The Differences between Nursing Home in the United States and Nigeria

The United State (U.S.) admission to nursing homes is based on health status, insurance and family preferences. Nigeria’s admission to nursing homes is based on lack of guardianship and poverty. U.S. has more health resources and can accommodate more than 100 seniors in the nursing home.U.S. nursing homes are government funding; in Nigeria it is by donations. Nigeria encourages community care. High life expectancy in U.S is 78.7 years, while Nigeria is 52 years. Nigeria needs to improve life expectations.

The Differences between Nursing Home in the United States and Nigeria

Individuals dream everyday on how to accomplish their milestone, which is to become a senior one day. This can be very challenging for people as nobody knows what the future holds for them. According to Brandon, "There is no clearly defined age when an American becomes a senior citizen" (2010, p. 1). People consider themselves seniors when they retire from their jobs, join America Association of Retired Persons (AARP) or qualify for Medicare. Most countries accept their seniors as those adults at the age of 65 years and above.

Seniors, as they get older, do not know where their destiny lies. Some of the older generations live in their homes; visit the centers for seniors to associate with one another, while some find themselves in a nursing home. Where seniors live in United States (U.S), depend on their choices, families, or the community they live in. Nursing homes in the U.S are different from the ones in Nigeria.

Nursing homes according to Medline Plus is a place for people who don't need to be in the hospital but can't be cared for at home (2014, p. 1). The majority of people in the nursing homes are older generations because of the use of the long term care unit in the facility. The U.S. has the necessary equipment needed to accommodate these elderly to keep them safe in the community while the less privileged countries, such as Nigeria, are still looking for ways to manage senior homes. The U.S. is one of the best countries in terms of health resources for seniors, based on my experiences, working in the long care facility. This paper will state the differences between U.S. nursing homes and the ones in Nigeria.

Culture is the way people live their lives. It can also be seen as a consistent uniformity of lifestyles of an individual in a community. Nigeria has a culture which encourages children to take care of their parents as they get old. Keeping the elderly at home creates a good relationship among family because life is too short. This gives family enough time to spend some time with their loved ones, thus appreciating every moment they have with each other. There are no regrets felt by the children when these elders die because they will never forget the days they had together, which is a memory that will stay with them for a long time. Most Nigerians do not work as many hours as those in the U.S. do. Working less hours gives people in Nigeria enough time to take care of their loved ones as they continue to embrace their culture. This cycle continues in a circular motion as it is passed on from one generation to the other.

The admission process for seniors to a nursing home in Nigeria is based on lack of guardianship. The seniors who are accepted to live in the nursing homes, located in the community, must have a proof or findings which indicate there are no family members around to take care of them. This can be in a form of not having a child, those that lost their children or was abandoned by their loved ones. At times, the nursing home may choose to admit those with rich families to support them financially with their project. Nigerian nursing homes are charity funded.

The U.S. accepts seniors to the nursing homes based on their health, insurance, personal preferences or family desire. Individuals in the U.S. work many hours in order to accommodate their cost of living. These people have no time to keep the seniors at home because of lack of supervision which can also attract a lawsuit for them if anything ever goes wrong in the home. There is a break in the family relationship of seniors as they leave home to live in a facility.

After the survey conducted with the elderly and their family, in one of the health care facility in Meriden, it was noted from the answers from the questions given, that 50% of the elderly refuse to go to the nursing homes, as they believe their families brought them to the home to avoid the responsibility of taking care of them. These seniors, in this situation, from their answers from the questions given, stated how they hate their family for a long time. They leave them with a guilt to judge themselves if the right thing was done for their love ones when they die. The visitations made by the family are no longer on every day basis, but is on the availability of their time. Most seniors in the nursing home believed and felt that a piece of their life was gone because of the disassociation of the family relationship they had with their loved ones.

The government understands the frustrations exhibited by the family as their parents go to nursing homes, wants to help the elderly, by keeping them at home, and saving money for the state. This is one of the postulated goals for the year 2020 (Healthy People 2020). They will do this by providing more aides to assist family to take care of their parents and cut down some of their work hours, which gives them enough time to spend together.

Nursing homes in the U.S. is mostly funded by the government. The article "Home and Community-Based Medicaid Options for Dependent Older Floridians" stated the high costs of nursing home care have led the state to implement care management alternatives that offer potential for cost savings along with greater consumer satisfaction through maintenance of community residence, (Golden et al, 2010, p. 371).

Most nursing homes use the Program of All-Inclusive Care for the Elderly (PACE) as the capital authorized by the Balanced Budget Act of 1997 to assist Medicare and Medicaid financing. The government reimburses nursing home according to state budget. The cost of living for the resident in the nursing home in Florida is approximately $3,839 per monthly (Golden et al, 2010, p. 374). In Connecticut, the average cost for semi-private room is $8,365 minimum, $11,254 median, and $14,904 for maximum care, and higher in private-room occupancy (Skilled Nursing Facilities - Your nursing home resource). The cost of living in Nigeria is zero because of charity donations.

