The non-profit sector and community-based care for the elderly in the U.S.: a disappearing resource?

Non-profit health and social service agencies have traditionally been an extremely important element of non-institutional community-based care for the elderly in the U.S. Policy shifts, commencing in 1981, increasingly concerned with medical cost containment are challenging private non-profit sector agencies delivering care to the elderly. At issue is the ability of communities to maintain a viable service sector predicated on service needs and service accessibility, as opposed to a highly discrete, medicalized, and fragmented service delivery system that is available primarily (or only) to those who can pay.