Continuum of Care- Long-term Care
Long-term care has and is continuing to become an important part of the continuum of care. Years ago Long-term care (LTC) was considered only to be for the elderly, but as time passes it is for anybody and everybody who needs it. Barton (2006) stated, “Regardless of the length of time (i.e., from weeks to years), long-term care is an array of services provided in a range of settings to individuals who have lost some capacity for independence due to injury, chronic illness, or condition” (p. 367). According to Barton (2006), it states that the services long-term care provides help the consumer with basic needs and shows the individuals how to do daily living activities, along with therapy and being able to manage their conditions. Today long-term care is serving consumers of all ages in home, community, and institutional settings (Barton, 2006).
Long-term care has contributed to the continuum of care tremendously because it is offering an array of services for consumers in different places and not just focusing on one specific population. In the last few years long-term care has become more of a need for more than 12million people in the United States, and out of these 12 million people, five million of them are nearly disabled (Barton, 2006). Barton (2006) stated, “a significant proportion of people needing long-term care-nearly half –is younger than 65: 40 percent are working age adults and about 3 percent are children younger than age 18” (p. 368). Therefore, long-term care is not just dealing with the medical aspect of being in a home, but is also for daily living such as personal care, meal preparations, housekeeping and chore services, and management of overall care for an individual. As the years go on the need for long-term care will only continue to increase.
The reason that long-term care will increase for need is due to a number of reasons. First, the baby boomer population has a huge impact and according to Barton (2006); people who are in the age group of 85 or older are the fastest growing population. Second, because technologies are advancing in the medical field people are living longer, and because of that, depending on the situation the services of long-term care may vary from a short amount of time to a long period of time (Barton, 2006). Third, because of the medical advances people who have certain ailments and can live with them as long as they have long-term care also affects the demand and makes it higher.
Long-term care has many different parts to it; there are the providers for long-term care that can be broken down from informal LTC providers to formal LTC providers and also the types of places or facilities that long-term care offers. They have home health care, home and community based services, nursing home care, veterans nursing homes, and places for the mentally frail. All these facilities are focused to help the individuals and make them feel comfortable in the environment that they are in and used to. Informal long-term care providers are family members, usually, people who know the person in need of the care and perform the care at the home of either the individual in need or their own home. This is a concern for long-term care because these are the same people who also become stressed out and compromise their own health, which may decrease the amount of informal caregivers. The formal caregivers are trained individuals those who get paid, and most are usually non clinical. They come and administer shots and drug treatments, or perform therapeutic services. They will travel to all settings no matter where the patient is.
Long-term care can be based in the individuals’ home, it may be financially feasible for the individual, and it may also be where they are more comfortable with receiving long-term care. These home health care services can include a formal provider coming to the home and checking for blood pressure, or if they had surgery and needed to get their wounds checked out, and administering shots. Nursing homes provide assisted living for individuals on a residential basis and this is not just for the older population but for all ages. Veterans are also entitled to long-term care and have their own nursing homes that provide them with the care they need. With the rising number of mentally frail individuals they can receive long-term care services in a setting more accommodating to them. There are still services that focus primarily on the each individual group separately.
For these individuals to be put in long-term care facilities or receive treatments they have to be diagnosed by a doctor first. This can raise some issues, The Raphael (2003) website states transitions from one setting to another are not smooth and because of the competition between providers. This has to a lot to do with how they get paid and what is covered, and that has to do with Medicare and the long-term care system. Raphael (2003), "the Medicare budget cuts started with the Balanced Budget Act of 1997 forced providers to focus on financial survival and discouraged experimentation with new models of care. Second, Medicare’s new prospective payment systems (PPS) for long-term and post acute care organizations reinforced existing isolation among care settings.” They are not building the necessary collaboration needed to provide proper long-term care. Due to the prospective payment system the health care system focuses on single sites rather than the entire care process. This causes more separation in long-term care and becomes more difficult for patients and families to go from one source to the next for care and treatment (Raphael, 2003).
The future of long-term care is at the hands of Congress and policy makers. The Gleckman (2009) website states that because there is such an increase in the Baby Boomer era that the demands for long-term care and the cost of it will increase at a drastic rate. Gleckman (2009), "Today, most paid care is funded by government, through Medicaid and other programs. Less than 10 percent is financed by private long-term care insurance, and much of the rest is paid for out-of-pocket by families themselves” (p. 2). Even though long-term care is helping some are not receiving proper care, and so policy makers are looking into long-term care more and seeing how they will be able to provide better care and better financing (Gleckman, 2009). Gleckman (2009), “as the number of those needing care rises, the pool of potential caregivers is expected to shrink” (p. 6).
Since Obama has taken office he has been trying to fix the health care reform and make it better for everyone. Since that has been happening, Gleckman (2009), “efforts to restructure long-term care are taking on greater urgency and policy experts have put forward several reform plans aimed at improving access to care” (p. 2). This is where the dispute comes into play, as some are looking at Medicaid as being the primary source of payment, whereas others are looking at other ways to pay like private insurance or social insurance or perhaps even both (Gleckman, 2009). With all this there is still the portion paid out- of –pocket by the individual or family member that can become a burden on them financially. As time goes on if the problem is not met it will only become worse due to the demographic change, along with money issues (Gleckman, 2009).
Policy makers are trying to come to a solution so that the future of long-term care will be met. They have several proposals in play, which fall under three categories; shifting the focus of Medicaid long-term benefits to home care, expanding the long-term care and geriatric workforce, and restructuring the means of finance (Gleckman, 2009). The benefits that come from these proposals seem to be encouraging as they will create incentives to encourage the growth of the workforce. They would provide tuition assistance for the caregivers to go to school for training, including the family members. Also Medicaid will not be just for institutions but also for home-based needs.
Gleckman (2009), "The Empowered At Home Act, would allow states to offer home and community services to people with higher incomes, and allow participants to keep more assets, which would give them greater ability to pay ordinary costs of staying at home, such as taxes and utilities” (p. 8). This by far would be a great solution in helping the delivery and financing of long-term care. Another act that they are trying to pass is “The Community Choice Act,” this act would offer equal access to home and community-based care by Medicaid (Gleckman, 2009). Even with some flaws that these proposals may have, they do have their advantages. If they can work it all out the delivery system of long-term care can be greatly improved for the individual consumer and the family, and if these reforms are done properly then they can happen without adding more a financial burden to the budget (Gleckman, 2009). Without a good system of focusing on the issues, there would not be any good solutions.

References
Barton, P. L. (2006). Understanding the U.S. health service system (3rd ed.). Chicago, IL: Health Administration Press.
Gleckman, H. (2009). The Future of Long-Term Care: What Is Its Place In The Health Reform Debate? Retrieved from http://www.urban.org
Raphael, C. (June 2003). Long-term care confronting today’s challenges. Retrieved from http://www.academyhealth.org