Alternatives to institutional care of the elderly: beyond the dichotomy
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There are strong pressures from all sides to search for alternatives to nursing home care for the dependent elderly, yet there has been no careful discussion of the goals of alternative programs. This paper addresses the problem of identifying appropriate populations at risk, strategies that might improve their condition, and the costs involved. The authors propose research needed to improve the basis for decisionmaking among alternatives: (1) clarify health status measurement of the elderly; (2) design demonstration projects to test feasible alternatives; (3) study cost-effectiveness of day care, home health care, sheltered housing; (4) find ways to improve institutional care for extremely disoriented individuals; (5) institute manpower policies to increase job incentives, and experiment to observe effects on recruitment, retention and job performance; (6) study ways the elderly make choices, and families and professionals influence the decision to enter nursing homes; (7) develop provider incentives based on outcomes achieved for the patients; and (8) disseminate information obtained from studies of nursing home alternatives.
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