by Maureen Totterer

Created on: August 05, 2009   Last Updated: November 25, 2009

American nursing homes face an uncertain future and not necessarily good. Everything depends upon the passage or defeat of health care reform. No one seems to know what the final package will look like because much will be worked out behind government closed doors. Four areas of change seem likely to occur if the final bill is passed.

1 - Rationing - If $400 billion is cut from Medicare rationing of services for seniors will necessarily occur. This will cause a quicker and sicker elderly population entering the nursing home setting which otherwise would have remained homebound in large part due to the benefits of Medicare and Medicare Advantage Insurance for seniors. This will change if and when Medicare changes.

2 - Increase in Nursing Home Population - An absence of once provided for services will cause an increase in elderly debilitation which will cause a greater influx of people into the nursing home setting. More seniors, veterans and handicapped people will enter the nursing home population. The governor of California might soon have an answer to his dilemma of elderly prisoners with no where to go.

3 - Increase in Nursing Home Workers - Due to the expansion of the nursing home population nursing home workers will necessarily increase as nursing homes become more and more populated. A problem arises because a new and different work force desperate for jobs might find nursing home work an unappealing source of income. This will cause an influx of people who are not necessarily called to the nursing vocation causing a diminishment of quality care for nursing home residents.

4 - Changes in End of Life Issues - Hopefully end of life issues will not include government guidelines as an incentive for physician reimbursement when discussing death and dying with prospective patients. However a recent preview of coming attractions was brought to light when a woman asked the President about her elderly mother. The President suggested a pain pill instead of a life-extending pacemaker. This could be a problem for someone contemplating nursing home care. In Missouri hospice care company personnel visit nursing homes scouting for residents, leaving their business cards and giving their best sales pitch to the staff. When a doctor writes an order for a resident to go on hospice care a process begins. Nurses are not allowed to suggest hospice care to a family or resident. If a family member or resident requests hospice care the nurse is allowed to refer the family to the doctor who writes the order. Next the family member or resident may choose the preferred hospice company. If they ask the nurse or social worker for a referral the family or resident will be provided with a list of different hospices available. Some residents are under hospice care for a few hours or weeks. Others are under hospice care for years. Most debilitating diagnoses will qualify an elderly person for hospice care not only cancer. Physician-assisted suicide is legal in Montana, Oregon and Washington states with other states seeking the same.

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