Todd Heisler/The New York Times
Lillian Johnson, seated, prepares for a ride home from the New York Archdiocese's ArchCare PACE Center in Harlem, an alternative to a nursing home.
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 medical and social services available in institutions.
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