Home Care Versus Nursing Homes Essay

Situated in the context of a rapidly aging population, this dissertation examines the
implications of supplying long-term care (LTC) services to the elderly in the United States. The
first two essays investigate private costs of LTC assistance borne by adult children of elderly
parents. In contrast, the third essay focuses on the cost of publicly-provided, formal LTC
services.Home Care Versus Nursing Homes Essay

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The first essay analyzes whether adult children devote less time to exercise as time
allocation in parental caregiving increases. The empirical model is a system of four correlated
equations, where the dependent variables are hours spent caregiving, frequency of moderate and
vigorous physical activity, and hours spent in paid work. I use pooled cross-sectional data from
the Health and Retirement Study (HRS) for this analysis. Results from joint estimation of the
four equations indicate limited evidence of a competition between time spent in caregiving and
frequency of physical activity. Parental factors that increase allocation of care time to parents do
not comprehensively induce reductions in the frequency of any type of physical activity, nor in
hours of work, among either men or women.
The second essay goes beyond time resources and examines whether dementia onset in
parents leads to a reduction in adult children’s household wealth. Towards this, I construct a
longitudinal dataset from seven waves of HRS. Estimates from unconditional quantile
regressions indicate that parental dementia substantially reduces household wealth of an
unmarried adult child in the upper quantiles of the wealth change distribution in the first two
years after parental diagnosis. These effects are more pronounced for unmarried adult children
without siblings. Further, this response is observed to persist in the subsequent time period as
well. An examination of mechanisms suggests that both, losses in labor income and nursing
home expenditures, may play a role in leading to wealth declines. This paper makes two
contributions: first, it focuses on a broader outcome of private cost, and second, unlike previous
studies, it does not limit the analysis to adult children who are informal caregivers.
The final essay examines the cost implications of publicly provided formal care services.Home Care Versus Nursing Homes Essay
Medicaid’s Personal Care Services (PCS) State Plan benefit is a key mechanism through which
states provide personal assistance services to eligible beneficiaries. But, it is widely claimed that
states are reluctant to adopt the program over fears of runaway spending. Surprisingly, there has
been very little empirical work on examining the effect of the PCS State Plan benefit on
Medicaid expenditures. Using aggregate state-level data from 1975 through 2009, this study
finds that PCS State Plan adoption had no overall effect on Medicaid expenditures, except briefly
during the early-growth years in 1980s. Further, findings suggest that states make decisions to
adopt the program based on financial experiences of other adopting states. This study provides
evidence consistent with the interpretation that when faced with the dilemma of balancing
increased access and uncontrolled expenditures, state officials adapt the design of an entitlement
benefit in an effort to make it less expensive.
In its entirety, the dissertation provides new thinking on two dominant themes in
conventional long-term care research: “caregiver burden” and “woodwork effect.” In particular,
the results of the first and third essay question the presence of “caregiver burden” and
“woodwork effect” respectively, while the third essay challenges the pervasiveness of “caregiver
burden” among unmarried adult children. These findings, which in some aspect are unexpected
in the context of existing literature, have important implications for policy intervention and the
direction of future research efforts in this area.

Living in the developing world force young generation to face the dilemma of putting their elder relatives, parents, or people they are familiar with into the nursing houses or take care of them at homes. Traditionally, it is believed that all those mentioned must be taken care of and looked after at homes. However, the modern way of life shows that the younger generation is now more concerned and busy with their own daily routine, private life, education, job and entertainment they have the right for. This leaves too little time and resources to focus on the issues of their elder relatives and care of them by their own. However, home care not always can be provided as it is necessary because of the lack of facilities or equipment needed. For that very reason, the dilemma of the nursing houses and home care is of great importance and gains a huge attention of all those people who have the problem of the kind. This essay will aim to discuss the burning issues related to the dilemma of the nursing homes and home care. Also, it will highlight the arguments of both the nursing homes and home care for elder relatives.Home Care Versus Nursing Homes Essay