Most of the things used to maintain the senior homes in Africa are received from the generosity of people in the community. The funding for the senior homes is from donations from civilians as the government does not have any business with the organization. Donations come in everyday to the facility and is carefully managed to avoid excessive usage or waste. Sometimes the management of the nursing home in Nigeria goes to different companies to ask for essential things that the facility need to be in a functioning state.

There are no mandated state rules or regulations for the nursing home in Nigeria to follow as it is not managed by the state. The facility cannot face any lawsuits because everything done for the resident is on a charity basis. The U.S. abides by the rules of the nursing home to avoid fines, which may be imposed for any violations that may occur in the home. This may lead to the closing of a facility or a lawsuit. Individuals who work in the nursing homes in U.S are mandated to take in-services, in which some may be mandatory to keep up with the changes as the world continues to advance with technology. Compliance with the education will facilitate standardization of care to seniors in nursing home in the U.S.

During the interview with the resident, it was noted, the residents seen in the nursing home in Nigeria are happy with their care. They express how the workers treat them well, answer their call bell whenever they call for help, and provide clothing for them. All the comments received from the seniors in the facility were positive. There were no negative statements from the people in the senior home in Nigeria.

This attitude exhibited by these people, based on the survey, is different in the U.S., as half of the seniors are angry and happy with their perception of nursing homes. They were forced to leave their homes against their will to live in the nursing homes. Some of these seniors believed their family stole from them, took their freedom, and brought them to the nursing home to die. These seniors are often seen at the front door of the nursing home as they always attempt to escape the building. Some of them show some aggressive behaviors towards their family or the caregivers who takes care of them.

According to Zeller et al, "An investigation in U.S nursing homes focusing on physical aggression toward nursing assistants revealed that 34% of nursing assistants experienced physical injuries from assaults by residents" (2012, p. 250). These aggressive behaviors exhibited by the resident are mostly from demented seniors because of their cognitive impairment cannot adjust well to the changes in their present environment. The U.S. is still having a hard time helping seniors adjust to their new environments because family participation and involvement in decision making plays an important role to the resident for them to accept all changes towards their continuum of life.

Life expectancy of the seniors in Nigeria is lower compared to the U.S. The World Health Organization (WHO) stated, "In 2012, life expectancy at birth for both sexes globally was 70 years, ranging from 62 years in low-income countries to 79 years in high-income countries, giving a ratio of 1.3 between the two income groups" (2015. P.1). According to Ortman et al, "In 2050, the population aged 65 and over is projected to be 83.7 million, almost double its estimated population of 43..1 million in 2012" (2014, p. 1). America is more at an advantage to life expectancy compared to Nigeria because of the high developmental standards it has in regards to health status. Nigeria is still under development and faces a lot of challenges when it comes to health because they do not have all the necessary things needed for the seniors in the nursing homes.

Falls is one of the leading causes of deaths found among the elderly. According to Centers for Disease Control and prevention (CDC), "One in three adults aged 65 and older falls each year of those who fall, 20% to 30% suffer moderate to severe injuries that make it hard for them to get around or live independently, and increase the risk of early death" (p. 1). CDC stated also that it costs U.S. in 2013, $34 billion for medical cost settlement for seniors 65 years and older who fell in the health care facility.

Safety measures are consistently taken by nursing homes for the caring of the seniors in the nursing homes. The U.S. continues to look for ways to protect their seniors from falling to prevent the consequences associated with falls in the nursing facility. Most workers in the nursing home are mandated to attend a yearly fall competency fair so to decrease the rate of the people who fall in the home. The U.S. keeps statistics, which is followed up by the safety personnel in the department of public health. Nigeria has no falls, which is hard to believe. It is probably because they do not have the techniques to track or monitor the fall rates.

The resources such as physical therapy, occupational, speech are easily accessible and available for the nursing homes in U.S. to use. Nigeria has limited resources and tries their best to get the family involved with the care of the elderly. The nursing home in Nigeria has no short term care because those who are admitted are expected to live inside the facility until they die. The U.S. has the doctors coming in to see the residents 3 times a week, while Nigeria depends on the availability of any medical doctor who wants to volunteer their hours to help in the facility. The nursing home in the U.S. averages about 100 beds or more. Nigeria, because it is under developed and managing a facility under charity, does not have enough beds; but averages about 44 beds or less. The call bell system is not attached to a moveable cord, but is on the wall.

