ISSUES IN PLANNING FOR GERIATRIC SERVICES

An intensive analysis is needed of the roles not only of the general hospital and of the extended care facility, but also of the skilled nursing home, the intermediate care facility and noninstitutional alternatives in providing necessary services to the aged. At present, training programs are not geared to develop a significant cadre of professionals with the idealism, enthusiasm and absence of ambivalence to move the field rapidly toward reasonable programs and measures. Rate-setting practices in geriatric services have often led to the perpetuation of apathy and incompetence, and programs have suffered accordingly. Currently, with Medicaid, the problem is more serious because experience with Medicaid suggests that even with massive intervention by subsidies from the Federal government, patterns of care of the elderly alter little, although there is an associated large shift in the price structure, including costs and charges for such care. Controls for monitoring the quality of care have been limited, especially in extended care facilities and in nursing homes and related institutions. Unless well-defined steps are introduced, the relationship between costs and quality of care at all levels will be subject to further variability. A critical problem is the snail-like momentum in the creation of alternate services which could provide competition for existing methods and services. Again, the problems of manpower and incentives come to the fore. Neither exists in the abundance required to create even a modest impact on the present system. © 1969 The American Geriatrics Society.