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Long-term care is usually required for those people, who have chronic illness and/or disabilities, thereby requiring personal care assistance for long period of time. This long-term care not only includes health-care services but also requires assistance in personal care and activities such as dressing, eating, bathing, walking, and transferring (Housing Bureau for Seniors, 2015). This paper deals with the information about the care required by older people and integration of long-term care services in a cost-effective and attainable manner.
Percentage of older people requiring long-term care
Older people require not only formal care at home but also require long-term care either at home or in community settings. It has been reported that nearly 20% of the older people having the age of 65 years or more and living with some functional disabilities are receiving long-term care in an institution in European countries. Moreover, 30% of older people are receiving formal care at home. However, the remaining 50% of the population are either receiving no formal care or they are dependent on informal care. It has been estimated that in the coming decades, the percentage of people with functional disabilities may increase by nearly 120%, and the percentage of people receiving formal care in medical or non-medical institutions by skilled or non-skilled people could increase by nearly 130% (Onder et al., 2012).
This rapidly growing population with chronic disabling conditions needs long-term care. Therefore, it is important to work on the health and social care requirements of these people, and to develop strategies for efficient and effective programs working on long-term care (Onder et al., 2012). Most importantly, it is important to integrate long-term care services in such a way that they would minimally disturb the financial lives of people.
Integrated long-term care services
Long-term services usually require the help of family members, friends, and other medical and non-medical health-care providers. These services can be provided at home or at an assisted living care residence (Housing Bureau for Seniors, 2015). Integrated long-term care helps in fulfilling all the requirements of the patient with the help of a multidisciplinary team of professionals. This team of professionals plans the long-term care of the patient after looking at patient records and integrates the best possible services. Sometimes, a nurse care manager and/or therapeutic specialists including occupational and physical therapist is involved in coordinating and integrating the health care services, and this type of care is usually provided to the elder community consisting of people with complex and multiple needs. Usually, frail and weak older patients have increased chances of adverse outcomes from conditions that could be controlled and treated in early stages (Trivedi et al., 2013).
Expected advantages of long-term care services in health-care include (Trivedi et al., 2013).
Decreased hospital utilization,
Enhanced level of daily activities and functioning,
Decreased use of nursing home, and
Enhanced satisfaction of caregivers.
Integrated long-term care can also help in reducing the risk of falls in older people.
Managed Care Programs
Managed care refers to the payment for health-care and delivering health-care and/or long-term services and supports to the payers. Usually, payers give a managed care organization a set of monthly payment that is used by the organization for the provision of health-care services and supports to the members for prolonged periods of time. Those services and supports are provided with the help of a network of contracted providers. Managed care organizations do their best to provide long-term care to the members as they have a financial incentive to work on the care of the members and to fulfill their requirements (ACL, 2014).
Managed care programs have been established for frail elderly people requiring long-term care services. Those programs can also help younger people with some kind of disabilities. One of the models for managed care programs is that Medicare and Medicaid pay a fixed monthly fee to a health system or an insurance company, who work as a managed care organization or provider for the patient and take responsibility for all the care required by the patient in long-term. The patient in this case is dual-eligible as he or she is receiving both Medicare and Medicaid benefits. This model can work efficiently, if the health-care systems and insurance companies figure out the best possible way to provide excellent coordinated care at an optimal price (Neuman, Lyons, Rentas, & Rowland, 2012).
Medicare is a health-care program covering health insurance for hospitals, physicians, and other such medical services including preventive and diagnostic services, acute and postacute care, and hospice care. However, Medicare services have high premiums and cost-sharing requirements that could be difficult to afford by many low-income beneficiaries. Moreover, Medicare does not provide coverage for long-term care. On the other hand, Medicaid is a program that is operated within broad federal rules, and can supplement Medicare for the population, who could not afford Medicare, by giving payments for those services which are not covered by Medicare such as long-term care, vision, and dental. It has been reported that largest spending by Medicaid is that on long-term care (Neuman et al., 2012).
Combination of these two programs for a frail older person can help in achieving more beneficial outcomes in long-term care services. Dual-eligible beneficiaries are using more Medicare-covered services as compared to other beneficiaries, and they can also utilize the services of Medicaid (Neuman et al., 2012). Combination of the two programs can help in using the saved costs from one care to the other type of care as, for example, decreased number of days in a hospital can help in saving Medicare costs and those savings can be used in the care provided in nursing homes, which are less costly as compared to hospitals. Moreover, extended care or long-term care in nursing homes can be financed by the patient or patient’s family members, or through Medicaid. On a further note, if a family decides to keep the person at home and provide care at home, long-term Medicaid costs can further be reduced. However, in this case, the costs could be transferred to the family, but a portion of funds from Medicaid may also help in fulfilling the requirements of the family.
