Development of a Policy Issue and Regulatory Response
To examine policy developments in a given social problem area, one must first understand the factors that give rise to an "issue." Bardach and Kagan ( 1982) point out:
The growth of regulation is not merely a product of the steady and relentless forces of logic and political and economic interests. Regulatory victories, as well as initiatives, are products of intermittent events or "occasions" that fire political imagination. . . . Most prominent are physical catastrophes; scandals that expose presumptive laxity, corruption, or incompetency in the regulatory agency; dramatic scientific discoveries; flareups of racial or intercommunal violence; and changes in administration. (P. 22)
Catastrophes most commonly initiate action. Nowhere is this process more evident than in the regulation of care for older people. In the past two decades, the nursing home industry has been the target of seemingly endless investigations of abuse and neglect. Beginning with in-depth newspaper investigations, followed by Senate and House special hearings that culminated in massive federal reports ( U. S. Congress, 1974), and numerous volumes describing the underside of care ( Mendelson, 1974; Moss & Halamandaris, 1977; Vladek, 1980), documentation of the excesses of treatment or the lack thereof has been substantial. In response to this evidence, public policy on services to the elderly has been legislated through the Social Security Act and the Older Americans Act. Federal and state governments have implemented layer upon layer of regulatory statutes, primarily linked to reimbursement through Medicare and Medicaid. Public awareness and policy responses in other care settings, such as board and care or RCFs, appear to be following a similar pattern.