Nursing homes: improving a flawed community facility.

The phenomenal growth in the number and population of nursing homes in this country over the past 40 years is a sign of the overreliance on institutional approaches to care for the ill elderly and the underuse of other community alternatives. The authors discuss the reasons for the growth of nursing homes and outline the problems homes have in securing funding and providing appropriate quality care for patients. Two broad approaches to improving care for the ill elderly in the community--finding alternative community placements and improving the nursing homes themselves--are examined, and the need for homes to document the cost-effectiveness and efficacy of their treatments is highlighted.