Long-term care

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This article is about an integrated health care system, often for parents or those with disabilities, which often rely on one type of health and social care service called a nursing facility, modernized into assisted living facilities. For specific information about these providers, see for example Professional Direct Support, Disability Public Policy (See also wiki wiki portal), Public Policy of Aging and Gerontology Sector.

Long-term care ( LTC ) is a range of services that help meet the medical and non-medical needs of people with chronic diseases or disabilities who can not take care of themselves for a time long. Long-term care is focused on individualized and coordinated services that promote self-reliance, maximize patient quality of life, and meet patient needs over a period of time.

It is common for long-term care to provide custodial and non-skilled care, such as assisting with normal daily tasks such as dressing, breastfeeding, using the bathroom. Increasingly, long-term care involves providing a level of medical care that requires skilled skilled practitioners to address the various chronic conditions associated with the older population. Long-term care can be given at home, in communities, at assisted living facilities or in nursing homes. Long-term care may be needed by people of all ages, although it is a more common need for elderly citizens.

Video Long-term care

Type of long-term care

Long-term care can be given formally or informally. Facilities offering formal LTC services typically provide live accommodation for people requiring surveillance services around 24 hours onsite, including professional health services, personal care, and services such as food, laundry and housekeeping. These facilities can use a variety of names, such as nursing homes, personal care facilities, on-site home-care facilities, etc. And operated by different providers.

While the US government has been requested by the LTC industry (long-term care) not to integrate health, personal care and services (eg, food, laundry, household) into large facilities, the government continues to agree that as the main use of taxpayers' funds instead (eg, new assisted life). Greater success has been achieved in areas such as supported housing that may still use older housing or building complexes, or may have been part of a new federal state initiative in the 2000s.

The long-term care provided at home, also known as home health care, can incorporate various clinical services (eg nursing, drug therapy, physical therapy) and other activities such as physical construction (eg installing hydraulic lifts, renovating bathrooms and kitchens). This service is usually ordered by a doctor or other professional. Depending on the country and nature of the health and social care system, some of these service fees may be covered by health insurance or long-term care insurance.

The modern form of long-term service and support (LTSS), which can be replaced by the government, is user-directed personal services, family-directed options, independent living services, benefit counseling, mental health counseling services, family education, and even self-advocacy and work, among others. Home services can be provided by personnel other than nurses and therapists, who do not install elevators, and are included in the US Long-term service and support system (LTSS).

The long term informal home care is the care and support provided by family members, friends and other unpaid volunteers. It is estimated that 90% of all home care is provided informally by loved ones without compensation and by 2015, families seek compensation from their government for care.

Maps Long-term care

The Consortium of Citizens with Disabilities (CCD) working with the US Congress, has indicated that while hospitals offer acute care, many non-acute, long-term services are provided to help individuals to live and participate in society. Examples are the international home emblem of community life and deinstallizationalization, and supportive services (eg, supported housing, supported work, life support, parental support, family support), supported education.

The term is also common in aging groups, such as the American Association of Retired Persons (AARP), who annually survey the US states on services for the elderly (eg, intermediate care facilities, assisted living, food delivered home). Long-term service and support is discussed in depth in the coming sections, Public Administration and Disability: US Public Service Administration (Racino, manuscript 2012, in press, 2014) The new US Support Force includes Direct Professional Support , which are mostly nonprofit or profit-making, and government labor, often unionized, in communities in the US state. The core competencies (Racino-Lakin, 1988) in the federal state interface for assistants "in institutions and societies" are identified in aging and physical disability, intellectual and developmental disabilities, and behavioral health ("mental health") by 2013 (Larson, Sedlezky , Hewitt, & Blakeway, 2014).

President Barack Obama, US House Speaker John Boehner, Minority Leader Nancy Pelosi, Majority Leader Harry Reid and Minority Leader Mitch McConnell received a copy of the US Senate Commission on Long Term Care about "service delivery, employment and financing issues that have challenged policymakers during several decades "(Chernof & Warshawsky, 2013). The new Commission envisions a "comprehensive financing model balancing private and public finance to ensure disaster costs, encouraging savings and insurance for LTSS (Long Term Service and Support) costs faster, and for providing a safety net for those without resources." (Ibid, 2013).

The direct-care workers envisioned by MDs (doctors, prepared by medical schools, later licensed for practice) in America (who do not develop a community service system, and serve different roles, valued therein) are described in 2013 as: auxiliary personal treatment (20%), home health aide (23%), nursing assistant (37%), and independent provider (20%) (p.10). The US has a diverse and competitive healthcare system, and hospitals have adopted a model for transferring "public funds to the hospital"; In addition, "hospital studies" indicate M-LTSS (long-term managed care services) as billable services. In addition, the preparation of allied health workers has shaped much of the preparation in specialized science and disability centers that theoretically and practically support modernized personalized assistance services across population groups (Litvak & Racino, 1999) and "behavioral health care managed "as part of" mental health services.