The current existing problems of the nursing homes in the United States
Being a volunteer in one of the campuses in Virginia, I was lucky to meet Jim. Sitting in his wheelchair, he seemed to me one of the most cheerful and interesting 60 years old persons I’ve ever met in my life. That is why I believe this acquaintance had all the right to be identified as a lucky chance. Jim was a local resident, and an experienced pilot in the past. I noticed a small sticker on his wheelchair titled something like “Treat your kids in a nice manner. They are the ones who choose a nursing home for you”. I was surprised and asked him about that stuffed. I was told that he had been nice to his children, which is why he was a resident of the best nursing home he could dream of. The thing is that his “kids” had no choice but put him in the nursing house to be looked after. But before they did it, there appeared to be an issue after a long research – most nursing houses are not fully appropriate and equipped with all the necessary thing to place the elder people and provide them with the healthcare they need (Sakauye KM, 1992). Not all of them are staffed appropriately and abuse their patients and a disservice to them. Such negative aspect of a poor quality the nursing home industry has, boosts to the question: is it rational to put the relatives in the nursing houses and to find a way out if there is a need to do it. Conversation with Jim pulled me to the answer: one should make a proper research before choosing a new “shelter” for the one you love when you have no opportunity to take care of them at home.Home Care Versus Nursing Homes Essay

Today, almost all the existing nursing homes are understaffed, which is currently one of the biggest problem. Thus, the residents are not provided with the service they need and their needs are not taken care of. In 2001 Reuters Health made a survey among the nurses in the United States. It showed that 5,000 of the nurses out of more than 7,000 surveyed admitted the decline in quality of the nursing care in the nursing homes. The statistic revealed some shocking facts. 34 residents of the nursing home have only one licensed nurse and 12 residents are assisted by only one nursing assistant per day. HCFA (Health Care Financing Administration), which is an organization aimed to regulate the quality of assistance and care in the nursing homes shared the information that “average staffing time of nurses was 3,5 hours a day” (Harrington in “Nursing Home Residents”, 12).

The other issue that influences the quality of assistance in the nursing homes has a lot to do with hiring temporary nurses. This reveals another problem hidden in the way the nurses are trained. The thing is that the nursing homes inform all the residents that the assisting staff is trained properly indeed when in reality it isn’t so. So, the nursing homes are satisfied when there are no complaints about it. However, the issue of improperly staffed of such organizations must be revealed by a careful previous research before putting relatives in the nursing homes (Hertzberg A, 2003).Home Care Versus Nursing Homes Essay

However, the major problems of the nursing care industry are not limited by all those mentioned above. The United States Department of Health and Human Services identified nursing home physical abuse as an even more frightening argument for monitoring the right home before making a choice. Up to seven categories of such abuse were revealed, including physical and emotional neglect, which is a real problem because in reality all the nursing homes promise a good service as if the residents are taken care of at homes, where they are loved.

Putting older people into the nursing homes. Pros and cons of living beyond home.
The aging population class is regarded as the major consumer of the resources provided by healthcare. Thus, the nursing homes are required to have the necessary drugs available just like the appropriate staff to take care of the nursing home residents. The lack of both resources causes difficulties in making decision whether put the old relatives into their “new homes” or not, while it is believed that the healthcare houses are much better places for living than the families.Home Care Versus Nursing Homes Essay

As a matter of fact, before planning to put old people into the nursing homes one must do a research to take the right decision for the beloved ones. This fact gives all the grounds to reveal pros and cons related to this question.


Following are the facts considered as pros for the nursing homes care. Again, with the increase of the elderly population, most of us can face with the challenge to provide the members of our family with the nursing assistance in communities or stay beside them at our home. The decision itself may appear to be stressful. It is said that the nursing homes have the highest levels of service and all the appropriate equipment and resources, including a trained staff, to look after the residents. Some of them do really provide custodial care as it is required, which includes help related to getting out of bed, dressing up, feeding and bathing. This mens that the nursing staff is available for the patients around the clock and are always ready to help in case of need and giving drug therapy as required. Adequate healthcare, drug therapy and rehabilitation is promised and followed, while home care is not always possible in an appropriate way.Home Care Versus Nursing Homes Essay

Though, all the existing cons of the nursing homes must be paying even much more attention to make sure that old people are taken care of at the promised level. One should note again that nursing assistance offered in the community must meet all the daily needs of the residents and help them in various activities. All that mentioned relates to the medical assistance for the patients who suffer from diseases, and meeting the needs with eating, bathing, toileting, dressing, walking around, etc. These types of so called services can be provided by a very skilled and experienced personnel, which turns out be not enough as promised by the hospital care management. Or, the staff working there is not appropriately trained to cope with the problems they face with on practice. Again, as mentioned sometimes the residents may be abused by the nurse assistance in terms of moral principles, or even physically.

