injured, convalescent, or disabled. In the United States, LPNs work under the direction of physicians, mid-level practition ...
(LPN) on duty 24 hours a day. Direct care nursing home employees usually include registered nurses, licensed practical nurses, social workers, certified nursing assistants, and physical therapists, amongst others.


Medical staff


Nurses

Nursing homes require assessment and monitoring of residents by a
registered nurse A registered nurse (RN) is a nurse who has graduated or successfully passed a nursing program from a recognized nursing school and met the requirements outlined by a country, state, province or similar government-authorized licensing body to o ...
(RN) who is typically required to have between two and six years of education. The RN's job duties include implementing care plans, administering medications, recording and maintaining accurate reports for each resident, monitoring and recording medical changes, and providing direction to the nursing assistants and
licensed practical nurses A licensed practical nurse (LPN), in much of the United States and Canada, is a nurse who cares for people who are sick, injured, convalescent, or disabled. In the United States, LPNs work under the direction of physicians, mid-level practitio ...
(LPN). RNs are not required to choose a specialization. To gain recognition as a specialized nurse professional, RNs typically need education in their specialized field, and further experience through clinical practices. LPNs are typically required to have a year of training before working with any patients. The LPN monitors residents' well-being and administers treatments and medications, such as dressing wounds and dispensing prescribed drugs. LPNs are responsible for patients' direct bed care and carry out a daily routine.


Nursing assistants

A nursing assistant provides basic care to patients while working directly under a LPN or RN. These basic care activities, also referred to as activities of daily living, can include assisting with bathing and dressing residents, helping residents with meals, either serving them or with feeding, transferring to and from the bed or wheelchair, making and cleaning beds, assisting with toileting, and answering call lights. Nursing assistants' official titles can vary between jurisdictions and facilities. They can include Certified Nursing Assistants (CNAs), nursing aides, caregivers, patient care associates, patient care technicians, personal care attendants (PCAs), and care assistants. Physicians At skilled nursing facilities, in addition to required 24 hour skilled nursing, a licensed physician supervises individual patients. At nursing homes other than skilled nursing facilities, patients receive care from physicians not affiliated with the nursing home. These physicians are typically employed by a private agency that sends physicians to nursing homes per the request of the patient, nursing home, or patient's family. The majority of these physicians are family medicine doctors or internists; however, some specialists such as cardiologist or nephrologist may also make independent visits to supplement their care.


Non-medical staff


Administration

Depending on the size of the nursing home, a nursing home may have either a nursing home administrator or an
executive director Executive director is commonly the title of the chief executive officer of a non-profit organization, government agency or international organization. The title is widely used in North American and European not-for-profit organizations, though ...
. Some nursing homes may have both, but their job duties are similar and can include overseeing staff, supplying medical supplies, and financial matters. Some nursing homes also have human resources personnel, who are in charge of all aspects of hiring new employees. Human resources job duties vary but can also include coordinating payroll, organizing orientation programs for new employees, interviewing, disciplinary actions, and ensuring compliance with federal and state laws. Nursing homes are usually licensed and heavily regulated under governing legislation. Compliance with the federal and state legislatures are reviewed regularly for adherence to strict standards of building codes, care plans, behavior and altercations between residents, nutrition and dietary services, medical services, nursing and personal care, religious and spiritual practices, pets, and recreational programs.


Housekeeping

Housekeepers perform everyday
cleaning Cleaning is the process of removing unwanted substances, such as dirt, infectious agents, and other impurities, from an object or environment. Cleaning is often performed for aesthetic, hygienic, functional, environmental, or safety purposes. ...
and upkeep in nursing homes. They play a huge part in ensuring that nursing homes are kept clean and free of disease causing agents. Housekeepers have a long list of duties which include cleaning floors, changing linens, disinfecting bathrooms, changing towels, washing clothes, emptying trashcans, sanitizing rooms, replenishing supplies, dusting, vacuuming, and keeping windows and woodwork clean. These duties can vary from facility to facility but it will overall include basic cleaning. Housekeeping does not require any licensure or schooling, but some jobs may prefer experienced housekeepers.


