The Key to Wanting to Live in a Nursing Home

      A recent article in the New York Times entitled “Nobody Wants to Live in a Nursing Home. Something’s Got to Give”
      • Cottle M.
      Nobody wants to live in a nursing home. Something’s got to give.
      speaks to the pervasive sentiment about nursing home care. In large part, the reason for disdain may be the challenge that was identified more than 20 years ago: “Embedded in most of our rules and regulations is the idea that long-term care should aspire to the best possible quality of life as is consistent with health and safety … but ordinary people may prefer the best health and safety outcomes possible that are consistent with a meaningful quality of life.”
      • Kane R.
      Long-term care and a good quality of life: bringing them closer together.
      The problem is simple: in nursing homes, psychosocial care and well-being have been, and in some cases remain, neglected or regarded as secondary. Until we prioritize residents’ quality of life and psychosocial care such that their importance is at least equal to that of their physical care,
      • Zimmerman S.
      • Connolly R.
      • Zlotnik J.L.
      • Bern-Klug M.
      • Cohen L.W.
      Psychosocial care in nursing homes in the era of the MDS 3.0: perspectives of the experts.
      people will never want to live in a nursing home.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the American Medical Directors Association
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Cottle M.
        Nobody wants to live in a nursing home. Something’s got to give.
        August 1, 2021 (New York Times)
        • Kane R.
        Long-term care and a good quality of life: bringing them closer together.
        Gerontologist. 2001; 41: 293-304
        • Zimmerman S.
        • Connolly R.
        • Zlotnik J.L.
        • Bern-Klug M.
        • Cohen L.W.
        Psychosocial care in nursing homes in the era of the MDS 3.0: perspectives of the experts.
        J Gerontol Soc Work. 2012; 55: 444-461
        • Simard J.
        • Volicer L.
        Loneliness and isolation in long-term care and the COVID-19 pandemic.
        J Am Med Dir Assoc. 2020; 21: 966-967
        • Bethell J.
        • Aelick K.
        • Babineau J.
        • et al.
        Social connection in long-term care homes: a scoping review of published research on the mental health impacts and potential strategies during COVID-19.
        J Am Med Dir Assoc. 2021; 22: 228-237
        • Briggs R.
        • McDowell C.P.
        • De Looze C.
        • Kenny R.A.
        • Ward M.
        Depressive symptoms among older adults pre- and post-COVID-19 pandemic.
        J Am Med Dir Assoc. 2021; 22: 2251-2257
        • McArthur C.
        • Saari M.
        • Heckman G.A.
        • et al.
        Evaluating the effect of COVID-19 pandemic lockdown on long-term care residents' mental health: a data-driven approach in New Brunswick.
        J Am Med Dir Assoc. 2021; 22: 187-192
      1. Behavioral health services. 42 CFR § 483.40.
        • Chick D.
        • Davis P.
        • Begelow A.
        • et al.
        Caring with compassion. A guide for providing clinical care across the bio-psychosocial domains.
        • Werth J.L.
        • Blevins D.
        Psychosocial Issues Near the End of Life: A Resource for Professional Care Providers.
        American Psychological Association, 2006
        • CMS
        State operations manual, appendix PP - Guidance to surveyors for long term care facilities.
        • MacDonald G.C.
        • Baldassare F.
        • Brown P.
        • et al.
        Psychosocial care for cancer: a framework to guide practice, and actionable recommendations for Ontario.
        Curr Oncol. 2012; 19: 209-216
        • Institute of Medicine
        (US) Committee on Psychosocial Services to Cancer Patients/Families in a Community Setting.
        in: Adler N.E. Page A.E.K. Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs. National Academies Press, 2008
        • Estabrooks C.A.
        • Titley H.K.
        • Thorne T.
        • et al.
        A matter for life and death: managing psychological trauma in care homes.
        J Am Med Dir Assoc. 2022; 23: 1123-1126
        • Bender A.A.
        • Chozom T.
        • Saiyed S.A.
        Concern about past trauma among nursing home admissions: report from screening 722 admissions.
        J Am Med Dir Assoc. 2022; 23: 1499-1502
        • Kusmaul N.
        • Wallace B.H.
        • Cheon J.H.
        • Sundorg S.
        Implementation of trauma informed care in nursing home settings.
        J Am Med Dir Assoc. 2022; 23: 1505-1506
      2. Training requirements, 42 CFR § 483.95.
        • Grabowski D.C.
        • Aschbrenner K.A.
        • Rome V.F.
        • Bartels S.J.
        Quality of mental health care for nursing home residents: a literature review.
        Med Care Res Rev. 2010; 67: 627-656
        • Radermacher H.
