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Home Care for the Elderly The New Institution

Knight Steel, MD
Arch Intern Med. 1991;151(3):439-442. doi:10.1001/archinte.1991.00400030009002.
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Virtually any individual, when required to assume the role of a patient, prefers home care to institutional care of any kind not only for reasons of personal comfort but because even at their best, hospitals are foreign and inimicable environments. Institutional care is associated with a loss of autonomy and control. This is dramatically highlighted by the legal considerations presently taking place over the use of feeding tubes in terminally ill individuals where even a person's right to stop a procedure that invades the body is in question in the institutional setting.

The home, in striking contrast, is recognized by both patient and physician as the patient's "turf."1,2 It is clear that there are many varieties of home care delineated by both patient need and reimbursement policy. Some home care is clearly "substitutional" in character; under these circumstances home care obviates the need for acute hospital care or custodial


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