The Changing Roles of Nursing Assistants and Aides

Abstract

Changes in health care financing over the past twenty years, combined with changing demographics of the U.S. population, have transformed many facets of the health care system. A trend toward shorter hospital stays began with implementation of the Medicare prospective payment system for hospital services in 1984 and accelerated with the rapid growth of managed care and capitated payment in the 1990s. Hospitals’ financial incentive to shorten patients’ length of stay has contributed to more intensive service needs for hospitalized patients. But it has also resulted in sicker patients being cared for in longterm care facilities, sub-acute facilities, and at home. Patients who once would have been cared for in the hospital are being cared for in a wide range of settings. In addition, the number of older adults in the U.S. is growing rapidly. Many of those for whom aging brings frailty, cognitive impairment, dementia, or functional disabilities are in nursing homes or receiving care through home health agencies or programs.