Recreational staff

Recreational staff usually include an activity director and possibly activity assistants depending on the size of the nursing home. Activities aim to meet each resident's
emotion Emotions are mental states brought on by neurophysiological changes, variously associated with thoughts, feelings, behavioral responses, and a degree of pleasure or displeasure. There is currently no scientific consensus on a definitio ...
al, intellectual, physical, social, spiritual, and vocational needs. The transition from being independent to having to depend on others and be away from home is oftentimes very difficult, which is why activities are important to combat depression and
anxiety Anxiety is an emotion which is characterized by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events. Anxiety is different than fear in that the former is defined as the anticipation of a future threat wh ...
. Some of the different activities that may be offered include hosting birthday parties, celebrating
holiday A holiday is a day set aside by custom or by law on which normal activities, especially business or work including school, are suspended or reduced. Generally, holidays are intended to allow individuals to celebrate or commemorate an event or t ...
s, book clubs, musical events,
outdoor activities Outdoor recreation or outdoor activity refers to recreation done outside, most commonly in natural settings. The activities that encompass outdoor recreation vary depending on the physical environment they are being carried out in. These activiti ...
, discussion and social groups,
exercise Exercise is a body activity that enhances or maintains physical fitness and overall health and wellness. It is performed for various reasons, to aid growth and improve strength, develop muscles and the cardiovascular system, hone athletic ...
, arts and crafts,
pet therapy Animal-assisted therapy (AAT) is an alternative or complementary type of therapy that includes the use of animals in a treatment. The goal of this animal-assisted intervention is to improve a patient's social, emotional, or cognitive functioni ...
, religious services and community outings. Volunteer involvement is also an important part of nursing home activities given that volunteers can act as a link between the nursing home and the outside community.


Therapy


Occupational therapy

One of the many services offered in a nursing home is
occupational therapy Occupational therapy (OT) is a global healthcare profession. It involves the use of assessment and intervention to develop, recover, or maintain the meaningful activities, or ''occupations'', of individuals, groups, or communities. The field of ...
. Occupational therapy may be necessary following an injury or illness in order to regain skills and to receive support during any physical or cognitive changes. Occupational therapy will focus on activities of daily living such as 
bathing Bathing is the act of washing the body, usually with water, or the immersion of the body in water. It may be practiced for personal hygiene, religious ritual or therapeutic purposes. By analogy, especially as a recreational activity, the term is ...
, dressing,  grooming. Occupational therapy also assists with instrumental activities of daily living which include home and  financial management, rest and sleep, 
education Education is a purposeful activity directed at achieving certain aims, such as transmitting knowledge or fostering skills and character traits. These aims may include the development of understanding, rationality, kindness, and honesty ...
, work, play, 
leisure Leisure has often been defined as a quality of experience or as free time. Free time is time spent away from business, work, job hunting, domestic chores, and education, as well as necessary activities such as eating and sleeping. Lei ...
, and social participation. Occupational therapists work to allow the person to safely and comfortably reintegrate into society by practicing public dining, transferring to different surfaces (chairs, beds, couches etc.), and will assess the need for any home modifications or safety equipment to ensure a proper and safe transition. When a cognitive and/or perceptual deficit is presented, therapists will work with the person by teaching strategies to maximize memory, sequencing and attention span length.


