ABSTRACT
Implicit decisions to prioritize the needs of other Philadelphia health and corrections institutions over the needs of Riverview demonstrated assumptions about the purposes of public institutional care, in which acute and chronic tiers were treated differently, thus revealing gaps and failures in long-term care policy. Local county responses varied from institutional closure to boarding residents in neighboring institutions to increasing the size of the county home, while appropriate facilities for long-term sickness care remained startlingly absent. Medical care gradually replaced residential care as the organizing framework for long-term services, ultimately leading to restructure of institutional control processes, including admission, service management, and care delivery. A larger care role for public nursing homes would also reduce pressure on hospital utilization through increased availability of accessible, less expensive institutional care, especially for public assistance recipients awaiting hospital discharge. Homes for the aged rarely accommodated the poor, and family care might be unavailable.
