A new trend not seen before in skilled nursing has been developing over the last two decades. In 2000, young adults between ages 31 and 64 made up 12% of the nursing home population in the United States. In 2010, the number rose to 14% and in 2022 the National Center for Health Statistics reported that almost 17% of nursing home residents and under age 65. It’s safe to say that long-term care may no longer be synonymous with old age or geriatric care. Why is this trend occurring?
Medicaid Expansion of The Affordable Care Act
Historically, there has been nowhere else to go for younger adults living with conditions like traumatic brain injury, HIV/AIDs, serious injuries due to motor vehicle accidents, drug overdose, hemiplegia, quadriplegia, severe mental illness and neurodegenerative diseases. The significant increase in younger people moving into nursing homes followed the Medicaid Expansion of the Affordable Care Act, which covers nursing home services for younger adults. Although they now have a place to live for a short- or long-term stay, it remains unclear if younger adults benefit from this type of care setting and if their needs can be met.
Who Are They?
Younger adults between the ages of 16 to 64 are very different from older adults and seniors residing in skilled nursing homes. Beside age, their physical, medical, social, psychiatric and substance use issues make them a unique group. Some enter the facility with developmental or intellectual disabilities, trauma-induced hemiplegia and quadriplegia, higher rates and greater severity of psychiatric illnesses and substance-related diagnoses. Others are admitted with chronic neurological conditions like muscular dystrophy, Huntington’s disease, Parkinson’s disease, ALS, and peripheral vascular disease, to name a few.
Many have had previous stays in psychiatric hospitals or rehab centers for substance-related conditions. Rates of anxiety, depression and suicidal behaviors are higher than those of older adults and seniors, and may be associated with the possibility of living in a nursing home for the next 20, 30, 40 or more years. All of these characteristics create unique challenges for nursing home staff, who will require specialized training and new approaches to care for younger adults.
Two Populations Under One Roof
Younger and older adults in nursing homes are uniquely different in a wide variety of ways. The majority of younger adults are male, whereas older adults and seniors are mostly female. White people make up the majority of older residents and black and Hispanic make up the younger group. Serious mental illness and psychiatric medications are far more common among younger adults. Younger adults also have greater rates of cerebral palsy, paralysis, traumatic brain injury, multiple sclerosis, diabetes and ventilator use.
Final Thoughts on Younger Adults in Skilled Nursing
For the last 20 years or so, the population in skilled nursing facilities has been getting younger. It was rare to see a 30- or 40-year-old in a traditional home for older adults and seniors. But that has changed. People between the ages of 16 to 64 now make up a sizable group whose characteristics are quite different from traditional residents. Characteristics including more severe mental health conditions, trauma-induced injuries, and neurological disorders will require specialized training and education to better meet unique needs of this population.