"Say-So" as a Predictor of Nursing Home Readiness

Article excerpt



Having a voice, or "say-so", in decisions affecting one's life is important throughout life. Nursing home placement often follows a major health crisis when decisions have to be made quickly. This study investigated satisfaction of nursing home residents as it related to readiness to move to a nursing home. "Say-so" was the most significant factor; positive attitude and heart conditions were also significant predictors. The findings suggest that families should include the potential nursing home resident in decisions whenever possible.

For individuals who turned 65 years of age in 1990, about 52% of women and 33% of men will spend some time in a nursing home (Papalia, Camp, and Feldman, 1996). Demographic trends showing a marked increase in the number of individuals over the age of 65, and an especially sharp increase in the number of individuals over the age of 85, are focusing attention on nursing home care and admissions (Hobbs and Damon, 1996; Velkoff and Lawson, 1998). Factors and processes that lead to nursing home admission have substantial personal and policy consequences for the resident, their families, and society (McAuley and Travis, 1997).

Studies evaluating demographic, socioeconomic, health, Activities of Daily Living (ADL), independence, and social support variables as predictors of nursing home admissions have had mixed results (cf. Coward, Netzer, and Mullens, 1996; Kane and Kane, 1987; Kersting, 1994; Pearlman, 1990; Roy, Ford, and Folmar, 1990; Rudberg, Sager, and Zhang, 1996; Satish et al., 1996; Tusji, Whalen, and Finucane, 1995). Some factors that predicted future nursing home admissions were limited functional ability or those needing ADL assistance (Kane and Kane, 1987; Kersting, 1994; Pearlman, 1990); prolonged bed rest (Satish et al., 1996); cognitive impairment (Pearlman, 1990; Satish et al., 1996); limited social support from family (Kersting, 1994); limited social support as a result of living in thinly populated areas (Coward et al., 1996); lack of a long-term caregiver; and living alone (Roy et al., 1990).

In addition to these risk factors, most older persons have one or more chronic diseases, including but not limited to, diseases of the heart, lungs, arthritis, diabetes, osteoporosis, and Parkinson's (Administration on Aging, 1998; Hobbs and Damon, 1996). Individuals who might have died from a heart attack in earlier years are now saved by doctors, only to live out their remaining lives with a chronic limiting illness or condition. Even with chronic diseases and physical limitations, the attitude of the older individual can literally be the difference between life and death. In fact, recent research has found that individuals who have self-reported good health are more likely to live longer than those who have self-reported poor health (Rogers, 1995).

From the nursing home residents' perspective, the process involved in the actual admissions decision may be far from ideal. In prior research, children and physicians were reported as the main initiators of the nursing home admission decision (Friedsam and Dick, 1964; McAuley and Travis, 1997; Reinardy, 1992). In many cases, family members made the final decision regarding nursing home placement following the illness of the resident, which left the family with insufficient time to investigate options and little opportunity to wait for space to become available in a home of their choice (Prawitz et al., 1991). In 50% or more of the cases, nursing home residents felt that they were not involved in the decision-making process. Earlier studies generally revealed fewer residents who perceived that they had a hand in the admissions decision process (Kane et al., 1990; McAuley and Travis, 1997; Reinardy, 1992; Sherwood, 1975). For example, in one study conducted by Sherwood in 1975, 90% of the residents felt that they had no input into the decision to enter a nursing home. …