When I mention to people that I work full time in a nursing home, I often see reflected
on their faces a measure of the distaste that society has for nursing homes. I suspect
tax collectors experience a similar phenomenon. As a geriatrician, I recognize that
nursing homes are a necessity for some, but that nursing home placement implies a
series of trade-offs of cost and institutional environment versus the provision of
complicated and relatively intensive care. Generally this makes us consider the nursing
home as a placement of last resort. Although much attention has been paid to factors
triggering nursing home placement from the home or hospital, much less attention has
been devoted to factors that prevent a short-term, putatively rehabilitative stay
in a nursing home from converting to a permanent long-term placement.
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References
- Medicare managed care and frail elders: Lessons from social HMOs.Care Manag J. 2003; 4: 161-169
- Utilization and costs of home-based and community-based care within a social HMO: Trends over an 18-year period.Int J Integr Care. 2005; 5: e25
- Partnership working: Key concepts and approaches.in: Glasby J. Dickinson H. International Perspectives on Health and Social Care: Partnership Working in Action (Promoting Partnership for Health). Wiley-Blackwell, Chichester, UK2009: 42-55
- Conversion diversion: Participation in a social HMO reduces the likelihood of converting from short-stay to long-stay nursing facility placement.J Am Med Dir Assoc. 2010; 11: 333-337
- Community-based care and risk of nursing home placement.Med Care. 2003; 41: 1407-1416
- Program of All-inclusive Care for the Elderly (PACE): An innovative model of integrated geriatric care and financing.J Am Geriatr Soc. 1997; 45: 223-232
Article info
Footnotes
I am employed by a skilled nursing home, and serve on the Board of Directors of On Lok, Inc., which operates PACE programs.
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Copyright
© 2010 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.
