Small Change, Big Impact: Remove Nursing Home From Your Vocabulary

By Lisa Wigton, PT, DPT

Physical Therapist

Words Matter & Nursing Home Shouldn’t be on my Lips or Yours

The term “nursing home” should be a phrase that fizzles away from society like “old people’s homes,” “convalescent home,” “care homes,” or “rest home.” These words have a negative connotation which will affect a person’s self-worth. Can you imagine how utilizing words with a negative connotation make an already vulnerable population feel? What about for the person who has lost a majority of their independence and freedom and then is coerced to live in a nursing home.  This negativity also applies to the healthcare professionals working tirelessly to provide compassionate care.  The healthcare system fails to recognize the efforts of many working in senior living communities generating a damaging impression as employees.  These professionals need the benefit of reaffirming language as much as the residents. Nevertheless, nursing home does not adequately describe the necessary treatment this population requires.

What could have been a doomed Fate at a Nursing home turned out to be a kick start to my professional career

I have been a physical therapist working in geriatrics for nine years in a variety of settings, and never have I worked in a nursing home. My first job after graduating with my DPT was in a skilled nursing facility, and I thought it was a perfect fit. Even though some people just saw an older building in a rough downtown Denver, CO, neighborhood, I saw excellent sub-acute and long-term care for primarily the geriatric population. We saw patients seven days a week with no time off for holidays. This was a little frustrating for my small team, but our job was essential and our patients needed the treatment to achieve their goals.

My work wasn’t always glamorous, but I was able to positively impact a multitude of patients and work with the nursing staff to provide optimal care. Some patients were at the facility for a short period of time (few weeks to a few months), while the majority permanently required long-term care. I remember Jim who had a high-level spinal cord injury in his 40s.  He didn’t have a family who would have been able to care for him and would have been absolutely unable to survive without skilled nursing care 24/7.

Later in my career, I worked in acute care where I assisted in discharge planning. The doctors and social workers looked to the therapy department for guidance for the safest and most appropriate discharge plans. These included home (with/without therapy), skilled nursing, acute inpatient rehab, or long-term care. There was no option to discharge someone to a nursing home. My decision was based upon an individual’s prior to function, rehab potential, motivation, level of social and physical support, and patient expectations. If a patient or family member started talking about returning to the “Nursing-Home” I would inquire about therapy needs and assuming they also had skilled nursing maybe that would be more appropriate. Or perhaps the patient was at a prior level of function and ability to safely return to long-term care.

What do the projections for the growing geriatric population mean for us?

According to the World Health Organization, the average life expectancy at birth in 1955 was 48 years, in 1995 it was 65 years, and the projection for 2025 is 73 years. That’s a quarter of a century increase in just 70 years! According to the most recent numbers, that is a quarter of a century increase in a person’s lifetime. People are living longer with greater numbers of chronic conditions like diabetes and heart disease with advancements in medical management. In addition, the Pew Research Center estimates that there will be 3.7 million centenarians across the globe in 2050. In 2016, nursing homes could house 1.7 million people according to the CDC.

The prevalence of aging Americans is astounding. What about the people that care for them? The CDC reports that for every 100 residents, nursing home employees 90 full-time staff. Not only do we have a growing population of individuals that require higher long-term care, but we also have more people caring for them. In my experience, an average American is only one to two degrees of separation of knowing someone in a nursing home. With this prevalence, society should not be utilizing such an outdated and negative term.

PTs: Pride in where you work and supporting each other

The APTA lists possible settings to work in as:

• Acute Care
• Rehab/ Subacute Rehab
• Extended Care Facility
• Skilled Nursing
• Outpatient Clinic/ Private Practice
• Home Health
• Hospice
• Education
• Research
• Schools
• Local, State, Federal Government
• Industrial/Workplace/occupational environments
• Wellness/Prevention/Fitness
• Sports training facilities

Regardless of your individual setting, PT’s have a common goal in rehabilitation. The absence of nursing home is intentional. FOX Rehab utilizes the term post-acute center or PAC. I personally had never heard of a PAC before I started working with FOX. However, I think that PAC has quite the ring to it and the more I think about it, the more I think PAC perfectly describes the ongoing care and therapy required in the management of chronic conditions. Therapists and healthcare professionals in all settings need to support us in Senior Living. We are all in this together and should pack together to remove Nursing Home from society’s vocabulary.

With the negative public perception about nursing homes, the senior living communities can and should showcase the value and need for SNFs and PACs. With most people wanting to age in place as long as possible, these facilities are integral to our society and must remain viable. Therapists know the need for helping our patients achieve their goals, but does society respect and understand the need? There will be an exponential need in the near future for sub-acute care as well as post-acute care. There will also be an additional reliance on healthcare workers and support staff to care for this population. Let’s continue to encourage our #HealthcareHeros and not let this new appreciation dwindle.

As George Eliot said, “It will never rain roses: when we want to have more roses, we must plant more roses.” It may take some time, effort, and care to change the way society looks at senior living. I am ready to roll up my sleeves and get to work, will you join me?