Managed care and multilevel long-term care providers: Reluctant partners

Managed care is reshaping our health care system, although long-term care i s only beginning to feel its effects. We report on the managed care involve ment of 492 multilevel, long-term care facilities (MLFs; including skilled nursing and assisted/independent living) nationally. Organizational structu re and culture and especially environmental characteristics are associated with whether facilities have contracts with managed care organizations (MCO s), plan to have contracts, are only gathering information on MCOs, or inte nd to do nothing in the near future. Resource dependence theory best explai ns MCO contracting patterns with MLFs appearing to be responding more to su rvival than to growth.