Long-term service and support laws (LTSS) are developed, as are community services and personnel, to meet the needs of "individuals with disabilities" submitted to state governments, and in many cases are required to report regularly on the development of community-based systems. These LTSS options initially provide categorical services such as housing and vocational rehabilitation and habilitation, family care or adoptive family care, small medium-sized facilities, "group homes", and then support work, clinics, family support, supportive lives, and day services (Smith & Racino, 1988 for the US government). The original state departments are Intellectual and Developmental Disabilities, the Office of Mental Health, the main appointments in the Department of Health in brain injury to the community, and later, Alcohol Abuse and Substance Abuse.

Among government and Executive initiatives is the development of an internationally supportive life, a new model in housing that supports (or even more sophisticated housing and health), and creative plans that absorb the literature on independent living, user-driven categories (approved by the Center US for Medicaid and Medicare), expansion of home services and family support, and assisting living facilities for aging groups. This service often undergoes revolutions in payment schemes that begin with a system for payment of valuable community options (Smith & Alderman, 1987). then called evidence-based practice.

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Need for long-term care

Life expectancy is increasing in most countries, which means more people are living longer and entering an age when they may need treatment. Meanwhile, the birth rate generally declines. Globally, 70 percent of all older people now live in low- or middle-income countries. Countries and health care systems need to find innovative and sustainable ways to address demographic shifts. As reported by John Beard, director of the Department of Aging and Life of Life World Health Organization, "With rapid population aging, finding the right model for long-term care becomes more and more urgent."

Demographic shifts are also accompanied by changes in social patterns, including smaller families, different patterns of living, and increased participation of female workers. These factors often contribute to an increase in the need for paid care.

In many countries, the largest percentage of elderly people in need of LTC services still rely on informal home care, or services provided by unpaid nannies (usually non-professional family members, friends or other volunteers). Estimates of OECD numbers are often in the range of 80 to 90 percent; for example, in Austria, 80 percent of all older citizens. A similar figure for dependent elderly people in Spain is 82.2 percent.

The Medicare and Medicaid USA Service Center estimates that about 9 million American men and women over the age of 65 require long-term care in 2006, with the number expected to jump to 27 million by 2050. It is estimated that most will be treated. for at home; family and friends is the sole caregiver for 70 percent of the elderly. A study by the US Department of Health and Human Services said that four out of every ten people reaching the age of 65 would enter a nursing home at some point in their lives. About 10 percent of people entering nursing home will stay there five years or more.

Based on projected needs in long-term care (LTC), the 1980s demonstration version of US Nursing Homes Without Walls (Senator Lombardi of New York) for parents in the US is very popular, but limited: On LOK, PACE, Channeling, Section 222 housewife stairs, ACCESS Medicaid-Medicare, and new Social Day Care. The main argument for new services is cost savings based on institutional reductions. Demonstrations are significant in developing and integrating personal care, transportation, housekeeping/feeding, nursing/medical, emotional support, financial aid, and informal care. Weasart concludes that: "Increased life satisfaction appears to be a relatively consistent benefit of community care" and that the "prospective budget model" of long-term home-based and community-based care (LTC) uses "break-even costs" to prevent institutional treatment.

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Long-term care costs

A recent analysis shows that Americans spend $ 219.9 billion on long-term care services for the elderly in 2012. Home spending treatments spend the majority of long-term care spending, but the proportion of home-based and community-based care spending has increased over the past then. 25 years. The federal-state-local US government system has supported the creation of modern health care options, although new intergovernmental obstacles continue to exist.

The Medicaid and Medicare health care system in the US is relatively young, celebrating 50 years by 2015. According to the Health Care Financing Review (Fall 2000), its history includes a 1967 expansion to ensure primary and preventive services for children qualified Medikaid (EPSDT), home use and neglect of community-based Medicaid (later HCBS services), Clinton healthcare demonstration (under 1115 waiver authority), a new era of SCHIP to protect uninsured children and families, coverage for groups population of HIV/AIDS, and attention to the provision of ethnic and racial-based services (eg, beneficiaries). Then, a managed care plan that uses "intensive housing" options and non-traditional outpatient services (school-based services, partial hospital care, home care and case management) develops a "behavioral health care plan".

