Ageism occurs when society does not value the rights of the elderly, and instead turns a blind eye toward ageist discrimination. Research shows across the globe; every second person holds ageist attitudes indicating the issue is widespread and deeply rooted in society. 

Much like other forms of discrimination, ageist attitudes have found their way into long term care. Dr. Jeffrey Farber, the president and CEO of New Jewish Home in New York, highlights the need for a complete overhaul of the current long term care system, which is on the verge of collapse. 

Farber opines there is also the need for reform, starting with those staff members who, in his words, “rather than respecting and valuing the old amongst us, do the exact opposite.” Farber recently appeared on the LTC Heroes podcast and shared his experiences as a geriatrician as well as his concerns about how ageism is affecting older adults in long term care. 

How Ageist Attitudes Affect Long Term Care

Ageist attitudes are prevalent in both society and long term care. It is essential to understand where these misconceptions come from to tackle them. Farber believes ageist attitudes exist because there is a distinct lack of education within society and a lack of specialized training in long term care. 

The media often perpetuates stereotypes about older people being forgetful, slow, and inefficient. This leads to misconceptions that manifest themselves in decreased levels of respect, appreciation, and distorted views that older people are less capable. These portrayals impact the mental wellbeing of older people who often become angry, demoralized, and depressed as a result. This, though, can be countered through spreading awareness, encouraging more diversity, and using less patronizing language.

In the context of long term care, ageism was catapulted to the forefront of national dialogue during COVID-19. The broken system that Farber mentioned on the podcast is the product of negligent preparation and ageist attitudes that COVID-19 is an “older person problem” costing thousands of lives.

Meanwhile, insufficient government funding through Medicaid and Medicare continues to cause multiple problems for facilities that operate at a loss. A survey released in June 2021 from the American Health Care Association and the National Center for Assisted Living worryingly indicates that only a quarter of US-based long term care facilities are confident they will make it through 2022. 

Currently, Medicaid only covers 70 to 80 percent of the actual cost of nursing home care. This results in shoestring budgets for nursing home facilities that are already struggling to make ends meet. Farber shared that within the last fourteen years, in New York state, Medicaid funding has “decreased twice, even during the pandemic,” showing a distinct lack of empathy towards the elderly, even during times of crisis.

Other problems—like lacking the funds to update EHR (electronic health record) systems—affect the overall level of care. An EHR has proven results in improving clinical care, efficiency, safety, and cost-effectiveness, which play a crucial role in providing better care for residents and improving their quality of life. 

One of the biggest problems long term care is currently facing is the difficulty in retaining and recruiting staff. The struggle is real, as working with older people is not seen as an attractive form of employment, yet another example of ageist attitudes in modern society. As Farber puts it, “No one wants to see, touch, or be around old people.” 

This has been further exacerbated by a combination of factors like the pandemic and the vaccine mandate, with figures showing that 94 percent of nursing homes reported a staffing shortage in August 2021. The crisis is only getting worse, with 53 percent of unvaccinated long term care staff are planning on finding other work rather than getting vaccinated. This is a big concern, as insufficient staffing directly impacts the residents’ health and quality of life. 

Licensed nursing assistants (LNA), like Ashley Lanctot at the Genesis-operated Wolfeboro Bay Center in Wolfeboro, N.H., are often overloaded with up to 40 residents to care for, meaning Lanctot only has an average of 1.2 hours per resident per 24-hours. This is lower than the minimum hours required in several states like California (3.2 hours) and Florida (2.9 hours), making it impossible for staff to provide adequate care, forcing them to cut corners and deny residents basic hygiene requirements, like bathing. 

Besides nursing staff problems, geriatricians are also in demand because they are typically paid less than other specialists. A 2018 study by the Medical Group Management Association found that geriatricians take home half the salary of anesthesiologists and cardiologists. This is a significant factor for physicians when picking a specialty, as they have high medical school student loans to repay. Many also tend to pick glamorous fields with more “interesting” studies, again highlighting the lack of interest in the elderly due to ageist attitudes.

What is Assisted Living and Memory Care?

After the age of 65, activities of daily living (ADLs) become more difficult. While most people love and care for their elderly family members, this does not always apply to elders in society. 

Elderly care is dependent on the situation, with some seniors requiring more assistance than others. Here we will clarify the differences between assisted living and memory care facilities and explain how ageist attitudes can affect the facilities.  

