evaluate the attributes of each of these settings in relation to long-term care, the attributes of persons providing care within these settings, and the ability of specific settings to adjust to the changing needs and personal resources of older persons.

Quality Assurance

The interactions among the need for care (based on functional status), the nature of long-term care intervention, and the outcome of care are poorly understood. Lacking are standards for long-term care and valid and reliable measures of the need for and quality of care, including quality of care at different sites (e.g., home care), and instances where quality of care may conflict with quality of life. Development of such standards and measures for community-based care is particularly critical because of the shift in locus of care to the community. Such measures include indices of the quality of family care along with the quality of formal community care.

Several issues that cross health services and clinical research areas require attention. First, information about how a provider's perception of age and aging might affect treatment decisions in long-term care is essential. Second, research focusing on understanding rehabilitation strategies and their relationship to treatment outcomes is needed.

Technologies

Recent technical advances have the potential to enhance life for many disabled people, but little work has been done to delineate the positive and negative effects of such technologies. Three categories of technology are relevant to long-term care: (1) universal technologies (those shaping the environment in home and community to enhance, or to inhibit, independence), (2) individual technologies (those providing aids to individuals to help overcome deficits), and (3) life-sustaining technologies (those replacing or supplementing failed organs or bodily systems). The use of these technologies is value laden and leads to central questions that have not been addressed in our society. This and other ethical issues are discussed further in Chapter 6.

Theoretical development in the area of universal technologies suggests that such strategies may be key to reducing the need for both individual aids and service interventions (Orleans and Orleans, 1985; Zola, 1988). This area needs more research attention and represents a promising research direction.



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