In 2012, the annual cost of home care care in the United States is $ 81,030 for a semi-private room. The average annual cost of assisted living is $ 42,600. Home health aides are paid an average of $ 12 per hour and housewives service an average of about $ 20 per hour. The average cost of a nursing home for a year is more than that of an ordinary family to retire in 401 (k) or IRA. In 2014, 26 countries have contracts with managed care organizations (MCO) to provide long-term care for elderly and disabled individuals. The states pay a monthly capitalization rate per member to a MCO that provides comprehensive care and accepts the risk of managing total costs.

When the percentage of elderly individuals in the population increases to nearly 14% by 2040 as predicted, large tensions will occur in nanny finances as well as ongoing care facilities and nursing homes as demand will increase dramatically. New choices for parents during the era of expansion of choice (eg, seniors assisting seniors, companions), which includes restrictions on doctor's choice, assisted living facilities, retirement communities with indicators of disability access, and new "aging in place" plans (eg , aged in a group home, or "moved" to home or support services with siblings after intellectual disability and parental development dies).

Politically, the 21st Century has shifted to cost-free family care (assessed by AARP in aging at $ 450 billion in 2009), and the government in the US was asked to "pay some of the bills or charges" for family care. members at home. This movement, partly based on feminist trends in the workplace, has intersected with other hospitals into the home, home health care and visiting nurses, user-directed services, and even home care treatments. The government's Medicaid program is considered the main payer of Long Term Services and Support (LTSS), according to the American Association of Retired Persons, Institute of Public Policy. New trends in family support and family care also affect a diverse population of disabilities, including very young children and young adults, and are expected to experience elevated elevations in Alzheimer's due to longevity over 85 years.

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Long-term care funding

Governments around the world have responded to the need for long-term care that continues to grow to different degrees and at different levels. This response by the government, partly based on a public policy research agenda on long-term care that includes special population research, flexible service models, and managed care models to control high costs and high levels of personal payments.

Europe

Most Western European countries have put in place mechanisms to finance formal care and, in a number of Northern and Continental European countries, arrangements exist for at least some of the informal care funds as well. Several countries have had open-ended funding arrangements in place over the years: the Netherlands adopted the Extraordinary Medical Cost Act (ABWZ) in 1967, and in 1988 Norway established a framework for paying cities to informal caregivers (in cases certain make them city employees). Other countries have just implemented a comprehensive national program: in 2004, for example, France established a special insurance fund for elderly people and in 2006 Portugal created a nationally funded public network for long-term care. Some countries (Spain and Italy in Southern Europe, Poland and Hungary in Central Europe) have not established a comprehensive national program, relying on informal caregivers combined with a mix of formal service mixes that vary in quality and by location.

In the 1980s, some Nordic countries began making payments to informal caregivers, with Norway and Denmark allowing relatives and neighbors who provide regular home care to become city employees, complete with regular retirement benefits. In Finland, informal caregivers receive fixed costs from municipalities as well as pension payments. In the 1990s, a number of countries with social health insurance (Austria in 1994, Germany in 1996, Luxembourg in 1999) began to provide cash payments to recipients, who could then use the funds to pay for informal caregivers.

In Germany, funding for long-term care is covered through a compulsory insurance scheme (or Pflegeversicherung ), with the contribution shared equally between the insured and their employer. This scheme covers the care needs of persons who as a result of illness or disability can not live independently for a period of at least six months. Most of the beneficiaries stayed at home (69%). The LTC funds in the country can also contribute to pensions if the informal caregivers work more than 14 hours per week.

The major reform initiatives in the health care system in Europe are based, in part on the expansion of demonstrations and user-directed service agreements in the US (for example, cash demonstrations and evaluations and counseling). Clare Ungerson, a Professor of Social Policy, together with Susan Yeandle, Professor of Sociology, reported Cash Demonstration for Treatment in Countries in Europe (Austria, France, Italy, The Netherlands, England, Germany) with comparative United States ("home care paradigm and society ").

In addition, direct payment schemes are developed and implemented in the UK, including in Scotland, for parents with disabled children and those with mental health problems. This is a "health care scheme" on commodification care compared to individual planning and direct funding in the US and Canada.

North America

Canada

In Canada, facility-based long-term care is not publicly insured under the Canadian Health Act in the same way as hospital and physician services. Funding for LTC facilities is regulated by provinces and regions, which vary across the country in terms of the range of services offered and the coverage of costs. In Canada, from 1 April 2013 to 31 March 2014, there are 1,519 long-term care facilities that hold 149,488 residents.

Canada-US has a long-term relationship as a neighboring border in health care; However Canada, similar to the UK (National Health Service), has a "socialized drug" system (eg, US, Bernie Sander's Proposal for Medicare for All during the US President's campaign). In the development of home and community-based services, individual services and support became popular in both countries. Canadian quotes from US projects include a cash assistance program in family support in the US, in the context of individual and family support services for children with significant needs. In contrast, US initiatives in health care during that period involved Medicaid abandonment authorities and health care demonstrations, and use of state demonstration funds separate from federal programs.

