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Commentary |

The Continuing Paradoxes of Nursing Home Policy

Bruce C. Vladeck, PhD
JAMA. 2011;306(16):1802-1803. doi:10.1001/jama.2011.1527.
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Few individuals choose to live in a nursing home rather than in their own home. Many older people and their families fear nursing homes; advocates for younger disabled people lobby for alternatives.1 Only a small fraction of practicing physicians and nurses work in nursing homes, not all as a first choice. Hospital administrators, who rely on nursing homes as a destination for patients who cannot be discharged to home—and in many instances, as a source of admissions as well—tend to not understand them very well. State and federal budget-makers believe they cannot live without nursing homes, yet fund them reluctantly. For 30 years, public policy toward long-term care has attempted to minimize the number of people residing in nursing homes. Yet every day 1.5 million individuals in the United States are living in nursing homes, half of whom will never again live anywhere else. More than 1 in 3 US residents who reach age 65 years will spend some time in a nursing home before they die.2 Nobody, it seems, loves nursing homes very much, but nursing homes are as necessary as they are misunderstood.

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