Long-term care for the elderly: public dreams and private realities.

The health care policy and provider community is struggling to come to grips with the dual problems of the burgeoning "old-old" population that is putting an increasing strain on nursing home bed supplies, and the increasing difficulty of paying for long-term care through Medicaid budgets and out-of-pocket payments by the individuals and families affected. The Reagan administration's approach to the problem is away from public solutions and toward private ones. This paper reviews the trend toward privatization in long-term care for the elderly, raises some concerns about these trends, and concludes with some alternative suggestions.