Most nursing homes in this country were built with a different population in mind than the population that currently lives in them. The current health care financial environment is driving changes now and will continue to do so in the near future. When they were originally built, most nursing homes were intended to house cognitively intact but medically ill individuals who would convalesce there in hopes of ultimately returning home. As a result, most nursing homes resemble hospitals, with high, hospital-style beds, long corridors and visibly prominent nursing stations. Over the last 25 years, however, nursing homes have become home to a million or more individuals with dementia and related conditions, requiring 24-hour supervision and "custodial" care.
Almost two thirds of all nursing home residents are cognitively impaired and, overall, the prevalence of mental disorders, (including dementia, delirium and psychiatric illness), among nursing home residents is over 90 percent. These buildings were, unfortunately, never intended to house these individuals. The physical plant was tailored to an entirely different purpose. As a result, these elderly nursing home residents often have difficulty conforming to the nursing home environment and their illness puts them in contact with a number of environmental hazards. Crowded public areas, slippery floors, and dim lighting increase the risk of falls, while hard floors and high beds increase the risk of injury.
Recent economic and regulatory changes have led to an increasing demand for nursing home beds to accommodate medically ill patients transferred from acute care hospitals and to serve as an alternative to hospitalization for some managed care systems. Nursing homes themselves have sought to increase operating income by preferentially admitting patients in need of skilled care. These market forces have had the effect of displacing cognitively impaired but physically well individuals.