Educational Activities Lead to Wellness in Older Adults in Care Facilities Such as Retirement Homes/Nursing Homes
Do Educational Activities Lead to Wellness in Older Adults in Alternative Care Facilities
The United States is experiencing a fundamental shift in demographics as the percentage of elderly citizens continues to increase. More and more people will become residents of nursing homes, retirement communities, skilled nursing facilities and other alternative residential arrangements in the future, and much remains unclear about what the impact of this transition from a gainfully employed lifestyle to one without such outside activities might be on this segment of the population. To this end, this study seeks to determine the extent to which educational activities contribute to wellness in older adults in alternative care facilities such as nursing homes and retirement communities through a qualitative review of the scholarly and peer-reviewed literature.
Purpose and Potential Benefits
The purpose of this study is to determine the extent, if any, to which educational activities in nursing homes and retirement communities contribute to wellness among the elderly residents. The potential benefits to be derived from such a study are profound and are discussed further below.
A. Background and Overview. The 21st century is going to witness some profound changes in the human condition, particularly in the United States. According to Alan C. Weinstein (1996), "With the 'graying' of the baby-boomer generation, the United States is on the verge of an unprecedented demographic revolution that will see the proportion of elderly increase to twenty percent of our population by the year 2050" (133). Likewise, in his essay, "The Shape of Things to Come: Global Aging in the Twenty-First Century," Peter G. Peterson (2002) reports that, "The world stands on the threshold of a social transformation -- even a revolution -- with few parallels in humanity's past.... Perhaps two-thirds of all people who have ever reached the age of 65 are alive today" (189). As late as the 1970s, uncontrolled population growth appeared to represent a major threat to the world's long-term survival. Books such as Paul Ehrlich's best seller, the Population Bomb, helped to fuel concerns at home and abroad about the unrelenting growth of humanity of a world of finite size. Things have changed, though, and more recently, demographers have projected a dramatic deceleration in global population growth and an equally dramatic aging of societies all over the world. Indeed, as Peterson points out, "In 1970, the future was crowded with babies. Today, it is crowded with elders" (190). The fundamental shifts in demographics that have taken place over the past several decades may have surprised demographers, but there were other surprises in store for researchers as well. For example, previous studies of later life that were conducted prior to the 1960's indicated a great deal of dissatisfaction with mandatory retirement, along with difficulty with adjusting to retirement, especially for "the old, the poor, and those who like their work..." (Graebner 1980:220). Disengagement theory was advanced in the 1960's by sociologists and gerontologists; this concept provided elderly people with the permission they believed they needed to withdraw from the workforce and the social roles associated with work (Luken & Vaughn 2003:145).
Still others grew concerned that separating the routines of work and leisure would result in the devaluation of work and the relegation of leisure as being an unpleasant experience; however, some gerontologists viewed this situation as only being temporary and argued that future generations of Americans, raised in an era of economic abundance, consumption, and leisure, would intuitively already know how to recreate during their twilight years (Luken & Vaughn 146). Unfortunately, just as with the inaccurate predictions about demographics, these early estimations of how elderly people would readily transition into their old age have simply not panned out in the real world. There has been an enormous increase in the number of older people resorting to nursing homes, retirement communities and other alternative housing arrangements for elders, but there does not appear to have been a concomitant increase in the amount of attention being paid to their unique needs during this period of their lives, particularly as regards education; these issues are discussed further below.
B. Nursing Homes, Retirement Communities and Quality of Care Issues. The rapid increase in the number of elderly being experienced in the United States would likely place an inordinate amount of stress on any society in the form of spiraling demands on publicly-funded retirement programs, healthcare providers, and social welfare institutions. In modern American society, these demands are being further exacerbated because the growth in the elderly population has been accompanied by several significant changes in the fundamental social structure. According to Weinstein (1996), "The most basic of these changes has occurred in the structure of our families and communities. just a few decades ago, the vast majority of our citizens were part of traditional nuclear and extended families residing in relatively stable communities, an arrangement that offered numerous advantages to the elderly" (133).
Because families moved infrequently during this period in American history, the elderly enjoyed a lifestyle where they were generally surrounded by relatives, friends, and familiar institutions such as churches, clubs, and various organizations that provided them with both the increasing levels of assistance often required during the aging process and opportunities for them to feel they were still a useful and needed part of their community. Whereas once the old, the ill, and the dying were cared for within extended families, Allor (1994) notes that more and more senior citizens are electing, voluntarily or otherwise, for alternative arrangements such as congregate-living residences, elder apartments, nursing homes, and hospice facilities in nuclear-family residential areas. This process has been successful only in terms of marginalizing those who could least afford it: "The segregation of American society by income, by ethnicity, by race, and by generation has been horrifyingly successful in producing both social isolation and cultural banality" (Allor 437). While more and more elders are residing in nursing homes, a growing number are also seeking out alternative living arrangements in the form of retirement communities, skilled nursing facilities and other nontraditional living arrangements (Weinstein 134).
Based on current growth projections for the elderly population, particularly for those over the age of 85 years, Schneider and Guralnik estimate nursing home costs in the U.S. could increase between 2.7 and 4.5 times current costs in real terms between now and 2040; however, if the current relative mix between those living at home and receiving living assistance and those in nursing homes today, compared to the potential needs for institutional help in the future is considered, the situation could become much worse than these authors predict. Today, the elderly are primarily the parents of more children than the baby boomers as parents are having. People with fewer children are going to face smaller likelihood of getting help from family members in dealing with functional limitations than those who have more. The baby boomers almost certainly will face an increasing problem in this regard (Schneider & Guralnik 2338).
Today, approximately 40% of nursing home costs in the United States are paid through the Medicaid program, a funding arrangement that makes improvements in the system are the more complicated. According to William Hovey's analysis, "The Worst of Both Worlds: Nursing Home Regulation in the United States" (2000), "Government regulators of nursing home care face an even more difficult than usual task in balancing cost and quality concerns, because unlike most areas of health care in the United States, government payers (primarily Medicaid) fund nearly three-fourths of all nursing home care in the U.S." (43). As a result, the already difficult task of ensuring quality long-term care is all the harder, because the same government entities responsible for ensuring quality will be forced to fund the needed quality improvements; this process is what Deborah Stone (1997) termed the "cost-quality tradeoff."
Furthermore, it is difficult to improve the quality of nursing home care without incurring increased costs because the majority of operating costs in most nursing facilities is related to staffing. According to Joan Fitzgerald's essay, "Better-Paid Caregivers, Better Care" (2001):
Nobody is happy with the nation's nursing homes. Too many patients are receiving substandard care. Workers, particularly nurse's aides who provide the majority of direct care, suffer from low wages, lack of benefits, understaffing, inadequate training, and limited career opportunities. Families are often appalled at how their loved ones are treated. Owners and managers struggle with government reimbursements that do not allow higher pay or better treatment. Clearly, the $96.2-billion-a-year nursing home industry is failing its residents and workers" (30).
Because the majority of nursing home bills are paid by Medicaid or Medicare, governments at all levels are inextricably involved in this problem; however, the current administration's tax-and-budget program precludes a national strategy that would allow a substantive upgrade to nursing homes and provide the training required to professionalize the caregivers who work in them. Further, the quality of care that might be expected to be received in…