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Nursing homes in an era of health reform: implications for the future.

Nursing homes have fulfilled a difficult role in recent years. Beset with increasing regulatory controls, they have endured a persistently tarnished public image for failure to satisfy regulations and consumers.1 Operating without substantial physician involve ment within facilities, nursing homes have used licensed vocational nurses (LVNs) and nursing assistants to provide the bulk of patient care. Facility nursing staff have also been called upon to care for increasingly disabled patient populations. These have been daunting challenges, and coming decades are likely to present a new set of problems and opportunities for nursing home administrators and directors of nursing. This article describes new and possible future trends and influ ences in the external environment of nursing homes. The adoption of new federal regulations and anticipated advances in regulatory over sight will have considerable influence on nursing home management. Emerging demographic and social trends will also affect patterns of care for the elderly. A growth in health maintenance organizations (HMOs) and health networks and changes in the panoply of health care services for elderly individuals will impact the demand and reimbursement for nursing home services. Current long-term care (LTC) research efforts also eventuate in new patterns and regula tions within musing homes. The final section describes competencies or abilities that may be needed by future LTC managers and the