PubMed · 500025
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M O'Neill. 1979. Will anybody buy a program called deinstitutionalization?. https://doi.org/10.1176/ps.30.12.853
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In 1935, in 1965, and in 1972, the original Social Security Act and amendments to it were used by states to deinstitutionalize. In each instance a private, profit-making nursing home and board and care industry was stimulated. Poor care in such facilities was an unintended consequence of the legislation. Neither the Congress nor evaluators have clear concepts of what constitutes a life of decency and dignity for the chronically dependent. Behaviorally oriented social scientists and legislators have in common the difficulty of dealing with soft variables such as decency and dignity. In the absence of clear goals, care drifts below a lower threshold of acceptability and is corrected to some extent following public scandal. Social scientists need to learn to develop concepts and measurements suitable to monitoring the implementation of humane ideals.
Political forces motivated the New York State Department of Health to withhold payment for Medicaid-financed inpatients on therapeutic passes. The elimination of therapeutic passes had many negative effects on patient care. The authors believe this experience demonstrates that political factors can overwhelm standard clinical practice and reasoned health planning to force irrational change on health care delivery.
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