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Seeking an Effective Care Continuum
Learning Objectives
After reading this chapter, you should be able to:
• Identify programs that address the health issues surrounding workplace accidents.
• Assess the need for a continuum of care that comprises a comprehensive approach to health care for vulnerable populations.
• Identify the preventive care services available to vulnerable populations.
• Examine the treatment services available to vulnerable populations.
• Explain the options that vulnerable populations have for accessing long-term care.
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CHAPTER 4
Critical Thinking
OSHA provides many programs to ensure workers’ health and safety. Is there a similar program for health care elsewhere? If not, could OSHA be used as a model to create or redesign existing programs?
Introduction
Introduction
Workplace injuries, deaths, and work-related illnesses cost the United States approximately $693.5 billion a year (National Safety Council, 2009). The Occu-pational Safety and Health Administration (OSHA), established in 1970, ensures safe and healthy working conditions for men and women by setting standards and providing training, outreach, and education. In other words, OSHA focuses on the prevention of injuries by regulating the workplace.
In contrast, workers’ compensation programs, which are administered through the Department of Labor, help workers who have already sustained a work-related injury or an occupational disease. These programs focus on wage replacement, medical treatment, and rehabilitation services coverage. Employers pay into the workers’ compensation programs through companies that work to mitigate costs to insurance companies, called insurance underwriters, or government programs to help cover these expenses. Although paying into the national workers’ compensation program represents a significant expense for employers, lost employee productivity is more costly. To minimize workers’ compen- sation and lost productivity expenses, many employers have preventive workplace safety programs that include educational sessions on safety and even posters with images and safety messages to remind workers of best practices for safety. These preventive programs aim to minimize risks both to the workers and the employers. Some of these programs are available through OSHA, the national programs for workers’ compensation, or their company insurance or liability underwriter.
Workplace safety programs and workers’ compensation programs provide a continuum to address the health issues surrounding workplace accidents. From prevention to treat- ment to rehabilitation to return-to-work, workplace safety and workers’ compensation programs address the specific health care needs of America’s working population. This is one example of the way a continuum of care works and how programs can work together to create a continuum of care. Every population group can benefit from a strong contin- uum of care, but America’s most vulnerable populations often have particular needs that are best met with a quality care continuum. This chapter discusses the need for an effec- tive continuum of care and the existing programs that provide this type of continuum of care for America’s vulnerable populations.
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CHAPTER 4Section 4.1 The Need for an Effective Continuum of Care
Self-Check
Answer the following questions to the best of your ability.
1. According to the 2009 National Safety Council, what cost the United States approximately $693.5 billion?
a. DWI prosecution b. workplace injuries and illnesses c. health care fraud d. immigration services
2. Which types of programs help workers affected by workplace accidents? a. substance abuse counseling b. legal advice c. workers’ compensation d. financial planning
3. Employers pay into workers’ compensation programs through _____________, which work to mitigate costs to insurance companies.
a. insurance underwriters b. employees c. federal agencies d. undocumented immigrants
Answer Key
1. b 2. c 3. a
4.1 The Need for an Effective Continuum of Care
An effective continuum of care ensures access to preventive health services, treat-ment services, and long-term care services. These three types of health care do not function independently; rather, each is reinforced or weakened by the quality of the others, with treatment services in the central position. A solid continuum of care should be available throughout a person’s life.
There is a push in the American health care system to increase access and use of preven- tive care services, which are medically related and medically based services that focus on maintaining health. These services range from patient education on healthy lifestyle choices, to medical and commonsense aids to help patients make healthy choices. For example, smoking cessation programs offer preventive care in the form of education on the risks of smoking while enabling patients to quit through support groups and pharma- ceutical smoking cessation aids. Preventive care is vital for reducing the cost of health care in the nation, as it is less expensive than treatment and long-term care services. Maintain- ing physical health also improves quality of life and keeps people in the workforce.
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CHAPTER 4Section 4.1 The Need for an Effective Continuum of Care
Although physicians play an important role in prevention, preventive services in the United States more frequently come from community-based health services and resource develop- ment. Treatment services are delivered by physicians and the health care delivery system, which includes clinics, doctors’ offices, hospitals, and long-term care facilities. The goal of treat- ment services is to restore health to ailing individuals. Long-term care, on the other hand, focuses on the constant, ongoing health care needs of individuals. It is delivered through both commu- nity-based programs, such as Hospice, and institutional set- tings, such as nursing facilities and assisted living facilities.
