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Nobody wants to. But when we are over 65, half of us do. Some of us move there earlier. One in seven nursing home residents is under 65.1

People in a nursing home need care by an R.N. or L.V.N. which is more frequent or less predictable than that scheduled home visits. They may also need more physical, speech and language or occupational therapy than Medicare can provide at home, whatever the doctor orders. They often need a total of more than 30 hours per week, including substantial help from certified nurse’s assistants (C.N.A.s) with medication management or the six recognized Activities of Daily Living (ADLs). These activities are bathing (shower, bath or sponge bath), dressing and grooming, using the toilet and maintaining continence, getting sufficient nutrition and hydration and transferring from one position to another.

Often people’s needs exhaust their families.

Often they start out in an assisted living facility but need to move to a nursing home because they need a two-person lift, cannot feed themselves, need injections from a nurse or reach a level of cognitive decline which involves not just agitation but aggressive behavior or wandering.

Sometimes, despite a level of medical need which makes them eligible for nursing home care, they could stay at home, or in a family member’s home or in an assisted living facility if only there were enough money to pay for additional care. There just isn’t.

This is the poor farm reality of our generation, the poor farm for middle-class Americans.

1Centers for Medicare and Medicaid Services, “Nursing Home Data Compendium 2010 Edition”


Elder law attorney, Terry Garrett, is a member of the National Academy of Elder Law Attorneys and is active in the Texas and Austin Bar Associations. She graduated with honors from Cornell University. She was on the Dean’s List at Wharton Business School. She earned her J.D. at Columbia Law School, receiving the Parker Award and a Mellon Fellowship.

She assists families of people with special needs, people planning for the retirement years and people administering estates.

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