A Right to Personal Assistance Services: “Most Integrated Setting Appropriate” Requirements and the Independent Living Model of Long-term Care

2001 ◽  
Vol 27 (1) ◽  
pp. 17-43
Author(s):  
Andrew I. Batavia
Keyword(s):  
Independent Living ◽  
Long Term Care ◽  
Cost Effective ◽  
Chronically Ill ◽  
The United States ◽  
Term Care ◽  
Care Services ◽  
Effective Manner ◽  
Care Capacity

The United States is currently entering a period in which the demand for longterm care services is growing at a particularly rapid rate; it is projected that the inflation-adjusted expenditures for long-term care will double between 1993 and 2018. As the population continues to age and become more chronically ill and disabled, the need to expand our long-term care capacity, and the long-term care options available, has become self-evident. The question is how we can meet this need in a cost-effective manner that is satisfactory to the consumer of services.

Quelques dilemmes, quelques valeurs pour une politique de services de longue durée

1995 ◽  
Vol 14 (2) ◽  
pp. 263-293 ◽  
Author(s):  
François Béland ◽  
Anne Lemay
Keyword(s):  
Medical Care ◽  
Long Term Care ◽  
Chronically Ill ◽  
The Elderly ◽  
Community Services ◽  
Provincial Government ◽  
Main Function ◽  
Term Care ◽  
Care Services

ABSTRACTLong-term care is available for individuals with functional incapacities. Long-term care includes medical, social, and personal hygiene services, which help to maintain the autonomy of the elderly and allows them to live with dignity in spite of loss of autonomy. This definition provides long-term care services with a goal and a clientele. However, are individuals with functional incapacities first and foremost chronically ill? Should long-term care services be conceptualized as independent from medical care? Provincial government policy documents promote a social model of long-term care which privileges community services as opposed to institutional services. What in fact does this choice imply? To what extent have resources been allocated in accordance with these objectives? A study of these questions based on Canadian data on the relationship between illnesses, disabilities and functional incapacity and data from a historical survey of expenditures in Quebec for hospital care, medical care, institutional long-term care and community services indicates that illnesses, disabilities, and functional incapacity, although strongly correlated in an elderly population, cannot be collapsed into one big category for planning services; co-ordinated services in a multidisciplinary approach are needed, not dominance from one professional group. As to costs, an examination of the data shows that in relative terms costs for community care tended to increase significantly in the recent past. Yet it is not clear that there has been a transfer from short-term medical and hospital services to long-term care. However, there has been an important internal change in hospital costs, with the elderly representing the only group whose costs are rising. In short, despite the political rhetoric on long-term care for the elderly promoting a community approach, these services' main function is still the surveillance of the vulnerable elderly in both short- and long-term care facilities; adapting the elderly to their environment and the environment to the elderly play a growing, though minor, role in the overall picture of medical and social services.

scholarly journals Can Asia provide models for tax-based European health systems? A comparative study of Singapore and Sweden

2020 ◽  
pp. 1-18
Author(s):  
Richard B. Saltman ◽  
Ming-Jui Yeh ◽  
Yu Liu
Keyword(s):  
Health Service ◽  
Health System ◽  
Health Systems ◽  
Long Term Care ◽  
Health Sector ◽  
Chronically Ill ◽  
Term Care ◽  
Care Services ◽  
Case Comparison

Abstract Singapore's health system generates similar levels of health outcomes as does Sweden's but for only 4.4% rather than 11.0% of gross domestic product, with Singapore's resulting health sector savings being re-directed to help fund both long-term care and retirement pensions for its elderly citizens. This paper contrasts the framework of financial risk-sharing and the configuration and management of health service providers in these two high-income, small-population countries. Two main institutional distinctions emerge from this country case comparison: (1) Key differences exist in the practical configuration of solidarity for payment of health care services, reflecting differing cultural roots and social expectations, which in turn carry substantial implications for financing long-term care and pensions. (2) Differing arrangements exist in the organization of health service institutions, in particular balancing public as against private sector responsibilities for owning, operating and managing these two countries' respective hospitals. These different structural characteristics generate fundamental differences in health sector financial and delivery outcomes in one developed country in Far East Asia as compared with a well-respected tax-funded health system in Western Europe. In the post-COVID era, as Western European policymakers find themselves forced to adjust their publicly funded health systems to (further) reductions in economic growth rates and overall tax receipts, and as the cost of the information revolution continues to rise while efforts to fund better coordinated social and home care services for growing numbers of chronically ill elderly remain inadequate, this two-country case comparison highlights a series of health system design questions that could potentially provide alternative health sector financing and service delivery strategies.

