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The Focus of Long-Term Care in the United States: Nursing Home Care

Published online by Cambridge University Press:  29 November 2010

Joan F. Van Nostrand
Joan F. Van Nostrand
Affiliation:
U.S. Department of Health and Human Services
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Abstract

Major milestones in the evolution of nursing home care in the United States between 1960 and 1985 were the introduction of Medicaid and Medicare (resulting in a rapid growth in beds), national health planning (slowing the growth of beds), and prospective payment system for hospitals (shifting the case mix to a more disabled population). Critical policy concerns for nursing home care in the mid-1980s were the appropriate mix of public and private expenditures, impoverishment of some elderly persons as a result of long stays, improvement of the quality of care, and the funding bias toward institutional longterm care. Policy changes in the past few years have addressed quality by requiring a standard assessment linked to a care plan, although quality remains a major issue. Recent policies creating home care and community-based care programs may signal a shift away from institutional care. The issues of impoverishment and of the appropriate mix of expenditures are unresolved. Nursing homes certified by Medicaid and Medicare differed from those not certified in providing more services, having more nursing staff, and having more residents with disability and behaviour problems. Between 1985 and 1994, there were some significant changes in sources of funding for national nursing home expenditures. Out-of-pocket expenditures dropped, while government expenditures rose, with the increase occurring in the federal-government share.

Résumé

Les grandes étapes de l'évolution des soins institutionnels aux États-Unis, de 1960 à 1985, ont été marquées par l'adoption de Medicaid et de Medicare (hausse rapide du nombre de lits), des tentatives de planification nationale de la santé (croissance ralentie du nombre de lits), et le programme de paiement prospectif (DRG) s'appliquant aux hôpitaux (proportion accrue de personnes handicapées parmi les patients). Les préoccupations concernant les politiques institutionnels, au milieu des années 80, étaient principalement: le juste équilibre entre les coûts privés et les coûts collectifs, l'appauvrissement d'un certain nombre de personnes âgées exigeant de longs traitements, l'amélioration de la qualité des soins, et un parti-pris en faveur du financement des soins institutionnels de longue durée en institution. Les changements de politiques survenus au cours des dernières années ont permis de régler les problèmes de qualité et le parti-pris institutionnel. Les questions touchant l'équilibre entre les coûts et l'appauvrissement sont demeurées irrésolues. Les centres d'hébergement approuvés par Medicaid et Medicare different des centres non-conventionnés en ce qu'ils offrent davantage de services, sont mieux pourvus en personnel infirmier et ont un plus grand nombre de résidents souffrant d'incapacité et de problèmes de comportement. En 1985, les principales sources de fonds servant à couvrir les frais des centres d'hébergement nationaux étaient Medicaid et les revenue personnels alors que le financement de Medicare était minimal.

Keywords

Nursing Homes in the U.S.Long-Term CareHistory of Nursing Home CarePolicy Concerns for Nursing Home CareMedicaid and Medicare Nursing HomesPotential Users of LTCResidents in Certified Nursing Homes.Centres d'hébergement aux États-Unissoins de longue duréeévolution des soins institutionnelspréoccupations envers les politiques en matière de soins institutionnelscaractéristiques des centres d'hébergementbénéficiaires potentiels de soins de longue durée.
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 15 , Issue S1 , Automne/Fall 1996 , pp. 73 - 90
Copyright
Copyright © Canadian Association on Gerontology 1996

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