Physical therapy

Another important service found in a nursing home is
physical therapy Physical therapy (PT), also known as physiotherapy, is one of the allied health professions. It is provided by physical therapists who promote, maintain, or restore health through physical examination, diagnosis, management, prognosis, pat ...
. Physical therapy may be necessary following an injury, illness or surgery. Physical therapy works with the person to help them regain strength, endurance, flexibility, balance and
range of motion Range of motion (or ROM), is the linear or angular distance that a moving object may normally travel while properly attached to another. It is also called range of travel (or ROT), particularly when talking about mechanical devices and in mechanic ...
. Physical therapy is also used as a way of preventing injuries and accidents by focusing on restoring mobility, increasing fitness levels, reducing pain and overall reaching a certain point of independence. There are many conditions that can benefit from receiving physical therapy in a nursing home, these conditions include
arthritis Arthritis is a term often used to mean any disorder that affects joints. Symptoms generally include joint pain and stiffness. Other symptoms may include redness, warmth, swelling, and decreased range of motion of the affected joints. In som ...
, pain associated with
cancer Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...
,
dementia Dementia is a disorder which manifests as a set of related symptoms, which usually surfaces when the brain is damaged by injury or disease. The symptoms involve progressive impairments in memory, thinking, and behavior, which negatively affe ...
,
Alzheimer's Alzheimer's disease (AD) is a neurodegenerative disease that usually starts slowly and progressively worsens. It is the cause of 60–70% of cases of dementia. The most common early symptom is difficulty in remembering recent events. As t ...
,
stroke A stroke is a disease, medical condition in which poor cerebral circulation, blood flow to the brain causes cell death. There are two main types of stroke: brain ischemia, ischemic, due to lack of blood flow, and intracranial hemorrhage, hemorr ...
and
incontinence Incontinence or Incontinent may refer to: *Fecal incontinence, the involuntary excretion of bowel contents * Urinary incontinence, the involuntary excretion of urine * Lack of moderation or self-control, especially related to sexual desire - see ...
.


Speech language therapy

Speech-language pathology is another service found in a nursing home. Speech language pathologists specialize in working with those who have a difficult time with language and/or speech, usually following an injury or an underlying diagnoses. The SLP will evaluate the persons
speech Speech is a human vocal communication using language. Each language uses phonetic combinations of vowel and consonant sounds that form the sound of its words (that is, all English words sound different from all French words, even if they are th ...
. If the person is having trouble with speech, this points to an issue with coordinating the movements and muscles used to produce speech. While trouble with language points to the person having difficulty with understanding what they are hearing and seeing. The SLP will also look at difficulty with
swallowing Swallowing, sometimes called deglutition in scientific contexts, is the process in the human or animal body that allows for a substance to pass from the mouth, to the pharynx, and into the esophagus, while shutting the epiglottis. Swallowing i ...
food and will evaluate the person in order to figure out which part of the swallowing process is not working. Some of the many speech disorders worked with by the SLP are: *
phonology Phonology is the branch of linguistics that studies how languages or dialects systematically organize their sounds or, for sign languages, their constituent parts of signs. The term can also refer specifically to the sound or sign system of a ...
meaning the speech patterns used, * apraxia meaning difficulty with coordinating the movements needed to make sounds, *
receptive language Language processing refers to the way humans use words to communicate ideas and feelings, and how such communications are processed and understood. Language processing is considered to be a uniquely human ability that is not produced with the sa ...
meaning difficulty understanding language, * fluency meaning
stuttering Stuttering, also known as stammering, is a speech disorder in which the flow of speech is disrupted by involuntary repetitions and prolongations of sounds, syllables, words, or phrases as well as involuntary silent pauses or blocks in which the ...
, *
expressive language A spoken language is a language produced by articulate sounds or (depending on one's definition) manual gestures, as opposed to a written language. An oral language or vocal language is a language produced with the vocal tract in contrast with a si ...
meaning difficulty using language, and many other disorders.


