Abstract
Long-term care is rendered to people with varying levels of functional deficit. Depending on the type of the disability and the status of the wellbeing of the long-term care user, the needs vary. Some long-term care users need minimal assistance while others need maximum assistance. Long-term care is meant to help people with functional deficits to live a comfortable life as much as possible. There are various levels of long-term care options that people should select according to their needs. They include among others; nursing home, home care, home health care, assisted living facility, and community-based care settings. Each option has its benefits and disadvantages. Besides, the financial obligations differ from one option to another. People should select the option that best provide the needs of their loved ones who are in need of long-term care services. Besides, people should choose the long-term care option whose cost can be met with the available resources.
Introduction and Background Information
This report presents the findings concerning the various levels of long-term care options available to the family members of my neighbor who has recently been disabled from the stroke. The report also discusses how my neighbor’s family members can prepare to deal with a lifetime of disability. Some of the factors to consider while choosing the appropriate level of long-term care, the financial costs involved in each, and the role for each are also discussed. The report also acknowledges that the availability of various levels of long-term care varies from one state to another. Besides, some new emerging trends in long-term care are also discussed in the report.
Stroke is one of the most life-threatening cardiovascular conditions known. It is associated with various complications that lead to different disabilities. The types of disabilities attributed to stroke depend on the part of the brain that is damaged by the condition. In general, there are five major types of disabilities associated with stroke: emotional disturbances, sensory disturbances, problems with controlling movement (paralysis), problems using and understanding language, and memory and thinking problems (Pons, Rafael, and José, 31; Stolov, and Michael, 129). Difficulty controlling movements is a common disability associated with stroke. It is usually characterized by the paralysis on one side of the body that is opposite the side of the brain damaged by stroke; a condition referred to as hemiplegia. The paralysis might affect the whole side of the body or at least an organ on the affected side. For instance, the paralysis might affect an arm on one side of the body. In some cases, hemiplegia results in difficulty swallowing. This condition is attributed to the damage caused to the part of the brain that controls the process of swallowing. If the stroke causes damage to the cerebellum, the part of the brain that controls muscle coordination, then the ability of the body to control movement might be affected. This disability is referred to as ataxia. People with ataxia tend to exhibit difficulties in walking, maintaining a given body posture, and balancing.
Memory and thinking problems common in people affected by stroke are due to the damage caused to the parts of the brain that controls memory, awareness, and learning. Stroke survivors affected by this problem tend to exhibit a significant decrease in the ability to comprehend meanings and engage in complex mental activities. Besides, they may also display difficulty learning new tasks. Other common functional deficits may include the loss of sensory stimuli, in particular on the affected side and apraxia.
The sensory disturbance is also a common problem among stroke survivors. This condition is characterized by the loss of the ability to feel touch, pain, or temperature. In some cases, the affected people may not be able to recognize objects they are holding on their hands. Furthermore, sensory disturbances may cause failure by the affected people to recognize their limbs. Such cases present risks of severe harm to the affected limb without the person realizing. Different chronic pain syndromes are also common among some stroke survivors. In most cases, the pain is caused by the immobilization of joints and the ligaments and tendons being fixed in one position as a result of the lack of movement. Chronic pain can also be caused by the damaging of the pathways for sensation in the brain (Saab, 100). This causes the brain to transmit false signals that induce pain sensation in the limbs. The pain sensation may also be felt on the side of the body that is paralyzed. Sensory deficit in stroke survivors may also result in the loss of the ability to sense the need to empty the urinary bladder. Besides, they may lose their ability for voluntary control of the muscles of the urinary bladder.
