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PREFACE An unprecedented increase in the number of elderly persons in the population, spiraling public expenditures for nursing home care, and persistent concern about quality of care have drawn widespread national attention to long-term care. Believing that the time has come for the nation to plan more adequately for long-tar-m care, the Institute of Medicine of the National Academy of Sciences initiated planning in late 1984 for a major study of national options in the matter. The purpose of the study was to construct a cohesive framework that will lead to improved, cost-effective long-term care services. The broad support for an Institute of Medicine study is reflected in the diversity of public and private sponsors of the Institute's planning effort, and the responses of private sector organizations whose views were solicited on issues that a major study should address. Funding for the planning effort was provided by the National Research Council, Health Care Financing Administration, National Institute on Aging, American Medical Association, American Nurses' Association, and the Henry J. Kaiser Family Foundation e Most of the 80 private sector organizations responding to the Institute's letter request concerning critical issues in long-term care (see Exhibit D-1) expressed substantial interest in and support for the major study, with many commending the Institute for taking leadership in the complex long-term care area and indicating a willingness to collaborate during the study. The Institute committee charged with the planning effort was composed of people from a wide variety of backgrounds. They included those directly concerned in long-term care professions, such as practitioners in internal medicine and psychiatry, nursing, social work, psychology and allied health; those in closely related substantive fields including private insurance, housing, and ethics; those involved in social policy analysis, including economics, sociology, biostatistics and health services research; and those with federal and state government perspectives. In planning the study, the committee was asked to consider the needs of the functionally dependent of all ages, not only the elderly, and ~ V11

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the full range of long-term care services they require, not only institutional care in nursing homes. Specifically, the planning committee was charged to: identify the policy issues that should be examined in the major study, including the matching of needs and services, the organizational arrangements--both non-institutional and institutional--for providing the services, the costs and financing of the services, and private sector roles and responsibilities. create an inventory of major data bases, analytic studies, research, demonstrations, and experiments, both existing and planned, that would be relevant to examination of the critical policy issues and assessment of policy options. formulate a plan for the study that gives structure to the many issues and focus to the available knowledge, including specification of objectives, scope, general approach, major tasks. anticin=~d m',f Rome and estimates of time and cost. ~ Or ~ ~ ~ ~ ~ ~ ~ ~~~ ~ ~ A description of the Nobel A.. :~ ~ a_ ~ ~ a_ ~ ~ ~ . _ ~ ~_~ =~~ ~ = Mu on one Hollowing pages. For the sake of clarity and simplicity, much of the detailed information supporting the text of the proposal is presented as exhibits. They include: (1) a series of papers prepared by committee members and staff as contributions to the committee's deliberations, (2) an inventory of existing and ongoing or planned research that can ~ Jo At (3) a summary report on the survey of private sector organizations, and (4) a bibliography of source material reviewed in the planning study. be drawn unon ; n the m= ; ^- cant . . V111