nursing home nursing home a nursing home is a facility for the residential care of older people, senior citizens, or disabled people. nursing homes may also be referred to as care homes, skilled nursing facilities (snf) or long-term care facilities. often, these terms have slightly different meanings to indicate whether the institutions are public or private, and whether they provide mostly assisted living, or nursing care and emergency medical care. nursing homes are used by people who do not need to be in a hospital, but cannot be cared for at home. the nursing home facility nurses have the responsibilities of caring for the patients' medical needs and also the responsibility of being in charge of other employees, depending on their ranks. most nursing homes have nursing aides and skilled nurses on hand 24 hours a day. a therapy dog visiting an elderly man in a nursing home in the united states, while nearly 1 in 10 residents age 75 to 84 stays in a nursing home for five or more years, nearly 3 in 10 residents in that age group stay less than 100 days, the maximum duration covered by medicare, according to the american association for long-term care insurance. some nursing homes also provide short-term rehabilitative stays following surgery, illness, or injury. services may include physical therapy, occupational therapy, or speech-language therapy. nursing homes also offer other services, such as planned activities and daily housekeeping. nursing homes may offer memory care services, often called dementia care. history mennonites visiting a nursing home in 1961 poorhouses/workhouses were the first implemented national framework to provide a basic level of care to the old and infirm. pictured, is "the workroom at st james's workhouse" from the microcosm of london (1808). from before the 17th century to modern day, many families care for their elders in the family's home. while this is still common practice for many communities and families around the world, this has become increasingly more difficult over time as life expectancy increases, family size decreases, and increased expertise in caring for a person with a chronic disease is needed. in the 21st century, nursing homes have become a standard form of care for most aged and incapacitated persons to account for those complexities. nearly 6 percent of older adults are sheltered in residential facilities that provide a wide range of care. yet such institutions have not always existed; rather, their history and development reflect relatively recent demographic and political realities that shape the experience of growing old. in the 17th century, poorhouses (also referred to as almshouses) originated in england as municipalities were expected to care for their poor. orphans, people determined to be mentally ill, and elderly people were often placed into these living commons while able-bodied individuals were expected to work and could be imprisoned if they refused. this model was brought to north america by english settlers. before the 19th century, no age-restricted institutions existed for long-term care; elderly individuals, who needed shelter because of incapacity, impoverishment, or family isolation, often ended their days in an almshouse. placed alongside people deemed insane, people who were inebriated, or people who were homeless, they were simply categorized as part of the community's most needy recipients. poorhouses gave a place where they could be given shelter and daily meals. in the 1800s in the us, women's and church groups began to establish special homes for the elderly persons. often concerned that individuals of their own ethnic or religious communities might die alongside the most despised society, this led to the creation of private care facilities for the elderly in these communities. poorhouses continued to exist into the early 20th century, despite the criticism of the poor conditions of the poorhouses. in the us, the great depression overwhelmed the poorhouses, leading to not enough space and funding. due to muckraking in the 1930s, the less-than-favorable living conditions of the poorhouses were exposed to the public. this led to the provision of the social security act (1935) to only give people their pension if they did not live in poorhouses, but could live in private institutions. in the us, poorhouses were then replaced with residential living homes, known as board-and-care homes or convalescent homes. these board-and-care homes provided basic levels of care and meals in a private setting for a specific fee. board-and-care homes proved to be a success and by world war ii, the new way of nursing homes began to take shape. as the times continued to change, the government identified the issue of people spending extensive amounts of time in hospitals. to combat these long stays in short-term settings, board-and-care homes began to convert into something more public and permanent that was state and federally funded. from this, by 1965 nursing homes were a solid fixture. nursing homes were a permanent residence where the elderly and disabled could receive any necessary medical care and receive daily meals. these nursing homes showed improvement in maintaining care and cleanliness standards in comparison to almshouses and poorhouses. from the 1950s through the 1970s, the dynamics of nursing homes began changing significantly. in the united states, medicare and medicaid began to make up much of the money that would filter through the homes and the 1965 amendment laws enforced nursing homes to comply with safety codes and required registered nurses to be on hand at all times. additionally, nursing homes may sue children for the costs of caring for their parents in jurisdictions which have filial responsibility laws. later in 1987, in the u.s. the nursing reform act was introduced to begin defining the different types of nursing home services and later added the residents' bill of rights. in the uk, after world war ii many soldiers and civilians needing hospital care due to casualties during the war were placed in the hospital along with the many elderly patients present there, leading to overcrowding. the implementation of the nhs in 1948 and the abolishment of the old poor law allowed for the creation of what would become modern day, public nursing homes. in the 1950s, professor peter townsend brought to light the discrepancies the standard of care between the publicly and privately funded cares homes, leading to health policy reforms that assured the standard care practices for the elderly living in nhs funded care homes. the 1980s and 1990s saw care