Community-Based Long-Term Care for the Elderly: Evaluation Practice Reconsidered (original) (raw)

Over the past decade and a half, geriatric long-term care has been recognized as a critical, expensive, and inadequately structured component of the health and social service delivery system, available through an array of discrete providers (e.g., hospitals, home health agencies, day health programs, and nursing homes). As the need for these services has increased in the aging population, three principal problems in the current long-term care system have become evident: inequitable access to services, inadequate quality of care, and rising public and private costs of delivery . This situation is the result of several factors, including fragmented and incomplete coverage of existing programs, a lack of mechanisms for coordinating the delivery of care, and a bias in public reimbursement for long-term care toward institutional rather than community-based approaches (Zawadski 1983).