The study focuses on primary health care (including both acute and chronic care) and long-term care services for older adults, defined here as those individuals ages 65 and older. Primary care is the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community (IOM, 1996). Long-term care is broadly defined as an array of health care, personal care, and social services generally provided over a sustained period of time to persons with chronic conditions and with functional limitations (IOM, 2001b). While the committee primarily focused on the health care aspects of long-term care, it acknowledges that these services are often intertwined with personal care and, in particular, that many health care services are provided by the same workers who provide personal-care services.

The study considers a broad range of care delivery settings, including ambulatory clinics, hospitals, and the home and other long-term care settings. Older Americans from across the entire spectrum of health care status are included in the study, but the committee focused in particular on the care of individuals with chronic conditions, who account for the bulk of health care services and spending.

The committee defined the health care workforce broadly to encompass all personnel involved in the delivery of health care services, including health care professionals (physicians, nurses, physician assistants, social workers, oral-health care workers, pharmacists, allied health care workers, and so on), and direct-care workers (e.g., nurse aides, home health aides, and personal- and home-care aides). The committee recognized the significance of informal caregivers, not only because of the amount and breadth of services they provide to older adults but also because the availability of informal caregivers greatly affects the need for formal, or paid, services. The committee also acknowledged the importance of consumers playing an active role in their own care.

The committee also limited its consideration of models of care and workforce challenges to the United States. While the committee recognized that many unique efforts exist around the world, it concluded that the systems of care are too different and heterogeneous to warrant extensive examination of these systems in this report. Instead, the committee suggests that lessons learned from these international models in general may help to inform future research and development programs in the United States.

As seen in Box 1-2, the committee was charged with determining the health care needs of older adults. The committee recognizes that the term “need” can seem to be somewhat ambiguous and open-ended. An individual asked to list his or her needs without regard to price might, for instance, evince an almost unending desire for various services. It is for this

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