Nursing homes that care for the poor in Detroit are frequently dependent upon Medicaid as their principal source of revenue. These facilities face numerous challenges because they face limited resources for maintenance of facilities, staff and administrative supports, and other normal costs. They lack the kinds of support that are provided in-kind, or by more generous sources of revenue and are often characterized as institutions of poor quality; yet nearly 70% of the nation’s Medicaid-recipient elderly nursing home patients are in for-profit facilities that are sustained largely on Medicaid funding. These facilities are often sources of care for underserved minority populations, the adult mentally-ill, and others for whom alternative venues of care are no longer available. The case mix of aged, mentally ill, and numerous other chronic adult conditions is unlike any other health care environment in Michigan, yet the facilities that offer such care are poorly understood and insufficiently supported. The situation has established a health care disparity for the aged, urban poor
