A Brief History Of Long-term care.

Early 1900s

Almshouses, poor farms for elderly "inmates"; homes for the aged (often sponsored by religious or ethnic groups) founded or in their early years; "rest homes" and "convalescent homes" emerge.

1925

U.S. Dept. of Labor finds "dilapidation, inadequacy and

1926

1926: Harry Evans's The American Poor Farm and Its Inmates creates early public demand for reform.

1935

Social Security Act creates Old Age Assistance to bolster incomes of needy elderly but forbids OAA payments to inmates of almshouses.

1950

Social Security amendments lift the ban on payments to public long-term care institutions; also permit direct government "vendor" payments to providers and require state licensure programs for nursing homes. (Also, Nursing Homes Magazine founded.) First geriatric nursing textbook published (Geriatric Nursing, by Kathleen Newton; published by Mosby).

1954

Hill-Burton Act amendments allow federal grants to public and not-for-profit organizations to build nursing homes; also provide first federal standards for design and construction of these facilities.

1956-1959

For-profit organizations made eligible to receive Small Business Administration and Federal Housing Administration financing for nursing homes, following a campaign by the American Nursing Home Association.

1960

Kerr-Mills Act provides for federal-state matching funds for medically indigent, including those in skilled nursing facilities.

1964

First training program for geriatric nursing assistants (intended to create a level of nursing between a nurse's aide and a licensed practical nurse) approved, with funding coming from the Federal Manpower Development Training Act. The program started in Tennessee, with the cooperation of the Tennessee Employment Security and the State Department of Vocational Education.

1965

Medicare and Medicaid created; Medicare to cover post-hospital "extended care" (100 days), but no specific nursing home provisions for Medicaid other than continuation of federal matching funds to states.

1967

Medicare extended-care provisions go into effect.

1968

Moss amendments to Social Security Act set new operational standards for nursing homes accepting Medicaid. Kennedy amendment requires state licensure of nursing home administrators.

1969

Medicare begins restricting extended-care services (Intermediary Letter 371).

1970

Dept. of Health, Education and Welfare issues regulations based on Moss amendments. HEW accused of weakening the intent of Moss amendments.

1971

Office of Nursing Home Affairs created in HEW. Disbands two years later. Intermediate Care Facility (ICF) category created.

1972

Social Security amendments extend Medicare coverage to the disabled. Supplemental Security Income (SSI) created. "Skilled nursing facilities" (SNFs) defined. Medicaid "reasonable cost" reimbursement authorized to SNFs and Intermediate Care Facilities (ICFs).

1974

Federal health planning legislation adopted creating certificate-of-need. Mary Adelaide Mendelson's Tender Loving Greed targets Medicaid fraud.

1977

Congress adopts Medicare and Medicaid Antifraud and Abuse amendments.

1982-1997

Series of National Institute on Aging studies shows a declining rate in geriatric disability.

1983

Medicare Diagnosis-Related Groupings (DRGs) created; lead to nursing home-based post-acute care.

1987

Omnibus Budget Reconciliation Act (OBRA '87) incorporates nursing home reform; creates state survey and enforcement system.

1995

Congress passes legislation repealing OBRA '87 and establishing Medicaid block grants. President Clinton vetoes. Clinton Administration issues beefed-up survey-enforcement regulations.

1997

Congress passes Balanced Budget Act establishing Prospective Payment System for Medicare-funded post-hospital care.

1999

First PPS-related bankruptcies among proprietary chains occur. NAB notes 25% drop in applicants for nursing home administrator licensure examination.