Other Free Encyclopedias » Medicine Encyclopedia » Aging Healthy - Part 3 » Long-Term Care - The Growing Need For Long-term Care, Where Is Long-term Care Provided?, Financing Of Long-term Care

Long-Term Care - Ensuring Quality Of Long-term Care

age aging nursing home nursing washington health

Monitoring quality of long-term care services has been a long-standing challenge, especially in nursing homes. The Nursing Home Reform Act of 1987 set new standards for care and established rights of nursing home residents, in response to numerous reports of neglect and abuse in nursing homes. A notable impact of the act is a substantial reduction in the unnecessary use of physical restraints and chemical restraints (drugs) in nursing homes.

The Nursing Home Reform Act has been difficult to enforce, however, and has often failed to protect nursing home residents from poor care and unsafe conditions. Federal and state inspections showed that more than one in four nursing homes nationwide had deficiencies that caused harm to residents or placed them at risk of death or serious injury each year from 1995 to 1998 (GAO, Nursing Homes, 1999).

Because the picture is often bleak in nursing homes, home and community-based services may offer better quality of life. These services allow individuals to receive care in a home or community setting rather than in an institution. In 1987 federal law mandated new quality standards for home health care agencies that are reimbursed by Medicare and Medicaid. States also have their own licensing laws for home health services covered by state-funded programs. Within the same state, several government agencies may be involved in regulating or contracting for home care services. In addition, there are hundreds of unlicensed agencies, such as agencies that provide temporary home care workers for private-paying consumers, operating in every state. Many researchers are skeptical that the fragmented regulatory system can effectively enforce quality home care (Coleman).

Quality of home care has been difficult to assess. Studies have found that clients reported high levels of satisfaction and at the same time reported serious deficiencies in worker performance. These inconsistencies suggest that clients may overstate their levels of satisfaction (Coleman).

A new movement called consumer-directed care presents an opportunity to empower individuals to manage their own home care. Many publicly funded programs now give beneficiaries the option to choose their own care providers and to manage their own plans of care, much as privately paying individuals do. Consumer-directed care is advocated primarily by younger adults with disabilities, who want to live in the least restrictive environment possible and to direct their own care. While some advocates contend that providing consumers with autonomy and control will improve care quality, others are concerned about potential health and safety risks. Experts have noted that long-term care often involves a trade-off between maximizing consumer choice and ensuring safety (Coleman).

Assisted living facilities often emphasize a philosophy of facilitating residents' privacy, autonomy, independence, and dignity, and promoting care in a homelike environment (Lewin-VHI). They are licensed and regulated by the states rather than the federal government, and standards and oversight approaches vary across the states. In a 1999 study of assisted living in four states, the General Accounting Office found that more than a quarter of facilities were cited by state oversight agencies for having five or more quality-of-care or consumer protection deficiencies or violations during 1996 and 1997. Frequently identified serious problems providing insufficient care to residents; having insufficient, unqualified, and/or untrained staff; not providing residents the appropriate medications or storing medications improperly; and violating state admission and discharge regulations (GAO, Assisted Living, 1999). Nonetheless, older persons and their families frequently choose assisted living for persons who do not need the more intense services of nursing homes, because the quality of life in assisted living is typically preferred over that in nursing homes.

BERNADETTE M. WRIGHT

BIBLIOGRAPHY

ARNO, P. S.; LEVINE, C.; and MEMMOTT, M. M. "The Economic Value of Informal Caregiving." Health Affairs 18, no. 2 (March/April 1999): 182–188.

BISHOP, C. E. "Where Are the Missing Elders? The Decline in Nursing Home Use, 1985 and 1995." Health Affairs (July/August 1999): 146–155.

BLANCHETTE, K. New Directions for State Long-Term Care Systems. Vol. II: Supportive Housing. Washington, D.C.: AARP, Public Policy Institute, 1997.

COLEMAN, B. Assuring the Quality of Home Care: The Challenge of Involving the Consumer. Washington, D.C.: AARP, Public Policy Institute, 2000.

CORONEL, S. A. Long-Term Care Insurance in 1997–1998. Washington, D.C.: Health Insurance Association of America, 2000.