Language impairment is also a common condition among stroke survivors. In this case, the capacity to write, speak, and comprehend both the spoken and written language is often significantly affected. The people living with this problem may lose the ability to speak the words in their mind. In some cases, they may be able to speak the words in their mind, but fail to do so in a coherent manner. This condition is referred to as expressive aphasia (Barnett, 63). Some people may also exhibit difficulty comprehending written or spoken language even though they can construct sentences that are grammatically correct. This condition is known as receptive aphasia (Nicolosi, Elizabeth, and Janet, 18). The impairment of the verbal communication in stroke survivors may be partly attributed to the injury caused to any of the centers of the brain that control language. Expressive aphasia occurs when the language center on the dormant side of the brain is damaged. On the other hand, receptive aphasia is caused by the damage caused to language center that is located in the rear part of the brain. Another common problem experienced by stroke survivors is the emotional disturbance. Many stroke survivors often experience fear, anxiety, sadness, and anger because of their physical and mental deficits. Some of them become hopeless and develop depression. Due to the emotional disturbances that stroke survivors go through, they tend to exhibit even lower ability to perform various activities. Therefore, dealing with the psychological consequences of stroke is crucial to the efforts involved in delivering care to stroke survivors.
The disabilities suffered by stroke survivors render them unable to accomplish certain basic daily activities on their own. For instance, activities such as cooking, bathing, grooming, taking medications, and visiting the toilet are often affected. Therefore, stroke survivors who are left disabled by the condition depend on family members or caregivers in the long-term care facilities. The level of care needed depends on the extent of the disability and other factors. My neighbor, having been disabled from stroke, may present with one or more of the disabilities described above. Therefore, he may need personal assistance that addresses these disabilities.
Decision-Making Concerning Long-Term Care
Family members are usually the first people to provide care to an individual in need. Therefore, decisions concerning whether the individual in need of long-term service should be moved to a long-term care facility or not lie with them. Indeed, the whole family should take part in deciding on whether there is the need to consider a long-term care facility or not. Such decisions should be made through a discussion where all family members can express their views and concerns. Members caring for the individual in need on a daily basis shoulder the burden of the tasks involved. Furthermore, they tend to have deep understanding of the person’s ability to perform certain chores. Besides, the caregivers can predict the ability of the individual to adapt to the environment in the long-term care facility. Consequently, the caregivers make the final decisions concerning whether the family member in need of long-term care service should be sent to a long-term care facility or not.
Before choosing the level of long-term care service appropriate for one’s loved one, one should consider various factors. First, the level of assistance needed by the person in need of long-term care plays a significant role in determining whether the person should be transferred to a long-term care facility or not. In other words, it is important for the family members to consider the type of help their loved one may need and what is required to provide it. It is also important to consider that the needs may change over time. Therefore, the level of care option selected by the family members should be able to provide the possible future needs of their loved ones.
How much help one needs is important in informing the level of care to be given to an individual. There are various levels of needs that should inform decisions concerning the type of long-term care facility to choose. For example, the needs of people who need occasional assistance can be catered for at home. Such people can accomplish the following tasks on their own: they can bath, dress, and groom on their own; they can do most housekeeping chores and prepare their meals without assistance from others; they can communicate, take medications, walk, and eat on their own. In general, these people are relatively more independent. They need assistance occasionally, especially during an emergency. Therefore, providing care to them is not as burdensome as doing so to people who are in need of significant or maximum assistance.
Individuals in need of minimal assistance can also perform most of the daily tasks on their own. For instance, they can walk on their own without falling. However, they exhibit more functional deficits than their counterparts in need of occasional assistance. For example, they tend to experience difficulty remembering things. Therefore, they need occasional reminders about performing simple chores such as bathing, grooming, and taking medications among other chores. Moreover, these people need assistance with meal preparations and housekeeping as well as during an emergency. The third level of long-term needs is “significant assistance”. The people in need of significant assistance need community-based care services. However, the services could also be provided at home by family members, personal attendants, or friends. Individuals whose needs fall in this category need help in accomplishing most of their daily chores. For example, they need assistance in bathing, preparing meals, and taking medications. They also need assistance during an emergency.
Another level of long-term care needs is maximum support. The services required by people whose needs for long-term care fall in this category are mainly provided in residential care facilities such as nursing homes. However, arrangements can be made to have these services provided at home. Individuals who need maximum assistance require help in nearly all chores. For instance, they need in bathing, taking medications, moving from wheelchair to bed, and preparing meals. They also need to be reminded to eat. Moreover, they need to be encouraged to take part in social activities. Help in case of an emergency is also necessary for them. Some of the people with maximum assistance also require 24-hour nursing assistance such as occupational therapy, physical therapy, and speech therapy among other needs. In general, persons who are in need of maximum assistance are the least independent of all persons using long-term care services. They simply cannot do without assistance. They also require more intimate care than their counterparts who are in need of occasional, minimal, or significant assistance. Providing the needs of these people at home may not be convenient to their loved ones since some resources needed for maximum support may not be available. Besides, making arrangements to have maximum assistance given at home may have serious financial implications on the individual’s loved ones.
