The first question of the episode is the one most families never think to ask until they are already in a hospital corridor: what is a nursing home? Erin Hart, strategy director at the Ohio Health Care Association, answers that nobody quite agrees. The term “is used really broadly because it’s not explicitly defined thing from state to state,” she says, and then separates the two places it usually means.
That exchange sets the tone for Living Choices: Understanding Long Term Care on the Rethinking Aging Club Podcast, hosted by Linda Sherman with co-hosts Benjamin Surmi and Debbie Howard. Recorded on Ageism Awareness Day during Long-Term Care Residents’ Rights Month, it brings together Erin Hart, home care agency owner Stacey Eisenberg, and Peter Murphy Lewis, the former CNA who makes the People Worth Caring About docuseries. The show describes it as a departure from its usual format, and it is: no product, no pitch, just four people arguing about where older adults should live.
The arguing is the useful part. Benjamin Surmi presses the case that large institutions were never designed for human beings to flourish in. Erin Hart pushes straight back with what she saw on camera in Ohio. Peter Murphy Lewis sits between them with the finding that started his series, which is that half the country holds an opinion about these places without having set foot in one. For a family working out what to do next week, the disagreement is worth more than a brochure. For more on this, see our article on the Nebraska nursing home docuseries.
Key Takeaways
1. “Nursing home” is not one place, and the confusion starts at the state line
Linda Sherman opens by asking Erin Hart to define the term, and the answer is that it covers at least two different things. A skilled nursing facility accepts Medicare and delivers skilled therapies. A long-term care facility is usually Medicaid or privately funded, for people who need help with daily activities well beyond what they can get at home. Ohio certifies buildings for both; many states certify them separately. “When we talk about nursing homes, you could be referring to a skilled nursing facility or a long-term care facility or both,” she says. A family comparing two states is often comparing two different products.
2. Most families believe they have one option, and they almost never do
Linda puts the case everybody recognizes: your mother falls, she goes into hospital, she comes out, and what happens next? Benjamin Surmi says the trouble is that families “think they only have one” choice, whatever the discharge social worker names. He lists the rest out loud. Home, with private duty care and a home health agency delivering therapy. A short respite stay in assisted living using the therapy already on site: “you don’t need to go there for a whole year.” Or skilled nursing with therapy on staff. He is honest about the limit, too, that a rural family may genuinely have one building within an hour.
3. What your state allows decides what care can happen where
Benjamin describes the states he considers friendly, where primary care physicians do rounds in memory care and speech, physical and occupational therapists and wound care nurses come to the resident rather than the resident moving. Erin says that in Ohio wound services in assisted living are “not permissible,” and the reason is resident safety: a less restrictive setting carries less regulation and less clinical expertise on site. Benjamin agrees on the mechanism if not the philosophy. “There is no federal regulation. Each state decides what care can be delivered in a home and community based setting,” he says. Advice from a friend in another state may simply not apply.
4. Half the country has an opinion about nursing homes without ever having been inside one
Peter Murphy Lewis says he spent about forty years in a bubble. His four grandparents were cared for in the same hometown nursing home and his father took him there several times a week. He assumed that was everyone’s experience. Then he became a CNA and started traveling. He says on the episode that around half of Americans hold a neutral or negative view while having no contact with these places at all: “They haven’t been in. They don’t k