By NextBestFitShift to small homes and home care
Fund small-house models and home care instead of large institutions.
Better quality of life over time.
Review ledgerHow this path connects
This path
Shift to small homes and home care
Concrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- Fund small-house models and home care
Effects
Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.
What it fixes
- Nursing home understaffing and quality
Funding small-house models and home care instead of large institutions improves quality of life and reduces infections.
- Medical errors and poor care coordination
Shifting care from large institutions to small homes and home care reduces infections.
What it creates or worsens
- Takes years, or money up front, before it pays off
Moving from large institutions to small homes and home care brings transition costs.
- Raises spending or loosens control over it
Smaller care homes cost more per resident.
Who's affected
Who gains
- Older and disabled people needing long-term care
- Nursing home understaffing and quality: Understaffing and low reimbursement contribute to quality and safety problems.
- Doctors, nurses, and other clinicians
- Nursing home understaffing and quality: Understaffing burdens nursing-home staff.
- People with ongoing or specialist care needs
- Medical errors and poor care coordination: Delivery and coordination failures cause preventable harm.
Who loses
- Hospitals, clinics, and care organizations
- Nursing home understaffing and quality: Owners benefit from related-party transactions and real-estate structures.
- Medical errors and poor care coordination: Fee-for-service providers are paid for treating complications.
- Private equity firms and investors
- Nursing home understaffing and quality: Owners benefit from related-party transactions and real-estate structures.
- Taxpayers and public budgets
- Raises spending or loosens control over it: Public budgets pay the added spending.
Where it has been tried
- Denmark: Denmark’s nursing-home beds declined 30% between 1985 and 1997 as home services and adapted housing expanded; the cited paper dates legislation limiting new nursing-home construction to 1988.Sources: The Gerontologist (2001)