Few people say, during their middle years, that they hope to take their last breath in a nursing home. However, the reality is that many of us have, and many more of us will. I know. Juggling the care of five elders at one time, plus two children and other demands on my time, made a nursing home for a few of my elders a necessary choice.

While, for years, I made the rounds of homes and condos to care for the elders in my family who could still live at their respective homes, there were health issues with my uncle, then my dad, and eventually all of my elderly loved ones, that made a good nursing home the only viable choice. We were fortunate.There was an excellent home within walking distance of my house. I spent 15 years going to that home nearly every day.

As the years went by, sharing what I'd learned during my years of caregiving became a passion for me. My first step outside of my comfort zone was to write a book. It was during the interviews with caregivers that I conducted for my book that my eyes were opened. Not all nursing homes were as good as the home where my loved ones lived. Later, as I became more involved nationally, I was often shocked by what people told me about homes in their communities.

As with so many issues, awareness is half the battle. During the last century, nursing homes, while still having distinct personalities, still leaned toward the staff efficiency, military model. This was not beloved by the public, but accepted because, well, that was the way nursing homes were.

However, Baby Boomers have become more aware of nursing home culture as their parents hit the age where such care is needed. And Boomers haven't been, in general, pleased with the average facility.

Activists to the core, this generation has been pushing for change and they are getting results. Change is slow, and much depends on state regulations and expectations. But progress is being made. In another decade, through hard work and awareness, most nursing homes should reflect the new attitude of person-centered care that is the goal of culture change.

Person-centered care simply means that each resident of a nursing home is treated with the respect and dignity they deserve as a unique individual. The facility learns as much about the individual as possible and tailors care to that person's needs.

This idea, while at one time considered too expensive by many facilities, is proving in many to be the best business tool they've used. People who are well cared for and treated as individuals are, in general, easier to "manage." Fewer drugs are needed. This is not to say medication is bad, or that good care means no medication. Quite the contrary. Good care means tailoring the mediations to those that are needed, while eliminating those used for staff "convenience." Happy residents mean happy families. There is no better advertising.

How Do You Choose a Good Nursing Home?