United States

Long-term care is usually funded using a combination of sources including but not limited to family members, Medicaid, long-term care insurance and Medicare. One is out-of-pocket expenditure, which often becomes exhausted when an individual needs more medical attention during the aging process and may require home-care or care in a nursing home. For many, out-of-pocket outlays for long-term care is a transitional state before it ultimately requires Medicaid coverage. Private savings can be difficult to manage and budget and often run out quickly. In addition to personal savings, individuals can also rely on individual Retirement accounts, Roth IRA, Pensions, Severance Packages or family member funds. This is basically a retirement package available to individuals once certain requirements are met.

In 2008, Medicaid and Medicare accounted for about 71% of national long-term care spending in the United States. Out-of-pocket expenditure accounts for 18% of national long-term care spending, private long-term care insurance accounts for 7%, and other organizations and agencies contribute the remaining costs. In addition, 67% of all nursing home residents use Medicaid as their primary payment source.

Private Long Term Care Insurance in 2017 pays more than $ 9.2 Billion in benefits and claims for this policy continue to grow. The biggest claim for one person is reported to be more than $ 2 million in benefits

Medicaid is one of the dominant players in the country's long-term care market because of the failure of private insurance and Medicare to pay for expensive long-term care services, such as nursing homes. For example, 34% of Medicaid was spent on long-term care services in 2002.

Medicaid operates as a distinct program involving home-based and community-based (Medicaid) designed for special population groups during the later deinstitutionalization to the community, direct medical services for individuals who meet low-income guidelines (held steadily with the Act of Health Act Acting Act new) facilities development programs (eg, midwife facilities for intellectual and developmental disability populations), and additional reimbursement for certain services or bedding at the facility (eg, over 63% of beds in nursing facilities). Medicaid also fund traditional home health services and pay for adult care. Currently, the US Centers for Medicaid and Medicare also have user-directed service options that were previously part of the gray market industry.

In the US, Medicaid is a government program that will pay for certain health care and nursing home care for the elderly (after their assets run out). In most states Medicaid also pays for some long-term care services at home and in the community. Eligibility and closed services vary from state to state. Most often, eligibility is based on personal income and resources. Individuals eligible for Medicaid are eligible for community services, such as home health, but the government does not adequately fund this option for parents who wish to remain in their homes after long aging illnesses in place, and Medicaid costs are mainly concentrated in care in nursing homes which is operated by the hospital-nursing industry in the US.

Generally, Medicare does not pay for long-term care. Medicare pays only for skilled medical care facilities or medical care at home. However, certain conditions must be met for Medicare to pay for even that type of treatment. Services should be ordered by a doctor and tend to be rehabilitative. Medicare will not specifically pay for custodial and non-skilled care. Medicare usually will only cover 100 days of skilled care after 3 days of admission to the hospital.

A 2006 study conducted by AARP found that most Americans are unaware of the costs associated with long-term care and exaggerating the number of government programs such as Medicare will pay. The US government plans for individuals to have treatment from the family, similar to the days of the Depression; however, AARP reports annually on Long Term service and support (LTSS) for aging in the US including home-delivered food (from the senior center site) and its defense for nursery payments to family caregivers.

Long-term care insurance protects individuals from the depletion of assets and includes various benefits with varying durations. This type of insurance is designed to protect policyholders from long-term care fees, and policies are determined using an "experience rating" and impose a higher premium for high-risk individuals who have a greater chance of becoming ill.

Currently there are a number of types of long term care insurance plans including eligible tax packages, partnership plans (providing additional dollar-for-dollar asset protection offered by most states), long-term care policies and hybrid plans (live or annuity policies with the driver to pay for long-term care).

Residents of LTC facilities may have certain legal rights, including the Red Cross ombudsman, depending on the location of the facility.

Unfortunately, government-funded assistance aimed at long-term care recipients is sometimes misused. The New York Times explains how some businesses that offer long-term care misuse the loopholes in the newly redesigned New York Medicaid program. The Government rejected progressive monitoring involving the requirements of continuing education, public service administration with quality of life indicators, evidence-based services, and leadership in the use of federal and state funds for the benefit of individuals and their families.

For those who are poor and elderly, long-term care becomes more challenging. Often, these people are categorized as "double eligibility" and they are eligible for Medicare and Medicaid. These people contributed 319.5 billion in health care spending in 2011.

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See also

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References

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External links

• California Partnership for Long-Term Care
• Long Term Medical Care Medical Association Canada Canadian-based medical nurse association in Long Term Care setting
• Cost of care calculator for UK residents
• American Association for Long Term Care Insurance

Source of the article : Wikipedia