From the one hand, the government is obliged to organize more funds that would observe the existing problem and develop more programs for the patients who receive healthcare or any other assistance in the nursing homes. Currently, many of the communities may not have facilities available for the separate situations occurred because of illness that may be possibly carried by the patient and the urgent attention might not be paid in due course just for the reasons of understaffed homes. Moreover, the fact that there are too many old people left alone who has no sponsorship provided by their relatives is also must be taken into account.Home Care Versus Nursing Homes Essay

On the contrast, home care appears to be the alternative for the nursing homes, which also has both its advantages and downsides. On the whole, home care permits patients stay home and get an assistance in recovering from illnesses, after serious medical surgery activities or to those who are disabled to living a normal life in terms of the aging or disease as well.

Most of the patients that are taken care at home also receive all the types of treatments and services from their homes offered by healthcare facilities. These services are covering the main needs in cooking and delivering food, various works about the house like laundry and help involving washing the hair, bathing, dressing or getting out of the bed. All these services may be donated or provided for free by the government programs that cover the costs for the home care. For that very reason, most of aging people give preference to aging at their homes and staying with people they know and love. The surveys revealed that it is much easier and adoptable for aging people to be looked after at homes, which makes them much happier to be in the circle of the family members.Home Care Versus Nursing Homes Essay

Even though, the positive arguments in favor of home care are met by the downsides. Globally, the rapid rise of the aged population is met by the young generation rather than negatively. Since the young people tent to rise their own families and living happy life, taking care of their oldest relatives seems too inconvenient. For that very reason most of the aging people feel lonely and have all the symptoms of depression and mental disorders (Gaugler JE, 2004). Currently, most families do not tend to spend too much time together in a warm circle of relatives and the aging members will need help from the retirement homes and nursing homes.

With the aging population issue being currently one of the most significant for the children who are looking for an appropriate nursing home for their parents or relatives, it is becoming a vital question for them. Viewing both negative and positive sides of care provided in the nursing homes and at homes by the family, one may conclude there’s no univocal answer. However, the facts gathered with the help of surveys signify that home care is far better than the one provided in the understaffed nursing homes. I am deeply convinced that there is no better place for the aging population than their home with those who love them.Home Care Versus Nursing Homes Essay

Hospice in the Home and Home Health Care
If an individual was recovering from an illness and needed continued support at home, what type of care would be needed? Home Health Care (HHC) focuses on patient rehabilitation and traditional medical management. With HHC, the patient, family, or friends are educated and trained how to care for the patient at home with anticipation of recovery. Hospice focuses on the quality of life and patient comfort. Hospice care is meant for the time when treatment can no longer help, and there is no expectation of recovery. The focus of Hospice is pain and symptom management as well as support services providing counseling and education to the patient and family. Medicare, Medicaid, and most private insurance plans pay for services that Home Health Care Agencies provide. Payment from these sources depends on whether the care is medically necessary and the individual meets specific coverage criteria. Individuals may opt to pay out of pocket for services that are not covered by other sources. Some agencies receive special funding from state and local governments and community organizations to cover the costs of needed care when other options are not available. To qualify for home care services, the individual must have a skilled need and must be homebound in order for Medicare, and most insurance to pay for care. Coverage for hospice care is available through Medicare and Medicaid programs in 38 states, and most private insurance plans. (Wright, 1999) If insurance coverage is insufficient or unavailable, the patient and his or her family may pay for services out of pocket. Most hospices may provide free services to individuals who have limited or no financial resources. Hospice covers medications related to the terminal illness and symptoms, where home health usually does not cover medications. Hospice covers usual and customary medical supplies and equipment, such as: beds, commodes, walkers, wheelchairs etc  Home Care Versus Nursing Homes Essay

IELTS Sample Essay: Who Should Pay for Nursing Homes

Here is one more sample essay for the topic taken from IELTS website

Essay topic is:

In Britain, when someone gets old they often go to live in a home with other old people where there are nurses to look after them. Sometimes the government has to pay for this care. Who do you think should pay for this care, the government or the family?

