Long-Term Care Policy: Past, Present, and Future

• Public policy can take many different forms and can come from different governmental sources. • There is no single process or model that can describe how policies are made, except that legislative policymaking follows a welldefined process. • Policies do not always achieve their intended objectives and sometimes produce unintended side effects that can be positive or negative. • In the United States, long-term care policy and general welfare have been closely intertwined. The Social Security Act of 1935 and the creation of Medicare and Medicaid in 1965 were landmark policies that indirectly started the nursing home industry. Regulation of the industry soon followed. • Quality of care issues in nursing homes took center stage during the 1980s. The Nursing Home Reform Act of 1987 provides current nursing home regulations dealing with patient care, but the regulations also have some serious drawbacks. • Most of the current activity in long-term care policy is at the state level. Community-based services and purchase of private insurance are receiving various degrees of state-level attention. • The complex interaction of financing, access, utilization, and expenditures is critical to current and future long-term care policy. • Future policy initiatives are necessary in the areas of prevention, financing, workforce development, health information systems, mental health, and evidence-based practices. 74035_CH02_5368.qxd 8/4/09 9:43 AM Page 25