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 recognises: 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 travelling. 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 know anyone.” His summary of the coverage families read is blunt: “The legacy media captures what we do poorly, but they don’t capture what we do well.”
5. Some residents do call the building home, and there are signs a visitor can look for
Erin Hart pushes back on the idea that a long-term care facility cannot be somebody’s home, and she does it with what she saw while filming. Knitted blankets over the chairs. Photographs of children on the walls. A bird feeder on the patio. One resident took her outside to see the squirrels she feeds every day and told her, “I love it here. I found my people here and this is my home.” Erin does not pretend the sector is fixed. She says in the same breath that there are drawbacks and “things that we absolutely need to work on as an industry.”
6. The ombudsman is free, underused, and worth calling early
Stacey Eisenberg, who owns a home care agency in Austin and sits on an adult protective services advisory board, tells families to pick up the phone: “if there is any kind of issue in any kind of residence or with any kind of agency that you’re working with, definitely make those phone calls and make those reports.” She has reported buildings herself. Benjamin, a former memory care director, says he treated his ombudsman as a partner and was once berated by a competitor for telling a family to call one. Both flag the catch: ombudsmen help residents advocate for themselves, and Stacey says she has seen retaliation.
Rapid Fire Q&A
Q: What actually is a nursing home?
A: Erin Hart says it depends where you are. A skilled nursing facility takes Medicare and delivers skilled therapies. A long-term care facility is usually Medicaid or private pay, for people needing help with daily activities. Ohio certifies buildings for both, while many states certify them separately.
Q: Mum has fallen and is leaving hospital. What are the real options?
A: Benjamin Surmi lists three. Home, with private duty care and a home health agency providing therapy. A respite stay in assisted living of a week, a month or three months, using the therapy on site. Or skilled nursing with therapy in the building. Metro areas usually have all three.
Q: Can assisted living or memory care bring in medical care?
A: Sometimes, and it depends on the state. Benjamin describes physicians, therapists and wound care nurses visiting residents where they already live. Erin says Ohio does not permit wound services in assisted living, because a higher clinical need placed in a less regulated setting can be dangerous.
Q: What did COVID expose about residents’ rights?
A: Benjamin Surmi says it showed how fast rights vanish in a licensed setting, while independent living residents kept theirs as tenants under landlord and tenant law. Erin Hart says it exposed how unprepared the sector was for an outbreak, and how much it has since learned about infection control and cohorting.
Q: Are there smaller, more home-like options for older adults?
A: Erin says Ohio calls them residential care facilities, and the legal minimum is three beds, though very small ones struggle to stay open financially. She also describes skilled nursing built as small modules around a shared kitchen, and Ohio communities that have adopted the Eden Alternative.
What This Means for Families Choosing Long Term Care
Get the vocabulary straight before you tour anything. Ask what licence the building actually holds, what it is permitted to do clinically in your state, and what happens if your parent’s needs rise. Erin Hart’s list of the things that force a move is specific: a stage four wound, congestive heart failure, or a dementia a physician says needs a secured setting. Ask that question on the first visit, not the third.
Then widen the list before you accept it. The name the discharge planner gives you is one option, not the option. Ask about a short respite stay with therapy on site. Ask what home care plus home health would look like. Ask whether the choice can be time-limited, because Benjamin Surmi’s point is that a family can buy a month rather than committing to a year while everyone works out what recovery looks like.
Judge the place on what you see rather than on what you have absorbed. Peter Murphy Lewis built the People Worth Caring About docuseries precisely because the coverage families read is one-sided, and Erin Hart’s tell is worth borrowing: blankets, photographs, a bird feeder, a resident who takes you outside to show you something. Those are cheap to look for and hard to fake on a tour.
Finally, find your advocate before you need one. Ask who the ombudsman is for that building and ring them with a question rather than a complaint, so the relationship exists early. If you want more of these conversations, the archive of Peter’s podcast appearances collects the interviews where he and operators work through what long-term care gets right and where it still loses families.
Listen to the Full Episode
Living Choices: Understanding Long Term Care was published on 13 October 2025 on the Rethinking Aging Club Podcast, hosted by Linda Sherman with co-hosts Benjamin Surmi and Debbie Howard, and recorded live on 9 October 2025 with Erin Hart, Stacey Eisenberg and Peter Murphy Lewis. It is worth an hour of anyone’s time who has a decision coming. Listen to the full episode.
