Agenda for the Future: A Reformist View
This book initially discussed the role and function of residential care within the dichotomy of housing and health care, and noted its progression into the socalled "long-term care continuum." The place of the residential care option along this continuum has evolved largely as a function of the states' implementation of the Keys Amendment. At least in the state of Oregon, the degree of regulation and the commitment to reimbursement and support are functions of state policy.
In general, the growth of political capacity has been an important aspect of state government development in recent years. This change has significant implications for the way that states develop policies for the aging. It is particularly true for the residential care industry since few increases in the federal role for regulation and policy development are foreseen. As Lammers and Klingman ( 1984) have noted, "The gubernatorial, legislative, and administrative areas have all seen changes that enhance the capacity for states to design their own policies and to carry out policy implementation effectively" (p. 196). While increasing power may have been given to the state units, no source of increased funding has been forthcoming.
Other factors, including a climate of political openness, fiscal capacity, general policy liberalism, socioeconomic and demographic characteristics of the state's aging population, and levels of aging advocacy, may also affect the level and design of aging policy within a given state structure ( Lammers & Klingman, 1984). As I have argued, an awareness of and commitment to residential care as an important alternative in the continuum of options for older persons is also a critical factor in the state's response. A review of current and proposed changes in the state of Oregon with references to other states may provide insight into the way of the future.