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The significant changes in the age demography of this country are reflected in the growth of nursing home care. The most recent change has involved the aging of the oldest portion of the aged population. That group is most likely to need skilled nursing home care, yet we are conflicted in our provision of such care. Within the skilled nursing facility (SNF), we see at least two types of populations—those whose stay is 90 days or less and those who remain over 90 days. Patients in the latter group typically spend the remainder of their lives in the SNF.SNFs are now marketing themselves as convalescent and rehabilitative centers, yet there is little evidence of any serious efforts at developing rehabilitative programs. Entrance into an SNF is dependent on a variety of factors, particularly the availability of a spouse or children. The presence of community programs can also defer SNF placement.The future of the nursing home is now linked to the availability of private as well as public support, and recent concerns about governmental expenditures in health care are likely to place more pressures on private strategies, with the implications of a two-tier system of quality.