Long-Term Care

In the United States today, we are at a demographic threshold. Not only are people generally living longer, but the members of the baby boom generation -- a population cohort of 78 million people born between 1946 and 1964 -- are approaching the age of 60. As a result, our country's elderly population will increase substantially in the coming years, putting a serious strain on employer-sponsored retirement plans, the Social Security system, the healthcare delivery system, the Medicare program, and other services and programs for the aged.


But the needs of the elderly are not limited to retirement income and medical care. As people age they become more likely to develop a chronic condition that prevents them from functioning normally -- they may not be able to move about easily or dress or feed themselves, or they may suffer from disorientation or impaired memory. When such a loss in physical or cognitive functioning occurs, a person needs long-term care-home healthcare, assisted living, nursing home care, or other services.


These services are expensive, and if they are needed for an extended time, the cost can be substantial. How can the average person pay for long-term care? And how can we as a society ensure that the need for long-term care is met without placing such a burden on government benefit programs that they become no longer viable? That is the focus of this course.


To fully understand long-term care funding, long-term care insurance, and state partnership programs, which will be discussed in the chapters that follow, we must first understand long-term care itself. What exactly is meant by long-term care? When is it needed? What services and settings does it include? And how much do these services cost?



What Is Long-Term Care?


Long-term care is a broad range of services provided over a prolonged period, the purpose of which is to minimize or compensate for a person's loss of physical or mental functioning resulting from an illness, disability, cognitive impairment (such as Alzheimer's disease), or simply the frailties of old age.


To understand long-term care, it is helpful to understand how it differs from acute care.


Acute care is medical treatment for an illness or injury. Its purpose is typically to cure the patient and restore previous levels of functioning. Acute care is provided by physicians, nurses, and other medical professionals, and it normally takes place in a hospital, clinic, or doctor's office. It typically lasts a relatively short time.


Long-term care, unlike acute care, is not primarily intended to cure or treat a medical condition. Instead, it focuses on coping with a person's reduced level of physical or cognitive functioning over an extended time, sometimes indefinitely. Some long-term care services are rendered by healthcare professionals, such as nurses and therapists, but it is more often provided by nonprofessional personnel, such as home health aides, or by informal caregivers, such as family and friends.


Coping with a person's reduced level of functioning can include medical treatment, skilled nursing care, and various kinds of therapy. But it more typically involves assisting a person with the following:


 basic functions, such as bathing, dressing, getting in and out of bed, going to the toilet, and eating (called activities of daily living, or ADLs -- see below);

 household chores, such as meal preparation and cleaning;

 life management, such as shopping, money management, and taking medications; and



Long-term care also often involves the supervision required by a person with a cognitive impairment so that he will not harm himself or others.



When Is Long-Term Care Needed?


Whether a person needs long-term care and what care she needs are determined by a healthcare professional, such as a physician, nurse, or medical social worker experienced in long-term care. An important part of the process is an assessment of the person's ability to perform activities of daily living (ADLs), basic functions required for a person to take care of herself. The inability to perform ADLs is the most reliable and objective indicator of the need for long-term care services. The following six ADLs are commonly used to assess this need:


 bathing -- washing oneself by sponge bath or in a tub or shower (including getting into and out of the rub or shower);

 dressing -- putting on and taking off all clothing and any necessary braces, fasteners, or artificial limbs;

 toileting -- getting to and from the toilet, getting on and off the toilet, and performing associated personal hygiene;

 transferring -- moving into or out of a bed, chair, or wheelchair;

 continence -- being able to maintain control of bowel and bladder function or, when unable to maintain control, being able to perform associated personal hygiene (including caring for catheter or colostomy bag); and

 eating -- feeding oneself by getting food into the body from a receptacle such as a plate, cup, or table, or by a feeding rube or intravenously.


The inability to perform ADLs constitutes functional (or physical) impairment. However, some people can perform all ADLs but still need long-term care because of a cognitive impairment, a condition (such as Alzheimer's disease) that causes a significant diminishment of reasoning, intellectual capacity, or memory and results in confusion, disorientation, impaired judgment, or memory loss.



Chapter 1 Contents



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