Long-term care can have a different definition for each individual. Before taking this course my understanding of Long-Term Care was a community that the elderly would live in when not being able to take care of themself or not have a caretaker. However, having been able to obtain more knowledge on the subject, Long-Term Care can vary from Adult Day Care to Assisted Living. There are different options to choose from when having to choose a Long-Term Care facility for you loved one. An Adult Day Care is similar to a child day care. It is a facility where one can drop off a loved one while they are at work and can then pick them up at the end of the day. These facilities offer the amenities to socialize with one another and do activities that can strengthen their minds and increase mobility on their motor skills. During my college years, I had to participate in one of these facilities for an assignment and it was a great experience. Members would play dominoes, sew, and do plenty of arts of crafts. Another form of Long-Term Care is an Assisted Living Facility, this consist of a facility that can be mostly associated with an apartment complex. It can offer services as a regular living community with medical attention for those who require it. When comfortable with your living settings and are able to be fully independent, residents are able to upgrade their living arrangements. Only those who are able to independent with their ADL’s are able to living in this type of facility. Also, Nursing homes are facilities that patients are admitted when not independent or require medical attention that cannot be given at their primary residence or if they don’t have a caretaker. There is also Hospice Care which entails to make the patient as comfortable as possible on their last days of living. It prepares the family mentally, emotionally, and physically for the loss of their loved ones. When a patient is transferred to hospice care it means the patient is in very bad condition. These are some of the most common of Long-Term Care facilities. In order to keep these facilities running there has to be some sort of income. The most common source of income for these facilities is those paying out of pocket. Most of insurances don’t cover Adult Day Care, Assisted Living Facility or Nursing homes, they require for patients to meet certain requirement in order to be covered under insurance. Although Medicare typically covers for 80 percent of medical expenses and Medicaid covers the co-insurance, not everyone is able to qualify for Medicare and Medicaid. Private insurances are pickier on what is covered. I believe the top three issues the elderly face in terms of Long Term Care is having a caretaker, insurance and discharge plans. Having a caretaker is extremely important once you’re in the stage of needing medical attention and someone to look over you. There are plenty of people who do not have a caretaker at home whether it is a loved one or nurse who can provide them assistance on a daily basis after an operation. When one doesn’t have a caretaker they are forced to go to Nursing Care facility until they are independent. Even then, the patient needs to meet the nursing care facility requirements in order to be admitted. Insurance is a big deal in this country, those who are low-income typically qualify for Medicaid or while admitted can quality for financial assistance from the hospital. However, those who do not qualify for either one need to pay out of pocket. We all know how high a hospital bill can be, even though hospitals will offer you a payment plan it is still a high cost for medical attention that most people don't have the income to pay back. Those patients with private insurance at times still have to pay either deductible, co-payment or out of pocket cost. Last but not least, a discharge plan is very important. It can be home, nursing home, assisted living facility or hospice. But it is extremely important that the patient has somewhere to go after being discharged. A patient is not to be discharged without a discharge plan. This all takes in to place the three issues elderly face: caretaker, insurance and discharge plans. It is important to know the discharge plans because the patient would still need assistance after discharge and would still need medical attention. The Long-Term Care in the United States is entirely different than in other countries. The United States does not require for everyone to have insurance and requires for those with insurance to see their Primary Physician in order to obtain a referral to see a specialist. Also, the expense of an admission to the hospital or a visit to the doctor is extremely expensive compared to other countries. Medical personnel make a high salary for a poor quality of work. When going to see a doctor, you can probably say the amount of time the doctor spends with you is about 15-25 minutes. The visit that lasted you 15-25 minutes can cost you anywhere from $400-$900 per visit, depending if it was a General Doctor or a Specialist. Since the United States does not require for everyone to have insurance, it can make those with insurance pay a high cost for it. For a member who has no pre-existing condition, does not smoke, and no previous health conditions can pay monthly $200. However, with a pre-existing condition some insurance may not except you do to the amount of expenses that will be applied to your condition or the premium may be too high for one to afford. Hospital takes advantage when patients go in with no insurance. They increase the amount of the expenses of the hospitals so that the patients with insurance can afford and be able to balance out the services that unpaid for from those without insurance. Most insurance require a referral to see a specialist. Personally, I believe this is just another way of billing more money to the insurance. If your back has been hurting or your knees have been causing you problems then it would be obvious to see an orthopedic. However, in the insurances defense it could be that some people would not know how to make this choice and would go to a chiropractor instead and causing even more expenses to the insurance. Although it can be frustrating for the member, the primary physician and the specialist, the insurance companies have their reasons on why this procedure is required. Although not all insurances require this procedure some do. Another way the United States is different from other countries is that the premium is to be paid on a monthly basis compared to the other countries that the premium is paid through their taxes. In Canada for example the insurance is at no cost and everyone is required to have it. In Japan, primary physicians are known as gatekeepers and it is not required to have a referral to see a specialist. Their cost of medical expenses come of their taxes and is not paid on a monthly term. In order to get a better understanding of Long-Term Care on a personal level, I interviewed Allyson Krigger from an Adult Day Care close to home. Allyson is 78 years old African American who was an elementary teacher for Charles R. Hadley Elementary School for 35 years. Her first impression of being enrolled into an Adult Day Care was very negative. She imagined of caretakers abusing her physically and emotionally since she has heard horrifying stories of others. Allyson stated how she felt like a child as if she constantly had to be watched over and her independency was gone. She struggled with the thought of being in an Adult Day Care Center with a bunch of strangers. She compared the felling similar to the first day of school. She went on how she tried to become as independent as possible before the big day. However, her efforts did not go very far. The first day of Adult Day Care approached and she was more nervous than ever. On the first day, caretakers gave a tour of the facility and were very welcoming in having her. They explained the expectations of the facility and also asked her for expectations. Allyson made an instant connection with Maria Gonzalez through a game of dominoes. Maria and she became the best of friends, where they would do activities outside of the Adult Day Care. One of the most frequent conversations Allyson and Maria had was the expense of Adult Day Care. They both have Medicare and Medicaid as their insurance, but either insurance covered any of their expenses meaning their loved ones had to pay out of pocket on weekly basis. Allyson expressed how her daughter pays $235 a week for Adult Day Care. Ultimately, Allyson expressed her satisfaction with the Adult Day Care facility and her outlook of it has completely changed. She would recommend Adult Day Care to all her friends and anyone who approaches her and asks for her opinion.