Opinion: The BIG Picture: — So much for convention

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In The Affluent Society, Economist John Kenneth Galbraith coined a term for ideas or explanations viewed as being generally true: conventional wisdom.

When supported by evidence, conventional wisdom can be a useful way to cut through sensory overload. But what happens when conventional wisdom proves to be unwise?
For years, a prevailing view toward nursing home residents has been that they are getting "older and sicker." This perception has been supported by the available facts for much of the past quarter century. Conventional wisdom also held that this trend was likely to continue into the future.
But a new study from the Lewin Group indicates that the trend is actually reversing. The study shows that since 1999, the number of people aged 65 and older in nursing homes dropped more than 8% – from 1.44 million to 1.32 million. Moreover, nursing home use among the "oldest old" fell by a full one-third, from 21.1% in 1985 to 13.9% in 2004. Had this shift not occurred, nearly 2 million seniors would now be living in nursing homes. Instead, the nursing home population is closer to 1.32 million residents, according to the study.
So why is the reversal happening? Anyone familiar with the field can point out several key reasons. None have had a more dramatic impact than the assisted living movement, which essentially has cornered the lower-acuity, private-pay market. Other options, such as home- and community-based services, also have fueled a migration. At the same time, the federal government and states have adopted payment and regulatory mechanisms that encourage the shift.
Nor should it be overlooked that many providers have dramatically re-engineered the way they serve the market. On the for-profit side, we have seen a major push toward rehab care and other Medicare-covered services, as a way to escape Medicaid-payment dependence. At the same time, many nonprofits are attempting to become more "community" oriented.
Residents also are changing. Compared to previous generations, they have more money to spend. And many more are living into their late 80s and 90s in good health. As the American Association of Homes and Services for the Aging's Barbara Manard has noted, "Eighty-five is the new sixty-five."
Does this mean that nursing homes as we have come to know them are on the way out? Not necessarily. There will always be a market for skilled nursing care. And let's not forget that this option still serves more than a million people each day.
That said, change is happening. How your facility looks in the future is likely to be quite a bit different from the way it looks today. At least, that's the latest conventional wisdom.

John O'Connor is Vice President, McKnight's Long-Term Care News
john.oconnor@mltcn.com