Elder abuse

Elder abuse is more prevalent in hospitalized settings including nursing homes than in the general community. There are three major types of abuses reported in nursing homes: physical, emotional, and sexual abuse. Physical abuse is the intention or action to hurt an elderly person resulting in
scar A scar (or scar tissue) is an area of fibrous tissue that replaces normal skin after an injury. Scars result from the biological process of wound repair in the skin, as well as in other organs, and tissues of the body. Thus, scarring is a ...
s and
bruising A bruise, also known as a contusion, is a type of hematoma of tissue, the most common cause being capillaries damaged by trauma, causing localized bleeding that extravasates into the surrounding interstitial tissues. Most bruises occur close ...
.
Emotional abuse Emotions are mental states brought on by neurophysiological changes, variously associated with thoughts, feelings, behavioral responses, and a degree of pleasure or displeasure. There is currently no scientific consensus on a definition ...
occurs when an employee makes verbal
threat A threat is a communication of intent to inflict harm or loss on another person. Intimidation is a tactic used between conflicting parties to make the other timid or psychologically insecure for coercion or control. The act of intimidation for co ...
s and continuously degrades the patient, resulting in the patient experiencing mood swings,
anxiety Anxiety is an emotion which is characterized by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events. Anxiety is different than fear in that the former is defined as the anticipation of a future threat wh ...
, and depression.
Sexual abuse Sexual abuse or sex abuse, also referred to as molestation, is abusive sexual behavior by one person upon another. It is often perpetrated using force or by taking advantage of another. Molestation often refers to an instance of sexual assa ...
is when an elderly patient is being forced into unwanted sexual activity by an employee, resident or visitor, usually attempted and reported when the patient is sleeping, sick, or weak. Nursing home neglect is similar to
elder abuse Elder abuse (also called "elder mistreatment", "senior abuse", "abuse in later life", "abuse of older adults", "abuse of older women", and "abuse of older men") is "a single, or repeated act, or lack of appropriate action, occurring within any rela ...
. It is when employees begin to repeatedly ignore and leave a patient alone, neglect the patient's personal
hygiene Hygiene is a series of practices performed to preserve health. According to the World Health Organization (WHO), "Hygiene refers to conditions and practices that help to maintain health and prevent the spread of diseases." Personal hygiene refer ...
like bathing and brushing of teeth, provide the patient with an inadequate amount of food and water, or neglect to provide the patient with the correct amount of
medication A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to diagnose, cure, treat, or prevent disease. Drug therapy ( pharmacotherapy) is an important part of the medical field and ...
they require. One factor unique to elder abuse in nursing homes is that many nursing home contracts require residents to sign delegation clauses, giving up their right to trial by jury and instead using an Arbitrator to settle disputes.


By country


Canada

Long-term care facilities exist under three major types: privately owned, non-profit/charitable, and municipal. Regardless of their ownership, aspects of funding, admission criteria, and cost to the individuals are all regulated by their respective provincial governments. As medical care is publicly funded in Canada, all long-term care facilities receive funding from provincial governments for the health care component of the residence – the nurses and personal support workers. Residents pay daily rates for 'room and board' (accommodation and food) that are determined by the type of room chosen, either shared or private. Provincial governments manage waiting lists for long-term care facilities. People who cannot afford to pay the monthly fees receive subsidies, and no one is refused due to inability to pay.


