Hospitals and Nursing

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Hospitals and Nursing

Managing the continuum of long-term and
chronic care

Introduction

Long-term care is an issue increasingly demanding growing attention from policy makers. This is because of the proportion of elderly people in the general population. Debate over the topic since the 1970s by policy makers and the public has ebbed and flowed. A dilemma is faced by leaders and their followers on how to work out the needs of the older proportion of the population who have chronic disabilities.

Long-term care has a high cost which needs to be efficiently planned for and in advance. Other emerging issues about the continuum of long-term and chronic care are the quality of long-term care and its resultant burden on the society.

Managing the continuum of long-term and chronic care has three strands which demand the same attention from policymakers. They are: means financing the long-term care, means and methods delivering the care and providing the labor force required to provide the care.

This paper aims at analyzing health care in the United States in relation to managing the continuum of long term and chronic care.

Long-Term and Chronic Health Care

Long-term and chronic care refers to a range of medical and non-medical services aimed at meeting the medical and personal needs of people with disabilities or chronic illnesses.

The care represents all the forms of help offered on a daily basis for a long period of time to individuals who are chronically disabled.

Long-term care can be provided to individuals at any age and the services are aimed at rehabilitating, minimizing or reduce effects of the loss of mental or physical functioning. They include basic and instrumental activities of daily living, (ADL and IADL) and life management activities.

The assistance involves always on stand-by assistance by human beings, helping devices such as crutches and technological aids such as pace setters. Modifying the environment to suit the emerged needs of the individual also is another form of long-term and chronic service.  Family members are intensively involved in the provision of these services.

The need for long-term care arises from medical conditions that are chronic. These conditions occur at birth or during the stages of development or as a result of accidents. Since long-term care goes on for a long period of time, it becomes and important part of the life the individual with the disability[1].

Managing the continuum of long-term and chronic health care

In managing the continuum of long-term and chronic health care, three issues are considered important. These are delivery of the care, the labor force needed to make long term chronic health care work and financing the care.

Delivering long-term and chronic health care

Long-term care needs are differentiated in terms of level of disability and the age of he individual. The largest of this proportion is the elderly people. These form the largest percentage, measured by the need for help with ADL and IADL in the U.S.

57%of the 12.8 million people in need of long-term cares were over 65 years old. Children were a mere 3% whereas adults under 65 were 50%.[2]

One potential way of utilizing public funds is by directing them to home and community-based long-term chronic care. The eligibility for the benefits is determined in amongst several ways using a type of trigger of functional disability. The allocation of the funds on a priority basis can be possible if assessment tools were developed to calculate the needs met and those not.

The difficulty in performing physical activities, ADL and IADL has been note to be higher in the aged as compared to the young, and females as compared to males.

Cognitive impairments such as dementia are difficult to assess. These impairments nevertheless result in limitations in performance of individuals and therefore the need for assistance. A National Long-Term Care Survey (NLTCS) research in 1994 reported that the number of old people impaired by dementia such as Alzheimer’s disease is almost one million.[3]

It is important to note that the demand for long-term care is higher as one grows older. This means that people at the age of 85 years and above require more attention.

According to the U.S Bureau of Census, the number of the older population is growing and is projected to be about 20% of the total population by the year 2050[4]. This is the same case with the number of chronic cases, whose projections are also high as illustrated by the figure below. This means that more planning for increased resources should be put in place to cater for those projections.

Care provision

Long-term care is mainly provided by close friends and family members whose assistance is unpaid. Paid professional workers also do provide the assistance. The primary caregiver is described as the person who provides most of the care and on a regular basis. This caregiver is usually a family member and they also coordinate help from secondary caregivers who include friends and relatives.

The unpaid caregivers invest more time with the person in need of assistance than the paid caregiver. Nevertheless, offering assistance to a long-need and chronic needy person means sacrificing time and energy. In most cases, caregivers who are employed in paying jobs are faced with conflicts between their jobs and offering care.

The paid care providers are also referred to as formal. Nurses are the ones that provide most of the work in providing care to the elderly. The professional care is offered mainly in nursing homes and other professionals involved here are physicians. These are needed to direct the activities of the nursing homes as well as signing off on home health care plans. Therapists are involved in the long-term care rehabilitation. They are paraprofessionals who make up the largest number of paid long-term care providers. Their tasks include assistance with managing day to day life. They are almost as important as the unpaid workers in maintaining the quality of life of the elderly.

Long-Term Care Financing

The cost of long-term care provision is becoming a bigger proportion of personal healthcare expenditures. These funds come from the government, the private sector and the consumers themselves.

The state health insurance scheme for the poor is the major public source of long-term care for the disabled and old members of the population. Nevertheless, this funding is in most cases biased towards services from institutions.

Delivery of long-term acute care

Financing long-term care has dual and at times conflicting needs as faced by stakeholders in it. These needs have shaped some trends in long-term service delivery with strong implications for the delivery.

Governments have in place initiatives that seek to manage the long-term chronic service delivery. They achieve that by integrating services in a number of ways. According to Booth et al., (1997), this integration involves flexible benefits, extensive systems of delivery, quality control systems that are overarching and funding that is flexible and with incentives[5].

Workforce Preparation

A sound long-term and chronic care system needs effective financial mechanisms. This is not enough nevertheless and the next most important factor is adequate and available workforce, trained and ready to deliver care.[6] This is in a despicable situation today and the situation is likely to worsen. This is bad than problems that are financial in providing this care.

