Long-Term Care
Long-term care is vital in the United States health care system. As the population ages, more people will need assistance to recover from illness or injury, and others will need end of life care to ease their passing. People who use long-term care are all ages. From young to old, people can receive it if they cannot care for themselves because of a condition, an illness, or an injury that requires assistance for a period of 90 days or more. The concern people face when looking at long-term care is the funding. Medicaid will likely be drained of funds long before the country’s aging population is past its peak and while there are some options of insurance coverage, not everyone may afford them.
There has been development since the 1980s of government programs to assist those needing long-term care in locating the services that fit their needs best. A couple of centers created are the Administration on Aging (AOA), the Centers for Medicare and Medicaid Services (CMS), and the Aging and Disability Resource Centers (ADRC). The purpose of these centers is to help people of all ages, disabilities, and income levels to more easily access long-term services and support and transition among various sites of care, make more efficient use of care options, and maximize available services (O'Shaughnessy, 2011). These organizations help so that where ever people enter the system, they find direction to what services best meet their needs. These organizations are state run and have received high satisfaction ratings in some of the states. People’s experiences are also evaluated nationally, even though it is difficult to have a national evaluation because of the differences in the population demographics throughout the country. The AOA, CMS, and ADRC will continue to instigate changes as more elements are considered.
There are a variety of services provided in long-term care that may include case management, home health aide, personal care, adult day health, habilitation, or respite care. People can receive care in a home setting, a community, or an institutional setting. Some of these settings include home care services, nursing homes, or assisted living facilities. The amount of care given varies by person based on his or her needs to function in their daily lives. They are determined by Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). Barton lists ADLs as eating, bathing, dressing, getting to and using the bathroom, getting in or out of bed or a chair, and mobility. Barton describes IADLs as going outside the home, keeping track of money or bills, preparing meals, doing light housework, using the telephone, and taking medicine.
People provide care by informal family providers in the home setting as well as nurses or other staff that they hire to assist. The majority of the informal settings consist of an elderly parent under the care of an adult daughter. Often these women have young children of their own to take care of. This group is sometimes referred to as the “sandwich generation” because their own needs become sandwiched between those of older parents or other family members and those of children, adolescents, and young adults (Barton, 2006). There may be a decline in informal care in the future as family trends change and less that can give the time, support, and finances to do this job.
In a formal setting, trained caregivers are compensated for their care. This may be medical or nonmedical in need. Usual formal care providers include an array of specialists: home-makers, home health aides, visiting nurses, home health nurses, social workers, mental health services providers, transportation aides, personal care attendants (PCAs), adult day-care providers, meal deliverers, therapists (i.e., speech, physical, occupational, recreational), and others (Barton, 2006). People can receive care in different locations, including institutional, in a community setting, or through home care. Medicaid and Medicare pay for many of these expenses. Care for those with developmental disabilities is also a form of formal long-term care through Intermediate Care Facilities for the Mentally Retarded. This is a newer facility to replace those with developmental disabilities formerly just placed in nursing homes or institutions.
In many circumstances, people may move out of long-term care. Those recovering illness or injury may regain independence after they are well. Some may not every be able to live a life without long-term care again. It is noted that 40 percent of people over 65 will need two or more years of long-term care with half of those needing care for more than five years (Grote, 2011). Unfortunately, with today’s aging population, the numbers in the long-term care are most likely to keep increasing instead of transitioning people out. Of the 12 million people who need LTC, 6.6 million are age 65 or older and are likely to be Medicare beneficiaries and entitled to the LTC coverage that Medicare provides (Barton, 2006). That said, not everyone who receives care from a nursing home will stay there through the remainder of their lives. In 2003, 1.5 million people, the majority of them elderly, resided in nursing homes in the United States, and an additional 600,000 lived in other LTC facilities. In addition, 2.5 million persons were discharged from nursing homes in 1999, indication a short stay for recuperation or rehabilitation (Barton, 2006). These nursing homes can be public, private, or specifically for veterans funded by the Department of Veterans Affairs.
The future concerns of long-term care stem around the payment of services and who is will provide the care. Informal care is likely going to decline due to the lack of available informal caregivers as times and family structures change. Medicare funding will not last to pay through the Baby Boomer generation. One way people can look to their own future long-term care costs is by investing in long-term care insurance. Typically this insurance covers home care, adult day-care, assisted living facilities, and skilled nursing facilities. Long-term care insurance is rising in costs both for new and existing policies. Insurance companies used to rely on shorter longevity rates, larger policy lapse assumptions, and greater investment returns (Grote, 2011). These factors no longer remain consistent with past rates. Lapse rates are smaller and people are living longer. Those looking to save on long-term insurance coverage may wish to look at a few options. Check into employer-sponsored coverage. Also there are some policies with rider options, which cover the spouse. Then there are new types of hybrid long-term care insurance coverage plans. Basically they are riders that can be added to annuities or life insurance. Even with long-term care insurance, it is not the main payer for LTC in the U.S. Medicaid is a major LTC provider through its home- and community-based services waiver programs, payment for home health care, and its role as the primary payer for the nursing home care (Barton, 2006).
Change does need to be made to our long-term care and health care system when concerning financing. The United States spent approximately $2.2 trillion on healthcare in 2007, or $7,421 per person-nearly twice the average of other developed nations (Hussain & Rivers, 2009). America’s Affordable Health Choices Act of 2009 was put in place to work with our current health care system and strengthen where it is weak. Specifically in regard to long-term care, Hussain and Rivers talk discuss the ways the America’s Affordable Health Choices Act of 2009 by controlling costs, without sacrificing the quality of care or access to health care by encouraging a community based health system; promoting healthy aging to reduce disability rates; fostering social and interpersonal relationships; and incorporating evidence-based health policy.
It is very clear that long-term care in the United States will be essential to sustaining our aging population. From the likely swing away from informal care situations to the changes in the government is making like America’s Affordable Health Choices Act of 2009, as a nation we are striving to improve the funding and care received. Options other than Medicaid are available for those that can afford insurance. Now is the time to push to keep quality of long-term care up along with the affordability of it, not only for the elderly population that use it but also for everyone else that may have a need for the assistance.

References
Barton. P. L. (2006). Understanding the U.S. health services system (3rd ed.). Chicago, IL: Health Administration Press, 367-404

Grote, J. (2011). Keeping Ahead of the Long-Term Care Domino. Journal Of Financial Planning, 24(5), 22-27.

Hussain, A., & Rivers, P. A. (2009). Confronting the Challenges of Long-Term Health Care Crisis in the United States. Journal Of Health Care Finance, 36(2), 71-82. O'Shaughnessy, C. V. (2011). Aging and Disability Resource Centers Can Help Consumers Navigate the Maze of Long-Term Services and Supports. Generations, 35(1), 64-68.