Long-Term Care
Long-term care services (LTCS) are services offered to weak elderly people and other adults who have ceased to have the ability for self-care due to injury, chronic illness, mental, physical, or cognitive disability, or any other health-related condition (Harris-Kojetin et al., 2013). The care services may include personal care, supportive services, and a broad range of health care services. The older adults are assisted with the activities of their daily living (ADLs) like bathing, toileting, and dressing. They also receive instrumental activities of daily living (IADLs) like housework and medication management (Harris-Kojetin et al., 2013). Other services offered include tasks for health maintenance. The individuals who receive long-term care are assisted to maintain or improve a level of physical functioning and life quality that is optimal. The service may incorporate help from other individuals and/or from assistive devices and special equipment (Wiener, 2013).
The services can be offered to individuals in different settings including homes, communities, residential settings or in institutions. Home care is offered by home health agencies and families and friends (Wiener, 2013). The adult day services center offers help to people in the community setting, while residential care is offered by assisted living communities. Nursing homes are the providers of long-term care in the institutions. In the United States, for example, a major component of personal spending on care is long-term care from paid, regulated providers. The estimates for spending on LTCS vary with regard to the types of populations, providers, and services included. In 2012, the annual expenditure on paid long-term care services ranged between $210.9 billion and $306 billion (Harris-Kojetin et al., 2013).
Over the last 30 years, the delivery system of long-term care services within the United States has undergone substantial changes. Even though nursing homes still play a larger part in the provision of LTCS, skilled nursing facilities have become more common in the provision of short-term, post-acute care and recuperation. Many elderly people who need long-term care also opt to stay at their homes and receive home-based care. Developments in state and federal policies such as the introduction of Medicare Prospective Payment System, the Supreme Court’s Olmstead ruling, and the expansion of Medicaid-financed services to non-institutional settings from institutional settings have also led to increments in the different alternatives to nursing homes. Such alternatives include community- and home-based care service provision (Wiener, 2013).
Today, hospices, adult day service centres, home health agencies, residential care communities and assisted living are some of the major sectors of paid LTCS providers. By 2012, there were already about 4,800 adult day service centres, 15,700 nursing homes, 3,700 hospices, 22,200 residential care communities, and 12,200 home health agencies in the United States (Wiener, 2013). These make up approximately 58,500 providers of long-term care services that are regulated. Of these, about two thirds offered care within the residential areas. About 37.9% of them being residential care communities while nursing homes made up 26.8%. Approximately one-third of the providers offered care within home-based and community-based settings, of which 20.9% were home health agencies, 8.2% were adult day services centres, and 6.3% were hospices (Harris-Kojetin et al., 2013).
By 2012, there were significant differences in the geographical distribution of the long-term care services sectors providers’ supply. The South had the largest share of home health agencies (48.3%), nursing homes (34.5%), adult day service centres (32.4%), and hospices (42.4%), while the West had the largest proportions of residential care communities (36.4%) (Wiener, 2013). The metropolitan statistical area status areas had vast majorities of all the five sectors of LTCS. The distribution is properly explained by the fact that such areas have higher population densities. Metropolitan areas had higher percentages of home health agencies (83.9%), adult day service centres (83.9%) and residential care communities (81.0%), as compared to nursing homes (70.8%) and hospices (73.9%) (Harris-Kojetin et al., 2013).
Surveys indicate that by 2012, nearly 300,000 participants could be served in a single day by the 4,800 adult day service centres in the country, considering the maximum participants allowed. The daily capacity that was allowed for the adult day services centres was between 1 and 780, the average being 58 participants. About 1669100 certified beds were provided by the nursing homes in the country. The capacity of the nursing homes ranged from 2 to 1389 and the average was 106 certified beds. The number of licensed beds provided by the residential care communities in the US was 851400. The average capacity of the residential care communities was 38 licensed beds (Harris-Kojetin et al., 2013).
Long-term care service is the provision of supportive care to elderly adults and other individuals who have lost the capacity for self-care. The provision of such services can be done at home, in institutions, in the residential setting, and in the community setting. Some of the providers include nursing homes, residential care communities, and adult day services centres. The provision of LTCS has been evolving over time, especially with the emergence of newer technologies and policies, and the number of people who want to be offered home-based care continues to rise. There were also geographical variations in the supply of the long-term care services within the United States. It is expected that newer methods of providing long-term care will continue to arise as human needs and preferences continue to change.
References
Harris-Kojetin et al. (2013). Long-term care services in the United States: 2013 overview. Vital Health Stat, 3(37).
Wiener, J.M. (2013). After CLASS: The long-term care commission’s search for a solution. Health Aff (Millwood), 32(5): 831-34.
