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March 15, 1976

Whither the Chronic Disease Hospital?

JAMA. 1976;235(11):1107-1108. doi:10.1001/jama.1976.03260370017015

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To the Editor.—  In the commentary, "Whither the Chronic Disease Hospital?" (234:709, 1975), Dr Ruskin calls attention to the frequently complex medical needs of the long-term or chronically ill patient population, with stress on their rehabilitation needs. Dr Ruskin's analysis of the problem is valid, but in my view, his proposed solution for meeting these needs is oversimplified and, to a degree, inaccurate.The medical needs of long-term patients vary widely and should be met in more than one medical setting. The medical rehabilitation institute that Dr Ruskin proposes has an important place in the pattern of care. It should stress rehabilitation, however, and not purport to provide total care for long-term patients who may only occasionally have unusual medical needs. The skilled nursing facility as it is being defined under the Medicare and Medicaid programs is a far cry from the definition offered by Dr Ruskin, which is that