Saturday, February 19, 2011

In Texas, growing number of disabled young people end up in nursing homes

From The Houston Chronicle:

Nursing homes are seeing a little less gray among their residents as more people like 38-year-old Tim Lowe (pictured) receive care alongside the elderly.

The former executive recruiter suffered a spinal cord injury that left him a quadriplegic, requiring around-the-clock care.

"Before my injury, I thought of nursing homes as places for people who are retired or toward the latter stages of life," said Lowe, who resides at West Janisch Healthcare Center in northwest Houston.

People ages 31 to 64 have entered nursing homes at a higher rate than those 65 and older in the past eight years, according to data from the Center for Medicare and Medicaid Services. The age group has climbed to 14 percent of the nursing home population.

In Texas, the young population in nursing homes has jumped to 15.3 percent, up from 11 percent in 2002.

It's hard to pinpoint what's causing the trend. Few studies have been done, and many states are just now noticing the changing age profile.

Emerging evidence shows that many younger residents have debilitating conditions caused by chronic diseases or traumatic injuries. Some have histories of mental illness and substance abuse.

Most cannot afford home care services, and their families are unable to meet their medical needs.

"Because of their health conditions and medical needs, there's nowhere else for them to go," said Carmen Castro, program manager of the Center on Aging at the University of Texas Health Science Center in Houston.

Castro helped write a 2008 study on how younger residents differ from older residents. It suggests that with few long-term care alternatives, the percentage of younger people in nursing homes will continue to grow.

Community-based long-term care programs are available to move people out of nursing homes, but many states have cut funding for them.

In Texas, lawmakers pumped more than $334 million into community-based programs over the past three legislative sessions to reduce waiting lists, but with a looming budget shortfall this year, that might change.

Lowe, who receives Medicaid and Medicare benefits, would prefer to be in a home setting but knows that likely will never happen because it's much cheaper for him to receive care in the nursing home. He's adjusted to a life surrounded by people decades his senior.

At his first nursing home, he advocated for more activities geared toward younger people. He also briefly went back to school at the University of Houston Downtown using a motorized wheelchair to get around.

Since coming to West Janisch two years ago, he's been stricken with medical setbacks, but he keeps busy surfing the Internet, talking on the phone and watching movies on his laptop computer using a voice-activated program. Lowe also has a girlfriend and an 18-year-old daughter who visit regularly.

"I don't feel isolated," he said.

But many young people in nursing homes do feel isolated because the facilities are not set up to meet their social and recreational needs, the Houston study found. Some younger residents become resigned to their situation and fall into depression.

Lee Williams, administrator at West Janisch, said younger residents present a challenge to nursing homes.

Of the 83 residents at his facility, 20 are younger people. Traditional activities such as bingo and card games aren't enough to keep them engaged. He said the facility brought in a Wii video game console, hoping that would help entertain both older and younger residents, but the novelty has worn off.

Most young people, if they are physically able, prefer to leave the facility, especially on the weekends, he said.

"I can't blame them," he said.

Nursing homes also have to be more concerned about safety because younger residents with substance abuse or mental health issues can pose a threat to older residents, Williams said.

One study suggests that the closure of large psychiatric hospitals has driven more people with these issues into nursing homes.

While many young residents may be clamoring to get out of nursing homes, just as many have made a choice that a nursing home is the best option for them, said Patty Ducayet, ombudsman for the long-term care program in Texas. The state has advocates and relocation contractors who help residents with alternative placement. Federal law requires states to provide alternatives when possible.

But not all young people are in nursing homes for long-term care.

As more nursing homes move into rehabilitation, young people are likely coming in for occupational and physical therapy on a short-term basis, said Janice Zalen, senior director of special programs for the American Health Care Association.

"Statistics don't tell us how long they are there," Zalen said. "It would be good to look at the variable of age with the variable of how long they stay."