United Kingdom

In the
United Kingdom The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom (UK) or Britain, is a country in Europe, off the north-western coast of the continental mainland. It comprises England, Scotland, Wales and ...
, care homes and care homes with nursing are regulated by different organisations in
England England is a country that is part of the United Kingdom. It shares land borders with Wales to its west and Scotland to its north. The Irish Sea lies northwest and the Celtic Sea to the southwest. It is separated from continental Europe ...
,
Scotland Scotland (, ) is a country that is part of the United Kingdom. Covering the northern third of the island of Great Britain, mainland Scotland has a border with England to the southeast and is otherwise surrounded by the Atlantic Ocean to ...
,
Wales Wales ( cy, Cymru ) is a country that is part of the United Kingdom. It is bordered by England to the east, the Irish Sea to the north and west, the Celtic Sea to the south west and the Bristol Channel to the south. It had a population in ...
and
Northern Ireland Northern Ireland ( ga, Tuaisceart Éireann ; sco, label=Ulster Scots dialect, Ulster-Scots, Norlin Airlann) is a part of the United Kingdom, situated in the north-east of the island of Ireland, that is #Descriptions, variously described as ...
. To enter a care home, a candidate patient needs an assessment of needs and of their financial condition from their local council. The candidate may also have an assessment by a
nurse Nursing is a profession within the health care sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life. Nurses may be differentiated from other health ...
, should the patient require nursing care. The cost of a care home is
means tested A means test is a determination of whether an individual or family is eligible for government assistance or welfare, based upon whether the individual or family possesses the means to do without that help. Canada In Canada, means tests are use ...
in England. Care homes for adults in the UK are regulated by Care Quality Commission, which replaced the
Commission for Social Care Inspection The Commission for Social Care Inspection was a non-departmental public body and the single, independent inspectorate for social care in England. Its sponsor department was the Department of Health of the United Kingdom government. It incorpora ...
, and each care home is inspected at least every three years. In Wales the Care Standards Inspectorate for Wales has responsibility for oversight, In Scotland
Social Care and Social Work Improvement Scotland The Care Inspectorate (formally known as Social Care and Social Work Improvement Scotland) is a scrutiny body which supports improvement. They look at the quality of care in Scotland to ensure it meets high standards. Where improvement is neede ...
otherwise known as the Care Inspectorate, and in Northern Ireland the Regulation and Quality Improvement Authority in Northern Ireland. In 2002, nursing homes became known as care homes with nursing, and residential homes became known as care homes. As of April 2009, the lower capital limit is £13,500. At this level, all income from
pension A pension (, from Latin ''pensiō'', "payment") is a fund into which a sum of money is added during an employee's employment years and from which payments are drawn to support the person's retirement from work in the form of periodic payments ...
s, savings, benefits and other sources, except a "personal expenses allowance" (currently £21.90), goes towards paying the care home fees. The local council pays the remaining contribution provided the room occupied is not more expensive than the local council's normal rate. The NHS has full responsibility for funding the whole placement if the resident is in a care home with nursing that meets the criteria for NHS continuing Health Care. This is identified by a multidisciplinary assessment process. In May 2010, a coalition government announced the formation of an independent commission on the funding of long-term care, which was due to report within a 12-month time frame on the financing of care for an ageing population. It delivered its recommendations on Monday 4 July 2011. The Care Quality Commission have themselves implemented a re-registration process, completed in October 2010, which will result in a new form of regulation being outlined in April 2011. In 2020 it emerged that some UK care home residents had blanket Do Not Attempt Resuscitation ( DNACPR) orders applied during the COVID-19 pandemic. These decisions were made without discussion with the patients involved, and the practice is being investigated by the Care Quality Commission.


