The nursing home has become an increasingly important component of the health care system, experiencing continuing growth at the same time that hospital stays are decreasing nationwide. There are currently close to 2 million nursing home residents in the United States, and this number is expected to reach 3.4 million by 2020.1 More than $75 billion is spent annually on nursing home care, more than half of which comes from public funds, representing almost 10% of the national health care budget.2
See also p 557.
The nursing home environment differs from the acute hospital in many ways. Nursing home residents, on average, are much older, frailer, more chronically ill, and more physically dependent, have a much higher prevalence of geriatric conditions such as dementia and gait disturbances, and have much longer lengths of stay and higher mortality rates than patients in acute care hospitals.3 Chronic disease management