Deinstitutionalization and Its Effects on the Elderly: Inappropriate Placement into Long-term Care

Abstract

The primary reason for electing to examine the inappropriate placement of the elderly into long-term care resulted from my ownership of a twelve-bed adult foster care home for the elderly in the small rural town of Sandusky, Michigan. In the five years that my wife Diana and I operated the home, we became aware that some of the elderly residents had been admitted appropriately, others should not have been placed in our facility, had an adequate community-based home care network been available and still others should have been placed in skilled nursing care environments. Additionally, some residents were transferred to nursing homes who should have remained at the adult foster care level. As I examined the materials used for this thesis, I discovered that the problem was much more severe than I had anticipated. The inappropriate placement of the elderly into long-term care has puzzled policy makers and administrators since the days of the almshouses and public asylums. In the 1960’s and 1970’s, deinstitutionalization emerged as a matter of public policy and many elderly patients were returned to their homes in local communities without supports. Medical professionals, administrators of long-term care facilities, service providers and families often disagree regarding the needs of the elderly and have complicated the placement decisions for elders being placed into long-term care. These problems carry on into the 1990’s. Mental illness and economics are the two most evident factors that contribute to the inappropriate placement of the elderly into-long term care. This paper provides potential answers to the problems presented and an avenue that may allow public administrators to become a part of the solution by playing a major role in the development of a national health care plan that will meet the needs of the elderly in this country.