Summary: The use of nursing home care, when community-based care would have been preferred or appropriate, has serious implications. Premature or avoidable institutionalization results in high human costs for individuals who must give up their independence and accustomed way of life when they enter a nursing home. It also represents ineffective use of Medicaid funds. Avoidable use of nursing homes is partly a result of problems in the admissions process. These problems include: Medicaid's eligibility policies, which create financial incentives to use nursing homes rather than community services; inaccessible or unavailable community services; and Medicaid assessment procedures for determining the elderly's need for nursing home care. Most admission reviews take place after admission when it is difficult to discharge the resident, and they focus primarily on medical conditions without taking other factors into consideration. Another problem in nursing home admissions is that private pay applicants are not required to go through any assessment procedures, and since they are charged higher rates than Medicaid residents, they are often admitted over Medicaid patients regardless of who has the most critical need for care. Specific changes are needed to assure that the elderly who are at risk of institutionalization are offerd a viable alternative to nursing home placement. The Preadmission Screening Program has been proposed as an approach designed to intervene in the admissions process to offer individuals community-based long-term care options.