DOTY, P. Cost-Effectiveness of Home and Community-Based Long-Term Care Services. Washington, D.C.: U.S. Department of Health and Human Services, Assistant Secretary for Planning and Evaluation; Office of Disability, Aging and Long-Term Care Policy, 2000.

Federal Interagency Forum on Aging-Related Statistics. Older Americans 2000: Key Indicators of Well-Being. Hyattsville, Md.: FIFARS, 2000.

GABREL, C. S. Characteristics of Elderly Nursing Home Current Residents and Discharges: Data from the 1997 National Nursing Home Survey. Hyattsville, Md.: National Center for Health Statistics, 2000.

GAO (U.S. General Accounting Office). Long-Term Care: Diverse, Growing Population Includes Millions of Americans of All Ages. Washington, D.C.: GAO, 1994.

GAO (U.S. General Accounting Office). Long-Term Care: Baby Boom Generation Presents Financing Challenges. Washington, D.C.: GAO, 1998.

GAO (U.S. General Accounting Office). Assisted Living: Quality of Care and Consumer Protection Issues in Four States. Washington, D.C.: GAO, 1999.

GAO (U.S. General Accounting Office). Nursing Homes: Additional Steps Needed to Strengthen Enforcement of Federal Quality Standards. Washington, D.C.: GAO, 1999.

HCFA (Health Care Financing Administration). Medicare and You 2001. Washington, D.C.: HCFA, 2000.

HCFA, Office of the Actuary. National Health Expenditures Projections: 1998–2008. Washington, D.C.: HCFA, 2000.

HCFA, Office of the Actuary. "Table 7: Nursing Home Care Expenditures Aggregate and Per Capita Amounts and Percent Distribution, by Source of Funds: Selected Calendar Years 1960–98." 2000. www.hcfa.gov

HCFA, Office of the Actuary. "Table 9: Personal Health Care Expenditures, by Type of Expenditure and Source of Funds: Selected Calendar Years 1991–98." 2000. www.hcfa.gov

KASSNER, E. Medicaid Financial Eligibility for Older People: State Variations in Access to Home and Community-Based Waiver and Nursing Home Services. Washington, D.C.: AARP, Public Policy Institute, 2000.

KASSNER, E., and BECTEL, R. W. Midlife and Older Americans with Disabilities: Who Gets Help? Washington, D.C.: AARP, Public Policy Institute, 1998.

Lewin-VHI, Inc. National Study of Assisted Living for the Frail Elderly: Literature Review Update. Washington, D.C.: U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation and Administration on Aging, 1996.

"Long-Term Care Insurance Special Report: How Will You Pay for Your Old Age?" Consumer Reports (October 1997): 35–50.

LUTZKY, S.; ALECXIH, L. M. B.; DUFFY, J.; and NEILL, C. Review of the Medicaid 1915c Home and Community Based Services Waiver Program Literature and Program Data: Final Report. Washington, D.C.: Health Care Financing Administration, 2000.

MOLLICA, R. State Assisted Living Policy: 2000. Portland, Me.: National Academy for State Health Policy, 2000.

MUNSON, M. L. Characteristics of Elderly Home Health Care Users: Data from the 1996 National Home and Hospice Care Survey. Hyattsville, Md.: National Center for Health Statistics, 1999.

MURTAUGH, C. M.; KEMPTER, P.; SPILLMAN, B. C.; and CARLSON, B. L. "The Amount, Distribution, and Timing of Lifetime Nursing Home Use." Medical Care 35, no. 3 (1997): 204–218.

NAC/AARP (National Alliance for Caregiving/American Association of Retired Persons). Family Caregiving in the U.S.: Findings from a National Survey. Bethesda, Md., and Washington, D.C.: NAC/AARP, 1997.

NADSA (National Adult Day Services Association). "Adult Day Services Fact Sheet." 2000, www.ncoa.org

O'KEEFE, J. People with Dementia: Can They Meet Medicaid Level-of-Care Criteria for Admission to Nursing Homes and Home and Community-Based Waiver Services? Washington, D.C.: AARP, Public Policy Institute, 1999.

[back] Long-Term Care - Financing Of Long-term Care

User Comments

The following comments are not guaranteed to be that of a trained medical professional. Please consult your physician for advice.

Your email address will be altered so spam harvesting bots can't read it easily.
Hide my email completely instead?

Cancel or