        Mental health and residential aged care: are we there yet?.
        Australas J Ageing. 2021; 40: 10-11
        • Kales H.C.
        • Chen P.
        • Blow F.C.
        • et al.
        Rates of clinical depression diagnosis, functional impairment, and nursing home placement in coexisting dementia and depression.
        Am J Geriatr Psychiatry. 2005; 13: 441-449
        • Office of the Inspector General
        Psychosocial services in skilled nursing facilities.
        (US Department of Health and Human Services)–01–00610.pdf
        Date: 2003
        Date accessed: July 14, 2022
        • National Academies of Sciences, Engineering, and Medicine
        The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff.
        The National Academies Press, 2022
        • Mansbach W.E.
        • Mace R.A.
        • Clark K.M.
        • Firth I.M.
        Meaningful activity for long-term care residents with dementia: a comparison of activities and raters.
        Gerontologist. 2017; 57: 461-468
        • Van Haitsma K.
        • Abbott K.M.
        • Heid A.R.
        • et al.
        Honoring nursing home resident preferences for recreational activities to advance person-centered care.
        Ann Long-Term Care. 2016; 24: 25-33
        • Galambos C.
        • Rollin L.
        • Bern-Klug M.
        • Oie M.
        • Engelbart E.
        Social services involvement in care transitions and admissions in nursing homes.
        J Gerontol Soc Work. 2021; 64: 740-757
        • Groom L.L.
        • McCarthy M.M.
        • Stimpfel A.W.
        • Brody A.A.
        Telemedicine and telehealth in nursing homes: an integrative review.
        J Am Med Dir Assoc. 2021; 22: 1784-1801
        • Newbould L.
        • Mountain G.
        • Hawley M.S.
        • Ariss S.
        Videoconferencing for health care provision for older adults in care homes: a review of the research evidence.
        Int J Telemed Appl. 2017; 56: 11394-11398
        • Gaugler J.E.
        • Statz T.L.
        • Birkeland R.W.
        • et al.
        The residential care transition module: a single-blinded randomized controlled evaluation of a telehealth support intervention for family caregivers of persons with dementia living in residential long-term care.
        BMC Geriatr. 2020; 20: 133
        • Miller S.C.
        • Mor V.
        • Wu N.
        • Gozalo P.
        • Lapane K.
        Does receipt of hospice care in nursing homes improve the management of pain at the end of life?.
        J Am Geriatr Soc. 2002; 50: 507-515
        • Stevenson D.G.
        • Bramson J.S.
        Hospice care in the nursing home setting: a review of the literature.
        J Pain Symptom Manage. 2009; 38: 440-451
        • Bern-Klug M.
        • Smith K.M.
        • Roberts A.R.
        • et al.
        About a third of nursing home social services directors have earned a social work degree and license.
        J Gerontol Soc Work. 2021; 64: 699-720
        • Gammonley D.
        • Wang X.
        • Simons K.
        • Smith K.M.
        • Bern-Klug M.
        Serious mental illness in nursing homes: roles and perceived competence of social services directors.
        J Gerontol Soc Work. 2021; 64: 721-739
        • Ferrell B.R.
        • Handzo G.
        • Picchi T.
        • Puchalski C.
        • Rosa W.E.
        The urgency of spiritual care: COVID-19 and the critical need for whole-person palliation.
        J Pain Symptom Manag. 2020; 60: e7-e11
        • Low L.F.
        • Goodenough B.
        • Fletcher J.
        • et al.
        The effects of humor therapy on nursing home residents measured using observational methods: the SMILE cluster randomized trial.
        J Am Med Dir Assoc. 2014; 15: 564-569
        • Robinson H.
        • Macdonald B.
        • Kerse N.
        • Broadbent E.
        The psychosocial effects of a companion robot: a randomized controlled trial.
        J Am Med Dir Assoc. 2013; 14: 661-667
        • Hermer L.
        • Cornelison L.
        • Kaup M.L.
        • et al.
        Person-centered care as facilitated by Kansas' PEAK 2.0 Medicaid Pay-for-Performance program and nursing home resident clinical outcomes.
        Innov Aging. 2018; 2: igy033
        • Daaleman T.P.
        • Williams C.S.
        • Hamilton V.L.
        • Zimmerman S.
        Spiritual care at the end of life in long-term care.
        Med Care. 2008; 46: 85-91
        • Roberts A.R.
        • Smith A.C.
        • Bowblis J.R.
        Nursing home social services and post-acute care: does more qualified staff improve behavioral symptoms and reduce antipsychotic drug use?.
        J Am Med Dir Assoc. 2020; 21: 388-394