Trends in the spatial dimensions of the long term care delivery system. The case of New York State.
Over the past twenty years, the long term care sector of the health delivery system has sought to shift the delivery of services away from costly (nodalized) facilities to community-based (dispersed) delivery structures. An anti-institutional societal view has influenced the formation of current long term care policy. While home is the preferred site for elderly in need of care, the health services literature suggests that the cost and personal functional benefits expected to result from community-based long term care occur only for a small segment of the dependent elderly. This paper also looks at health planning policy as it has been carried out in New York State during the 1980s to find that, despite mid-1980s thrusts to disperse care in the community, an expansion of residential health care facilities is underway as of the end of the decade. Moreover, congregate care provided in group homes (supportive housing) is being added to the care spectrum.