It is interesting you bring this up. My therapist and I were discussing this very system and how it began to fall apart in the 60s at my appointment this week.

I know there was a lot of corruption. Pretty much every system I have ever studied suffers from it in one form or another eventually. However, I think there is a need for long term care for many. I know the hospital I was recently in had a long term program that seemed pretty ok. They have apartments and the rules are more flexible than the typical IP programs. A guy I was in with transferred to it and had done it before. He said it was a nice program and it gave his family a much needed break. He also said it is quite expensive. It seems cost is always the deciding factor. People usually cannot afford what their insurance wont pay for and most companies push back hard after 10 days or so. I remember watching several people being discharged that definitely needed more time. Some of them didnt want to leave, but they were pushed out because of insurance. It seems counterproductive though. These same people told me stories of their frequent hospital stays. Maybe they wouldn't need to return as often if they were allowed to stay and truly heal the first time.