The future of long-term care and the role of the medical director.

Anticipating the needs of aging baby boomers and responding to market demands for consumer choice and low-cost care, long-term care providers are changing the way they do business. As part of that change, they are offering new and, in some cases, more complex services at both the high and low end of the spectrum. At the high acuity end, long-term care providers are delivering hospital-like subacute care to increasing numbers of patients at roughly half the costs of providing the same care in hospitals. At the low acuity end, providers are offering new assisted living services, as well as a full range of community-based long-term care. At the same time, traditional nursing facilities continue to meet the needs of chronically ill elderly and people of all ages needing rehabilitative care. These changes point to a shifting role for physicians (and especially medical directors) in the long-term care setting.