What is Assisted Living?

Assisted living is a popular choice for seniors who are still healthy and want to maintain a level of independence. These are residential facilities that cater to seniors with differing medical and personal care needs. Typically, residents will live in separate spaces, which can vary from individual rooms or apartments. 

These facilities also encourage residents to bring comforting items from home, like furniture, photographs, and personal items so they can adjust to their new surroundings. Most facilities offer 24-hour care, with a range of services like meal prep, housekeeping, gardening, laundry, and transportation. 

Before a resident enters an assisted living facility, staff will assess the resident to create a personalized care plan providing the appropriate level of care needed. Residents in assisted living facilities do not need around-the-clock supervision. These are suitable for seniors who may suffer from the early stage of dementia, providing them with help for ADLs. 

Assisted living facilities also organize communal activity programs, like book clubs, painting classes, and games, giving residents ample opportunities to build a social life within the facility, improving their quality of life, and preventing feelings of isolation.  

While Medicaid contributes towards some assisted living costs, it does not cover the total cost, so a resident’s stay can become quite expensive. We recommend that families review the Medicaid state-specific information regarding assisted living costs.

The nature of assisted living differs from that of a memory care facility, where residents need a much higher level of care with 24-hour supervision. In the US, around 50 percent of long term care residents suffer from cognitive declines, like Alzheimer’s or dementia, and, therefore, require assisted living and memory care services.

Dementia affects everyone differently. It is the deterioration of cognitive function that usually occurs from biological aging. It worsens over time and can affect an individual’s physical, psychological, social, and economic circumstances. 

There are three stages of symptoms:

1. The Early (Mild) Stage of Dementia is often gradual and tends to be overlooked. Symptoms to look out for include:
   • Forgetfulness
   • Misplacing things
   • Confusion and getting lost in familiar places
   • Trouble organizing or expressing thoughts

2. The Middle (Moderate) Stage of Dementia is when the signs and symptoms become more prominent and occur regularly. It is worth monitoring the symptoms by keeping a diary. Symptoms to look out for include:
   • Increased forgetfulness with recent events and people’s names
   • Confusion in familiar environments, like one’s home or local neighborhood haunts 
   • The inability to communicate coherently: This can range from forgetting a word to the complete loss of speech.
   • Need for additional help with personal care and ADLs.
   • Changes in behavior with a tendency to wander and repeat questions
   • Changes in sleep patterns, such as sleeping in the day and being unable to sleep at night

3. During the Late (Severe) Stage of Dementia, the physical signs and symptoms become apparent with more mental decline. The individual will struggle with daily living activities. At this stage, they will have near-total dependence and severe memory disturbances. Telltale signs include:
   • Loss of spatial awareness, particularly with time and place
   • The inability to recognize family and friends
   • A need for full-time assistance with ADLs.
   • Limited physical movement, which shows itself when walking or sitting 
   • Impromptu behavioral changes, such as anger outbursts and signs of aggression
   • An increased vulnerability to infections like pneumonia

Although there is no known cure for dementia at present, there are new treatments in various stages of clinical trials and testing. There is also a wide range of support for people living with dementia, their families, and carers, who often become overwhelmed caring for people with dementia. 

When the time comes, and the individual’s symptoms worsen, they will need additional care. At that point, a memory care facility makes sense, as it can offer care tailored to an individual’s needs and provide the relief of knowing your loved one is properly looked after. 

What is Memory Care?

A memory care facility provides many of the same services as an assisted living facility, like housekeeping, meal prep, bathing, and activities of daily living. However, they also specialize in caring for residents who have Alzheimer’s and dementia. 

A memory care facility provides the following additional services:

• Specially designed spaces with built-in emergency alarm systems and daily check-ins. For people suffering from dementia, there is a tendency to wander as they become confused with their surroundings. Therefore, environmental security is of utmost importance, and it is wise to include locked entrances and exits, keypad entries, and doorbells signaling the opening and closing of doors. Facility spaces are also designed to minimize confusion by having a soothing atmosphere to reduce agitation and aggression when residents become confused. 
• Experienced support staff who are specially trained to support residents with 24-hour care. Residents with dementia need person-centered care, meaning the staff must know about the resident’s life, from family traditions to learning their favorite meal or pet peeve. Facility staff applies this information to effectively and compassionately manage residents when they experience dementia episodes. 
• Meal prep and assisted activities are essential for residents who have dementia, as it creates a sense of normalcy. Eating familiar meals triggers memories that give residents a sense of bearing. Planned activities are a great way to appeal to the residents’ hobbies. They also provide residents with some comfort and routine, which helps to reduce agitation. 

