Appropriate placement of nursing-home residents in lower levels of care.

Too often individuals with long-term-care needs are placed in nursing homes when they might well be better served at a lower level of care. The uneven distribution of residents across settings stems from interacting factors of supply and demand: clinical need; lack of consensus among physicians about what constitutes the best setting for their patients; regulations restricting services in personal care homes. Three sets of clinical criteria identify nursing-home residents according to their appropriateness for lower levels of care. Factors like cost and ability of the patient's family to make informed decisions affect placement as well. Policies for shifting patients to lower levels of care must be carefully designed in order to save costs and ensure that quality of care is retained.