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Long-term care in the U.S. began with almshouses and charitable institutions that provided basic shelter for the poor, elderly, and chronically ill. Care was minimal and often lacked professional oversight.
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The Social Security Act provided financial support to older adults, laying the groundwork for modern long-term care by acknowledging the needs of an aging population.
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Private nursing homes expanded rapidly as families began moving away from multi-generational households. However, oversight and quality standards were limited.
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The creation of Medicare and Medicaid was a turning point. Medicaid, in particular, became the primary payer for nursing home care, leading to significant growth in facilities but also increased government regulation.
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Concerns about quality of care led to new regulations. The Nursing Home Reform Act of 1987 required standards for staffing, patient rights, and quality of life. Administrators were now expected to balance compliance with patient-centered care.
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Long-term care expanded beyond nursing homes. Assisted living, home health, and adult day care became more common. Administrators managed not only facilities but also networks of services designed to support independence.
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The Affordable Care Act and other reforms emphasized reducing hospital readmissions, improving quality, and integrating long-term care with healthcare systems. Today, administrators focus on balancing regulations, staffing shortages, rising costs, and the use of technology such as electronic health records and telehealth.