Jacquelyn Slade
HCS310
August 30, 2010
Audrey Crooms

A variety of health care services in the United States provides continuum of care for health services. The need for long-term care is growing as the average life span of Americans continues to lengthen. The Centers for Medicare and Medicaid services estimates that about nine million men and woman over the age of 65 in the United States will need long-term care. Long-term care is a range of medical and social services designed to help people who has disabilities or chronic care needs. Services may be short or long-term and may be in a personal home in the community or in a residential facility. Long-term care facilities such as nursing homes provide care for the elderly or people who are unable to take care of them selves. The important of this paper is to discuss the continuum care of long-term care and examine the future trends of long-term care.
Long-Term Care In defining long-term care there are several points. Long-term care is low tech, although it has become more complicated because many elderly patients with complex medical needs are being discharge into long-term settings. The age groups that mostly require long-term care are those who are 85 and older. This age group will double by 2030 and double again by 2050. Long-term care facilities are facilities that provide 24- hour skilled nursing assistance with activities of daily living, health services, and a number of activities. Many people would prefer not to be placed in a long-term care facility. However, some elderly have to because of their condition, circumstances, or the availability of in-home services. Most of the residents who live in a long-term facility can’t function without 24-hour monitoring, extensive personal assistance, nursing care because of illness or physical or mental limitations. The goal of long-term care is to integrate custodial care with nursing on a continual basis. Long-term care facilities include nursing homes, rehabilitation facilities, and long-term care hospitals. Long-term care is a variety of services which helps meets the medical and non-medical needs of people who can’t care for themselves. Long-term care is best understood as a continuum of care. Long-term care concentrates on helping individuals to function as well as possible. Long-term care helps with daily living activities, such as bathing, dressing eating, or other personal care. Patients, who require long-term care also requires acute care when they are sick. The predominant strategy in long-term care is to integrate treatment and living for elders with functional disabilities not to undervalue health care for those obtaining long-term care but to incorporate health care into the context of the functions of daily life ( Kane et al. ,1998). Long-term care is diverse in terms of level of disability and age. Although a minority of all elderly people needs long-term care at any given time, the need rises after the age of 65. In providing care for the elderly in long- term facilities the nurses provide the majority of the health care while physicians are acting only as medical directors in long-term care in nursing homes or home health agencies. The most paid providers of long-term care are the certified nursing assistants and paraprofessional who works in the nursing home who delivers the largest share of personal care, and assistance with managing daily life. Long-term care costs make up a small but growing proportion of personal health care expenditures increasing from less than four percent in 1960 to more than 11 % in 1993 ( Alecxih, 1997b). Concerning long-term health care many Americans assume that Medicare, supplemental policies or standard health insurance polices will cover expensed, but financing to pay for long-term care comes from the federal, state, and local levels and private dollars, coming form the consumer’s own pocket. Medicaid is the primary public payer for long-term care particularly in nursing homes. Medicaid will cover both medical and non-medical related long-term care but to qualify for Medicaid a person has to have less than $2,000 in assets and insufficient to the pay the cost. Medicare does not pay for long-term care. In some situations Medicare will pay some of the cost of Medical beneficiaries who require skill nursing services. Although the majority of long-term care services aren’t paid at all, they are taken care of by 52 million unpaid caregivers primarily family members and friends of those needing long-term care. Long-term care is an important component of health care reforms and resources providing accessible, affordable, and high quality long-term care service to an aging population presents a growing challenge to long-term care providers.
Transitioning Patients The definition of care transition is “a series of movement back and forth one functional state to another and from one service setting to another” (Kane &Kane, 1998, p. 218). The individuals in long-term care the concept of transition is extremely important. The role of long-term is transitioning patients is to identify all of the needs of the older adult, identify all community providers and their services offering, and identify unmet needs and gaps in services. The long- term care facility needs to know and trust their ability to care for patients.
Continuum of Care Services in the continuum of care vary with the level of assistances required. Continuum care falls into two categories non-medical and personal care services and skilled care of nursing services. Continuum of care is important to the quality of care because it is thought to improve outcomes of care by increasing clinician’s knowledge of relevant facts about a patient. Continuum care is a new term that fully illustrates the spectrum of care and services available to older Americans who are thought of as long- term care. Continuum of care is a client-orient system of services for the elderly. Continuum of care is made up of two parts. The first part has a variety of up of services including health care, mental health care, social services, transportation programs, and housing for the elderly. The second part consist of community planning, coordinated financing integrated management, unified administration structures. Continuum care tracks patients over time as they use the different services. Continuum care includes a range of supportive services and these services are not given to a patient based on illness, but the patient ability to perform activities of daily living and instrumental activities of daily living. Activity of daily living includes bathing, dressing, getting into or out of bed or a chair, and toileting and instrumental daily living includes preparing meals, managing medications, and paying bills.
Future Trends Many factors will shape the future of long- term care including changing demographic, the health of older adults, the availability of family and informal caregivers, the financial status of future generation, and their degree of planning for long- term care needs. The disable older population will grow faster than the younger population, which will likely raise the economic burden of long-term care. How long- term care actually turns out will depend heavily on future policy choices. The rapid changing health and long-term care environment makes it difficult to predict what kind of financing and delivery system will emerge. A major demographic shift is about to take over this country as the number of elderly people increases dramatically, and with it the demands for long-term care. The changes need to take place is that the United States must continue their quest for more effective ways to finance and deliver long-term care. Some observers argue that financing will continue to shift from the federal government to state, individuals, and families (Cohen, 1998). The people of the United States must develop a unified comprehensive financing and delivery strategy in the future. The idea is to become more person-centered that where relatives becomes more involved in the decision making. Together with family members and formal care providers, individuals should be able to choose the services they prefer, and to choose alternative if their needs and circumstances changes as time passes. In the meantime this type of system is unlikely to develop anytime in the future but this framework will provide a tool for assessing financing, delivery and training strategies as “we” move into the new century. In order for long-term care to meet the future trends in health care it must make changes, here are several considerations for shaping reform: determining social responsibilities, considering the potential role of social insurance in financing, encouraging the personal preparedness, recognizing the benefits, burdens, and cost of informal care giving. Conclusion Long-term care is changing the way America looks at health care. The future demand for long-term care will depend heavily on how old age disability rates evolve over time. The number of elderly Americans being in long term facilities is increasing every year, whether we are preparing or not long-term care is coming of age. Long-term care will be one of the major challenges of the 21st century. Even though there is no clear wary of balancing public and private financing for long-term care, we can surely try to develop a financial strategy before the crisis hit.

References Responding to the Challenges of Long-term Care http://www. csg.org Continuum Care in the 21st Century http:// www.jfgv.org Alecxih, L.M. 1997b Who Pay, How Much? In Boyd,ed. (1997), 19-27 http://www. Milbank.org