Apart from the needs of long-term care users, other factors should be considered in selecting the most appropriate long-term service option. For instance, the resources involved in each option and the ability of the loved ones to raise them is crucial in determining the most appropriate option a loved one. In this case, there is the need to choose an option for which one’s resources can cater. Secondly, the beliefs or attitude towards a given long-term care facility play a significant role in determining whether the option is acceptable to an individual or not. Therefore, it is important to consider one’s attitude towards a given option before advising one on the appropriate choice.
Long-Term Care Options
The long-term care options are determined by the needs and resources of the user. There are various long-term care options available to people with diverse needs across the United States. The availability of various long-term care facilities differs from one community to another and from one state to another in the United States. Some of the long-term care options include the following: home care service, community support services, home health care service, accessory dwelling units (ADUs), subsidized senior housing, respite care, and other facility-based care programs.
Home care services are long-term assistance offered at home. In this case, the caregiver might be a family member or a friend. It may also be a nurse, therapist, or home care aide who reports to a home every day to provide assistance to the care recipient. In a case where the caregiver is a friend or a family member, no payment is often given. However, home care services sought from home care service providers are paid for. The home care service providers train professionals who can offer assistance to the recipients of long-term care services. Some of the services commonly provided at home include bathing assistance, grooming assistance, walking assistance, meal preparation, eating, joyful companionship, and medication reminders among other services. Home health care services are also offered at home. Unlike home care providers, home health care providers offer skilled nursing care such as home health care aide services, occupational therapy, physical therapy, and speech therapy among other services in addition to personal care. While most home health care providers charge for the services offered, some non-profit home health care agencies provide free services.
The number of home care and home health care providers has increased significantly in the United States over the years, and so is the number of people using home care and home health care services. According to the Centers for Disease Control and Prevention (CDC) (2016, March 11, home health agencies, para. 1), there was a total of 12, 400 home health agencies in the United States in 2014. Home care services are recommended in cases where the environment at home is conducive for the recipient. Besides, home care is preferred when friends, family members, or volunteers are available to provide free care. Home care is beneficial to both the care recipient and the caregiver in several ways.
First, home care services enable recipients to receive personal care from the comfort of their homes. Consequently, they can enjoy privacy since they do not have to share the resources with other people who might be unknown to them. The only ones around them are usually family members who understand them. Besides, home-based care enables recipients to stay in the environment with which they are familiar. Home care also provides a sense of security to the recipients. Besides, recipients of home care services tend to enjoy more intimacy than their counterparts who are under facility-based care. Studies also show that people who received home-based care are less likely than their counterparts who are under facility-based care to be re-admitted to the hospital. In most cases, family members are the first caregivers to the long-term care users. Therefore, they are in the best position to anticipate possible changes in the needs of their loved ones. Home-based care provides an opportunity for them to adjust care given to their loved ones to correspond to the changes in their needs. Home care is also advantageous because it is tailored to the needs of the patient. It is also easier for friends to visit the patient who is being taken care of at home than those being cared for in the facility-based care. Caregivers also derive some benefits from home care in the sense that it allows them to take a break from their duties whenever the family members of the home care recipients offer to help.
The financial cost of home care services varies depending on who the caregiver is. In cases where caregivers are members of the family, friends, or volunteers, no cost is incurred. However, the loved ones of the long-term care user can choose to reward the caregiver as a way to appreciate the services rendered. Similarly, home care services provided by the non-profit-making home care providers are not paid for. On the other hand, services rendered by home care providers are paid for. In this case, the cost incurred varies from one state to another and from one provider to another. Furthermore, the type of needs of the long-term care user also determines the cost of home care services rendered. According to the U.S. Department of Health and Human Services (HHS) (n.d., Costs and Care, para. 1), the average cost of home health aide was $21 per hour in 2010. The sources of finance for home care vary. First, the user or the user’s loved ones can cater for the cost from their income. This source can only be effective if income is adequate.
