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TOWARD A NATIONAL STRATEGY FOR LONG-TERM CARE OF 1~E ELDERLY A STUDY PLAN FOR EVALUATION OF NEW POLICY OPTIONS FOR THE FUTURE Report of a committee of the Institute of Medicine April 1986 INSTITUTE OF MEDICINE NATIONAL ACADEMY OF SCIENCES

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NOTICE The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the Councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the Committee responsible for the report were chosen for their special competencies and with regard for appropriate balance. This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an advisor to the Federal Government, and its own initiative in identifying issues of medical care, research, and education e This volume is the final report of a planning study conducted under grants from the American Medical Association, the American Nurses' Association, and the Henry J. Kaiser Family Foundation, contracts with the Health Care Financing Administration, the National Institute on Aging, and support from the National Research Council Fund, a pool of private, discretionary, nonfederal funds that is used to support a program of acadPmy-initiated studies of national issues in which science and technology figure significantly. The NRC Fund consists of contributions from a consortium of private foundations including the Carnegie Corporation of New York, the Charles E. Culpeper Foundation, the William and Flora Hewlett Foundation, the John D. and Catherine T. MacArthur Foundation, the Andrew W. Mellon Foundation, the Rockefeller Foundation, and the Alfred P. Sloan Foundation; the Academy Industry Program, which seeks annual contributions from companies that are concerned with the health of U.S. science and technology and with public policy issues that have technological content; and the National Academy of Sciences and the National Academy of Engineering endowments. 2101 Constitution Ave., N.W. Washington, D.C. 20418 Publication IOM-85-05

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TOM Committee to Plan A Major Study of National Long-Term Care Policies Linda H. Aiken, (Chairman), Vice President, The Robert Wood Johnson Foundation, Princeton, New Jersey Patricia G. Archbold, Professor, The Oregon Health Sciences University, School of Nursing, Portland, Oregon Robert M. Ball, Visiting Scholar, Center for the Study of Social Policy Washington, D.C. Walter M. Bortz II, Palo Alto Medical Foundation, Palo Alto, California Rhetaugh G. Dumas, Dean and Professor, School of Nursing, University of Michigan, Ann Arbor, Michigan Rev. Msgr. C. J. Fahey, Marie Ward Doty Professor of Aging Studies and Director, Third Age Center, Fordham University, New York, New York Amasa B. Ford, Associate Dean for Geriatric Medicine, Case Western Reserve University, School of Medicine, Cleveland, Ohio Margaret M. Hastings, Executive Director, Illinois Commission on Mental Health and Developmental Disabilities, Kenilworth, Illinois Susan L. Hughes, Director, Program in Gerontological Health, Assistant Professor, Department of Community Health and Preventive Medicine, The Medical School, Northwestern University, Evanston, Illinois Robert L. Kane, Dean, School of Public Health, University of Minnesota, Minneapolis, Minnesota Frank B. McGlone, Denver, Colorado William A. Morrill, President, Mathematica Policy Research, Inc., Princeton, New Jersey Alicia H. Munnell, Senior Vice President and Director of Research Federal Reserve Bank of Boston, Boston, Massachusetts Robert F. Phillips, Secretary of Life and Disability, Fireman's Fund Life Insurance Company, San Rafael, California Edward Re Pierce, Dean for Allied Health Sciences, Associate Dean, Indiana University, School of Medicine, Division of Allied Health Sciences, Indianapolis, Indiana

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Dorothy P. Rice, Professor, Aging Health Policy Center, University of California, Department of Social and behavioral Sciences, San Francisco, California John C. Rather, Associate Director, Division of Legislation, Research and Developmental services, American Association of Retired Persons. Washington, D.C. William J. Scanlon, Co-Director, Center for Health Policy Studies, Georgetown University, Washington, D.C. Raymond J. Struyk, Senior Research Associate, Center for Housing and Community Development, The Urban Institute, Washington, D.C. John A. Talbott, Professor and Chair, Department of Psychiatry, University-of Maryland, School of Medicine, Baltimore, Maryland Stanley S. Wallack, Director, Health Policy Center, Heller School, Brandeis University, Waltham, Massachusetts TOM Staff Karl D. Yordy, Director, Division of Health Care Services William A. Lybrand, Principal Staff Officer Leopold G. Selker, NRC Fellow-In-Residence Kathleen Drennan, Research Assistant H. Don Tiller, Senior Secretary iv