Best at Home Assuring Quality Long-Term Care in Home and Community-Based Settings (1996) / Chapter Skim
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2 LONG-TERM CARE IN HOME AND COMMUNITY-BASED SETTINGS
2 LONG-TERM CARE IN HOME AND COMMUNITY-BASED SETTINGS
Pages 13-28
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From page 13... ...
People Who Use Home and Community-Based Long-Term Care More clean 10 million Americans of all ages currently need some type of LTC to remain in their own homes or in other community-based settings (compared with only 2 million persons in institutions such as nursing facilities or chronic care hospitals)
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From page 14... ...
such as getting in and out of bed and administering complex medical procedures; others need only occasional help with such tasks as cleaning or going grocery shopping. Although all kinds of users can be found in both home and residential care settings, on the aggregate level some notable differences exist between the users in these two types of settings.
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From page 15... ...
Estimates of impairments ' Sirrocco (1994) actually used the term "board and care home," defined as "a residential setting that provides either routine general protective oversight or assistance with activities necessaryfor independent riving to mentally or physically limited persons." 2 The statistics cited in this section refer primarily to residents of board and care facilities.
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From page 16... ...
Some studies indicate much higher percentages (Hawes et al., 1995~. Likewise, studies consistently find that between 10 and 15 percent of residents in these settings experience developmental disabilities and that approximately 33 percent are diagnosed as having a chronic mental illness (Dittmar and Smith, 1983; Mor et al., 1986; Hawes et al., 1994~.
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From page 17... ...
Medicare provides home health benefits for individuals who are in need of skilled nursing care on an intermittent basis or who need physical or speech therapy. Medicare spent $10.
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From page 18... ...
All in all, the outlook for governmental financial support of LTC services, especially for home and community-based care, is uncertain at best. Providers of Home and Community-Based Long-Term Care Home Care Home care services are provided by both informal caregivers such as family members and friends, and fonnal caregivers such as home health nurses and chore aides.
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From page 19... ...
To give a sense of the size of the workforce, in 1990, Medicare-certifiedhome health agencies employed 146,958 fill-time-equivalent workers including nurses, therapists, and personal care aides. Estimates of the total number of paraprofessional aides alone in the home care industry range from 300,000 to 500,000 (Feldman et al., 19901.
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From page 20... ...
In general, a typical staff might include administrative personnel, kitchen workers, housekeepers, and personal care aides (Kane and Wilson, 1993~. Compared with staff duties in nursing facilities, staff responsibilities in residential care settings, particularly smaller facilities, are less complex and differentiated; a housekeeper may help prepare meals as well as provide transportation to medical appointments.
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From page 21... ...
Among the more important are shifts in attitudes about the provision of care; a growing population; changes in the supply and role of informal caregivers; heightened concerns about cost, access, and availability of services; and an increase in service delivery experimentation. These trends are discussed in more detail below.
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From page 22... ...
For example, large, hospital-based ventilators have been replacedwith smaller portable models that can be used at home, on the job, or at school (Perrin et al., 1993~. Changes in the Supply and Roles of Informal Caregivers The majority of LTC services continue to be provided by informal caregivers such as family members and friends.
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From page 23... ...
As a result, policymakers have proposed solutions such as spending caps, block grants, limitations on provider fees and new nursing facility beds, and case management or gatekeeper systems. Importantly, almost every new federal or state proposal for Medicare and Medicaid has called for the increased use of managed care in an effort to decrease costs.
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From page 24... ...
The difference appeared to occur mostly as a result of capitated organizations' limitation on the number of home health visits. Additionally, few managed care organizations have experience in providing LTC services to older and disabled individuals (Lewin-VHI, 1995a)
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From page 25... ...
Most states have received approval from the Health Care Financing Administration to waive federal Medicaid requirements in order to experiment with new delivery systems designed to prevent at-risk individuals from being institutionalized (Folkemer, 1994~. While the target population may vary, most programs share common characteristics in their focus on functional eligibility criteria, emphasis on service delivery in the least restrictive setting, and increased reliance on consumer input in the care planning process.
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From page 26... ...
Finally, many consumers and their advocates worry that attempts to improve and protect consumers' health and safety may actually force a consumer to accept undesirable services. Many state and local governments, for example, have standards regarding admission and discharge of individuals in residential care settings.
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From page 27... ...
LONG-TERM CARE IN HOME AND COMMUNITY-BASED SETTINGS 27 SUMMARY This chapter gave a brief overview of the current home and communitybased LTC system and discussed some of the major trends that are influencing that system. In keeping with its overall charge, the committee now turns to an examination of the ways quality of care is assured and improved in that system.
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