May 11--SEBRING -- Nursing homes and long term care facilities are places where many of us hope we never go, but where nearly half who reach retirement age will eventually reside.

Several factors determine when it's time to sell the car, stop cooking and move into a skilled nursing facility or adult living center.

Hanford Brace is a family physician with Integrity Health and regularly works with seniors. He said that residency at a skilled nursing facility after an illness or injury doesn't rule out a return home.

"Even though they're older, they will get better," said Brace. "They have to rely on some means to recover. As we increase in age, our bones heal much, much slower than if you were 30 years old."

Cynthia Boyer-Green is a nurse and case manager for Florida Hospital. She said the hospital first considers a move to a long term care facility when a patient is admitted.

A patient's diagnosis, level of functioning prior to admission, resources, anticipated length of stay at the hospital, support system and treatment plans all help determine whether a patient goes to a new home.

"While they possibly will need IV antibiotics, they might also need rehabilitation and physical therapy," said Boyer-Green.

The hospital case manager and a hospital team determines finances, insurance coverage and then, if required, which facility is the best fit.

Why Go To A Care Facility?

James Baker, administrator at Kenilworth Care & Rehab Center, said we live in a more transient society with family members scattered all over the country.

Aging Baby Boomers will double the number of seniors to about 75 million, and a lack of public transportation in Highlands County will help lead to a major increase of care center patients.

Baker expects the number of patients to increase in the next few years.

"The baby boomers are coming like a tsunami and transportation is a huge issue," said Baker.

When a spouse dies and the remaining partner loses driving privileges because of poor eyesight or frailty, a senior becomes dependent. This is often the first major loss of independence.

The life of the elderly mirrors itself -- the first loss of independence is what, for many, was the first sign of independence -- the ability to drive a car, according to Baker.

The administrator also noted that a lost ability to perform the five activities of daily living, also known as ADLs or self-care tasks, is a sign that it might be time to consider a nursing home.

The ADLs are feeding, dressing, bathing, ambulating and toileting. Many can manage the ADLs, but fail in other ways.

"The activities of daily living are things that keep people independent -- it's not just taking care of themselves -- but taking care of their environment," said Baker. "It's not our minds that grow old, our bodies grow old."

When independence is lost, simple tasks, often taken for granted by the young, like visiting a physician, taking the trash to the curb or trips to the supermarket, require help from an agency, family member, a visiting nurse or neighbor.

Upkeep of the home becomes difficult or impossible. Money can become tight, and there is no one to rake the yard or mow the grass.

Baker said that safety can become a major issue and the elderly become a risk to themselves. Often hospitalization is required because of illness. Many can perform the ADLs but can't keep up with household chores or eating properly and taking medication as prescribed.

"The things that keep people independent are not just taking care of themselves, but taking care of their environment," said Baker.

Brace talked about the support system for the elderly.

"I like to tell a patient's family that when relatives or family become caretakers, it becomes a 24-hour a day job," said Brace. "And there are very few workers who can complete a 24-hour a day job, seven days a week -- they can't physically handle it.

"Sometimes the caregiver becomes ill taking care of the patient," said Brace.

A Smooth Transition

Chuck Oakes owns Southern Lifestyle Assisted Living of Lake Placid and said when a spouse dies, it often triggers loneliness, depression and isolation for the remaining spouse.

Oakes talked about dealing with the move to a skilled nursing facility for both the patient and family members.

"The family needs to leave them alone for a week or two to adjust -- to get through that mourning period, or (patient's) never seem to adjust," said Oakes. "We know that's hard for the family, but they can call every day. Mom is going to make you feel as guilty as she can."

At Southern Lifestyle, Oakes keeps everybody busy, including during Monday's Cinco de Mayo celebration, which featured mock frozen margaritas and festively dressed staff.

"Once they go to that first activity, and they've stepped out of their room, the light has shined and they've gone through the door," said Oakes.

Donna Pontious, manager, agreed with her boss.

"Once they come out of their shell, they're a whole different person," said Pontious. "You're never too old to try. You can promise the world, but if somebody doesn't want to come, you have to give them time to adjust."'

Both Pontious and Oakes agreed that patient camaraderie and making friends makes patients feel better.

"They talk to people who understand them on the same level," said Oakes. "When someone starts talking about World War II, the other one knows what they're talking about."

Boyer-Green, of Florida Hospital, said sometimes people are unrealistic about what they will be able to do after leaving a hospital.

"We put a positive light on it," said Boyer-Green. "And tell them to look at the positives -- we help them to regain their independence."

NURSING HOME CARE BY THE NUMBERS The following statistics concerning nursing homes was published on the Web site, www.the rubins.com: --There are about 1.7 million beds in more than 18,000 nursing homes and long term care centers, nationwide. --Two-thirds operate as for-profit centers and 55 percent are owned by large nursing home chains. --Six percent of all Americans 65 to age 74 reside in nursing homes. --For males who reach age 65, the average additional life expectancy is 15.5 years. For females, it is 19.2 years. Males aged 85 should expect live an average of 5.2 more years and females on average will live for 6.8 years. --The population of nursing homes for those between 65- and 74 -years old is 12 percent. Forty five percent of residents are 85-years-old and older. --Twenty-four percent of residents will spend less than a year in a nursing home.

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