Writing: Services

Chapter 3 Toward an Ideal System

Learning Objectives

1. Identify the characteristics of an ideal long-term care system

2. Describe what it means for the long-term care system to be consumer-driven

3. Identify the roles of formal and informal caregivers

Learning Objectives (continued)

4. Define the components of a full and uniform assessment of a consumer's service needs

5. Discuss the need for incentives for providers and consumers

The Criteria for Designing or Evaluating a Long-Term Care System

What are they? How were they developed? How are they used?

Criterion I. The long-term care system should be based on recognition of the needs, rights, and responsibilities of individuals.

It should: A. Be consumer driven B. Meet all of the needs of the consumers C. Focus on the individual, recognizing that

individuals have unique needs D. Respect different cultures and cultural

values

Criterion I (continued)

It should: E. Promote quality, dignity, and self-

improvement for consumers F. Balance consumer rights and

responsibilities G. Offer consumers a choice of service

providers and service delivery modalities

Criterion II. The long-term care system should be easily accessible.

It should:

A. Be universally accessible

B. Be user friendly

C. Provide care in the least restrictive environment

D. Encourage single-site care availability

Criterion III. The long-term care system should coordinate professional, consumer, family, and other informal caregiver resources.

It should: A. Integrate professional, community, family,

and other informal caregiver efforts B. Evolve from the current medical model to

a holistic model of service delivery C. Involve families in case management and

care delivery

Criterion IV. The long-term care system should be an integral part of the health and social system to promote integration, efficiency, and cost-effectiveness.

It should: A. Include a full continuum of services B. Include a full and uniform assessment

(initial and ongoing) of the consumer's needs.

Criterion IV. (continued)

It should: C. Provide emphasis on, and reimbursement

for, illness prevention efforts as an integral part of the overall system

D. Be planned and coordinated to reduce fragmentation and inefficiencies

E. Be based on outcome-oriented accountability

Criterion V. The long-term care system should be adequately and fairly financed.

It should: A. Utilize public and consumer resources

to ensure universal access to services B. Provide incentives for consumers to

use services in an appropriate and cost-effective manner

C. Provide incentives for consumers to self-finance their care

Criterion V. (continued)

It should: D. Avoid causing impoverishment of consumers

and families E. Provide incentives for providers to develop

cost-effective measures F. Develop payment mechanisms that allow

efficient providers to adequately compensate staff and to allow for appropriate operating surplus and/or return on investment

Criterion V. (continued..)

It should:

G. Operate within the limits of a well- conceived budget

H. Provide significant flexibility to enable consumers to meet long-term care needs as each consumer defines those needs

I. Be based on uniform financial eligibility criteria

Criterion VI. The long-term care system should include an education component to create informed consumers, providers, reimbursers, and regulators.

It should:

A. Include community education

B. Include education for providers

C. Educate young, healthy persons to better prepare them to cope with chronic illness

Summary

The Criteria provide a basis for evaluating the current long-term care system and for developing an ideal long-term care system.