Long-term care and AIDS: perspectives from experience with the elderly.

The driving concern of policy thinking in regard to both the elderly and AIDS patients has been cost containment. It has been presumed that the best way to cut costs, as well as to serve the medical and emotional needs of AIDS patients, is to limit hospital and nursing home stays and expand the role of community-based services. The experience of the elderly has demonstrated, however, that these services have had little impact on the use of institutional care, only limited outcome benefits, and have not reduced the overall costs; rather, they have increased the utilization of all services and total expenditures. In the case of AIDS patients, a preoccupation with community care alternatives to hospitalization fails to acknowledge the central role of medical care in the management of the disease.