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Publius: The Journal of Federalism Advance Access originally published online on November 6, 2008
Publius: The Journal of Federalism 2009 39(1):138-163; doi:10.1093/publius/pjn030
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© The Author 2008. Published by Oxford University Press on behalf of CSF Associates: Publius, Inc. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org.

This article appears in the following Publius: The Journal of Federalism issue: Federalism and Health Policy [View the issue table of contents]

Poorhouse to Warehouse: Institutional Long-Term Care in the United States

Lydia L. Ogden* and Kathleen Adams{dagger}
*Emory University; logden{at}emory.edu
{dagger}Emory University

Nursing homes in the United States are a product of American federalism and reflect the complexities and variabilities of that system. Over time, institutional long-term care for frail elders has shifted from local government funding and administration to state-level oversight and support to a shared federal-state concern. The unsystematic American approach produces haphazard results in terms of quality, equity, and efficiency. The graying of the American population will increase the demand for long-term care, resulting in pressure for a more coherent policy response.


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