There are a few physicians and other trained workers trained in geriatrics despite the growing proportion of the older population[7]. The financial incentives available to avert this situation are limited and the cultural incentives are likewise.

The shortages can be overcome with the consideration of adequate wages, recognitions, advancements, benefits and opportunities[8].

Discussion

There has been a barrier to having effective management of the continuum of long-term and chronic care in hospitals and nursing homes. One of these has been the financial risk that is brought about by the lack of an adequate risk adjustment methodology and other relevant methods to ensure payments meet all the costs met in providing care to people suffering from long-term and chronic ailments[9]. There have been minimal adjustments aimed at expanding the existing medical care options. This in turn implies that managed care plans; nursing centers and hospitals will not be able to provide enrollees of long-term care benefits.

There is also a barrier due to ignorance of training and information relevant to providers of health care and long-term[10]. This means that their ability to provide manage and coordinate their service provision is compromised. Care management across time, location and profession is not recognized by the health care system’s authority and the movement suffered by patients with long-term and chronic ailments is not considered. There is a need therefore to streamline home-based care and hospital care so as to have effective management of the continuum of long-term and chronic health care.

All hope is not lost nevertheless because there are some service providers who are attempting to provide integrated systems. Hospitals are using the integration of home-based care and nursing care to increase service provision.

Conclusion

Several factors need to be considered in the management of the continuum long-term and chronic care. One of these considerations is addressing the long-term need for care across all ages. Services should be custom made to suit different people with different forms of impairment.

Secondly, the needs of the provider as well as those of the needy should be taken into consideration together. The informal care system should be recognized and be supported well by other institutions.

The number of homes for the aged and other types of care provision that is residential has reduced greatly due to replacement be nursing homes since th1960s and 70s. The care provided in these homes is nevertheless very little and therefore residential care is slowly returning to fashion. Nursing and the provision of medical care should be improved for the management of the continuum of long term and chronic health care.

Endnotes

[1] R. A. Kane et al., (1994), Perspectives on Home Care Quality, Health Care  Financing Review 16,  no. 1: 69 -90
2       O’Neil, G. (2007), Annual report, November 16,2007, National Agency on  an Aging Society,  NW,   Washington: Policy Institute of Gerontological Society of   America
[3]     Stone, R. (1998), Long-Term Care for the Disabled Elderly: Current Policy, Emerging Trends and Implications for the 21st Century, ASPE and AoA
4      Bernstein, R.& Edwards, T. (2008), An Older and More Diverse Nation by Mid-century, U.S Bureau of Census, Washington D.C from http://www.census.gov/PressRelease/www/releases/archives/population/012496.html
[5]     Booth et al., (1997), The treatment of unrelated disorders in patients with chronic diseases. New England Journal of Medicine, 338(21): 1516-1520
[6]     Stone, R. (1998), Long-Term Care for the Disabled Elderly: Current Policy, Emerging Trends and Implications for the 21st Century, ASPE and AoA

[7]     R. A. Kane et al., (1994), Perspectives on Home Care Quality, Health Care Financing Review 16, no. 1: 69 -90.

[8]     Cohen, M.A. (1998), Emerging Trends in the Finance and Delivery of Long-Term  Care: Public and Private Opportunities and Challenges, Gerontologist
E. Connie, (2005), The continuum of long-term care, New York, Thomson/Delmar Learning 3rd ed

[9]     Miller, B. and S. McFall. (1989), Caregiver Burden and Institutionalization, Hospital Use and Stability of Care, Department of Medical Social Work, University of Illinois, Chicago.

[10]   Cohen, M.A. (1998), Emerging Trends in the Finance and Delivery of Long-Term Care: Public and Private Opportunities and Challenges, Gerontologist
E. Connie, (2005), The continuum of long-term care, New York, Thomson/Delmar Learning 3rd ed

References:

Miller, B. and S. McFall. (1989), Caregiver Burden and Institutionalization, Hospital Use and Stability of Care, Department of Medical Social Work, University of Illinois, Chicago.
Bureau of Labor Statistics, (1999), Occupational Outlook Handbook: Homemaker-Home Health Aides, Washington, D.C.: U.S. Department of Labor, accessed from: http://stats.bls.gov/oco/ocos173.htm on 18th February 2009
Cohen, M.A. (1998), Emerging Trends in the Finance and Delivery of Long-Term Care: Public and Private Opportunities and Challenges, Gerontologist
E. Connie, (2005), The continuum of long-term care, New York, Thomson/Delmar Learning 3rd ed
R. A. Kane et al., (1994), Perspectives on Home Care Quality, Health Care Financing Review 16, no. 1: 69 -90.
O’Neil, G. (2007), Annual report, November 16,2007, National Agency on an Aging Society, , NW, Washington: Policy Institute of Gerontological Society of America
Stone, R. (1998), Long-Term Care for the Disabled Elderly:
Current Policy, Emerging Trends and Implications for the 21st Century, ASPE and AoA

Bernstein, R.& Edwards, T. (2008), An Older and More Diverse Nation by Mid-century, U.S Bureau of Census, Washington D.C from http://www.census.gov/Press-Release/www/releases/archives/population/012496.html
Booth et al., (1997), The treatment of unrelated disorders in patients with chronic diseases. New England Journal of Medicine, 338(21): 1516-1520

 

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