THE NEED FOR
NURSING HOME PLACEMENT
She had a couple of Jails at home, and we didn't know what was happening. Then, all
of a sudden her level of consciousness just totally changed.We did not know what was
happening with her, and we hired someone to come in and stay with her because she was
really confused, and she was changing rapidly. A physician I know offered to come to her
house and see her. He thought she needed to be admitted to the hospital, and he came
to her home and said we definitely need to admit her. Before her level of consciousness
changed, she said she didn't want to go to the emergency room, so this doctor admitted
her to the hospital and she didn't need to go to the emergency room. She was seen by a
neurologist who said that she had a hematoma, partly old, partly new. It had filled up
so much of the cranial space by now that we were seeing the symptoms, but it could have
been happening for years. They had to go in and evacuate, and once they evacuated it,
she lost a lot of her functioning and we just knew that she could never go back home
and live alone again. In fact, before this happened, we actually wanted her to have a
home health aide and she totally refused. I mean she was 92 … like, ma!
—A resident's daughter, two years after her mother's admission to te nursing home
WHILE SOME OLDER PEOPLE in the United States are able to live independently until the end of their lives, many, like the woman described above, eventually move to a nursing home. We need to understand all the factors, including contemporary social changes, that contribute to the need for nursing home placement. This chapter focuses primarily on two significant changes that are reflected in the decisions for placement made by many of the families in this study: extended life expectancy and employment outside of the home for greater numbers of women, who have traditionally been the primary caregivers.
The twentieth century saw a dramatic increase in life expectancy in the United States. In 1900 life expectancy at birth was 47 years; by 2002 it had increased to nearly 77 years (Moody 2002). According to the U.S.