Journal of Gerontological Nursing

EDITORIAL 

The 5% Fallacy

Cheryl Dellasega, MS

Abstract

Recently I read yet one more article citing what I call the "5% fallacy"; namely, that rather than a majority of elderly persons residing in nursing homes, in fact only a small percentage [ie, 5%) really do. Depending on data collection methods this figure may be true, yet is it really relevant to current practice in gerontological nursing? In our haste to overcome the stereotype of aging as synonymous with residency in a nursing home, we have overused a mathematical fact that may no longer be appropriate.

In 1976 Siegel1 surprised the nation with the revelation that only a small fraction of our elderly population actually resides in a nursing home, an estimate rhat was based on place of residence at time of death. However, if other assessment methods are used, the implications shift dramatically.

McConnel2 suggests that if point prevalence ratios are used (ie, on any given day the number of residents in nursing homes is compared to the number of persons who could theoretically be institutionalized), the actual risk of institutionalization rises to greater than 50%. This means that during his or her lifetime an elderly person is likely to enter or reenter a nursing home, albeit for different reasons than in the past. DRGs have shifted many acutely ill persons from the hospital into extended care institutions for short, rehabilitative, recuperative stays, thereby creating two categories of nursing home residents: short and long term.3

This means that extended care facilities are a pertinent focus for nursing attention. The likelihood of an elderly person residing in a nursing home at any one time or another is more probable than conventionally thought. In addition, the type of nursing care provided in an extended care facility is likely to be more complex and multifaceted than in the past. What an opportunity for nursing to gain national recognition as a primary force in planning and providing care for this segment of needs in the elderly healthcare continuum)…

Recently I read yet one more article citing what I call the "5% fallacy"; namely, that rather than a majority of elderly persons residing in nursing homes, in fact only a small percentage [ie, 5%) really do. Depending on data collection methods this figure may be true, yet is it really relevant to current practice in gerontological nursing? In our haste to overcome the stereotype of aging as synonymous with residency in a nursing home, we have overused a mathematical fact that may no longer be appropriate.

In 1976 Siegel1 surprised the nation with the revelation that only a small fraction of our elderly population actually resides in a nursing home, an estimate rhat was based on place of residence at time of death. However, if other assessment methods are used, the implications shift dramatically.

McConnel2 suggests that if point prevalence ratios are used (ie, on any given day the number of residents in nursing homes is compared to the number of persons who could theoretically be institutionalized), the actual risk of institutionalization rises to greater than 50%. This means that during his or her lifetime an elderly person is likely to enter or reenter a nursing home, albeit for different reasons than in the past. DRGs have shifted many acutely ill persons from the hospital into extended care institutions for short, rehabilitative, recuperative stays, thereby creating two categories of nursing home residents: short and long term.3

This means that extended care facilities are a pertinent focus for nursing attention. The likelihood of an elderly person residing in a nursing home at any one time or another is more probable than conventionally thought. In addition, the type of nursing care provided in an extended care facility is likely to be more complex and multifaceted than in the past. What an opportunity for nursing to gain national recognition as a primary force in planning and providing care for this segment of needs in the elderly healthcare continuum)

References

  • 1. Siegel JS: Demographic aspects of aging and the older population, in the US current population reports. US Bureau of Census, 1976.
  • 2. McConnel C: A note on the lifetime risk of nursing home residency. Geroniologist 1984; 24(2): 193- 198.
  • 3. Keeler E, Kane R, Solomon D: Short and long term residents of nursing homes. Medical Care 1981; 19(3): 363-369.

10.3928/0098-9134-19870201-04

Sign up to receive

Journal E-contents