ABSTRACT
Traditionally in the United States most long-term care has been institutional in nature (that is, provided in chronic care hospitals or nursing homes), has been delivered largely to impaired elderly individuals and has been paid for out of public funds. Concern about this situation grew as the costs and the number of recipients of care expanded, and as increasingly critical examination of care, especially during the past decade, suggested appalling mismatches between the need exhibited and the services rendered.
