Hostname: page-component-cd9895bd7-gvvz8 Total loading time: 0 Render date: 2024-12-23T16:56:11.916Z Has data issue: false hasContentIssue false
  • English
  • Français

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
Get access Rights & Permissions [Opens in a new window]

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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Adams, E.R., Meiners, M.R., & Burwell, B.O. (1993). Asset spend-down in nursing homes. Medical Care, 31(1), 1–23.CrossRefGoogle ScholarPubMed
Bureau of the Census. (1990a). Series P25, No. 1045. Washington, DC: U. S. Government Printing Office.Google Scholar
Bureau of the Census. (1990b). Series P25, No. 1057. Washington, DC: U. S. Government Printing Office.Google Scholar
Bureau of the Census. (1996a). 65+ in the United States, Series P23, No. 190. Washington, DC: U. S. Government Printing Office.Google Scholar
Bureau of the Census. (1996b). Population projections of the United States, by age, sex, race, and Hispanic origin: 1995 to 2050, Series P25, No. 1130. Washington, DC: U. S. Government Printing Office.Google Scholar
Clark, R. (1996). Home and community-based care for the elderly: The U. S. example. Canadian Journal on Aging, 15 (suppl. 1), 91–102.CrossRefGoogle Scholar
Congressional Research Service. (1993). Medicaid source book: Background data and analysis. Washington, DC: U. S. Government Printing Office.Google Scholar
Eggers, P. (1987). Prospective payment system and quality: Early results and research strategy. Health Care Financing Review: Annual Supplement, 29–37.Google ScholarPubMed
Estes, C, & Swan, J. (1993). The long term care crisis: Elders trapped in the no-care zone. Newbury Park, CA: Sage.Google Scholar
Guterman, S., & Dobson, A. (1986). Impact of the Medicare prospective payment system for hospitals. Health Care Financing Review, 7(3), 97–114.Google ScholarPubMed
Health Care Financing Administration. (1990). Health Care Financing Review, 12(2), 1–26.Google Scholar
Health Care Financing Administration. (1996). Health Care Financing Review, 17(3), 205–242.Google Scholar
Health Insurance Association of America. (1991). Research Bulletin. Washington, DC.Google Scholar
Institute of Medicine. (1986). Improving the quality of care in nursing homes. Washington, DC: National Academy Press.Google Scholar
Kemper, P., & Murtaugh, C. (1991). Lifetime use of nursing home care. New England Journal of Medicine, 32(9), 595–600.CrossRefGoogle Scholar
Lave, J. (1985). Cost containment policies in long term care. Inquiry, 22(1), 7–23.Google ScholarPubMed
Morris, J., Hawes, C, Fries, B., Phillips, C, Mor, V., Katz, S., Murphy, K., Drugovich, M., & Friedlob, A. (1990). Designing the national resident assessment instrument for nursing homes. The Gerontologist, 30(3), 293–307.CrossRefGoogle ScholarPubMed
National Center for Health Statistics. (1989a). The national nursing home survey: 198 5 summary. Vital Health Statistics, 13(97), 1–248.Google Scholar
National Center for Health Statistics. (1989b). Effects of the prospective payment system on nursing homes. Vital Health Statistics, 13(98), 1–73.Google Scholar
National Center for Health Statistics. (1989c). Nursing home utilization by current residents: United States, 1985. Vital Health Statistics, 13(102), 1–86.Google Scholar
National Center for Health Statistics. (1989d). Unpublished data.Google Scholar
National Center for Health Statistics. (1990). Discharges from nursing homes: 1985 summary. Vital Health Statistics, 13(103), 1–87.Google Scholar
National Center for Health Statistics. (1991). Proceedings of the 1988 International Symposium on Data on Aging. Vital Health Statistics, 5(6), 1–265.Google Scholar
National Center for Health Statistics. (1993). Proceedings of the 1991 International Symposium on Data on Aging. Vital Health Statistics, 5(7), 1–69.Google Scholar
National Center for Health Statistics. (1996). Health U. S., 1995. Hyattsville, MD: Public Health Service, pp. 1–328.Google Scholar
Pepper Commission. (1990). Access to health care for all Americans. Washington, DC: U. S. Government Printing Office.Google Scholar
Rivlin, A., & Wiener, J. (1988). Caring for the disabled elderly: Who will pay? Washington, DC: Brookings Institution Press.Google Scholar
Short, P.F., Kemper, P., Cornelius, L.J., & Walden, D.C. (1992). Public and private responsibility for financing nursing home care: The effects of Medicaid asset spend-down. The Millbank Quarterly, 70(2), 277–298.CrossRefGoogle ScholarPubMed
Simpson, J. H. (1985). State certificate of need programs: The current status. American Journal of Public Health, 75(10), 1225–1229.CrossRefGoogle ScholarPubMed
Social Security Administration. Office of Research and Statistics. (1989). Social security bulletin: Annual statistical supplement, 1989. Pub. No. 13–11700. Washington, DC: U. S. Government Printing Office.Google Scholar
Solon, J., & Baney, A. (1955, May). Ownership and size of nursing homes. Public Health Reports, 70, 437–444.CrossRefGoogle ScholarPubMed
U. S. House of Representatives, Committee on Ways and Means. (1990). Overview of entitlement programs. Washington, DC: U. S. Government Printing Office.Google Scholar
U. S. Senate, Special Committee on Aging. (1990). Developments in aging. Washington, DC: U. S. Government Printing Office.Google Scholar
Van Nostrand, J.F., Clark, R.F., & Romøren, T. I. (1993). Nursing home care in five nations. Ageing International, XX(2), 1–5.CrossRefGoogle Scholar
Van Nostrand, L.G. (1977). Capital financing for health facilities. Public Health Reports, 92(6), 499–507.Google ScholarPubMed
Vladeck, B. (1980). Unloving care. New York: Basic Books.Google Scholar
Wiener, J., Hanley, R., Clark, R., & Van Nostrand, J. (1990). Measuring the activities of daily living: Comparisons across national surveys. Journal of Gerontology, 45(6), S229–S237.CrossRefGoogle ScholarPubMed