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Old and Sick in AmericaThe Journey through the Health Care System$
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Muriel R. Gillick

Print publication date: 2017

Print ISBN-13: 9781469635248

Published to North Carolina Scholarship Online: May 2018

DOI: 10.5149/northcarolina/9781469635248.001.0001

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PRINTED FROM UNIVERSITY OF NORTH CAROLINA PRESS SCHOLARSHIP ONLINE (www.northcarolina.universitypressscholarship.com). (c) Copyright University of North Carolina Press, 2021. All Rights Reserved. An individual user may print out a PDF of a single chapter of a monograph in NCSO for personal use.date: 24 September 2021

Now and Then

Now and Then

(p.202) Chapter Twelve Now and Then
Old and Sick in America

Muriel R. Gillick M.D.

University of North Carolina Press

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.

Keywords:   Prospective payment, Family caregivers, Joint replacement, Intermediate care

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