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Nursing homes face challenges as more young people move in

Adam Martin, 26, worked with a physical therapist at the nursing home where he lives in Sarasota, Fla. Adam Martin, 26, worked with a physical therapist at the nursing home where he lives in Sarasota, Fla. (Chris O’Meara/ Associated Press)
By Matt Sedensky
Associated Press / January 30, 2011

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SARASOTA, Fla. — Adam Martin doesn’t fit in here. No one else in this nursing home wears Air Jordans. No one else has stacks of music videos by 2Pac and Jay-Z. No one else is just 26.

It’s no longer unusual to find a nursing home resident who is decades younger than his neighbor: About 1 in 7 people now living in such facilities in the United States are under 65. But the growing phenomenon presents a host of challenges for nursing homes, while patients such as Martin face staggering isolation.

“It’s just a depressing place to live,’’ Martin says. “People die around you all the time.’’

The number of under-65 nursing home residents has risen about 22 percent in the past eight years, to about 203,000, according to an analysis of statistics from the Centers for Medicare & Medicaid Services. That number has climbed as mental health facilities close and medical advances keep people alive after traumatic injuries. Still, less than 1 percent of nursing home residents are younger than 30.

Martin was left a quadriplegic when he was accidentally shot in the neck last year. He spent weeks hospitalized before being released to a different nursing home and eventually ended up in his current residence, the Sarasota Health and Rehabilitation Center. There are other residents who are well short of retirement age, but he is the youngest.

The yellow calendar on a wall in Martin’s small room advertises activities such as arts and crafts. He usually wakes up late, then waits for an aide to shower him, dress him, and return him to his wheelchair. He watches TV, goes to therapy five days a week, and waits most days for his friend to bring him meals.

Martin’s parents are unable to care for him at home. Medicaid pays his bills; it could take a lawsuit for him to get care outside a nursing home. Advocates who help young patients find alternatives to nursing homes say people are often surprised to learn there are so many in the facilities. About 15 percent of nursing home residents are under 65.

“When I tell people I try to get kids out of nursing homes, they have no idea,’’ says Katie Chandler, a social worker for the nonprofit Georgia Advocacy Office.

Federal law requires states to provide alternatives to institutional care when possible. Navigating the system can require a knowledgeable advocate and, sometimes, litigation.

Not all younger nursing home residents are there for good. Some nursing homes are seeing an increase in patients who come to recover there instead of in a hospital, because it is cheaper for their insurance company.

Like Martin, many younger residents have suffered a traumatic injury. Others have neuromuscular diseases such as multiple sclerosis, or have suffered a stroke.

The same generational tensions that exist outside nursing homes are inside them as well.

Older residents complain about loud music and visitors, younger residents complain about living with someone with dementia or being served creamed spinach.

For young people who find themselves newly disabled, the psychological and social needs are often even more challenging than their physical demands.

At Bayshore Health Center in Duluth, Minn., 34 of the 160 residents are younger people. The staff has found that subtle changes can improve their lives.

Instead of bingo night, there are poker games. Pizza is offered in place of lasagna; Mountain Dew and Coke are poured instead of coffee and tea.

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