Dr. Al Power writes…
A new study has been published in the Journal of the American Geriatrics Society, and like many studies, it raises some important issues, but does not address some larger concerns.
A group of people living in nursing homes (or their proxies) were interviewed regarding whether they could transition back to community living. Fewer than 1 in 4 elders or their proxies felt this was feasible, although nearly half stated a preference to do so. After discussing possibilities for community support, the number who thought they could make such a move increased to 1 in 3.
The study concluded that transitioning back to the community is a complex decision and that a systematic approach was needed to help people address this issue.
Some questions raised in my mind:
More residents felt they could move back home than their proxies. How much of this is due to the resident being unrealistic, and how much due to families not understanding their elders’ wishes?
How many of the elders felt they could not go back home because the institutional system has convinced them that they are helpless and unable to do more for themselves, or make more choices?
The MDS (a quarterly survey which is used to assess people in nursing homes) did not identify all of the people who wanted to move back home. How much more information is missed by our standardized assessments?
The larger question which was not addressed was: What if there were another option: a small non-institutional home for 8-10 elders, with skilled care provided by constant, enlightened universal workers, and visiting doctors and nurses? How many would want to leave then?
The citation is Nishita CM et al., JAGS 2008;56(1):1-7.