Nursing home care and its alternatives continue to be issues which face the elderly, their families, and the social workers who assist them. Families must struggle with the decision of what kind of help to give their elderly loved ones, while at the same time, social workers must try to accommodate an increasingly geriatric population.
Nursing homes have become part of the solution and part of the problem. Nursing home care has always been expensive, and state legislatures, concerned with the fact that people are living longer and at greater expense, have pursued ways of making the public dollar stretch further. Social workers, lobbying groups such as the American Association of Retired Persons (AARP), legislators, and the elderly themselves have attempted to find alternatives to long-term nursing home care.
Caregiving for the elderly has become a growth industry. Ever-increasing numbers of older persons and family caregivers have to confront difficult choices about types of living arrangements and levels of care for those who are experiencing diminished or reduced capacity. Various housing and eldercare alternatives have been devised. Amid a range of prospects, from skilled care to adult day care to in-home service providers to board and care homes, the nursing home remains as an unpleasant reminder of the old system of institutionalizing the elderly.
The practice of putting the elderly in nursing homes is a twentieth-century phenomenon, and, as Eshelman (1983) notes:
They have developed partly because they have received government support. During the Great Depression, when Social Security was established, old people used their pensions to pay for nursing care. In 1965, Medicare and Medicaid were established, and these medical insurance policies for the aged and the poor provided additional funds to be used for nursing home care. Nursing homes also developed because in the twentieth century families in urban are...