Poorhouse to Warehouse: Institutional Long-Term Care in the United States
Lydia L. Ogden; Kathleen Adams

Nursing homes in the United States are a product of American federalismand reflect the complexities
and variabilities of that system. Over time, institutional long-term care for frail elders has
shifted from local government funding and administration to state-level oversight and support to
a shared federal-state concern. The unsystematic American approach produces haphazard results
in terms of quality, equity, and efficiency. The graying of the American population will increase
the demand for long-term care, resulting in pressure for a more coherent policy response.

Publius: The Journal of Federalism 2008; doi: 10.1093/publius/pjn030
http://publius.oxfordjournals.org/cgi/reprint/pjn030?ijkey=gKbQFkBQyYSO7zF&keytype=ref


>>> SEE ACCOMPANYING SLIDES: Slides explain visually how spending has skyrocketed and who’s paying; along with the trouble ahead, giving the support ratio (working adults to retired adults consuming care).