Long-term care includes not only nursing homes but other environments such as day health centers, day hospitals, assisted living facilities, and home health services. Long-term care services all deal with concentrations of older adults who have significant ongoing needs for health care and various forms of personal assistance, depend on professionals to meet those needs, and spend substantial time in environments controlled by those professionals. The nursing home will be the focus of this discussion, but much of what is said about it will be applicable to other sites of long-term care as well.
Data from the National Nursing Home Survey provide a fairly illustrative picture of nursing home residents in the United States (Jones, 2000). More than 1.6 million persons 65 years and over reside in nursing homes. More than 90% are age 65 or over, and 46% age 85 or over. The current population has an average length of stay of 892 days. Those discharged from nursing homes have an average stay of 272 days. Many nursing home residents require help with basic needs such as bathing (94%), dressing (87%), toileting (56%), and eating (47%); 47.7% have an active diagnosis of dementia (U.S. Department of Health and Human Services, 1998).
Together, these data show that nursing home populations are vulnerable in several important respects. They depend on others to meet the most basic of human needs as well as their specific health needs. A high percentage have limited or questionable capacity for decision-making. The facility is home for its residents; but they do not have the same control over their home environment that we ordinarily use to gain privacy. They are subject to schedules and routines imposed for the good of the whole. They can be solicited for research participation in their home.
The nursing home can be an attractive and efficient site for aging research. It has an unusually high concentration of older residents; human and environmental variables are monitored, measured, and controlled; health records are close by; and professional resources are available. These very features that make the nursing home attractive for research can also make its population vulnerable and make the ethical conduct of research more complex.
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