A program for review of community nursing-home utilization.

Abstract

ABSTRACT:A Utilization Review Program in operation since January 1, 1971, has used a uniform method for studying over 5,000 patients in 35 nursing homes in the City of New York. New criteria for evaluating the need for long‐term care of these patients were accepted by the various sponsoring agencies. These criteria permit practical interpretation of the codes established for this purpose, and can serve as a blueprint for more such community programs as differentiated from programs associated with only a single institution. The new criteria should lead to tightening of the admission of patients who do not belong in nursing homes, and expedite the transfer of patients who no longer need long‐term care in these homes. The program was established for two main purposes: 1) to lower the costs for the sponsoring agencies, and 2) to improve the quality of medical care. To date there has been some progress in quality control, but no significant lowering of costs, apparently because of lack of health‐related facilities.The findings may help to stimulate the establishment of proper health‐related facilities geared to the problems of the custodial care of patients who need restorative health measures. Such a program within such health‐related facilities would take care of physical, psychological and social rehabilitation. The institutional patients would be taught how to participate in this program, and elderly persons in the community could also take part. Thus the facility could become a true geriatric center.