Nursing Homes

The concept of a residence set aside solely for the elderly and infirm was unknown until the nineteenth century. Before that, it was understood that elderly people would be taken in by family once they were unable to care for themselves. Those who had no family could rely on servants if they had the financial resources, but for those who were alone and poor the only choice was the local almshouse.

As the Industrial Revolution brought more people to cities, families spread out and often people had no local extended family to fall back upon when they were in need. The result was a growing number of single and widowed people who had no one to take care of them in their old age. The first homes for the elderly were established by churches and women’s groups, catering to widows and single women who had limited resources. Homes such as the Indigent Widows’ and Single Women’s Society in Philadelphia and the Home for Aged Women in Boston were a far better option than an almshouse. These early homes were not open to all. Many of them required entrance fees, and some asked for certificates of good character. Requirements like these shut out the neediest, which were still relegated to the almshouse.

By the beginning of the twentieth century, sensibilities about caring for the poor and incapacitated had begun to change. Specialized facilities were built for children, the mentally ill, and younger infirm individuals. But little was done for the elderly, and they merely became a larger percentage of the almshouse population. In 1880, one third of the residents of almshouses in the United States were elderly; by 1923, two thirds were elderly.

Choosing A Nursing Home

elderly couple and care worker enjoying a tea breakDeciding to opt for nursing home care is a difficult experience for the patient and for the family. Ideally, a nursing home should be a place that combines the benefits of modern health care with the amenities of a home-like atmosphere. A nursing home that is sterile and hospital-like may suit some people but probably not most, likewise a nursing home whose staff is pleasant but whose facilities are in poor repair. Most experts in nursing care advise people to explore the options before the need arises, but few people plan ahead to the day when they may need long-term care.

The Medicare web site ( includes a useful comparison tool called Nursing Home Compare. This tool provides information on Medicare- and Medicaid-certified nursing homes throughout the United States. Visitors can get information on nursing homes by geographic region, community, or ZIP code. They can compare facilities, patient-to-staff ratio, various programs offered within each home, and so forth.

While tools such as Nursing Home Compare can break down general information about nursing homes, they cannot provide information such as whether a particular facility met only the minimum standards or exceeded all standards. Experts recommend that the patient (if possible) and the family members involved in the decision-making process visit several nursing homes before making a choice. This is important because nursing home care is usually long-term, and also because it is particularly traumatic for elderly, infirm people to have to move. Moving from one nursing home to another is physically and emotionally taxing for patients and families.

Often, the decision to move to a nursing home is one that must be made quickly—often, the patient is sent to a nursing home after a hospital stay and must be transferred immediately after being discharged from the hospital. In some cases it may be better to pay for a longer stay in the hospital or arrange for temporary home care instead of taking the first available nursing home even if it seems less than ideal.

Nursing Home Abuse

With some 17,000 nursing homes serving 1.6 million individuals, it is expected that standards will vary, even among homes ostensibly adhering to the same standards. Unfortunately, in some nursing homes, abuse exists. Homes that are overcrowded, or homes with staff shortages or minimally trained staff, are susceptible, but it would be wrong to say that any specific condition makes abuse more likely. Under no circumstances is abuse excusable or acceptable in any way.

The greatest danger of nursing home abuse is that its victims are often either too frightened or too disoriented to report it, or even to tell friends or family. Those with family members in a nursing home should be aware of what to look for when trying to determine whether abuse exists:

  • The patient appears fearful or agitated, depressed or withdrawn.
  • The patient is isolated with no justification.
  • The staff is rude or makes humiliating or derogatory comments to patients.
  • Patients are making complaints.
  • Patients’ rooms are not kept clean by staff.
  • Common areas are unsanitary.
  • Patients appear unkempt or dirty.
  • Patients have bed sores or other untreated medical conditions.
  • Patients have unexplained wounds, cuts, scrapes, sprains, or broken bones.
  • Patients experience sudden unexplained weight loss.
  • Patients are restrained without explanation as to why.
  • Patient’s personal property is missing.
  • Money is missing from patient’s accounts.
  • Staff restricts or refuses visitors.
  • Patient makes sudden changes in a will or other financial documents

If you find abuse in a nursing home, you should report it at once. The U.S. Administration on Aging has a National Center on Elder Abuse web site ( that links to individual state agencies. You can also call the Elder Care Locator at 1-800-677-1116. In an extreme emergency (if a patient’s life is in danger, for example), dialing 911 may be the best idea.