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Nursing home care in the United States
In the United States, there are different kinds of residential "nursing" facilities (community facilities and institutional facilities) which have in common Medicaid federal funding and approvals through a state health department, no matter which categorical state department (e.g., intellectual disabilities, mental health, health) operates, staffs or oversees the facilities. The newer community versions, small in size rather than the exposed institutions (operated similar to "group homes" and even apartments),〔Janicki, M., Krauss, M. W., & Seltzer, M. (1988). "Community Residence for Persons with Developmental Disabilities: Here to Stay". Baltimreo, MD: Paul H. Brookes.〕 were developed around 1970s as part of the movement to the community (Racino & Schwartz, 1978).〔Racino, J. & Schwartz, D. (1978). Founding of the Education Committee of the New York State Association of Community Residence Administrators with funding from the One-to-One Foundation〕 Assisted living came from community living (CL) groups (not from the nursing home industry) who advocated for the separation of facility funding to home and supports in the communities(for information on residential services and reform, see supportive housing and supported living).〔Racino, J. & Heumann, J. (1992). Independent living in the community: Building coalitions among elders, people with disabilities and our allies". In: E.F. Ansello & N. Eustis, "Aging and Disabilities: Seeking Common Ground". Amityville, NY: Baywood Publishing Co.〕 Board and care homes have never been approved by community planning as intermediate care facilities (ICFs), or even the emblematic group homes, often falling far short at health and community gates. The leading practice in the US is to advocate for community Long Term Services and Supports (LTSS) led by groups such as the Consortium of Citizens with Disabilities representing over 200 national disability organizations.〔Consortium of Citizens with Disabilities. (2012). "Long-Term Task Force on Services and Supports". Washington, DC: Author.〕
==History==
In the United States, the national social insurance program Medicare, was established by the U.S. federal government in 1965, which guaranteed access to health insurance for Americans aged 65 and older. This program prompted many new nursing homes to be set up in the following years, although private nursing homes were already being built from the 1930s as a consequence of the Great Depression and the Social Security Act of 1935. Medicaid, the Nation's poverty program, often funds programs such as nursing beds as residents may be "impoverished" to access the facility.
In 1987, a report examined the nursing home problem in Wisconsin which involved 4,000 people, 80% under 65 years of age with an average of 110 patients per facility. 5% had developmental disabilities. They reported that 13 large institutions were certified as SNFs (skilled nursing facilities), that all were "absolutely inappropriate" placements for the developmental disabilities' clients (the federal GAO then reported a need to upgrade services in the homes, including day services), and the facilities resembled the institutions that resulted in the national exposés of institutions such as Willowbrook in other fields.〔Biklen, Douglas. & Knoll, James (1987). "On the Use of Nursing Homes as a Residential Option for People with Developmental Disabilities in the State of Wisconsin". Syracuse, NY: Community Integration Project, Center on Human Policy (by the National Institute on Disability Research and Rehabilitation )〕〔General Accounting Office. (1987). "Medicaid: Addressing the Needs of Mentally Retarded Nursing Home Residents". Washington, DC: Author.〕
Board and Care homes were the subject of exposés for lacking medical personnel at the time of the 1990s reviews.
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