Give reasons for your answer and include any relevant examples from your own knowledge or experience.

While reading essays of several students, I discovered that most of them went off-topic. Some students wrote about poor situation in Russia, others wrote that the elderly need to pay for nursing care out of their savings or retirement benefits. If you look closely at the topic, you will see that:

1) They don’t ask you about Russia or even “your country”

2) They don’t ask you anything about savings or retirement benefits.

You just need to give your opinion what’s better: to make the government pay for the elderly or their families. Here, a balanced opinion is also possible.Home Care Versus Nursing Homes Essay

Here is the essay I wrote:

As British population is aging, more and more elderly people need to resort to nursing homes services. There is a public controversy over the issue whether it is the government’s responsibility to finance such care or the families ought to pay for this. From my point of view, a balanced approach is required depending on personal circumstances of each household.

On the one hand, there are two main cases when it would be more reasonable for the government to cover the expenses for British retirees. First, if working-age adults have low income, they simply cannot afford to pay for nursing home treatment of their parents. Second, families with two or more children have primary responsibility to provide their offspring with appropriate education. Were they to pay the bills for retirement homes, they would not be able to save enough money for college fees of their children.Home Care Versus Nursing Homes Essay

On the other hand, some British families are wealthy enough to support their older members. According to statistics, at least, 10% of British population belong to high-income families and would be able not only to settle a standard retirement home bill, but also to pay for individual care at a private nursing home. Such facilities provide luxury accommodation, 24-hour medical surveillance and even gourmet nutrition. This way, not only would the financial burden be partly taken off the government, but also the families would feel deeply satisfied that their elderly relatives are being cared after.

In conclusion, from my perspective, a case-by-case approach ought to be adopted regarding nursing homes. For underprivileged families, it would be necessary to introduce government subsidies, while wealthy families need to be given a possibility to choose whether they pay for public or private nursing facilities.Home Care Versus Nursing Homes Essay


People who have to leave their homes and families and move into a nursing home experience lots of grief and loss. This article is designed to help the family members and friends to better understand these losses and how they are expressed in words, actions, and/or emotions. During this time of change these people are experiencing one of the most difficult periods of their lives. Not only is it difficult for the person making the move, but also for that person’s family and friends. Handling grief and loss also involves the staff and the volunteers working in the nursing home.

Frequently people being placed in a nursing home look at it as a one-stop place before dying. This feeling has nothing to do with the quality of care that the nursing home offers, but is just their way of thinking. Such thoughts are very understandable, because few people ever return to a “normal” life after being admitted to a nursing home facility. It represents a one-way street which no one really wants to travel, but people seldom have any choice. Lots of these individuals and their families and friends have little or no help during this very rough time in their life’s journey.Home Care Versus Nursing Homes Essay

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Their losses and grief seem overwhelming to them. They have nowhere to go for comfort, and quite often no one who will listen to their grief story. This article explains some of the losses that these people experience, their reactions to these losses, and ways that families, friends, volunteers, and staff might be more understanding and helpful to them. Also explored are ways that might help them to heal from some of these many griefs so that they can live the last years of their lives in a more positive way and enjoy life as much as possible.

Since each person is so different and unique, there are many ideas and thoughts to explore which may be beneficial in helping them to cope. As you read through this article, you will need to pick out the losses and ideas that are speaking to you or your friend or family member. Since each of us has unique concerns and an individual way of life, we need to choose the suggestions and options that fit each person individually. Reasons for Entering a Nursing Home There are many reasons why people are faced with the major decision of entering a nursing home.