The nursing homes in the U.S. are much different than the ones in Nigeria. Seniors as different individuals do not have equal rights to health, housing, or entertainment. The government in Nigeria does not have interest in nursing homes because it does embrace the culture of the people as they prefer to keep these seniors in their home. The seniors in the nursing home in Nigeria are happy and thankful for the opportunity to live a normal life like others. Thanks to the generosity of good civilians of the country, who have been donating money and items for the up keeping of the resident; Most Nigerians believed that the U.S. has many opportunities for the seniors. In the year 2020, the U.S. is looking towards keeping seniors in their homes with their family by providing all the necessary tools, which are needed for their care. This postulated goal has caused a decrease in the rate of admitting seniors in a nursing home, which will help the government to cut down on nursing homes spending thereby saving the state's budget, and keep the seniors happy too.

References

Brandon, E. (Speaker). (2010, April 13). U.S News & World Report [Audio podcast]. When Do You Become a Senior Citizen

Centers for Disease Control and Prevention. (2015, March). Costs of Falls Among Older Adults.

Golden, A. G., Roos, B. A., Silverman, M. A., & Beers, M. H. (2010). Home and Community-Based Medicaid Options for Dependent Older Floridians. The American Geriatrics Society, 58(2), 371-376.

Healthy people 2020. (2015, March). Retrieved from Healthy People 2020

MedlinePlus. (2014, November 13). Nursing Homes.

Ortman, J. M., Velkoff, V. V., & Hogan, H. (2014, May). An Aging Nation: The Older Population in the United States. Retrieved from Census.gov

Skilled Nursing Facilities. (2015, March). Nursing Home Costs. Retrieved from Nursing Home Costs - Skilled Nursing Facilities

WHO. (2015, March). Life expectancy.

Zeller, A., Dassen, T., Kok, G., Needham, I., & Halfens, R. J. (2012). Factors Associated with Resident Aggression Towards Caregiver in Nursing Homes. Journal of Nursing Scholarship, 44(3), 249-257.

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ubaike

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Specializes in Gerontology, Med surg, Home Health.

Is there a point to this? I admit I did not read every word so perhaps you covered this, but it's been my experience in the 30+ years I've been in the business that most people living in a nursing home are too sick for a lay person to care for. Most family members wouldn't have a clue what to do if someone had really low blood sugar or if they went into flash pulmonary edema.

I've known hundreds of people who are thrivng BECAUSE they live in a place where they don't have to worry about forgetting to take their meds, where they don't have to worry about not having food, where there is always someone to talk to and something to do.

We are not Nigeria.....I don't see your point.

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Specializes in TCU, Post-surgical, Infection Prevention.

Interesting - this may give me some insight into the culture of the many Nigerian nurses/nursing students that I encounter daily in SoCal.

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As a prospective Nurse, I find this article very informing. For instance, should I come in contact with a patient from Nigeria, I will somewhat be able to understand should they be upset/depressed for being in a nursing home granting how the concept of going to a nursing home is so different in their country. Since it is associated with having no loved ones to take care of the individual, it may make the patient feel that no one wants to care for the him/her and they may end up feeling unloved. I believe knowing this will allow me to be extra sensitive and more accommodating as a Nurse.

Thanks for sharing!

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This totally off the subject but is still regarding nursing home. Where I work as a an LPN in a nursing home, on the weekends we have so-called 'nurse manager' who may be a staff member from the kitchen or an activities person. How is it that these people are considered 'qualified' to be a nurse manager? I love my job as a nurse, but I never realized how much IT IS SO UNAPPRECIATED AND UNRESPECTED by other staff members. Would someone please respond to this!!

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Specializes in Gerontology, Med surg, Home Health.

We have a Manager on Duty on the weekends plus a nursing supervisor. The MODs don't pretend to be nurses(except for those of us who are nurses). They provide extra help for calling in staff if needed, giving tours if unexpected visitors show up and just being a management presence in the building. They are not the least bit disrespectful to nurses.

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Specializes in Psychiatric nursing; Medical-Surgrical.

Broaden your knowledge a bit. You can learn a thing or two about other cultures :up: we need more nurses who are culturally aware and who do not see life in a little box!

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Specializes in Aged mental health.

Can I point out a major limitation please:

You have stated that in comparision to Nigerian older people, US elders are less likely to be happy to be in care, have increased aggression, and attempts at absconding. However, there is some important information missing, as the age differences between the two countries are significant and offer different health issues.

For example, the mean age of RACF admission in the US may be 76 (just guesstimating), which means that the chance of having a dementia is significantly higher than the Nigerian counterparts, where the life expectancy is 52. So one could assume that the negative behaviours exhibited by US older people may be related to a dementing process and exhibition of BPSDs, rather than a genuine unhappiness about being in care, although that could also be a reason for exacerbation of BPSDs.

Nigerian older people who enter care are much younger than the US, have a smaller risk of gaving a dementia, and appear to have nothing to lose by entering care due to their unfortunate social and financial circumstances.

Food for thought.

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