CHAPTER 1

THE GOOD, THE BAD,
AND THE TERRIBLE

Whether you realize it or not, our society has shifted in demographics within the last few years, and continues to shift toward an aging population. The baby boomers are reaching their 60s, 70s and 80s, and as a result, elderly care has become not only a crisis but big business. The statistics are quite staggering. As of the 2000 census, nearly 19 million people were between the ages of 65 to 74 years of age in the United States; and over 11 million were between the ages of 75 to 84 years of age. Together this group made up 11 percent of the American population, and this percentage has continued to increase.

There are now over 17,000 nursing homes in this country, and more than 1.8 million nursing home beds available. Considering there are more than 30 million elderly in the country, (and likely more than 5% require skilled care), there remains a shortage of nursing home beds available. However, despite this, there is currently less than an 85% occupancy rate of the nursing homes. This means many elderly are receiving care at home through private care agencies or from family means of support, sometimes due to certain cultural beliefs that keep them at home. There may also be limitations in financial resources to afford nursing home placement from families and/or the elderly patient. Some families may feel the level of care in a nursing home facility is substandard.

Of the nursing homes in the United States, about two-thirds are for-profit, and the remaining are either non-profit or government-based. More than half are part of business chains, and about 13% are hospital based facilities. And a final note is that the majority of the care provided by nursing home staff comes directly from nursing aides and assistants. Registered nurses make up only five percent of the care, and LPNs (Licensed Practical Nurses) make up only about ten percent. As the elderly population has grown, and healthcare dollars have become scarcer, there has been a shift in the level of care provided. Both experience and education skills for the average nursing home worker have declined during this time, yet the demands of their jobs have consistently increased in the level of care required. Overall this is a bad recipe.

As pressures on our society have increased in both the healthcare sector as well as on the ability to provide services for our geriatric population, resources in general have been limited to accommodate these well. In order for many nursing homes to stay in operation, staff salaries have had to be cut to keep a positive bottom line. This has meant less