The emphasis on patient-focused care, as well as the impetus by the federal Medicare program and managed care to contain costs by reducing the length of hospital stays, has resulted in the growth of alternate care settings. These settings are important components of the continuum of care for patients whose care cannot be provided in the traditional hospital setting, due either to the types of services required or cost constraints. Long-term care facilities provide care for patients who have chronic, complex health problems and functional disabilities that prevent them from managing their own daily needs. These facilities include nursing homes, psychiatric and mental retardation hospitals, chronic disease hospitals and rehabilitation hospitals. Costs for the care of low-income, elderly patients in many of these facilities are covered by patients themselves or by Medicaid.
Most elderly patients enter nursing homes as self-pay patients.
Many of these patients become impoverished over the course of their stays, and then qualify for Medicaid coverage. Medicare provides for 21 days of nursing home healthcare after the patient is discharged from an acute care hospital. Hospice care provides emotional, physical and sometimes spiritual support for both terminally ill patients and their families during a particularly stressful period of their lives. Use of hospice care is increasing, as these patients prefer support services rather than more aggressive medical care. They prefer to focus on quality rather than duration of life.