Medicaid is eligible for low-income people who need memory care assistance. People who have dementia will often require long term care; therefore Medicaid will cover some or all the costs, depending on an individual’s circumstance. 

To apply for Medicaid assistance, the following information needs to be provided:

• Address
• Next of kin
• Property
• Belongings
• Savings
• Investments
• Medical expenses.  

The Pros and Cons of Nursing Homes

There are a variety of options for the elderly when they need assistance. The pandemic highlighted some fundamental flaws within the long term care system, causing many seniors and their families to look for alternative nursing home options amid safety concerns. 

Therefore, in recent times, there has been a rise in the popularity of home-based care partly because of its convenience to receive 24-hour care at home, but also because families are worried that some facilities harbor common attitudes towards aging that will negatively impact the residents. 

While it is undeniable that ageist attitudes exist in long term care, the impact has powerful ramifications on seniors’ mental health, putting them at risk of depression and social isolation. Studies show that when healthcare professionals express negative ageism towards older people, it significantly deteriorates their mental health. This demonstrates the need for more training for all facility staff who care for residents.

Seniors with dementia have specific memory care requirements that need skilled nursing and around-the-clock care. In the later stages of dementia, a memory care facility is the best place to be. Even though the pandemic caused many nursing home deaths, it also brought about better awareness and forced facilities to implement changes that improved their level of care. 

There is now an increased emphasis on the quality of life in nursing homes. Many facilities have an advocate who works alongside consumers, caregivers, legislators, and stakeholders to ensure a high level of care is provided.

Furthermore, there is also an extra financial incentive to make senior living facilities more accessible and affordable. Therefore, seniors and their families can rest assured knowing the facility will provide the best possible care. 

When choosing a long term care facility, it is essential to weigh the pros and cons of nursing homes to ensure that they meet the individual’s needs. 

Here is a helpful list to aid your decision-making: 

Pros

• Access to Full-Time Care: Nursing homes provide around-the-clock care with trained healthcare professionals and geriatricians. Families can rest easy knowing there will be qualified staff onsite to assist with any medical emergencies.
• Structured Schedules: It is crucial to establish a daily routine for seniors with dementia, as it provides stability from accidentally missing meals. It also improves sleep and nutrition as the body adapts to the scheduled meal times, so it subconsciously anticipates nutrition and rest time each day.
• An Active Social Life: As people get older, there is a tendency to isolate oneself from others. Facilities provide social activities for residents to bond with their peers and become integrated members of the community, all under supervised care. Studies show that elders who socialize with peers have more positive moods and fewer depressive symptoms.

Cons

• High Cost: Medicaid does not fully cover the costs of residing in a nursing home. Therefore it is advisable to take out long term care insurance in advance to counter this problem. Additionally, some facilities provide financial programs to ensure greater accessibility for those who need it.
• Varying Levels of Care: The media often reports horror stories of neglect, abuse, and mistreatment. While this is a bit one-sided and exaggerated, there is an element of truth. It is advisable to research the facility you are considering and find referrals from friends to ensure the residents are provided proper care. You can use the CMS’ Care Compare tool to see the nursing home(s) ratings you are considering.  
• Confined Freedom: Nursing homes tend to be places that emphasize routine. This can be difficult for some seniors to adjust to, especially those accustomed to living entirely independently. Of course, scheduled activities are often voluntary rather than compulsory. So residents have the right to choose whether or not they want to participate. 

Summary

While biological aging is inevitable, that fact seems to be lost on a large percentage of our society. This negatively impacts the amount of attention and dedication afforded the elderly. Whether a senior develops cognitive or mobility problems later in life, they will need some level of care and assistance. What’s important is to ensure they are well provided and cared for, whatever their needs. Choosing the best long term care plan isn’t an easy decision, with many factors coming into play. Yet, with adequate research, it is possible to find the best options available. 

For more on recent trends in long term care, read our blog and subscribe to the LTC Heroes podcast.