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Long Term Care Systems in the United States

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Submitted By meme67
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This paper will explore the long term care system in the United States focusing on the elderly. Understanding aging and the effects it shall have on the long term care industry is important for our society, as the numbers of the elderly are increasing. This paper shall also identify problems in the current long term care system that can cause risk to the elderly such as financial burdens and inadequate care. It will address the long term care professions and job opportunities available as well as give information needed for long term planning. Changes and needs to the long term care delivery systems will be addressed. In conclusion this paper will educate on the elderly needs for long term care and the best way to plan for their future.

Long Term Care Systems in the United States

When one contemplates the long term care system in the United States, the first thing one must do is understand the importance of aging. In the not so distant past, it was not uncommon for infants to die due to poor nutrition and infectious diseases, nor was the life span as high as it is today. The increasing number of elderly in our society, due to the “baby boomers and longer life spans,” and the changing patterns of activity among them, have led to new assumptions on how their needs and wishes govern the organization of long term health care. When thinking about long term care we must evaluate our rate of growth of the elderly. Statistics show that the population of 80 years or older in 2000 was 69 million. In the year 2050 this age group is projected to reach 337 million, increasing more than 5.5 times the 2000 level (Timonen, 2008.) On any given day in 2012, there were 273,200 participants enrolled in adult day services centers, 11,383,700 residents in nursing homes, and 713,300 residents living in residential care communities. In 2011, about 4,742,500 patients received services from home health agencies, and 1,244,500 patients received services from hospices (CDC 2013). Long-term care refers to a broad set of paid and unpaid services for persons who need assistance because of a chronic illness or physical or mental disability. Long-term care consists primarily of personal assistance with activities of daily living (ADLs) or instrumental activities of daily living (IADLs). ADLs are routine tasks of life, usually considered to include eating, bathing, dressing, getting into and out of bed or a chair, and using the toilet. IADLs are additional activities necessary for independence such as preparing meals, managing medications, and shopping for groceries. Long-term care also may include skilled and therapeutic care to treat and manage chronic conditions. Individuals may receive long-term care services in different settings depending on their needs, informal care such as in the home from a home health agency or from family and friends, or formal care such as in the community from an adult day services center, in residential settings from assisted living communities, or in institutions from nursing homes or hospitals and hospice (Feder, Komisar, Niefeld, 2000). Although most elderly Americans are universally insured through Medicare those who need long term care have less protection than they realize. Medicare covers many costs of acute medical care but does not cover much long term care services. Medicaid has coverage for long term care but low income or poverty stricken people are the only ones that qualify for it. Most long-term care is provided by families and friends in the community. As most are not prepared for the high cost of long term care they often do not get the care they need or prefer, and families caregiving and financial burdens are high. It is said that one in five adults with long term care needs, report that they are unable to get the care they need, often with serious consequences. Research shows “the lack of an insurance system, public or private, that spreads the financial risk of needing long term care, and, in its place, a system that protects people only if they are impoverished. Given the high costs of long term care on average more than $40,000 annually for nursing home care, and for the severely impaired (three or more ADLs), on average more than $500 per month for home care (or $6,000 annually) persons needing to purchase such care face a substantial financial burden” (Feder, Komisar, Niefeld, 2000). Research suggests that if savings rates are not increased and government programs to assist the elderly are not strengthened, many retirees will face serious problems attaining needed health and long-term care services in the future. By 2030, many retirees will not have enough income and assets to cover basic expenditures or any expenses related to a nursing home stay or services from a home health provider (2005). If the financial risks are not enough there is a risk for quality of care as well. Congress states that about 25% of more than 17,000 nursing homes nationwide have quality control deficiencies. About 40% of those have had repeated deficiencies (CDC 2013). This poor performance is believed to be caused by insufficient attention to and support for federal state enforcement activities. Both levels of government are working on plans to better maintain quality of care in nursing homes but it is still a challenge. This problem can also be attributed to the lack of employees in the field. Paid long term care services are provided by many trained professionals and paraprofessionals, with the largest share being direct care workers that include certified nursing assistants, personal care aides, and home health aides. This is one of the largest growing fields and continues to grow and provides many job opportunities. However, there is still a shortage among those who provide the care needed for those in need of long term care, including nurses, social workers, aides, and geriatricians. However, the needed skills and competencies for these caregivers is lacking in existing education and training systems. “In particular, the direct care workforce of paraprofessionals (mainly women ages 25 to 54), responsible for much of the hands-on, long-term care, continues to be insufficient, for reasons such as low wages, lack of benefits and little opportunity for career advancement. Employers will need to make these jobs rewarding through decent salaries and benefits, and offer both continuing education and advancement opportunities (Raphael, 2008)”. One must research and be prepared for the eventuality of long term care. About 70 percent of people over age 65 need some type of long-term care during their lifetime. More than 40 percent need care in a nursing home for some period of time. There are now insurance programs available that will pay after the first 90 days of care that can be very beneficial an eliminate much of the out of pocket spending that depletes so many peoples savings, retirement funds, and assets. The need to research what is available, what the elder wants, and what their need may be will give one a head start in being prepared for long term care. Having informed knowledge of your community long term care programs, facilities, and available financial resources will help one navigate the myriad of legal, family, and social dynamics along the way. In conclusion one can now see that we have an ever growing population of elderly due to the baby boomers and longer life spans. There are shortages of professional and paraprofessional care as well as quality control issues for long term care that need to be changed to reduce the risk to our elderly. The process of a long term care policy in the United States have some serious shortcomings, and the consequences of these will increase as the population ages. Policy makers continue to face complex problems regarding the balance between long term care and affordable access. Planning ahead will significantly help in both the wishes of the elder as well as making an informed decision on insurance, affordability, and type of care one is looking for. Everyone would love to stay young forever, the idea of aging is frightening, and however one can stay active, independent, and secure by planning ahead.

Resources:
Harris-Kojetin L, Sengupta M, Park-Lee E, Valverde R. Long-term care services in the
United States: 2013 overview. Hyattsville, MD: National Center for Health Statistics.
2013, retrieved 2014 from http://www.cdc.gov/nchs/data/nsltcp/long_term_care_services_2013.pdf

J Feder, H L Komisar and M Niefeld, Long-term care in the United States: an overview, Health Affairs, 19, no.3 (2000):40-56, http://content.healthaffairs.org/content/19/3/40.full.pdf , retrieved 2014

NCPC National Care Planning Council, Long Term Care Link, http://www.longtermcarelink.net/sitemap.htm , retrieved 2014

Raphael, C. (2008, July 21). A sense of urgency is needed; Solutions on long-term care demand action now. Modern Healthcare, 38(29), 24. Retrieved 2014 from http://go.galegroup.com/ps/i.do?id=GALE%7CA181826893&v=2.1&u=birm6829&it=r&p=PPNU&sw=w&asid=8c758da0e1111e73ba799b4be5c73e9d

Timonen, Virpi , Ageing Societies : A Comparative Introduction, McGraw-Hill Education, Buckingham, GBR, 04/2008, retrieved 2014

Walkinshaw, E. (2011, July 12). OECD urges more comprehensive long-term care strategies. CMAJ: Canadian Medical Association Journal, 183(10), E648+. Retrieved 2014 from http://go.galegroup.com/ps/i.do?id=GALE%7CA261386767&v=2.1&u=birm6829&it=r&p=PPNU&sw=w&asid=3564028c0fe8b2cb0a5ca9e4481c3c07

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