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

Nursing homes in the United States are a product of Americanfederalism and reflect the complexities and variabilities ofthat system. Over time, institutional long-term care for frailelders has shifted from local government funding and administrationto state-level oversight and support to a shared federal-stateconcern. The unsystematic American approach produces haphazardresults in terms of quality, equity, and efficiency. The grayingof the American population will increase the demand for long-termcare, resulting in pressure for a more coherent policy response.