Choosing an Adult Foster Home or a Nursing Home

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Table of Contents

Nursing home
Adult foster care
Relocation decisions
Characteristics of respondents
Relocation decision
Perceived control over the decision

Nursing home

A nursing home is well known to health and social services professionals as the long-term care service for older adults that accounts for that vast majority of public funding. A nursing home is defined somewhat circularly as a residential health care facility that meets the federal requirements for certification for payment under Medicare and Medicaid and any additional state licensure requirements. These standards have evolved since their initial enactment in 1965, particularly since the implementation of the nursing home reform act of 1987, which grew out of the institute of medicine.

Nursing home standards are organized into categories such as administrative practices, environmental concerns, quality of care, quality of life, residents’ rights, and infection control. Federal regulations that articulate some minimum nursing standards and staffing standards for the training of nursing assistants also have been enacted. Within these requirements, nursing homes vary in size and other attributes. They are modeled on hospitals with the preponderance of accommodations being shared and a predominance of nursing routines.

Adult foster care

Although adult foster care in the United States has been traced back to colonial times when boarding homes provided meals and laundry, foster care specifically for older adults with abilities is a fairly recent development.

Mehrotra and Kosloski (1991) identified four common assumptions underlying foster care placement:

Nursing homes have detrimental psychological and social effects.
A family setting is inherently superior to an institutionalized setting.
Adult foster care homes represent the least restrictive care environment.
Foster care is a desirable part of a continuum of long-term care.

Oregon is ideal for the present study of location decisions for two reasons:

Adult foster care is well established as a middle-class, as well as a low-income alternative, foom of long-term care.
Adults with substantial disability levels receive foster care in Oregon foster homes.

Indeed, Folkemer (1996) found that Oregon was one of only five states with a preponderance of private-pay residents in adult foster care and was the only state with a program of substantial size in comparison to its nursing home population.

There would be some overlap in characteristics of residents in foster homes and nursing homes in terms of functional and care needs.

The regulation defines an Oregon adult foster home as a family-style home in a residentially zoned area that provides care to a maximum of five elderly or disabled people. Foster home caregivers are required to attend 18 hours of preservice training supplemented by 10 hours of yearly training.

Relocation decisions

Relocation studies are typically divided into studies about relocation within the community from the community to institutions and between institutions. The distinctions blur, however, as new options are added to the housing-care continuum, such as community care, retirement communities, and various types of supportive settings.

Decision-making and control over the decision to move have received recent attention in the long-term care literature, particularly in studies of relocation to nursing homes.

Associations have been found between control or perceived choice and such post-admission outcomes as adoption and adjustment, satisfaction with posthospital care, psychological distress, satisfaction with nursing home services, participation in activities, higher physical functioning, decreased pain, reduced use of medications, life satisfaction, depression, and health status.

Characteristics of respondents

Respondents in nursing homes and adult foster care were similar in demographic characteristics: most were female, currently not married, ages 75 to 84, and overwhelmingly white. Most had lived at their current residence for under two years.

Three major areas in which the foster care resident and nursing home residents differed were place admitted from, physical health. The foster home residents were much less likely to have been admitted from hospitals. On the other hand, 24 percent of foster home residents had been admitted from other foster homes, whereas only 6 percent of nursing home residents had moved there from other nursing. Also, more of the foster care residents came from other types of settings, mainly residential care or residential care facilities that are board and care home with limited personal care services.

Relocation decision

Forty-three percent of the foster care residents saw themselves as having had complete or almost complete control over the decision to move, 30 percent indicated some control, and 27 percent said that they had little or no control, a significant cant difference from the nursing home residents. Thirty-six percent of foster care residents had considered one or more other foster homes before choosing the current one, not significantly different from the portion of nursing home residents who had considered other nursing homes.

Foster care and nursing home residents differed on whether they considered the decision to move to have been a good one. Although a high percentage of both groups agreed that the decision had been good, more foster care residents answered affirmatively than did nursing home residents.

For foster care residents, the two major groups influencing the decision to move were family members and Oregon senior services case managers. For nursing home residents, family members also were most likely to influence the move, but influence from physicians was more likely and from case managers less likely than was the case for the foster care residents.

Both foster care and nursing home respondents reported social workers, discharged planners, and home health- public health nurses as being far less likely to influence the decision.

Perceived control over the decision

The only demographic variable associated with perceived control was education.

A low positive association was found between years of education and degree of control for the foster care residents. For the nursing home residents, those admitted from acute care hospitals were more likely to indicate low control over the decision than those with other sources of admission, whereas those admitted from their own homes were more likely to indicate high control.

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