these populations—rehabilitation clients, hospice clients, people in comas, long-stay residents with only physical illnesses, and long-stay residents with cognitive impairments—and their concerned agents and relatives are likely to need advocates, but the characteristic problems presented may differ dramatically, as may the strategies of the advocates.
Although the average age of a nursing facility resident is in the mid-eighties, younger people also live in nursing facilities. Many are chronically mentally ill or developmentally disabled. Some of these younger, long-stay residents suffer from spinal cord injuries or deteriorating neurological diseases. In many areas of the country, persons with acquired immunodeficiency syndrome (AIDS) may live in nursing facilities when their disease reaches the advanced stage. Characteristic needs for advocacy may apply to some of these vulnerable populations. In addition, people under 60 (especially those who are disabled but not sick) are known to have particular problems achieving a satisfactory lifestyle in nursing facilities.
Between 600,000 and one million elderly and disabled persons are estimated to reside in B&C homes, also known as domiciliary care homes, personal care homes, residential care facilities, homes for the aging, rest homes, adult congregate living facilities, assisted living facilities, and adult foster care homes. These facilities provide residents with food, shelter, and 24-hour supervision or protective oversight. Usually they provide some form of supportive service or assistance as well. Such facilities vary significantly in size (from 2 beds to more than 1,000), monthly charge (from $383 to more than $4,000), and range and intensity of services provided (from no services to daily nursing care). Some facilities are targeted or marketed to younger persons with chronic mental illness or developmental disabilities, others are targeted to the elderly, and yet others serve a mixed-age population. The quality of care and life provided by these facilities to residents also varies (Dittmar and Smith, 1983; Reisacher, 1985; Mor et al., 1986; Eckert et al., 1987; U.S. House of Representatives, 1989; Hawes et al., 1993).
Further, the payment systems and regulatory structures that apply to these facilities also vary enormously. Within a single state, multiple classes of facilities can exist, each with its own target population and its own set of rates and regulations concerning staffing, admissions, and standards of care. In at least 10 states, multiple agencies are responsible for licensing various types of B&C homes that serve a primarily elderly or mixed-age population of residents; in many states, entirely separate classes of homes are licensed by