As we’ve read in the textbook, Long-Term Care Across the Continuum by John R. Pratt, the long term care system evolved over a period of time before it came to be what it is now. Up until recently, most families took care of their own members and there was no demand for institutions to provide this service for them. As the times have changed, so has the need for more formal caregivers. Today, the long-term care system is composed of many different levels of care from skilled nursing facilities, and assisted living facilities to home healthcare agencies, and adult day care centers. The long-term care system today, as we know it, consists of many different strengths and weaknesses. Before we could look to improve it at any time in the future, it is important for us to recognize both the strengths and the weaknesses.
The first strength to recognize is that as much as society and the world have changed in the last few years, the long-term care has continued to find ways to meet the needs of its consumers. For example, not only are there skilled nursing facilities, but within them, there are specialized units to meet the needs of its residents such as those with Alzheimer’s, Parkinson’s, and other forms of dementia. When I was in high school, I was fortunate enough to spend some time in the Alzheimer's unit. Within the unit, the resident's received more specialized care and had a better provider to patient ratio.
Another strength, is the development of more innovative types of care including “aging in place”, multi-level facilities, and adult day care centers (Pratt 25-26). For example, “aging in place” is designed to allow residents’ changing needs be met at the same facility. Although the system is not perfect, it still allows residents to receive the care they need in a setting that is both comfortable and safe. Multi-level facilities incorporate many different levels of long term care such as skilled/ non-skilled nursing facilities, assisted living facilities, and other independent or supported lifestyles all in one localized area (Pratt 25-26). This allows residents to move throughout the different levels of the facility as their needs change throughout time. Adult day care centers allow families to take a break by offering a daytime facility for those with long-term needs.
I think the adult day care center is a great idea. Some of the clients that came to the adult day care center that I volunteered at in high school rode a bus over from the nursing home just to spend the day and become involved in more activities that were provided by the day care center. Most residents were the elderly; however some were younger adults who had suffered from head trauma or chronic illnesses. The center was open from 6:00 am- 5:00 pm. Clients were provided breakfast and lunch, as well as 2 other snacks throughout the day. Activities included puzzles, singing, dancing, and crafts. Sometimes, service dogs were brought in to visit with the clients. Informal caregivers were relieved to have a service that could provide the care and allow them to take a break for certain hours of the day.
One of the most important strengths of today’s long-term care system is the effort to become a more integrated health system (Pratt 25-26). The long-term care system provides a holistic level of care to not only meet the medical needs of its residents, but also the spiritual and social needs as well. It offers a vast array of services including support with activities of daily living, feeding, exercise and socialization, medical care with chronic illnesses, nurses, volunteers, and more. Most facilities these days have physical therapists, occupational therapists, transportation, foot doctors and other kinds of specialized services that allow residents to receive care in a localized area. Facilities also may include a series of services in the same place such as assisted living, skilled nursing facility, and a home health care agency.
Although there are many strengths that surround our long-term care system today, there are also a few weaknesses that should be brought to our attention. The main one being the fact that our system is still driven by reimbursements (Pratt 25-26). Most services provided are those that will be reimbursed and it is hard to find services for which there is no reimbursement. The care that many residents receive and where that care is received is sometimes based off third-party payers and not what is best for the residents themselves. To improve the long-term care system, it is important to make decisions based on what is best for the consumers and allowing consumers to decide themselves what is best for them. I think this concept is a bigger problem for those that are on public insurance like Medicare and Medicaid. Patients on certain insurances are sometimes limited to who they can see and what services they can receive. For example, those who use MCO's are given a list of doctors that they can see. To receive coverage, they must go to the doctors used by that MCO. If they use a different doctor, they may receive less coverage or none at all. I think in the future, it will become more and more important for the system to become more consumer-driven.
Another weakness is that the system has a poor reputation. Most have acquired the reputation of being “a place someone goes to die” or “a place to get rid” of someone (Pratt 30). I must admit, I also have the same notion towards nursing homes. Through some of my own experience in both nursing homes and adult day care centers, I’ve seen residents receive inadequate care on occasion and would think twice about placing a family member of mine in a home. To fix the reputation that the LTC system has, I think that facilities should hire more qualified staff or implement programs that provide continuing education on patient’s rights and quality of care.
Finally, because the system is unequal, fragmented, and often uncoordinated, it is not exactly known as a “user friendly” system. Although I have seen the system from an inside point of view, I know nothing about how to understand it from a consumer’s point of view. This could be in part because we never hear much positive things about the system in the media and the lack of information out there.
I do believe that there are many positive aspects about long-term care. It takes a special person to become a long-term care provider. To become a better system, not only for long-term care, but also the health care system as a whole, I believe that it should be more consumer-driven. People should have access to all the information regarding the types of care and should be able to make decision for the benefit of them. After having some experience in both the adult day care level and skilled nursing facilities, I have seen some of the strengths and weaknesses surrounding the system. I believe in the future and with time, the long-term care system will eventually grow to become a more “user friendly” and consumer oriented system and will gain a more positive reputation within society.
Pratt, John R. Long-Term Care Managing Across the Continuum. Third. Sudbury, MA: Jones and Bartlett Publishers, 2010. 24-30. Print.
