The long-term care marketplace: an analysis of deficiencies and potential reform by means of incentive reimbursement

The Cost of Residential Care for the Elderly: The Effects of Dependency, Design and Social Environment

Despite the important role played by cost considerations in policy decisions regarding services for the elderly there has been relatively little reliable research on this topic. A large nationally representative survey of old people's homes conducted by the Personal Social Services Research Unit in England and Wales in 1981 provides a firm foundation for the careful examination of the cost of residential care. Focusing on residential homes in the public sector, the cost function analyses reported in this paper have a number of policy implications. The empirical results help to explain cost inflation and allow the prediction of future cost trends, they inform ‘balance of care’ discussions and inter-authority and inter-sectoral comparisons, and they provide evidence on the cost implications of scale, group-living design, day care and sheltered housing. Finally, the relationship between cost and social environment (a central component in any quality of care assessment) is examined. The results suggest that there is no significant association between the two.

Evaluating the effectiveness of nursing home administrations

There has been little previous research on the determinants of the effectiveness of health care administrators. This research gap pertains to virtually all health care areas but is especially germane to the long-term care field, which has only recently witnessed professional growth in nursing home associations and administrator licensing, education, and ethical behavior. The present study examines the effectiveness of nursing home administrators according to economic criteria (costs and profits per patient per day). Multiple regression analysis was used to determine structure and process variables related to those effectiveness measures. Results indicate that process variable which are controllable by administrators themselves account for the bulk of the variability in nursing home administrator effectiveness.

Care of the aged: old problems in need of new solutions

Long-term care for the aged in the United States is overly dependent upon the nursing home. This hospital-like model for long-term care is particularly inappropriate since it imposes a medical solution on a variety of social problems. An adequate long-term care program requires a range of resources in the community as well as in institutions; sheltered housing options seem a desirable alternative to the nursing home. To ensure the quality of nursing home care, the present focus on setting standards for care activities should be abandoned in favor of a focus on care outcomes (physical, mental, and social). In an effort to change our present perverse incentives in the nursing home industry, the proposal is made that nursing homes be reimbursed according to the degree to which patient outcomes meet predicted outcomes.