Long-Term Care: A Case Study

Long-term care services are sought out when an individual requires aid with their daily living activities, medical or non-medical, due to a chronic illness or disability. In the 19th century, it was common for long-term care to be given by family members and friends most often based on a need of feeling it was their duty even when it created privations for the family. After the Great Depression the Social Security Act of 1935, in addition to welfare programs, we began to see a positive impact helping those who could not care for themselves. By the 1960’s the federal government provided additional funding to address the needs of these individuals; however, they did not fully take into account how the influx of consumers into the system would
impact providers. For decades nursing homes have been historically associated as the long-term care facility provider. However, today there is a growing network of integrative innovative services available in addition to nursing homes depending on the needs of the individuals. Over 10 million adults receive long-term services and support with adults 65 and older comprising the bulk of this group. Characteristically once long-term care is required for an individual it typically follows them the remainder of their life and that is why it is vital that services are tailored to the needs of the individual. Long-term care providers are experiencing much more competition today for consumers than in the past. Due to reimbursement cuts facilities are competing specifically for certain payers and those consumers that can self-pay. However, Medicaid is the primary payer for long-term care and self-pay by individuals and family members is the second (Pratt, 2016).
Traditionally, when most of us hear long-term care facilities we generally associate them with the elderly; however, long-term care facilities are comprised of non-elderly individuals, the disabled, and the mentally ill as well.
Due to this diverse group of consumers this requires an emphasis be placed on innovative approaches in how we as health care providers address the needs of these individuals (Pratt, 2016). A significant change in the demographics is the increase in seniors due to the baby boomers. Due to the advancements in health care today, these baby boomers will live longer past retirement, which could further tax the long-term care systems if their health declines as they age. Additionally, this can further strain Medicaid and
Medicare.
As previously mentioned nursing homes are no longer perceived the traditional provider of long-term care. The type of service, needs of the service, and the payer dictate the categories of the providers. Long-term care industry provides services in a variety of settings, including nursing facilities, subacute care, independent residential care, assisted living residential care, and continuum of care community-based services. Nursing facilities are licensed by the state and include skilled nursing facilities, whereas subacute care is a step down from a hospital where an individual requires more care than a nursing home can provide. Assisted living residential care provides assistance as needed, whereas independent residential care/elderly housing options are owned or rented housing options with age restrictions. Lastly, community-based services can be provided in the consumer’s home, as well as adult day care and hospice care (Pratt, 2016). Several goals for the optimal long-term care system are enhancing quality of life, closing the gaps in the fragmented delivery and reimbursement systems, and growing and developing the utilization of home and community-based care. In addition to pay-per-performance to promote improving the quality of care provided. The fragmented payment system is difficult for the consumer to navigate through when there are multiple payers. Not only is it confusing to the consumer who may potential discontinue services it may as well set up conflicting incentives of reimbursement over quality when the provider receives reimbursement from multiple payers. In 2005, the Center for Medicare and Medicaid Services initiated a directive with stakeholders in nursing homes to promote culture change to improve the quality of life of residents. Although the stakeholders are in agreement of resident-centered care finding the right model has been a challenge. Medicare and Medicaid pay for different services so depending on the needs of the individual for each particular instance, the payer will be dependent on where they are placed and dependent on what coverage they have. This fragmented system leads to confusion, poor outcomes, and unnecessary costs. Many specialties are moving to bundled payments to contain costs and this may be a viable option for long-term care based on diagnosis where appropriate. Pay for performance used in conjunction with public reporting and providers are incentivized financially when they have met the targeted measure of quality of care (Konetzka & Werner 2010).
Due to the dedication of health care providers in long-term care facilities to increase their emphasis on customer service they have excelled at meeting the needs of their consumers by actively responding to change.
Innovative brands of care facilities are being established to meet the needs of a diverse group of consumers in order to stay competitive in the market and appeal to a wider range of consumers. Moreover, in some instances giving family members an outlet through the use of an adult day care programs so that they can maintain employment. Many of the long-term care programs are incorporating innovative ways to keep family members involved in activities with their loved ones to build on and stay connected. Lastly, incorporating integrated health systems is a growing trend within the long-term care system that would provide the consumer with continuity of care. Although there are obvious inherent weaknesses the long-term care system has vastly improved by learning from and improving on their weaknesses. Unfortunately, greed has taken over as it often does in health care when services are not utilized strictly due to lack of reimbursement. Again, another scenario where a consumer may not be offered or receive a service due to the payer unless the consumer can pay out of pocket, which creates the potential for gaps in service. Another growing concern is an individual may qualify for a service; however, the service may not be available to them. This is one of
the most difficult challenges for the long-term care system is providing accessible services for everyone in need. The current state of this system is fragmented. There is a lack of collaboration and direction of policies and regulations between providers, payers and regulators. Not only does it make it difficult for people to do their jobs it ultimately affects patient care. There is a lack of social services that if appropriately involved could better assess the needs of the patient thus making the long-term care services more successful and help reduce the gap in a fragmented system. Additionally, there is not one point of entry into the system, thus compounding the existing fragmented issues. Sadly, nursing homes have developed a perceived image over the years, predominately through negative publicity. This has had a negative impact on funding and regulations (Pratt, 2016).
A priority for improvement is approaching long-term care as a collaborative approach amongst providers rather than a competitive arena. By forming strategic partnerships with each organization could benefit on a whole by having access to a wider range of knowledgeable staff with different strengths that in the long run will benefit an integrated service network. This is going to become a more sustainable approach for all parties with long term health care reform. Care transition models are improving patient outcomes by facilitating safe moves from one care setting to another, decreasing hospital re-admissions, thus in turn decreasing medical costs. In order to be successful, it is vital that Area Agencies on Aging reach out to the medical community to form partnerships to integrate both the medical and community services (Blumberg et al., 2013).
In conclusion, as the aging population increases due to advancements in medicine, there is a concern of the sustainability of long-term care programs due to increased demands. As a health care provider our first priority is to improve the quality of care as well as the patient satisfaction, but we also need to be cognizant of reducing costs as well. The influx of aging baby boomers will shape the future of the financial structure of long-term care programs and it is imperative that legislators are proactive in providing solutions so that this debt is not left to future generations (Kane, 2014).