Very few people, if any, enter a nursing home because they want to. Usually there is a factor beyond their control which forces this decision on them and/or their families. The negative feelings and thoughts that arise from the need to enter a nursing home are not necessarily because of the nursing home, but because of the possessions and freedoms that must be given up in order to enter. Also significant is the fact that there are very few people, if any, who are ever able to go back home after entering a nursing home facility. They have just sort of reached a point of no return, and this is hard for anyone to accept.Home Care Versus Nursing Homes Essay

One of the major reasons for entering a nursing home is that the person’s health is poor, requiring nursing care that is not available to them at home. Due to unpredictable changes in insurance and hospital policies, many elderly people are forced to leave the hospital after a very short stay but are still in need of care, leading them into a nursing home situation. Home nursing care is not available in every area of the country, and sometimes, even if it is available, people cannot afford it and/or their insurance does not cover it. These situations leave the person with no other choices.

Families today are quite mobile and in many cases live in scattered parts of the country. Years ago, many of the family members might be located within a few miles of their original home. When an elderly person needed assistance or care, family members were available locally to help facilitate this care. People would be cared for in the homes of their children, or some of their children would move into the parent’s home to be available for care. Today this kind of care is seldom possible because typically the husband and wife both work, or a single child must work in order to live.Home Care Versus Nursing Homes Essay

So because of the lack of available help within the family, many people needing care have no choice but to enter a nursing home. Communities were much closer-knit years ago than they are today. Neighbors would assist an elderly person and give the needed care. Today such assistance is seldom possible because neighbors do not even know each other’s names. Lawsuits and legal restrictions have frightened neighbors away from helping each other as in former times. Churches were different in the past also. Caring congregations would bond together and offer assistance when needed.

Churches used to be very local groups in which everyone knew everyone else, but today people are more mobile and travel greater distances to church. Since church membership is not limited to people from just the surrounding community, true closeness rarely exists in the churches. Many churches have become more of a social gathering than a helping group as they were in the past. Lack of assistance from church and community, then, is another cause for someone to need the care of a nursing home. For some people, caring for a home or an apartment has become more than they can handle financially or physically.Home Care Versus Nursing Homes Essay

Too much work needs to be done to maintain the home and keep it clean and livable. Also, a house or apartment may now be too expensive for them in addition to their other expenses. Several older communities are becoming overrun with violence, gangs, and other criminal activity, and these elderly people do not feel safe in their homes when they are alone, nor are they able to make quick decisions or movements. They may fear falling or other injuries occurring with no one nearby to help them. Fears such as these may make a decision to enter a nursing home seem wise to them. Another major problem for many elderly is the loneliness.

Their children have grown up and moved away, and now have families of their own. They often forget Mom or Dad, or have neither time nor money to assist them. Their old neighbors may retire or move away, or they may die, leaving the elderly person feeling really alone. For many elderly, loneliness is quite a major problem. They are unable to drive a car to visit favorite places, but instead just stay in their house alone. The grief and sadness of being alone may overwhelm them, and thus the need to make a change is real and pressing, even though they would really prefer to be in their own home.Home Care Versus Nursing Homes Essay


At least in a nursing home there will be other signs of life around them. The above are some of the many happenings in people’s lives that make a decision to enter a nursing home or retirement home necessary. Sometimes the elderly have to make their decision alone, while at other times they will have help in making this choice. For some families there is the very difficult situation of role reversal in which children must make the decision. The parent may no longer be able to decide because of mental health problems, a stroke, Alzheimer’s disease, or various other handicaps.

Making the nursing home decision with roles reversed can be quite hurtful and sad for both parents and children. Parents have in the past made nearly all of their own decisions, and the role of the child was to respect the parent’s ideas and suggestions. With those roles now reversed, each has to accept a new position in life while giving up a previous one. To do so is painful if the parent protests or rebels against the move. Losses That Are Experienced In this chapter we will discuss the many losses that people experience when they need to enter a nursing home.

