More research is needed to find better ways to determine who really needs to be in a nursing home and who doesn't, Meador says. In her study, Meador found that out of 130 low-need people who social workers believed could live back at home or in assisted living with the right support, 74 were able to safely transition out — a 57 percent success rate. This included nine out of 11 of the people who needed 24-hour care. In one case, family members were willing to provide round-the-clock care in order for their loved one to return home.
The biggest obstacles to overcome were complex medical conditions, lack of family support and the inability to find suitable housing. For example, someone who couldn't get out of bed or a chair by themselves, or a person on oxygen therapy known to still be smoking, would not qualify for community living because of the safety risks.
Advocates crucial to shortening stays
Many of the participants in Meador's study, called Project Home, likely would have remained institutionalized without the program simply for lack of someone advocating for their return home. For instance, Project Home social workers were able to expedite the construction of a ramp at the home of one participant who had been told it would take six months before the home would be wheelchair-accessible. Eldercare experts say having social workers assigned to shortening nursing home stays — something they say is rare — is a crucial component in returning people to independent living.
"The problem is that the health care system is really fragmented," says Curran Gaughan, social worker with St. Paul's Program of All-Inclusive Care for the Elderly — or PACE — in San Diego. PACE provides social services, on-site medical care, adult day care and home care services to people over age 55 who otherwise would require nursing home care. "If someone doesn't have a real advocate on their side who's putting all the pieces together, it's going to be so hard to develop the system for how [living at home] is going to work."
An advocate can make the difference. At St. Paul's PACE, Gaughan was able to shorten an older person's nursing home stay to just one week after a shoulder injury. Gaughan arranged for Mike Hanson, 62, who is diabetic and also recovering from a stroke, to have a paid caregiver pick up groceries, clean and do laundry once a week. St. Paul's own transportation service brought Hanson to and from St. Paul's, where he receives physical therapy twice a week.