Long-Term Care for the Disabled Elderly: Current Policy, Emerging Trends and Implications for the 21st Century
By Robyn I. Stone, DrPH
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CONCLUSION
 

While there is no clear recipe for balancing public and private financing options, several elements are essential to the design and implementation of a future long-term care system. First, the system should address the long-term care needs of people of all ages, recognizing that services and other accommodations must be tailored to people with varying degrees of physical and mental impairment. Second, the long-term care system must be sensitive to the needs of the family as well as the person with long-term care needs. Although formal care should not, and probably will never, replace the efforts of family and friends, the repertoire of services should build the family into the process and ensure that the family is supported.

The future long-term care system should also recognize the wide array of options potentially available to meet the residential and care needs of the individual and that these needs do not necessarily increase in a linear fashion. The system must be flexible enough to address the acute, chronic and non-medical social needs (e.g., housekeeping, transportation) of the long-term care client that may fluctuate over time. Those who prefer more self-direction should have that option, although it is important that they recognize the tradeoffs involved in managing their own risk, including the possibility that their health and safety could be jeopardized.

In the ideal world, the dollars, whether public or private, would follow the person, rather than the provider. Individuals and their families would have the ability to make choices that include their preferences and values, within the financial constraints set by public programs and their private resources. Such a system, of course, would require major restructuring of our current public programs so that funding streams (e.g., Medicare, Medicaid, state funds) become truly seamless. While not essential, it would also be beneficial for individuals, their families and other surrogate decision-makers to have access to care managers or intermediaries who could assist the long-term care client in navigating the system and making the best choices.

Whether we like it or not, long-term care is coming of age and will be one of the major challenges of the 21st century. We can wait for the crisis to hit, or we can be proactive in developing financing, delivery, and training strategies that build on the lessons learned from the successes and failures of our own country and other nations, that strike the right balance between public and private resources and that recognize that the long-term care client and family must be in the driver's seat.

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Outline | I. Introduction | II. Defining Long-Term Health Care | III. The Three Legged Stool of Long-Term Care Policy
| IV. Trends in Long-Term Health Care Delivery | V. Workforce Issues | VI. The Future of Long-Term Care Demand | VII. The Future Supply of Long-Term Health Care Services
| VIII. Sinking or Swimming Into the Future? | IX. Conclusion | X. References | XI. Author