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      Faced with soaring health care costs and shrinking Medicare and Medicaid financing, nursing home operators are closing some facilities and embracing an emerging model of care that allows many elderly patients to remain in their homes and still receive the medicai and social Services available in institutions. 

    In the newer model, a team of doctors, social workers, physical and occupational therapists and other specialists provide managed care for individual patients at home, at adult day-care centers and in visits to specialists. Studies suggest that it can be less expensive than traditional nursing homes while providing better medicai outcomes. 

     The number of such programs has expanded rapidly, growing from 42 programs in 22 States in 2007 to 84 in 29 States today. In New York City, a program run by a division of Center Light Health System, formerly known as the Be th Abraham Family of Health Services, has over 2,500 participants at 12 sites in the metropolitan area.

       "It used to be that if you needed some kind of long-term care, the only way you could get that Service was in a nursing home, with 24-hour nursing care," said Jason A. Helgerson, the Medicaid director for New York State. "That meant we were institutionalizing Service for people, many of whom didn't need 24-hour nursing care. If a person can get a Service like home health care or Meais on Wheels, they can stay in an apartment and thrive in that environment, and it's a lower cost to taxpayers." 

(Adapted from http: //www. nytimes.com)