Past, Present and Future of Nursing Homes

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Past, Present and Future of Nursing Homes Amy B. Langevin Integrated Health Care Delivery Systems Daniel Hoppe Abstract Nursing homes are arguably the most criticized division of the US health care system. In fact, the nursing home industry's entire history has been marked by progressions of public clamor for improvement and ineffective governmental responses. Over the past century, multiple attempts to improve the quality of nursing home care have had inadequate success. This paper reviews these initiatives from the era of the poorhouse to the most recent reform law, implemented during the last century. Congress has been deeply troubled with the quality of nursing home care since 1986, when it held hearings that led to the Nursing Home Reform Act of 1987. It has never appropriated sufficient funds to enforce the provisions of the Act or funded the personnel and training necessary to inspect nursing homes regularly and intensively. Nursing home law provides significant benefits to clients and their families. On top of the federal rules, every state has its own system of nursing home inspections and laws that may provide residents with even greater rights. “Quality of life” is such a controversial concept because it is so subjective to define. But let’s assume for the moment that quality of life relates to choice and control, positive and meaningful interactions, and quality medical care. Regulations and the survey process have already started moving in this direction. They are promoting service to the concepts, changing their marketing language, describing former “units” now as “households” or “neighborhoods”. Introduction During the first part of the 20th century there were no federal or state funded nursing homes for the elderly. Without a federal assistance program to help pay for the care of elderly or disabled, most states sent their impoverished
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