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Improving the Quality of Long-Term Care
ering, and evaluating care. The notion of consumer-centered care is not new, but there is now tangible evidence, at least in the acute and primary care encounters, of consumer-centered care in many facets of health care delivery and financing. The committee finds guarded optimism in the increased acceptance of consumer-centered service as a core principle for assessing and improving long-term care. However, moving toward meaningful consumer-centered services in long-term care settings would require a mix of changes in consumer and provider attitudes, business practices, public policies, care processes, and management structures. Achieving such changes requires research, and time and effort to integrate the elements of consumer-centered care into the training and attitude of the full range of paid caregivers. A prerequisite to such care is an adequate supply of caregivers who are appropriately trained and sensitive to provide such care.
Broadly speaking, consumers and their families should have access to information, training, and resources necessary for them to participate in self-care and in the direction of their care providers at the level they choose. A recent General Accounting Office report (GAO, 1999a) on assisted living singled out inadequate contracts as a major problem in that sector. People receiving formal long-term care in any setting should have a care contract or admission agreement that is clear, understandable, and enforceable to ensure that long-term care users (or their representatives) have access to accurate, complete, and understandable information about the services that individual caregivers and provider organizations offer. For children receiving long-term care, family members have central roles in a child's care team including approval of care plans for the child and participation in updating the objectives and services set forth in the care plan, but are not always aware of their role. When care providers change their policies or practices, they should present information or, if appropriate, create training programs for consumers and directly related parties.
Public information and reporting to the community and to consumers should be required of providers annually, and should include financial and quality information, results of consumer surveys, and findings of regulatory and accrediting bodies. Federal and state laws should include specific provisions regarding consumer protections for nursing homes, residential care, and home care, and should provide specific mechanisms in addition to existing regulatory bodies to oversee the rights of consumers.
Supportive public policies are essential for the expansion of consumer-centered care because those using long-term care often rely heavily on public programs to help pay for care over long periods of time. Ideally, the policies governing such programs should permit various levels of participant involvement and direction, offer consumers access to a flexible array of benefits, and make available the assistance and resources