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Among the issues confronting America is long-term care for frail, older persons and others with chronic conditions and functional limitations that limit their ability to care for themselves. Improving the Quality of Long-Term Care takes a comprehensive look at the quality of care and quality of life in long-term care, including nursing homes, home health agencies, residential care facilities, family members and a variety of others. This book describes the current state of long-term care, identifying problem areas and offering recommendations for federal and state policymakers. Who uses long-term care? How have the characteristics of this population changed over time? What paths do people follow in long term care? The committee provides the latest information on these and other key questions. This book explores strengths and limitations of available data and research literature especially for settings other than nursing homes, on methods to measure, oversee, and improve the quality of long-term care. The committee makes recommendations on setting and enforcing standards of care, strengthening the caregiving workforce, reimbursement issues, and expanding the knowledge base to guide organizational and individual caregivers in improving the quality of care.
Long-term care services include a broad range of services that meet the needs of frail older people and other adults with functional limitations. Long-Term care services provided by paid, regulated providers are a significant component of personal health care spending in the United States. This report presents descriptive results from the first wave of the National Study of Long-Term Care Providers (NSLTCP), which was conducted by the Centers for Disease Control and Preventions National Center for Health Statistics (NCHS). This report provides information on the supply, organizational characteristics, staffing, and services offered by providers of long-term care services; and the demographic, health, and functional composition of users of these services. Service users include residents of nursing homes and residential care communities, patients of home health agencies and hospices, and participants of adult day services centers.
Life expectancy is increasing in many parts of the world and more are also being enabled to live with disabling conditions that once might have been fatal. People who are chronically ill, have serious disabilities, have HIV/AIDS, are mentally ill, or victims of accidents and disasters, or elderly - many will need continuing care and support and these numbers will grow. How best to meet these needs is getting more attention. Such care is not to just look after the sick but to enable those with long term illnesses or disabilities to live their lives as fully as possible. Institutionalization is often not the best way of care and the home where the patient lives with family members and friends nearby is often more appropriate. This report examines the options, highlighting the clear benefits of home-based care whilst being aware of the needs of the carers in the home. The report stresses it is time for health systems to take responsibility for providing caregivers in families and communities with the support they both need, and to bring greater benefit to the patient.
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Offers advice and recommendations from AARP experts and other specialists on planning for the financial, medical, legal, and personal aspects of long-term elder care.
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As more people live longer, the need for quality long-term care for the elderly will increase dramatically. This volume examines the current system of nursing home regulations, and proposes an overhaul to better provide for those confined to such facilities. It determines the need for regulations, and concludes that the present regulatory system is inadequate, stating that what is needed is not more regulation, but better regulation. This long-anticipated study provides a wealth of useful background information, in-depth study, and discussion for nursing home administrators, students, and teachers in the health care field; professionals involved in caring for the elderly; and geriatric specialists.
Florida has the largest proportion of elderly in the nation- 2.8 million persons are over age 65, representing 17.6% of its total population. The dramatic rise in the number of persons age 65 and over in Florida over the next 20 years-estimated to total 26.3% of total population-will further stretch the already limited resources of the state. Aware of the pressing demand for long-term care services well into the 21 * century, policymakers in Florida have begun seriously to review options for improving financing and delivery of long-term care for the frail elderly and persons with disabilities. Federal and state Medicaid spending in Florida was $2.6 billion in FY2001, and 30.5% of Medicaid spending was for long-term care. In FY2001, 75.3% of total Medicaid spending was for institutional care. Slightly less than 25% of Medicaid spending was channeled towards home and community-based services. Although institutional care dominated Medicaid spending, there has been slow but steady expansion of home and community-based services funding, both through the use of Medicaid's waiver programs as well as significant support through state sources. Among the major issues facing long-term care in Florida are: the fragmentation of long-term care services among state and local agencies, an imbalance in financing that favors institutional care rather than home and community based care, shortage of health care workers and well-trained staff throughout the long-term care , and disparities in availability of services across the state.
In exploring integration of acute and long-tern care, this book begins by characterising the dually eligible population, and describing problems associated with meeting their health and social service needs in an uncoordinated system. It continues by analysing the advantages of using capitation and care management as a vehicle for integrating those services, and by discussing concerns about care integration strategies. It concludes by profiling nine federal and state programs that to varying degrees, integrate the acute and long-term care services that people who are dually eligible for Medicare-Medicaid, often require. They are: Federal initiatives such as the Program for All-inclusive Care of the Elderly (PACE), which capitates both Medicare and Medicaid acute and long-term care services for those who are dually eligible, and the Social/Health Maintenance Organization (S/HMO) and EverCare demonstrations, which capitate Medicare benefits only; Comprehensive state demonstrations such as Minnesota Senior Health Options, the Wisconsin Partnership Program, and the Continuing Care Network Demonstration of Monroe County, New York, which, like PACE, capitates both Medicare and Medicaid benefits; and Capitated state Medicaid demonstrations such as the Arizona Long-Term Care System, Oregon Health Plan, and Florida's Community-Based Diversion Pilot Project, which capitate Medicaid only, but actively pursue various Medicare co-ordination strategies. Proposals that explore using care management techniques to integrate Medicare and Medicaid services delivery, without capitation, are also discussed briefly. The book concludes with the observation that although federal and state initiatives to integrate acute and long-term care for those who are dually eligible, only serve a relatively small percentage of this population, they provide a set of options which Congress may want to examine when formulating long-term care policy in the future.