Future directions for managed care in nursing homes

Managed care represents both an opportunity and a challenge to long- term care. On the one hand, it offers a fresh start to reconceptualize the field and to organize activities in a more coordinated and logical arrangement. On the other, it threatens to disrupt familiar ways of doing things. The track record of managed care does not breed a strong sense of trust that these organizations will seize the opportunity for creative reform. Areas of needed change include integrating acute and long-term care, developing better information systems, and using health care personnel more efficiently. A number of areas need to be studied better to develop an empiric base for implementing change. The greatest chance for successful innovation lies in those circumstances where better care cast also save money.