We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Commentary |

The Continuing Paradoxes of Nursing Home Policy

Bruce C. Vladeck, PhD
JAMA. 2011;306(16):1802-1803. doi:10.1001/jama.2011.1527.
Text Size: A A A
Published online


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.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

7 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles