Devolution and Aging Policy: Racing to the Bottom in Long-Term Care

1997 ◽  
Vol 27 (3) ◽  
pp. 427-442 ◽  
Author(s):  
Carroll L. Estes ◽  
Karen W. Linkins
Keyword(s):  
Long Term Care ◽  
Nonprofit Sector ◽  
State Level ◽  
The Elderly ◽  
The United States ◽  
Term Care ◽  
New Federalism ◽  
Trade Offs ◽  
The Future

For two decades, New Federalism, devolution, and other challenges to the federal role in domestic health and human services policy have fundamentally shaped the structure and delivery of long-term care in the United States. Devolution evokes crucial questions concerning the future of universal entitlement programs such as Social Security and Medicare and, with them, the future of aging and long-term care policy. This article examines the implications of the “devolution revolution” for long-term care in the context of the sociodemographics of aging and the managed care movement. Central issues are the extent to which state-level discretionary policy options (1) alter priorities, services, and benefits for the elderly and disabled; (2) foster a race to the bottom in long-term care; (3) promote generational, gender, racial and ethnic, and social class trade-offs; and (4) fundamentally alter the role and capacity of nonprofit sector services that comprise a significant part of the long-term care continuum.

Public Policy Issues Affecting the Homeless in America

1989 ◽  
Vol 11 (1) ◽  
pp. 4-21
Author(s):  
Margaret Boone ◽  
Thomas Weaver
Keyword(s):  
Public Policy ◽  
Long Term Care ◽  
The Elderly ◽  
The United States ◽  
Term Care ◽  
Educational Preparation ◽  
Income Gap ◽  
The Face ◽  
Multiple Issues

The issue of homelessness symbolizes and incorporates some of the most urgent public concerns in the United States today, and for the next several decades. Homelessness represents an intersection of five major public policy areas: first, the issue of growing poverty in the face of industrial prosperity, a widening income gap between rich and poor, and the disparity between educational preparation and occupational requirements; second, the issues raised by lifestyle-related health epidemics such as drug addiction and multi-substance abuse; third, the issue of mental health, which stubbornly remains one of America's major unrecognized health problems, with literally millions of organic, cognitive, personality, and affective disorders left untreated; fourth, the issue of housing, and whether and how the provision of dwellings is central to American requirements for "a human community" and a basic right to "the pursuit of happiness"; and fifth, the multiple issues raised by aging and long-term care, because as the nation's population ages, more and more of the elderly will be at risk for becoming homeless and will exert enormous pressure on government to provide long-term care.

New Federalism and Long-Term Care of the Elderly

1983 ◽  
Vol 2 (1) ◽  
pp. 113-126
Author(s):  
Claude E. Barfield
Keyword(s):  
Long Term Care ◽  
The Elderly ◽  
Term Care ◽  
New Federalism

Psychotropic Drug Utilization in Long-Term-Care Facilities for the Elderly in Ontario, Canada

1999 ◽  
Vol 11 (3) ◽  
pp. 223-233 ◽  
Author(s):  
David K. Conn ◽  
Ian Ferguson ◽  
Krystyna Mandelman ◽  
Carol Ward
Keyword(s):  
Nursing Homes ◽  
Long Term Care ◽  
The Elderly ◽  
The United States ◽  
International Studies ◽  
Prescription Data ◽  
Homes For The Aged ◽  
Term Care ◽  
Care Facilities

Objective: Despite considerable data from a number of countries regarding psychotropic utilization in long-term-care facilities for the elderly, there has been a lack of similar data from Canada. The purpose of this study was to gather prescription data from a series of institutions in Ontario and to compare the results to those of other international studies. Method: Single-day surveys were carried out in six homes for the aged, four nursing homes, two retirement homes, and a veterans' center. The results were compared to those of recent studies from other countries. Results: The data revealed considerable differences in rates of prescription between different classes of institutions and between similarly classified institutions. The prescription rate of neuroleptics ranged from 11.8% (of patients) in retirement homes to 29.8% in nursing homes. Antidepressant use ranged from 12.2% in nursing homes to 24.6% in homes for the aged, and benzodiazepine use ranged from 22.5% in nursing homes to 36.4% in retirement homes. Conclusions: The overall rate of prescription for psychotropic medications was somewhat lower than in most international studies. The rate of prescription of neuroleptics in nursing homes fell in the midrange of studies, somewhat higher than in recent studies from the United States and an earlier Italian study, but lower than in recent reports from Sweden, Austria, and Australia. The rate of neuroleptic use in homes for the aged was comparable to the rate in the U.S. studies. The overall rate of prescription of antidepressants and benzodiazepines appears to be comparable to that in recent studies from other countries.

Culture and Long-Term Care: The Bath as Social Service in Japan

2004 ◽  
Vol 5 (1) ◽  
pp. 53-60 ◽  
Author(s):  
John W. Traphagan
Keyword(s):  
Home Health Care ◽  
Social Service ◽  
Long Term Care ◽  
Family Care ◽  
The Elderly ◽  
The United States ◽  
Central Feature ◽  
Care Providers ◽  
Term Care

A central feature of Japan’s approach to community-based care of the elderly, including long-term home health care, is the emphasis on providing bath facilities. For mobile elders, senior centers typically provide a public bathing facility in which people can enjoy a relaxing soak along with friends who also visit the centers. In terms of in-home long-term care, visiting bath services are provided to assist family care providers with the difficult task of bathing a frail or disabled elder—a task made more problematic as a result of the Japanese style of bathing. I argue that the bath, as social service, is a culturally shaped solution to a specific problem of elder care that arises in the Japanese context as a result of the importance of the bath in everyday life for Japanese. While the services may be considered specific to Japan, some aspects of bathing services, particularly the mobile bath service, may also have applicability in the United States.

Long-Term Care for the Elderly

2013 ◽  
Author(s):  
Madonna Harrington Meyer ◽  
Jessica Hausauer
Keyword(s):  
Long Term Care ◽  
Current System ◽  
The Elderly ◽  
The United States ◽  
Historical Background ◽  
Term Care ◽  
Care For The Elderly ◽  
Long Term Care Insurance ◽  
Future Policy

Despite the growing need for long-term care, the United States does not have a coherent set of long-term care policies. The existing patchwork of programs and services can be difficult for patients and their families to understand and fails to adequately support many of those in need of care. This chapter traces the historical background of long-term care policy and assesses the three formal channels through which individuals currently navigate long-term care. It addresses the strengths and weaknesses of long-term care coverage briefly through Medicare and private long-term care insurance, and much more fully through Medicaid. The chapter concludes by focusing on families, particularly women, who continue to provide extensive care through informal care work. It is the most vulnerable older and disabled Americans, particularly those who are women, black and Hispanic, and single, and their families who face the greatest difficulties under the current system and who will be most affected by future policy changes.

Tuberculosis in Long-Term–Care Facilities

2000 ◽  
Vol 21 (9) ◽  
pp. 611-616 ◽  
Author(s):  
Philip W. Smith ◽  
Shobita Rajagopalan ◽  
Thomas T. Yoshikawa
Keyword(s):  
United States ◽  
Long Term Care ◽  
Clinical Manifestations ◽  
The Elderly ◽  
The United States ◽  
Community Dwelling ◽  
Infection Prevention And Control ◽  
Age Group ◽  
Term Care

AbstractThe geriatric population represents the largest reservoir ofMycobacterium tuberculosisinfection in developed nations, including the United States. Tuberculosis (TB) case rates in the United States are highest for this age group compared with other age categories. The subtle clinical manifestations of TB in the elderly often can pose potential diagnostic dilemmas and therapeutic challenges, resulting in increased morbidity and mortality in this age group; this treatable infection unfortunately often is detected only at autopsy. Compared with their community-dwelling counterparts, the institutionalized elderly are at a greater risk both for reactivation of latent TB and for the acquisition of new TB infection. Prevention and control of TB in facilities providing long-term care to the elderly thus cannot be overemphasized.

Diarrhea Among Residents of Long-Term Care Facilities

1993 ◽  
Vol 14 (7) ◽  
pp. 397-404
Author(s):  
Richard G. Bennett
Keyword(s):  
Long Term Care ◽  
The Elderly ◽  
The United States ◽  
Term Care ◽  
Older Americans ◽  
Infectious Gastroenteritis ◽  
Care Facilities ◽  
Control And Prevention ◽  
Sporadic Cases

Both sporadic cases of diarrhea and outbreaks of infectious gastroenteritis occur commonly in long-term care facilities. There are no national statistics on the prevalence or incidence of diarrhea among residents of nursing homes, but recent studies from the Centers for Disease Control and Prevention have described the increased morbidity and mortality associated with gastrointestinal illnesses among the elderly. Although deaths related to diarrheal illnesses have long been considered a problem of infants and young children in the developed world, 51% of the 28,538 diarrhea-related deaths in the United States from 1979 through 1987 occurred in adults older than 74 years, and 27% occurred in adults between 55 and 74 years old. In contrast, only 11% of these deaths occurred in children <5 years old (ie, the vast majority of deaths occurred in older Americans rather than in children). For both the very young and the very old, there were winter peaks in the mortality rates consistent with the presumption that infectious illnesses led to death, and one of the major risk factors for dying from diarrhea was being a resident of a nursing home. In a subsequent study in which 87,181 hospitalizations were analyzed, 85% of 514 diarrhea-related deaths occurred in adults over 65 years old. The odds ratio of dying during a hospitalization involving gastroenteritis was 52.6 (CI95, 37.0 to 76.9) for adults ≥70 years old as compared with children <5 years old.

scholarly journals Insuring Long-Term Care in the United States

2011 ◽  
Vol 25 (4) ◽  
pp. 119-142 ◽  
Author(s):  
Jeffrey R Brown ◽  
Amy Finkelstein
Keyword(s):  
United States ◽  
Long Term Care ◽  
Private Insurance ◽  
Insurance Coverage ◽  
The Elderly ◽  
The United States ◽  
Term Care ◽  
Variable Nature ◽  
Long Term Care Insurance

Long-term care expenditures constitute one of the largest uninsured financial risks facing the elderly in the United States and thus play a central role in determining the retirement security of elderly Americans. In this essay, we begin by providing some background on the nature and extent of long-term care expenditures and insurance against those expenditures, emphasizing in particular the large and variable nature of the expenditures and the extreme paucity of private insurance coverage. We then provide some detail on the nature of the private long-term care insurance market and the available evidence on the reasons for its small size, including private market imperfections and factors that limit the demand for such insurance. We highlight how the availability of public long-term care insurance through Medicaid is an important factor suppressing the market for private long-term care insurance. In the final section, we describe and discuss recent long-term care insurance public policy initiatives at both the state and federal level.

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