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Health Care Reform
May 27, 2013

Keeping the “Home” in Nursing Home: Implications for Infection Prevention

Author Affiliations

Author Affiliations: Divisions of Geriatric and Palliative Care Medicine (Drs Mody and Bradley) and Infectious Diseases (Dr Bradley), University of Michigan, Ann Arbor; Geriatric Research Education and Clinical Center (Drs Mody and Bradley) and Infectious Diseases Section (Dr Bradley), Veteran Affairs Ann Arbor Healthcare System, Ann Arbor; and Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine (Dr Huang).

JAMA Intern Med. 2013;173(10):853-854. doi:10.1001/jamainternmed.2013.330

A s they enter their retirement years, 76 million baby boomers with chronic illnesses will have an unprecedented impact on the health care system in the United States.1 Emerging provider-level accountable care organizations are charged with care management across the entire health care spectrum.2 For many older adults, residence in a nursing home (NH) is inevitable, and the “institution” truly becomes their “home.” Nursing homes also service a “short-stay” post–acute care population that is young, sick, prone to rehospitalization, and at a high risk of health care–associated complications like infections and adverse drug events. The Centers for Medicare and Medicaid Services, ie, the US taxpayers, pays over 60% of NH expenditure.3,4 As NHs become a partner in the health care delivery reform, they will undoubtedly be tasked to enhance the quality of care and resident safety to reduce interfacility transfers. Most NHs are unprepared to address the myriad challenges posed by providing care for 2 disparate long-stay and short-stay populations within this emerging framework.