Alternatively, home care services can be financed by Medicare. However, Medicare caters for specific situations. To be specific, Medicare only finances the long-term care services that fulfill the following requirements: services given to people aged 65 years and older, people of all ages living with end-stage renal disease, and people aged below 65 years and living with disabilities. Medicare also pays for home health care if the user meets the following conditions: has had a recent hospital stay for not less than 3 days; needs skilled health care such as physiotherapy, speech therapy, and skilled nursing care among other services; is admitted to a Medicare-certified nursing facility within 30 days prior to hospital stay (HHS, n.d., Long-term care services-skilled nursing, para. 1). Medicare caters for part of the home care cost for people who meet the above conditions for 100 days (HHS, n.d., Long-term care services-skilled nursing, para. 2). In this case, Medicare pays for the entire cost in the first 20 days (HHS, n.d., Long-term care services-skilled nursing, para. 2). According to the criteria used in 2013, the user is required to finance the cost incurred from the 21st day through 100th day (HHS, n.d., Long-term care services-skilled nursing, para. 1). In this case, the maximum cost that the user is required to cater for is $144 per day. If the cost of home health care services delivered during this period is more than $144, Medicare pays the balance (HHS, n.d., Long-term care services-skilled nursing, para. 1).
Other than the home-based care, facility-based care is also an option available to my neighbor. Facility-based care services are recommended when the services provided at home by family members, friends, or volunteers are not adequate to address all the needs of the long-term care user. The needs of long-term care users change with time. Thus, the care services provided at home may not be adequate to address all the needs. For instance, the user may develop the need for skilled nursing care that may not be provided by family members, friends, or volunteer caregivers. Furthermore, family members may encounter difficulties providing care to their loved ones due to changes in circumstances such as job transfer. The services provided by the facility-based home care services include the following among other services: nursing home care, adult foster care, continuing care retirement communities, assisted living facilities, and board and care homes.
Services provided by care facilities vary depending on the type of the facility. For instance, some facilities provide only housekeeping and housing services. On the other hand, other facilities provide personal care. Others provide medical services in addition to personal care. Board and care homes, for instance, do not render nursing and medical care. Rather, they offer personal care and meals only. Assisted living facilities provide a wider range of care than board and care homes. However, they cater for individuals with less personal care needs than those catered for in the home care facilities. In other words, assisted living facilities only provide assistance to people who need minimal assistance in carrying out basic activities such as bathing, preparing meals, dressing, and grooming among other functions. Each resident of the assisted living facility is often allocated an apartment. There are also common areas shared among the residents.
Nursing homes are common in the United States. They provide a wide range of personal care services as well as health services. Nursing homes put more emphasis on the medical and nursing needs of the residents more than the assisted living facilities. The services offered include the following among others: provision of meals, 24-hour supervision, personal assistance services such as bathing, walking, dressing, grooming, and medication reminders among others. Nursing homes also provide rehabilitation services such as speech therapy, occupational therapy, and physical therapy among others. People discharged from the hospitals are also often sent to the nursing homes to recover. Even though many people prefer home care to nursing home care, many benefits can be derived from nursing homes. First, nursing homes provide a social environment where long-term car users can interact with one another and share their experiences. Long-term care users living in nursing homes are in a suitable position to meet with people who share similar experiences. This provides them with constant companionship. Furthermore, some nursing homes also offer social events where residents participate. Such events provide the residents with opportunities to express themselves and interact with one another. Due to the social environment offered by nursing homes, the residents are less likely to develop depression that is attributed to social isolation than their counterparts receiving long-term care at home.