United States

In the United States, there are three main types of nursing facilities (NFs). An intermediate care facility (ICF) is a health care facility for individuals who are disabled, elderly, or non-acutely ill, usually providing less intensive care than that offered at a hospital or skilled nursing facility. Typically an ICF is privately paid by the individual or by the individual's family. An individual's private health insurance and/or a third party service like a
hospice Hospice care is a type of health care that focuses on the palliation of a terminally ill patient's pain and symptoms and attending to their emotional and spiritual needs at the end of life. Hospice care prioritizes comfort and quality of life b ...
company may cover the cost. Board and Care Homes are special facilities designed to provide those who require assisted living services both living quarters and proper care. Often referred to as residential care homes, these facilities can either be located in a small residential home or a large modern facility. In fact, a large majority of board and care homes are designed to accommodate fewer than 6 people. Board and care homes are typically staffed by licensed professionals, including nurses, doctors and other medical professionals. These facilities are highly regulated in order to ensure that the best possible care is being provided for the residents. Board and care homes offer residents 24-hour assistance, making them a highly popular choice for those in need of regular assistance. Assisted living residences or assisted living facilities (ALFs) are housing facilities for people with
disabilities Disability is the experience of any condition that makes it more difficult for a person to do certain activities or have equitable access within a given society. Disabilities may be cognitive, developmental, intellectual, mental, physical, ...
. These facilities provide supervision or assistance with activities of daily living (ADLs); ALFs are an eldercare alternative on the continuum of care for people, for whom independent living is not appropriate but who do not need the 24-hour medical care provided by a nursing home and are too young to live in a retirement home. Assisted living is a philosophy of care and services promoting independence and dignity. A skilled nursing facility (SNF) is a nursing home certified to participate in, and be reimbursed by Medicare. Medicare is the federal program primarily for the aged (65+) who contributed to Social Security and Medicare while they were employed.
Medicaid Medicaid in the United States is a federal and state program that helps with healthcare costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, including nursing home care and per ...
is the federal program implemented with each state to provide health care and related services to those who are below the poverty line. Each state defines poverty and therefore Medicaid eligibility. Those eligible for Medicaid may be low-income parents, children (including those in
State Children's Health Insurance Program The Children's Health Insurance Program (CHIP) – formerly known as the State Children's Health Insurance Program (SCHIP) – is a program administered by the United States Department of Health and Human Services that provides matching funds to ...
s (SCHIPs) and maternal-child wellness and food programs), seniors, and people with disabilities. The
Centers for Medicare and Medicaid Services The Centers for Medicare & Medicaid Services (CMS), is a federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer M ...
is the component of the
U.S. Department of Health and Human Services The United States Department of Health and Human Services (HHS) is a cabinet-level executive branch department of the U.S. federal government created to protect the health of all Americans and providing essential human services. Its motto is " ...
(DHHS) that oversees Medicare and Medicaid. A large portion of Medicare and Medicaid dollars is used each year to cover nursing home care and services for the elderly and disabled. State governments oversee the licensing of nursing homes. In addition, states have a contract with CMS to monitor those nursing homes that want to be eligible to provide care to Medicare and Medicaid beneficiaries. Congress established minimum requirements for nursing homes that want to provide services under Medicare and Medicaid. These requirements are broadly outlined in the Social Security Act, which also entrusts the Secretary of Health and Human Services with the responsibility of monitoring and enforcing these requirements. CMS is also charged with the responsibility of working out the details of the law and how it will be implemented, which it does by writing regulations and manuals.


See also

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American Medical Directors Association American(s) may refer to: * American, something of, from, or related to the United States of America, commonly known as the "United States" or "America" ** Americans, citizens and nationals of the United States of America ** American ancestry, pe ...
* Care Quality Commission *
Child care Child care, otherwise known as day care, is the care and supervision of a child or multiple children at a time, whose ages range from two weeks of age to 18 years. Although most parents spend a significant amount of time caring for their child(r ...
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Elderly care Elderly care, or simply eldercare (also known in parts of the English-speaking world as aged care), serves the needs and requirements of senior citizens. It encompasses assisted living, adult daycare, long-term care, nursing homes (often call ...
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Home care Homecare (also spelled as home care) is health care or supportive care provided by a professional caregiver in the individual home where the patient or client is living, as opposed to care provided in group accommodations like clinics or nursing h ...
* International Association of Homes and Services for the Aging *
List of companies operating nursing homes {{unreferenced, date=March 2017 The following is a list of companies operating nursing homes in the U.S.: * Association of Jewish Aging Services *Bailey-Boushay House *Brookdale Senior Living * Catholic Health Services * Ecumen * Emeritus Assiste ...
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Retirement community A retirement community is a residential community or housing complex designed for older adults who are generally able to care for themselves; however, assistance from home care agencies is allowed in some communities, and activities and socia ...
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Caring for people with dementia As populations age, caring for people with dementia has become more common. Elderly caregiving may consist of formal care and informal care. Formal care involves the services of community and medical partners, while informal care involves the s ...


References

{{Authority control Caregiving Types of health care facilities