homes becoming a large industry in the uk. thus, policies ensuring that private care homes are regulated (registered homes act 1984) and patient needs are met (care standards act of 2000) were established. today, nursing homes are varied. some nursing homes still resemble a hospital while others look more like a home. nursing home residents can pay for their care out of pocket or with government assistance. in the u.s., others may receive medicare for a short time, while in other countries, public assistance may be available, and some may use long-term insurance plans. across the spectrum, most nursing homes in the u.s. will accept medicaid as a source of payment. considerations below are a few reasons to consider a nursing home managing a worsening and progressive disease such as alzheimers after a recent hospital admission and not ready to transition to independently caring for oneself at home when medical needs at home become unmanageable by the primary caregiver at home. when looking into nursing homes, consider what activities and/or medical needs patients one would need from the nursing home. also consider finances, such as medical insurance and personal funds. ensure the nursing home is properly licensed and has qualified staff. if time allows, visit the nursing home in person to receive a walk through of the facility and if given the opportunity to speak with a guest or family member of guest, ask about their experience thus far. staff nursing home employees are all required to be licensed or uphold a certificate in the state of which they work. in most facilities, nursing homes are required to provide enough staff to adequately care for residents. in the u.s., for instance, nursing homes must have at least one registered nurse (rn) available for at least 8 straight hours a day throughout the week, and at least one licensed practical nurse (lpn) on duty 24 hours a day. direct care nursing home employees usually include registered nurses, licensed practical nurses, social workers, certified nursing assistants, and physical therapists, amongst others. nurses main article: nursing nursing homes require assessment and monitoring of residents by a registered nurse (rn) who is typically required to have between two and six years of education. the rn's job duties include implementing care plans, administering medications, recording and maintaining accurate reports for each resident, monitoring and recording medical changes, and providing direction to the nursing assistants and licensed practical nurses (lpn). rns are not required to choose a specialization. to gain recognition as a specialized nurse professional, rns typically need education in their specialized field, and further experience through clinical practices. lpns are typically required to have a year of training before working with any patients. the lpn monitors residents' well-being and administers treatments and medications, such as dressing wounds and dispensing prescribed drugs. lpns are responsible for patients' direct bed care and carry out a daily routine. nursing assistants a nursing assistant provides basic care to patients while working directly under a lpn or rn. these basic care activities, also referred to as activities of daily living, can include assisting with bathing and dressing residents, helping residents with meals, either serving them or with feeding, transferring to and from the bed or wheelchair, making and cleaning beds, assisting with toileting, and answering call lights. nursing assistants' official titles can vary between jurisdictions and facilities. they can include certified nursing assistants (cnas), nursing aides, caregivers, patient care associates, patient care technicians, personal care attendants (pcas), and care assistants. physicians at skilled nursing facilities, in addition to required 24 hour skilled nursing, a licensed physician supervises individual patients. at nursing homes other than skilled nursing facilities, patients receive care from physicians not affiliated with the nursing home. these physicians are typically employed by a private agency that sends physicians to nursing homes per the request of the patient, nursing home, or patient's family. the majority of these physicians are family medicine doctors or internists; however, some specialists such as cardiologist or nephrologist may also make independent visits to supplement their care. administration depending on the size of the nursing home, a nursing home may have either a nursing home administrator or an executive director. some nursing homes may have both, but their job duties are similar and can include overseeing staff, supplying medical supplies, and financial matters. some nursing homes also have human resources personnel, who are in charge of all aspects of hiring new employees. human resources job duties vary but can also include coordinating payroll, organizing orientation programs for new employees, interviewing, disciplinary actions, and ensuring compliance with federal and state laws. nursing homes are usually licensed and heavily regulated under governing legislation. compliance with the federal and state legislatures are reviewed regularly for adherence to strict standards of building codes, care plans, behavior and altercations between residents, nutrition and dietary services, medical services, nursing and personal care, religious and spiritual practices, pets, and recreational programs. housekeeping housekeepers perform everyday cleaning and upkeep in nursing homes. they play a huge part in ensuring that nursing homes are kept clean and free of disease causing agents. housekeepers have a long list of duties which include cleaning floors, changing linens, disinfecting bathrooms, changing towels, washing clothes, emptying trashcans, sanitizing rooms, replenishing supplies, dusting, vacuuming, and keeping windows and woodwork clean. these duties can vary from facility to facility but it will overall include basic cleaning. housekeeping does not require any licensure or schooling, but some jobs may prefer experienced housekeepers. recreational staff recreational staff usually include an activity director and possibly activity assistants depending on the size of the nursing home. activities aim to meet each resident's emotional, intellectual, physical, social, spiritual, and vocational needs. the transition from being independent to having to depend on others and be away from home is oftentimes very difficult, which is why activities are important to combat depression and anxiety. some of the different activities that may be offered include hosting