Is the United States facing a shortage of nursing homes for people with disabilities?

Although many nursing homes are equipped to handle the special needs of seniors with physical disabilities, they are less so prepared for those with intellectual disabilities (ID). This stands despite there being research on how seniors with ID are about 2.5 times more likely to develop chronic—potentially fatal—conditions that would require care compared with their neurotypical peers.

Facing the “services cliff” as a special needs adult

Much of the care-related problems that seniors with ID face stem from the “services cliff”. This is the moment when adults age out of government-backed care initiatives at age 21. Specifically in relation to special needs, while there has been a steady increase in the support of research and initiatives towards ID, much of this is focused on early intervention. The Centers for Disease Control (CDC) estimate that over 50,000 persons with autism will enter adulthood within the decade. Despite this, less than 2% of all funding is geared toward adults and seniors. Thus, the majority of older adults with ID must face the “services cliff”, wherein families and individuals must now contend with limited—and often expensive—resources directed for adulthood and aging.

Unfortunately, this leaves more than half of adults with ID to deal with physical and mental challenges, which can drastically affect their quality of life. Aside from seniors with ID being more at risk of diseases, as mentioned earlier, they are also the demographic most likely to face unemployment and housing insecurity. This has resulted in 69% of older adults with ID living with their own senior parents instead. For those who can sign up for special needs-centered housing, the waiting list on many can often reach up to 15 years. The recent government cut of over $700 billion in Medicaid’s funding further exacerbates these challenges. This is especially the case in homes for seniors and older adults (particularly those with autism), since the modest budget behind these homes often results in inadequate programs and a lack of qualified staff.

What is being done to remedy this?

Today, most private sectors have taken on the responsibility of caring for those aging with autism. By creating community residences, these organizations are hoping to create a sense of belonging and inclusivity that many with special needs may not receive elsewhere. That said, most of these programs are designed for those with more needs, thereby excluding others who still fall within the spectrum of ID but are more physically capable. In some states like Arizona and California, private and government agencies have begun partnering up to create programs that empower older adults with autism. These efforts usually cover housing support, vocational training, and medical treatment. However, since there already is a large demand for such services, these programs are very easily filled up.

Only one in three doctors has received training for adults with autism. Since this lack of specialists is another barrier to special care for older adults, many homes are turning to other healthcare providers. Medical experts like nurse practitioners who’ve acquired a traditional or online nurse practitioner certificate are effective alternatives. Having been trained in adult-gerontology and psychiatric mental health, they are among the non-doctor healthcare practitioners who can still treat, diagnose, and monitor seniors with such nuanced needs. Overall, by turning to other specialists to fill the medical care gap, advocates are hopeful that more seniors with ID can receive the medical attention they need.

After all is said and done, though, there is still an unfortunate shortage in nursing homes for seniors with special needs. While some local government entities have begun to pivot their resources and attention to better serve seniors with disabilities at home, we can only assume that down the line this will extend to creating more nursing home opportunities, too. Until then, seniors with special needs must continue to rely on the combined efforts of their family, private foundations, and their own resilience.