Residential Care for the Elderly: Critical Issues in Public Policy

By Sharon A. Baggette | Go to book overview

Introduction

Recent decades have witnessed the growth of an array of housing and care options for older adults. Specifically, residential care facilities (RCFs) have developed to provide personal care and oversight to older people, the mentally impaired, and the disabled. Currently, RCFs are a major component of the long-term care system in this country. Yet the growth in their numbers has not elicited the attention of policy makers or researchers in long-term care. The term residential care actually refers to many different types of housing/care arrangements with great variety in the types and levels of services provided.

To confound understanding of this alternative further, these facilities are referred to by various names in different states. These names include residential care, sheltered care, assisted living, domiciliary care, congregate care, adult foster care, personal care homes, family care, group homes, and homes for the aged ( Reichstein & Bergofsky, 1983; Harrington et al., 1985; Mor et al., 1986). As established by state regulations, they provide, at a minimum, room, board, supervision, and protective oversight; in addition they may provide assistance with activities of daily living (for example, bathing, grooming, eating), medication supervision, and in some instances assistance with transportation or obtaining medical and social services ( Kochhar, 1977; Harrington et al., 1985; Mor et al., 1986). This range in service provision "makes client identification, regulation and possible reimbursement (especially cost-related reimbursement) very difficult to design and implement" ( Palmer, 1983, p. 437). Moreover, even within a given state, the name and regulations governing a residential alternative may vary by kind of population served, number of residents in a specific accommodation, nature of the setting, or number of people per bedroom.

For the purposes of this analysis, residential care in the broad sense includes

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