Known variously as adult care homes, domiciliaries, or rest homes, board-and-care facilities offer an alternative lor elderly persons who can no longer live independently but who function well enough to not need the constant supervision provided in nursing homes. These facilities typically provide shelter, meals, minimal assistance with personal care, and sometimes supervision of medication administration.
While many elderly persons are able to pay their own expenses in board-and-care facilities, a large number are funded through the federal Supplemental Security Income (SSI) program at a cost of more than $X billion annually. More than 70,000 board-and-care homes in the USA provide services to more than one million frail, disabled people. The number of homes is increasing, sometimes at the instigation of the slate, since they offer an economic, federally funded means of accommodating the rising number of elderly persons who would olherwise require nursing home care paid for with state Medicaid funds.
Minimally regulated and sometimes unlicensed, the facilities serve a dual population, about 50% elderly and about 50% deinstilutionalized mentally ill. oflen mixed or cared for together. While some excellent homes exist, many facilities tend to warehouse the disabled in substandard buildings with few skilled staff members. Investigation by the House of Representatives Subcommittee on Health and Long-Term Care has uncovered widespread misuse of medications in adult care homes.
Physicians who have patients in board-and-care facilities should make every effort to ensure thai they are sale and are receiving appropriate care. This may necessitate making a personal visit or sending a nurse or social worker to ascertain that the facility complies with fire and safety regulations, keeps and stores proper medication records, and attends to health care needs.
