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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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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.
This is a comprehensive graduate textbook focusing on the full spectrum of long-term care settings ranging from family and community-based care through supportive housing options to a variety of institutional long-term care alternatives. Integrating theory and practice, the book features the perspectives of diverse fields regarding current long-term care options and new directions for the future. Prominent scholars from history, environmental design, family caregiving, social service delivery, clinical care, health service delivery, public policy, finance, law, and ethics explore such themes as: Relationships among independence, dependence, and interdependence Ethical considerations woven into the provision of long-term care Decision-making in long-term care Fluidity in long-term care The lived experience of long-term care A micro-macro perspective ranging from the individual to societal institutions The book examines future directions for long-term care, considering such factors as the interface of technology and long-term care, cultural diversity, and relationships between voluntary and paid services. Each chapter includes case examples, study questions, and exercises, additional resources, and website links. An extensive glossary of terms is also provided, as well as instructor’s resources are also available. Key Features: Focuses on the full array of long-term care options Integrates theory and practice Incorporates the perspectives of diverse fields including history, environmental design, family caregiving, social services, public policy, etc. Includes numerous case examples, study questions, exercises, and additional resources Considers new approaches to long-term care, incorporating technology and considering cultural diversity and voluntary vs. paid services About the Authors: Graham D. Rowles, PhD, is Founding Director of the Graduate Center for Gerontology and Chair of the Department of Gerontology, University of Kentucky. He is also Professor of Gerontology with joint appointments in Nursing, Behavioral Science, Geography and Health Behavior. An environmental gerontologist, his research focuses on the lived experience of aging. A central theme of this work is exploration, employing qualitative methodologies of the changing relationship between older adults and their environments with advancing age, and the implications of this relationship for health, wellbeing and environmental design. He has conducted in-depth ethnographic research with elderly populations in urban (inner city), rural (Appalachian), and nursing facility environments. Recent research includes leadership of the Kentucky Elder Readiness Initiative (KERI), a statewide project to explore the implications for communities of the aging of the Baby Boom cohort. His publications include Prisoners of Space? and six co-edited volumes, in addition to more than 60 book chapters and articles. He is a Fellow of the Gerontological Society of America and the Association for Gerontology in Higher Education and currently serves on the editorial boards of the Journal of Applied Gerontology and Journal of Housing for the Elderly. Dr. Rowles is Past National President of Sigma Phi Omega, Past President of the Southern Gerontological Society, Past President of the Association for Gerontology in Higher Education, and is currently Chair of the Commonwealth of Kentucky Institute on Aging. Pamela B. Teaster, PhD, is Associate Director for Research, Center for Gerontology, and Professor, Department of Human Development, Virginia Tech University. She established the Kentucky Justice Center for Elders and Vulnerable Adults and is the first President of the Kentucky Guardianship Association. Dr. Teaster is Secretary General of the International Network for the Prevention of Elder Abuse. She served as Director and Chairperson of the Graduate Center for Gerontology/Department of Gerontology as well as the Director of Doctoral Studies and Associate Dean for Research for College of Public Health at the University of Kentucky. Dr. Teaster serves on the Editorial Board of the Journal of Elder Abuse and Neglect. She is a Fellow of the Gerontological Society of America and the Association for Gerontology in Higher Education, a recipient of the Rosalie Wolf Award for Research on Elder Abuse, the Outstanding Affiliate Member Award (Kentucky Guardianship Association), and the Distinguished Educator Award (Kentucky Association for Gerontology). She has received funding from The Retirement Research Foundation, Administration on Aging, National Institute on Aging, Kentucky Cabinet for Families and Children, National Institute of Justice, Centers for Disease Control, National Institute of Occupational Safety and Health, Health Resources and Services Administration, and the Office of Victims of Crime. She is the author of over 100 peer-reviewed articles, reports, books, and book chapters.