Senior Health - Where Do The Frailest Of The Old Live?

We have seen that the majority of people aged 65+ live in homes they own. Poor health increases with age, and there comes a time when some older people may no longer be able to care for themselves. The chart shows data on the population aged 65+ who were in nursing homes from the period 1973-74 to 1999. The data are presented in tabular form below. According to the source, in crude numbers, there were 961,500 residents of nursing homes at the time of the survey in 1973-74 and 1,469,500 in 1999.¹⁰ In 1999 there were an estimated 18,000 licensed nursing homes. Their population is disproportionately female.

One trend is immediately obvious: If you are 85 years or older, you have a far greater chance of finding yourself in a nursing home. However, the data show that there was a decline among all age groups in the ratio of people confined to nursing homes.

The Nursing Facility Sourcebook 2001 summarizes results from a 1997 study showing: "[M]ore than a quarter of our nation's population currently over the age of 25 can anticipate at least one stay in a nursing facility in their lifetime…. The typical nursing facility patient is a white female Medicaid beneficiary aged 75 years or older…. Forty-two percent of nursing facility patients suffer from some level of dementia and 33% have documented symptoms of depression." The National Council on the Aging says: "A person turning 65 in the year 1990 had about a 40 percent lifetime chance of living in a nursing home."

Nursing Home Residents Aged 65+

Age	Residents per 1,000 population
	1973-74	1985	1995	1999
65 years+1	58.5	54.0	45.9	43.3
65-74 years	12.3	12.5	10.1	10.8
75-84 years	57.7	57.7	45.9	43.0
85 years+	257.3	220.3	198.6	182.5

The modern nursing home dates back to the 1940s; they expanded in the 1950s thanks to federal subsidies. Why the decline in nursing home residence? More people are taking advantage of home health care, and more people are taking advantage of the rising number of alternative facilities that are considered more desirable. This is a phenomenon that dates back to the 1980s and corresponds to the rising numbers, income, and clout of senior citizens. Where once older people had few options when health problems made running their household too hard to handle, today there is a variety of retirement communities that provide health-related services. They go by various names, the most common being continuing care retirement communities (CCRCs) or assisted living facilities (ALFs). CCRCs are the most expensive option and tend not to accept individuals with serious disabilities. According to AARP, most CCRCs require an entrance fee and monthly payments. The fees can range from $20,000 to $400,000; monthly payments range from $200 to $2,500.

The Assisted Living Federation of America (ALFA) says there are about 1 million older adults and individuals with disabilities residing in about 20,000 ALFs nationwide.¹¹ The average resident is age 83 and in need of assistance with at least one activity of daily living. An estimated 50% of residents have some form of cognitive impairment. It is usually a health care crisis or death of a spouse that prompts the move to assisted living.

Sources: Chart: Health, United States, 2001, Table 97, http://www.cdc.gov/nchs/hus.htm. The Nursing Facility Sourcebook 2001, http://www.ahca.org/research/nfbook.htm. National Council on the Aging, "Facts About Older Americans," http://www.ncoa.org/press/facts.html. ALFA, http://www.alfa.org/. U.S. Department of Health and Human Services, "Continuing Care Retirement Communities: A Background and Summary of Current Issues," http://aspe.os.dhhs.gov/daltcp/Reports/ccrcrpt.htm#admissions. "Continuing Care Retirement Communities, AARP, http://www.aarp.org/confacts/housing/ccrc.html.