Each person, being unique and special, will experience unique kinds of losses, with no set pattern to them. Readers will need to select the losses described here which apply to themselves or to the person they are helping, or the one who is special to them. Maybe few of the losses described will match your family’s situation, but there may be many which fit right into your life’s journey. These losses are described from the point of view of people who are entering a nursing home. Losses do not imply that a nursing home is wrong or bad, but they are discussed in order to show how people experience their losses.Home Care Versus Nursing Homes Essay

Loss of independence is one of the greatest losses. Having independence is something that nearly everyone has worked hard to accomplish in a lifetime. Now that independence must be given up, it seems that everything they have worked for in life is now ended, and that their accomplishments were for nothing. Losing their independence in favor of dependence on the nursing home staff often gives them the feeling that life is just about over. Losing most of their self-esteem, they feel they are no longer worth much. Their own parents were proud of them when they became independent, and now they see themselves as a burden.

They have little or no choice regarding what they will do or when they will do it. Most activities in the nursing home are done according to a schedule or depend on the availability of staff. Freedom is to a great extent sacrificed and missed. The freedom to eat whenever and whatever they wish, as they had at home, has changed into eating only when meals are served. They must also eat exactly what is served or do without, unless they are fortunate enough to have a friend who will bring them some snacks. Previously, they enjoyed the freedom of going out to eat when they were able, a luxury that is no longer possible.Home Care Versus Nursing Homes Essay

They formerly had the freedom of cooking whatever they wanted in whatever way they liked it. Maybe they liked everything fried, and now nothing is fried. Maybe they liked lots of cakes and cookies, and now the desserts are fruits. They formerly had the freedom to invite others to share their meals with them, and now this is often impossible. In a nursing home, people may lose the freedom of showering when they so choose, since baths are now given only when the nurses have time to do so, and in whatever manner the nurses choose. Their laundry used o be done as they wanted it done, but is now done as an institution does laundry. Their “good” things are thrown in with all of the other laundry. Their names must be attached to all clothing, even to very special garments as well as other personal items. The freedom to watch TV or listen to the radio at any time they choose may also be lost, especially if they have a roommate. The loss of their home or apartment, their furniture, and their possessions is tremendously difficult. Often they must give up heirlooms that have been in the family for generations, and perhaps keepsakes associated with their deceased spouse.Home Care Versus Nursing Homes Essay

Having these items may have been preventing excessive loneliness, and could have been their hope for the future or their assurance that their spouse was always with them while that item was near. For some people the dwelling they lived in at the time of the nursing home decision was their lifelong “home” place, the place where their children grew up, and they have many pleasant memories of it which they can sit and enjoy. Perhaps this “home place” was a house they themselves designed and built along with their spouse.Home Care Versus Nursing Homes Essay

If so, there will be many losses connected with leaving that home or selling it. Furniture fits into these same loss categories: some of it owned by their parents, some of it bought soon after their marriage, and some of it played on or slept on by their children. These thoughts and memories are most important for people as they grow old. They focus on important things from the past as they experience so many losses and changes related to the present and the future. Another area of loss is friends and neighbors who do not come to the nursing home often to see the person.

The elderly may have received great joy from watching through the window as a neighbor or a child left for work or school, or as they played or worked in the yard. This joy is no longer available to them as they sit or recline in a nursing home many blocks or miles from their former home or apartment. Not to be able to watch neighbors breaks their long, familiar schedule, causing another loss for these people who are creatures of habit and whose schedules have become a vital part of their lives. Many people can tell the time of day by an event outdoors, such as a certain neighbor walking or driving by.Home Care Versus Nursing Homes Essay

Living in the nursing home has changed all that, creating a loss that they feel. Another major loss is that of church or community. Because of the location of the nursing home, people often have to leave their church and community area. If church was a vital part of their lives, leaving it will create a difficult loss. They will find it almost impossible to become involved in a new church and feel a part of it when residing in a nursing home. At a time in life when church and community are so very important, giving these up can be quite difficult or even devastating.Home Care Versus Nursing Homes Essay

It becomes nearly impossible to meet new friends and acquaintances while living in a nursing home. Losing their regular doctor is a difficult loss for people entering a nursing home. Because of a location change or for other reasons, they must change doctors. If their regular doctor has been one in whom they have long placed great confidence and trust, losing that doctor will be felt as a severe loss, especially since there may now be major medical decisions that an unknown new doctor will be helping them make. Just when security and stability are especially needed, they are gone. Home Care Versus Nursing Homes Essay

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