Toward a Continuum of Caring Alternatives: Community Based Care for the Elderly

Abstract

This paper examines the roots and consequences of the “medicalization” of aging in America. The present set of programs under Medicare, Medicaid and Title XX are described, with particular attention given to the unproductive “dichotomy” created between health and medical needs (addressed primarily under Medicare and Medicaid) and the interrelated social needs of the elderly, provided for, albeit inadequately, through Title XX.The present medically and institutionally based approach to care for the elderly in America is contrasted with approaches that seek to create environments that increase self‐reliance for the elderly. Programmatic redesign strategies providing a full continuum of care are premised on such concepts as “normalization” and the “least restrictive alternative.” Particular attention is focused on the area of community based home health and social services.The experiences of several states in providing more comprehensive community based services are explored. One such program—California's recently initiated Multi‐Purpose Senior Services Project—is described. It potentially provides a wide range of services that previously were unavailable through more narrowly designed categorical programs. The importance of broader programs of community based care for the elderly, and important research directions, are examined.