Now and Then
Now and Then
The Skilled Nursing Facility (SNF) is largely a creation of Medicare: the institution of prospective payment for hospital care in 1983 led to early discharge of patients from the hospital. For frail, old people who were not ready to go home so quickly, the SNF evolved as an intermediate site of care. Social trends and scientific developments also affected the development of the SNF over the past fifty years. Changes in family structure as well as unprecedented geographic mobility weakened the ability of families to take care of older people after a hospital stay. The growth of mega-corporations and of mergers and acquisitions led to the development of SNF chains. In medical science, the development of hip and knee joint replacement surgery, along with the aging of the population, led to the rise in popularity of these procedures, with a concomitant need for post-surgical rehabilitation. The development of the intensive care unit and advances in anaesthesia resulted in a steady rise in the age of patients undergoing complex surgery, further stimulating the need for skilled nursing facility care.
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