title: The accumulated challenges of long-term care.
abstract: During the past century, long-term care in the United States has evolved through five cycles of development, each lasting approximately twenty years. Each, focusing on distinct concerns, produced unintended consequences. Each also added a layer to an accumulation of contradictory approaches--a patchwork system now pushed to the breaking point by increasing needs and financial pressures. Future policies must achieve a better synthesis of approaches inherited from the past, while addressing their unintended consequences. Foremost must be assuring access to essential care, delivery of high-quality services in an increasingly deinstitutionalized system, and a reduction in social and economic disparities.
authors.affiliation: Center for Health Equality, School of Public Health, at Drexel University, in Philadelphia, Pennsylvania, USA. david.b.smith@drexel.edu
authors.forename: David Barton
authors.initials: DB
authors.lastname: Smith
authors.forename: Zhanlian
authors.initials: Z
authors.lastname: Feng
mesh_terms: D002908:Chronic Disease; D003363:Cost Control / Q000379:methods; D006291:Health Policy / Q000639:trends*; D006297:Health Services Accessibility / Q000706:statistics & numerical data / Q000639:trends; D006299:Health Services for the Aged; D006303:Health Services, Indigenous / Q000191:economics / Q000600:supply & distribution; D054625:Healthcare Disparities; D006801:Humans; D008134:Long-Term Care / Q000379:methods / Q000458:organization & administration / Q000592:standards / Q000639:trends*; D008484:Medicaid; D009937:Organizational Objectives; D011787:Quality of Health Care / Q000592:standards; D014481:United States