While I was growing up, I'd hear, occasionally, about someone having to go to a "rest home" or an "old folk's home." As the decades slipped by, the term "nursing home" came into vogue. Regardless of the name change, they were all warehouses for those tough folks who actually survived a stroke or who had extremely crippling arthritis. Some were suffering from the effects of polio and could no longer be cared for by family. Of course, some had "senile dementia" and needed to be "put in a home."

As people's life spans increased, and more people lived through strokes and other ailments that had killed people just a few years earlier, these homes came under closer scrutiny. I noticed, at least up here on the high plains where I've spent a great deal of my life, that nursing homes started to lose some of their hospital like features. They took on a more home-like feel.

In the late 60s, my grandmother, who was crippled with severe rheumatoid arthritis, needed more care than we could be provide at home, so she moved to a brand new facility in town called Bethany Towers. Grandma had lived with us for seven years, and we weren't going to put her just anywhere. Bethany was nice, and they had a newer concept of what nursing homes should be like. As I recall, they also had big plans for expansion, and some of those plans included lower levels of care for those who didn't need full-blown nursing care. Bethany Towers was considered "progressive."

I don't remember exactly when assisted living facilities became a part of the caregiving landscape. Surely, it was long after my grandmother's death. I became acutely aware of that option during my own caregiving years, as my own mother became more disabled with her arthritis. Together, we toured these new assisted living places. They were expensive, and they didn't accept Medicare or Medicaid. Before I could talk Mom into moving from her apartment to assisted living, her health declined to the point that assisted living could no longer take her. She needed the twenty-four hour nursing care that nursing homes provide.

Now, assisted living facilities are popping up all over, and many larger nursing homes have expanded to include the option of starting out in their assisted living area, and then, "when the time comes," moving to the nursing wing. I've encouraged a few people who have sought my advice to look at this option. They've had elders who were in their 80s, yet still only needed minimal assistance. In-home care wasn't enough or wasn't working, for one reason or another. If people are still doing fairly well at that age, they are likely to keep on going for awhile, and the eventual need of more nursing care looms on the horizon. And it's important to remember that it is easier to move within a facility than from one to another.