Humane Care: Seeing the Person Behind the Patient—A Case Study

2011 ◽  
Vol 12 (1) ◽  
pp. 23-31 ◽  
Author(s):  
Sarajane Brittis
Keyword(s):  
Health Care ◽  
Long Term Care ◽  
Cost Effective ◽  
Vital Role ◽  
Term Care ◽  
Older Americans ◽  
Care Services ◽  
Care Recipients ◽  
Adult Day Health Care

This article is about the importance of retaining a focus on the humanity of older adults while rendering care to them through community and long-term care services. It is written from my experience as a director of a community service (Adult Day Health Care [ADHC] program), a program officer at a foundation devoted to improving health care for older Americans, a researcher who spent years conducting interviews with staff workers in long-term care services, and from the perspective of a professional and personal caregiver and friend to many elders living in the community—in their own homes and in nursing homes. From these diverse professional and personal roles and perspectives, I have learned that the formation of authentic human relationships, which go beyond the routine medical, nursing, and social work approach to care, can play a vital role in healing and addressing loneliness in elders—and transform the lives of their personal and professional caregivers as well. A focus on humanity need not cost money or place a heavy demand on the worker. In fact, it can be one of the most cost-effective approaches to improving quality in health care, attracting workers to the field of long-term care, and boosting the morale of both caregivers and care recipients.

Reliability and Validity of a New Preadmission Acuity Tool for Long-Term Care

1995 ◽  
Vol 3 (1) ◽  
pp. 77-88
Author(s):  
Elizabeth A. Swanson ◽  
Orpha J. Click
Keyword(s):  
Health Care Professionals ◽  
Long Term Care ◽  
A Priori ◽  
Reliability And Validity ◽  
Cost Effective ◽  
Functional Independence ◽  
Term Care ◽  
Effective Manner ◽  
New Instrument

The purpose of this project was to develop a new tool designed to assess the acuity of applicants to long-term facilities. Using a known groups method, residents of long-term care facilities were categorized as independent (n=68), assist (n=71), and dependent (n=65) and assessed using the Preadmission Acuity Inquiry Tool (PAI) to generate the data base for examining its psychometric properties. The progression of the mean scores from independent to assist to dependent demonstrates the ability of the tool to differentiate across varying levels of functional independence. Using discriminant analysis, the degree of accuracy in predicting group membership for the independent group was 88%, for the dependent group 75%, and for the assist group 17% with the overall agreement between PAI scores and a priori classifications at 60%. Kappa coefficients for interrater reliability ranged from .54 to 1.0 with a mean of .90. The Cronbach’s alpha coefficient was .81. The PAI has demonstrated sufficient reliability and validity to warrant further refinement and testing. This new instrument may enable health care professionals to provide the appropriate level of care in a cost-effective manner.

scholarly journals Person-Centered Health Care: An Approach That Integrates Acute and Long-Term Care

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 704-704
Author(s):  
Yuchi Young ◽  
Barbara Resnick
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Health Systems ◽  
Long Term Care ◽  
The United States ◽  
World Population ◽  
Term Care ◽  
The Usa ◽  
Aged Society

Abstract The world population is aging. The proportion of the population over 60 will nearly double from 12% in 2015 to 22% in 2050. Global life expectancy has more than doubled from 31 years in 1900 to 72.6 years in 2019. The need for long-term care (LTC) services is expanding with the same rapidity. A comprehensive response is needed to address the needs of older adults. Learning from health systems in other countries enables health systems to incorporate best long-term care practices to fit each country and its culture. This symposium aims to compare long-term care policies and services in Taiwan, Singapore, and the USA where significant growth in aging populations is evidenced. In 2025, the aging population will be 20% in Taiwan, 20% in Singapore and 18 % in the USA. In the case of Taiwan, it has moved from aging society status to aged society, and to super-aged society in 27 years. Such accelerated rate of aging in Taiwan is unparalleled when compared to European countries and the United States. In response to this dramatic change, Taiwan has passed long-term care legislation that expands services to care for older adults, and developed person-centered health care that integrates acute and long-term care services. Some preliminary results related to access, care and patterns of utilization will be shared in the symposium. International Comparisons of Healthy Aging Interest Group Sponsored Symposium.

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