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Viewpoint | Health Care Reform

Keeping the “Home” in Nursing Home:  Implications for Infection Prevention

Lona Mody, MD, MSc; Suzanne F. Bradley, MD; Susan S. Huang, MD, MPH
JAMA Intern Med. 2013;173(10):853-854. doi:10.1001/jamainternmed.2013.330.
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A s they enter their retirement years, 76 million baby boomers with chronic illnesses will have an unprecedented impact on the health care system in the United States.1 Emerging provider-level accountable care organizations are charged with care management across the entire health care spectrum.2 For many older adults, residence in a nursing home (NH) is inevitable, and the “institution” truly becomes their “home.” Nursing homes also service a “short-stay” post–acute care population that is young, sick, prone to rehospitalization, and at a high risk of health care–associated complications like infections and adverse drug events. The Centers for Medicare and Medicaid Services, ie, the US taxpayers, pays over 60% of NH expenditure.3,4 As NHs become a partner in the health care delivery reform, they will undoubtedly be tasked to enhance the quality of care and resident safety to reduce interfacility transfers. Most NHs are unprepared to address the myriad challenges posed by providing care for 2 disparate long-stay and short-stay populations within this emerging framework.

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