Nursing homes house the largest number of older residents of long-term care facilities. They are gov­erned by state and federal regulations that establish minimum standards of care. Two levels of care in nursing homes are defined in U. S. federal regulations (Ebersole et al., 2004). Skilled nursing care consists of 24-hour care including skilled medical and other health services, usually from nurses. Intermediate care is also 24-hour care including nursing supervi­sion, but at a less intense level. In actual practice, the major differences between the two are the types and numbers of health care workers on the staff. Perhaps
for this reason, the distinction between skilled and intermediate care often is blurred.

The cost of nursing home care is very high. With the aging of the baby-boom generation, how this cost will be met is an issue confronting millions of families. As noted in the Current Controversies feature, funding for nursing homes will be an increasingly important political issue in the com­ing decades.