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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INTRODUCTION
Long-term care is a policy issue that has ebbed and flowed in the eyes of policymakers and the public over the past three decades. As more and more of the American citizenry and their leaders face the dilemma of how to address the needs of chronically disabled elders, the issue has assumed a more human face. The mass media has highlighted the costs of long-term care and the need to plan far in advance for the potential need, the burden of long-term care on individuals, families and society, and concerns about quality of care. Despite this increasing attention, however, policymakers at the federal and state levels struggle to define their roles and the role of the private sector in financing and delivering care to the disabled elderly.
As we enter the 21st century, population aging–both an increase in the number and proportion of elderly in the United States– –and increased longevity among Americans reaching age 65, will significantly challenge policymakers to address the three-legged stool of long-term care policy: 1) how to and who should pay for long-term care coverage; 2) how to design and who should deliver services that best meet the needs of today's and tomorrow's disabled elderly population and their families; and 3) how to recruit, train and maintain a workforce to deliver the care.
The financing issue has received periodic attention by federal policymakers since the early 1970s. The potentially negative budget implications and the lack of political will, however, have impeded serious debate and resolution concerning viable public and private options for ensuring access to coverage for long-term care and how to achieve the "right" balance between the two sectors. With the exception of some federal demonstration initiatives, policy development related to the delivery of services has occurred primarily at the state and local levels. The availability and quality of the current and future long-term care labor force––both professional and paraprofessional––have received the least attention at all policy levels.
The purpose of this monograph is to describe the current status of the three dimensions of long-term care policy and to identify some of the major demographic and policy trends that will have a significant impact on the demand for and supply of long-term care in the future. It begins by defining long-term care, including the range of services and settings, the characteristics of populations that need long-term care, and the informal and formal care providers who comprise the long-term care workforce. This is followed by a review of the major issues related to the financing, delivery and workforce development in the long-term care arena. The third section identifies key trends and future projections that will help shape the long-term care landscape in the next century. The monograph concludes with a discussion of the implications of current and emerging trends for long-term care financing, delivery and workforce development.
While recognizing the importance of long-term care for people with disabilities of all ages, this monograph focuses on policy for those aged 65 and older–the group at highest risk for or currently in need of long-term care services. It is also important to note that while the boundaries between acute and long-term care have become significantly blurred over the last decade, this overview is not intended to address the wide range of issues related to the full continuum of services required by elders with chronic illness and disabilities. Consequently, an examination of such factors as the roles of managed care and integration of services is limited to the implications of these concepts and models for the development of long-term care policy and delivery systems. Finally, the goal of this monograph is not to make recommendations or provide prescriptions for an ideal system. Rather, it should be seen as a catalyst for further dialogue and debate among policymakers, providers and consumers at all governmental levels.
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