Pt. I. Overview. 1. Prospective Payment Revolution and Long Term Care. 2. Restructuring of the Nonprofit Sector -- Pt. II. From Hospital to Community. 3. Discharge Planners as Gatekeepers to Community Care. 4. Does Out of the Hospital Mean Out of Luck? 5. Service Paradox -- Pt. III. Home Health and Nursing Home Care. 6. Metamorphosis of Home Health Care. 7. Nursing Homes Under Prospective Payment. 8. Access to Nursing Home and Home Health Services -- Pt. IV. Elder Care and the Community. 9. Informalization and Community Care. 10. Access in Peril. 11. Community Variation in Policy Implementation. 12. Waves of Change -- Pt. V. The Future. 13. Policy Elites and Fiscal Crisis. 14. Empowerment Imperative. 15. No-Care Zone and Social Policy -- Appendix: Policy Changes Affecting Home Health Care, 1961 to 1990