Assessment of cost related characteristics and conditions of long-term care patients.

The present federal policy that requires a cost differential to be imposed between intermediate and skilled care residents/patients is based on a number of unproven assumptions that need to be tested. Are there groupings of cost related characteristics and conditions that allow appropriate distinctions between intermediate and skilled nursing care? If so, is the difference in the cost of care greater than the cost of collecting the data? Do the intangible costs exceed the benefits, especially if forced transfer of residents/patients is involved? If groupings do exist, will facilities reimbursed for high-cost patients be encouraged to maintain them in a state of dependence? Further, can the decisions be made reliably, even in communities where a spectrum of alternative resources is not available? Are there political reasons why objective decisions would not be acceptable to state administrators trying to balance their budgets? At the least, it appears that further research is needed in all of these areas. Before the results are in, perhaps a careful, judicious interpretation of the law is needed in order to positively affect the quality of life available to the persons consuming nursing home services.