This chapter describes the structure and trends of postacute care (PAC) in the United States and includes an overview of each of the types of providers, including the provider definition and characteristics, the provider payment system, and, where available, patient characteristics and quality data. It also describes the clinical and nonclinical factors associated with PAC utilization. The chapter discusses the current issues facing PAC providers and efforts to reform the delivery of health care services in the United States. Skilled nursing facilities (SNFs), the most numerous of the PAC providers, are certified by the Centers for Medicare and Medicaid Services to provide skilled nursing and therapy services. Utilization of PAC services increased when acute care lengths of stays (LOS) decreased. As further changes in health care delivery systems take place, undoubtedly more changes in PAC utilization will also occur.
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The population of older adults in the United States has grown exponentially over the past few decades. This chapter looks at the unique challenges of meeting the comprehensive healthcare needs of this population. It examines the implications for social policy and gerontological practice and highlights the current models of entitlements and support services for older adults. The chapter also illustrates knowledge and skills required by social workers in this field, and discusses the recommendations for holistic competence. It focuses on four federal social policies that have guided the development of healthcare in the United States. These policies have had a substantial impact on who is eligible for services, the type of services one is entitled to, the quality of services provided, and ultimately the lives of individuals affected by them. The four major social policies are Medicare, Medicaid, the Older Americans Act (OAA), and the Supplemental Nutritional Assistance Program (SNAP).