Implementation examples for integrated long-term care for older people
Some of the programs are already working on the integration of long-term care services for older people.
Program for All-Inclusive Care for the elderly (PACE)
One of the federal programs is PACE that is offering care for Medicare as well as Medicaid beneficiaries, who are eligible for nursing home care but have to remain at home. Moreover, people getting benefit from PACE have to have an age of 55 or more years. PACE organizations help in providing health-care and other such services not only in the PACE center but also in the home and community settings. These organizations work with many health-care experts and specialists in a community, and provide required care to the frail older people. Dual-eligible beneficiaries can get long-term care through PACE. This program has shown beneficial outcomes in case of hospitalization, health, and other basic function outcomes (Medicare, n.d.).
Programs by Affordable Care Act (ACA)
The ACA of 2010 has developed many opportunities to improve the services and support of health care to the people, who are eligible for both Medicaid as well as Medicare benefits. The Medicare-Medicaid Coordination Office located at the Centers for Medicare and Medicaid Services (CMS) is testing new strategies and implementing the reforms to improve the long-term care and decrease costs (Neuman et al., 2012).
An example is that of voluntary insurance program established by the ACA along with the Community Living Assistance Services and Supports (CLASS) Act. This program has been developed to help the participants to pay for community living services. In order to get benefits from this program, participants have to enroll in the program for a minimum of five years and have to fulfill the functional disability standards (ACL, 2014).
Long-term care services can be provided at home and in the prescribed institutions and facilities. Usually, family members take care of their older relatives, but care facilities may require proper assessment for appropriate functioning according to the requirements and financial incentives. In this regard, specially developed instruments such as interRAI instrument for Long Term Care Facilities (interRAI LTCF) can be used. This instrument not only helps in assessing the characteristics of residents of health care facilities, but also helps in collecting the information required to develop larger data sets. With the help of interRAI LTCF, clinicians can assess the long-term care needs of older people. Moreover, they can develop appropriate strategies of care as well as allocation of resources (Onder et al., 2012).
Concluding Remarks
The health-care services are usually provided by physicians, medical specialists such as surgeons, and nurses or therapeutic specialists such as occupational and physical therapist. However, if the care-related services are provided for an extended period of time, it is referred to as long-term care. These long-term care services include medical services such as those provided by nurses or therapists, and non-medical services such as those provided by assistants and housekeeping. Usually, long-term non-medical services are provided by family members and/or friends, but those services can also be bought from private individuals and/or agencies. Those services by private individuals and/or community agencies can be appropriately planned and financed, and can be provided at home or in community settings.
Finances and reimbursement processes have an important role in the provision of long-term care to elderly people. Medicare is one of the most important federally financed public insurance programs, but this program lacks long-term care as well as unskilled care. Therefore, payment for long-term care comes directly from the patient and/or patient’s family, or from other public programs including Medicaid. Dual-eligible beneficiaries utilizing both Medicaid and Medicare programs can also get benefits for long-term care. Governments may also utilize social service programs to help in fulfilling the payment issues related to long-term care or unskilled care.
References
ACL. (2014). Administration on Aging (AoA) - Affordable Care Act: Opportunities for the Aging Network. Retrieved from http://www.aoa.gov/aging_statistics/health_care_reform.aspx
Housing Bureau for Seniors. (2015). Long-Term Care Options for Low Income Older Adults. Retrieved from https://www.med.umich.edu/seniors/pdf/Long%20Term%20Care%20Options.pdf
Medicare. (n.d.). PACE. Retrieved from https://www.medicare.gov/your-medicare-costs/help-paying-costs/pace/pace.html
Neuman, P., Lyons, B., Rentas, J., & Rowland, D. (2012). Dx for a careful approach to moving dual-eligible beneficiaries into managed care plans. Health Aff (Millwood), 31(6), 1186-1194.
Onder, G., Carpenter, I., Finne-Soveri, H., Gindin, J., Frijters, D., Henrard, J. C., . . . Liperoti, R. (2012). Assessment of nursing home residents in Europe: the Services and Health for Elderly in Long TERm care (SHELTER) study. BMC health services research, 12(1), 1.
Trivedi, D., Goodman, C., Gage, H., Baron, N., Scheibl, F., Iliffe, S., . . . Drennan, V. (2013). The effectiveness of inter‐professional working for older people living in the community: a systematic review. Health & social care in the community, 21(2), 113-128.