Nursing homes also provide food services to the residents. The meals are often tailored to meet the dietary needs of the residents. Health services are also provided in nursing homes. Consequently, nursing homes are suitable for long-term care users who have particular medical needs. Specialized health services are also rendered in nursing homes. These services are mainly offered to residents with severe health conditions. For instance, health care services are provided for people with diabetes, cancer, Alzheimer's disease and several other conditions in nursing homes. Registered nurses and other qualified professionals are available to provide such services. For the long-term care users who are receiving care at home, most caregivers tend to be their loved ones who also have other obligations and children to attend to. Consequently, they often get overwhelmed due to the burdensomeness involved in providing the care while also attending to other obligations. Sending their loved ones to a nursing home helps in relieving them from this burden. Nursing homes also address the needs of long-term health users who are in need of maximum assistance more adequately than other facility-based care providers.
Despite the fact that many benefits can be derived from nursing homes, nursing homes are also associated with certain drawbacks. For example, nursing homes are relatively more expensive. Indeed, many people cannot afford the cost of staying in a nursing home for a long period. For instance, in 2010, the average cost of stay in a private room in a nursing home was $229 per day in the United States (HHS, n.d., Costs of Care, para. 1). Furthermore, it is relatively harder to monitor the quality of care rendered to one’s loved one in a nursing home. Therefore, one cannot tell whether all the needs of one’s loved ones are being addressed. Another disadvantage of a nursing home is that it does not provide adequate privacy for the residents. Furthermore, long-term care users in nursing homes lack the comfort associated with their homes. On the other hand, users who receive care at home tend to feel more comfortable since they are familiar with the home environment and are surrounded by people familiar to them. They do not have to undergo the process of developing friendship with new people like in the case of people receiving care at the nursing homes. Some nursing homes are also understaffed especially the non-profit-making ones. Services provided by such facilities are not likely to meet the needs of users adequately. Therefore, the ratio of staff to care users should inform decisions concerning the option of nursing home one should take.
One can finance the cost of nursing home care through various ways. To start with, one can use personal resources to finance their nursing home care or that of their loved ones. In this case, one can use one’s savings to pay for the services. Besides, some insurance companies can also cover the cost of nursing home services. Secondly, Medicare can also cover the cost of nursing home care. However, Medicare only covers short-term stays in nursing homes following hospitalization. Long-term nursing home stays, on the other hand, are not covered by Medicare. It is also important to note that some nursing homes are not certified to take part in Medicare. One must meet certain conditions to use Medicare for financing nursing home services. In some cases, friends and relatives may also help in paying for one’s nursing home care needs. Different nursing homes have different changes for the care rendered. The nursing home facility to choose depends on the cost and quality of care, the available resources, and the location of the nursing home. Community-based long-term care service is another option one can consider. However, community-based care does not cater for all the needs of long-term care users. Rather, they supplement the care given at home. For instance, some community-based care offer meals only.
How to Prepare To Deal with Lifetime Disability
In general, there are many different levels of long-term care in the United States. The choice of the long-term care service to use is based on the needs of the user, the available resources, the cost of the service, and attitude of the user. Dealing with a disability exhibits many challenges. However, planning ahead could save people from certain difficulties that are likely to arise following a family member becoming disabled. In the case of my neighbor, who has been recently disabled from stroke, the family members can plan effectively to deal with the situation.
First, my neighbor’s family should have his current and future needs assessed. Assessment is important because it provides the basis on which both the current and future plans can be made. The family members should also assess the possible impact that their loved one’s disability can have on the rest of the family members. This step is important in enabling them to be prepared emotionally to deal with the situation. Next, the family members should assess the various options available for long-term care of their loved one. This helps in identifying the options that can meet the current and future needs of their loved one. Besides, there is the need to identify the option whose cost the available resources can meet. Next, if home care option is picked, the home environment should be modified to suit the current and future needs of my neighbor. For instance, they can have the doorways widened for easy navigation with mobility devices such as a wheelchair. On the other hand, where the option of a nursing home is selected, the family could relocate to a neighborhood near the nursing home.
There are various levels of long-term care services available for people in need such as those disabled from stroke. Some of the common long-term care available in the United States includes home care, home health care, nursing home care, assisted living facility care, and many other long-term care providers. The choice of any of these care options depends on the current and future needs of the user and the resources available to finance them. These options are available to the family of my neighbor. Depending on the option selected, my neighbor’s family should plan effectively to deal with the lifetime disability of their loved one. The preparation should be intended at fulfilling the needs of the long-term care user.
Works Cited
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