ABSTRACT
Although only about 5 percent of the population age 65 and older reside in nursing homes at any given time, the lifetime risk of institutionalization is substantially higher. Most estimates suggest that 25 to 35 percent of current cohorts of older adults will receive institutional care at some point in their lives (Ingram and Barry 1977; Kastenbaum and Candy 1973; Liang and Tu 1986; Palmore 1976), but some estimates are considerably higher (Vicente, Wiley, and Carrington 1979; Cohen, Tell, and Wallack 1986; McConnell 1984). The sheer numbers of older persons affected thus testify to the importance of institutional care as part of the formal care service system for older adults. Concern about institutional care is heightened even further by persistent tensions between (a) the financial burdens that nursing home placements impose on both public coffers and private pocketbooks (Liu and Palesch 1981; Waldo, Levit, and Lazenby 1986) and (b) persistent perceptions that institutional care is often less than optimal and sometimes simply inadequate (Special Committee on Aging 1986).
