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Challenges and Solutions: Long-Term Care for the Disabled ElderlyTerm Paper

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Long-Term Care for the Disabled Elderly

The elderly population, as Lecovich (2014) points out, is rapidly increasing; and this is not only an American problem -- it is a global phenomenon. In the words of the author, "ageing is connected with increased chronic morbidity and functional disabilities" (Lecovich, 2014, p. 21). According to the Robert Wood Johnson Foundation (2014), as the population ages, there will be an explosion in the demand for long-term care services. The all important question in this case remains, "who will pay for these services and how will they be delivered?" (Robert Wood Johnson Foundation, 2014).

Long-term care, particularly for the disabled, is an issue of concern for most governments from across the world. Sometimes in 2003, the Commission on Long-term Care gave its recommendations to congress on the steps, both administrative as well as legislative, that ought to be embraced in an attempt to not only promote but also advance the financing as well as establishment of a system of long-term care services that guarantees the access to such services amongst individuals who require them. In the end, the commission came up with 28 proposals. The commission pointed out that if nothing was done, the long-term care crisis the U.S. currently faces was likely to worsen (Commission on Long-term Care, 2013).

It should be noted, from the very onset, that the number of Americans aged 65 and over is increasing rapidly, and as Stone (2000) points out, Americans within this bracket are living longer; and the dilemma of how to meet their needs, and the increased risk of age-related chronic disabilities remains a headache for health administrators. The Census Bureau estimates that by 2040, the number of elderly persons in need of long-term care will be 20.9 million, up from 8.3 million in 2010. As the Baby Boomer generation continues to age, the media has focused on highlighting the concerns surrounding the quality and cost of long-term care, the burden imposed on society, families, and individuals, and the need to plan and prepare appropriately for the same (DIANE Publishing Co., 1994).

What is being Done?

For the most part, policy makers seem unsure of how to approach the issue of long-term care financing. This is one of the key issues that the Commission on Long-term Care sought to analyze and address. Stone (2001) floats three questions that should get all those concerned about long-term care financing concerned. These are: who should bear the financial burden for long -- term care? How should services meant for the disabled elderly be structured or designed? Who should deliver these services, and how should they be hired, trained, and retained? According to data from the Congressional Budget Office and the national Long-term Care Survey, spending on long-term care is likely to increase by an estimated 2.5 percentile points (on an annual basis) between the years 2000 through 20140 (Stone, 2000). What solutions are there for both the Federal and State governments? Already quite a number of states are concerned that Medicaid costs are escalating at a rate that cannot be sustained in the long-term. In response, some of the said states, like Tennessee, are requiring their frailest as well as costliest patients to embrace managed care plans (Gilewitz, 2011). This, according to the author, is a move that has sparked protests from, amongst others, the nursing home industry. Under this arrangement, "states pay health insurers a fixed monthly fee for each Medicaid patient" (Gilewitz, 2011).

The Solutions

One of the problems the Commission on Long-term Care identified with the long-term services and support system - LTSS currently in place was that most of the care is provided by family caregivers (Commission on Long-term Care, 2013). According to Bookman and Kimbrel (2011, p. 117), "families -- particularly women -- have always been critical in providing elder care, but the entry of so many women into the paid labor force has made elder care increasingly difficult." The issue here is that the availability of family caregivers is likely to decline going forward -- as the population continues to age.

Yet another issue identified by the Commission was the fact that most Americans are not prepared for the costs associated with paid LTSS, which could, as a matter of fact, be rather costly for most (Commission on Long-term Care, 2013). Further, as the Commission observed, in addition to being fragmented, paid long-term services and support are difficult to access for most. The hardest hit families, as far as paying for elder care services, according to Bookman and Kimbrel (2011, p. 121), are "the working poor and those with moderate incomes, who are too 'rich' to qualify for subsidized services but unable to pay for care themselves."

Recommendations by the Commission on Long-term Care

It is for this reason that I support the three-pronged vision statement endorsed by the Commission on Long-term Care. This is particularly the case given that the said statement, in no uncertain terms, promotes an LTSS system that is not only financially sustainable but also more integrated. I am also in agreement that there is need for a variety of financing options. This will help ease the cost burden amongst those who end up making use of LTSS, particularly those whose incomes are low. It is, however, important to note that, from my reading of the report, the Commission couldn't come up with an agreement on one sure way of paying for long-term care services required by the disabled elderly. The two proposals floated by the Commission, in summation, were: some form of a private insurance option, or government insurance program (Commission on Long-term Care, 2013).

It should be noted that at the moment, middle class families have to bear the costly burden of long-term care, with those who get significant assistance from the government being those who not only qualify for Medicaid but are also impoverished. As it has been pointed out in the report, "the incentives to purchase private long-term care insurance are small…" (Commission on Long-term Care, 2013). I also doubt that the private market will supply a lasting solution, as far as insurance is concerned, where public insurance programs may not work. This is particularly the case given that in the past, private long-term care premiums have been on an upward trend.

In my opinion, one of the best approaches in seeking to ensure that the private insurance model works, financially speaking that is, would be to ensure that risk is spread over a significant policy-holder base. It is, however, highly unlikely that policies, given the high cost of long-term care coverage, would be purchased -- particularly by those who consider themselves healthy. What, therefore, is the likely solution to this scenario? Going back to the Commission on Long-term Care recommendations, it was proposed that a White House conference be convened to address or take into consideration the policies relating to long-term care -- with an advisory committee being established to advance the work of the committee. I doubt this will offer any long-term solutions. This is particularly the case given that it would be inappropriate to set apart the systems advancing care to the disabled elderly. In my opinion, the need to integrate long-term care with the entire healthcare delivery system and Medicaid cannot be overstated.

The Need for Stakeholders to Work Together

There is need for closer working relationships to be forged between the six key stakeholders in the eldercare sector. Bookman and Kimbrel (2011, p. 118) identify these stakeholder groups as "health care providers, nongovernmental community-based service agencies, employers, government, families, and elders themselves." It is important to note that as Bookman and Kimbrel (2011) further point out, the groups are often disjointed and work at cross-purposes. In my opinion, the financing for long-term care is a multi-stakeholder challenge. It is already clear that neither state provisions nor out-of-pocket payments by family members can cover the high cost of care in this case. It is for this reason that I recommend a multi-stakeholder approach.

Such an approach, in my opinion, ought to bring together insurers, care providers, healthcare facilities, the government, as well as the consumers themselves to make recommendations to long-term care solutions that are not only effective but also sustainable from a financial perspective. An example that would be appropriate in this case is that of employers playing an active role towards the creation of awareness on LTC related issues, private insurers investing in care services as well as infrastructure, the government providing the relevant tax incentives, etc. In the Netherlands, the government, as Mor, Leone and Maresso (2014), point out bears full responsibility for the country's long-term care system. In the recent past, however, there has been "a growing trend to give patients much more important role in healthcare" (Mor, Leone and Maresso, 2014, p. 218). The U.S. should try out this model. Of key importance would be to recognize that every stakeholder is critical on this front. For instance, hospitals, as Pratt (2010, p. 217) points out "have… [END OF PREVIEW]

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