In an effective care continuum, each type of care works in tandem with the others to maximize patient physical and psychological functions. Unfortunately, these programs are often systemically divided in a sort of “left hand doesn’t know what the right hand is doing” situation. For example, a woman might visit a gynecologist for annual preventive care but see a family practitioner when she gets sick. Unless they are located in the same office, the family practitioner does not have access to the patient’s records from the gyne- cologist’s office. In this way, the patient’s preventive medicine and treatment services lack communication between the two, so each is ignorant of what the other is doing. For the care continuum to be truly effective, prevention, treatment, and long-term care must be integrated and accessible.
Access to preventive services is subject to the limiting factors associated with most community-based health resources, among which funding ranks highest. Many community-based health resources are only partially funded by the legislature and rely heavily on private donations. Both funding sources diminish during economic down- turns, limiting what an agency is capable of providing. Similarly, financial constraints keep people from seeking medical attention when it is needed, and certainly there are many people with and without health insurance coverage who cannot afford to see a physician for preventive care. When community health resources cannot fill the gap, where are people to turn for health care?
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An effective continuum of care consists of three elements: access to preventive health services, treatment services, and long-term care services.
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CHAPTER 4Section 4.1 The Need for an Effective Continuum of Care
Self-Check
Answer the following questions to the best of your ability.
1. Where do preventive services in the United States frequently come from? a. long-term care facilities b. hospitals c. physicians d. community-based health services
2. Which of the following is a typical challenge for preventive services? a. need b. access to population c. costs d. effectiveness
3. Which of the following is a main advantage to building an effective care continuum?
a. reducing medical costs b. researching vaccination usefulness c. providing surgeries to newborns d. treating common illnesses
Answer Key
1. d 2. c 3. a
A Closer Look: Community Health Departments
Community Health Departments exist to help fill the need for accessible, affordable health care. Unfor- tunately, many people are unaware of the wide array of services offered at public clinics. Still others avoid them for fear of costly services; however, Community Health Departments provide services at significantly lower rates than many other options.
An effective care continuum reduces medical costs, allowing community-based services to serve more people. It also reduces the need for treatment and long-term care services by maintaining health rather than treating illness. Building an effective, integrated care continuum that will reduce vulnerability for those most at risk means considering the strengths and shortcomings of existing programs.
Critical Thinking
There are many benefits associated with preventive care services. Can you think of a disadvantage?
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CHAPTER 4Section 4.2 Health Maintenance Through Preventive Care Services
4.2 Health Maintenance Through Preventive Care Services
Vulnerability in the United States is rooted in poverty and social attitudes that deter-mine how resources are distributed among the population. These attitudes have changed dramatically in the last six decades, from being a top concern among the people and government to being marginalized and defunding programs that address vulnerability. America’s national poverty rate was 19% in 1964. President Lyndon B.
Johnson created the War on Pov- erty in response to the nation’s high poverty rate. The War on Poverty brought about the Eco- nomic Opportunity Act and the U.S. Office of Economic Oppor- tunity, which served to address the reasons for poverty in the country at that time.
Social attitudes about welfare programs began to change in the 1970s. America began a shift to a smaller federal role and decentralized government ser- vices by giving the states more power to administer social wel- fare programs. America began to rely more heavily on an econ- omy based on open competition among corporations with lim-
ited government regulation to address social needs. During the shift to an increasingly free market economy, the country experienced inflation and recession throughout the 1970s and 1980s. In doing so, programs such as the early childhood education program Head Start and Community/Migrant Health Centers, which provides health care access for low-income individuals, continue to lose funding, and, thereby, are increasingly lim- ited in the services they can offer.
The economy and unemployment rate improved during the 1990s. However, there was a considerable increase in the number of low-wage jobs during that decade. During this time, income-assistance programs continued to lose government funding and were increasingly disadvantaged in the face of inflation, or the loss of currency value. The savings and loan, economic housing, and technology bubbles widened the gap between groups of different income levels, or socioeconomic classes, and the free market failed to provide adequately for the vulnerable. When those economic bubbles burst under the presidency of George W. Bush in the early 2000s, the American middle class slipped further down the socioeco- nomic ladder. The Great Recession of 2008 caused millions of Americans to lose their jobs and their homes—and increased the strain on underfunded social welfare programs.
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As America shifted to a smaller federal role and decentralized government services in the 1970s, social attitudes about welfare programs began to change.
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CHAPTER 4Section 4.2 Health Maintenance Through Preventive Care Services
Clear evidence exists that public health issues are rooted in politics and economics. However, social attitudes about health care and the free market encourage a primary focus on microlevel, or personal, behaviors and environments. Experts on health care delivery have suggested that focusing on the microlevel is not enough to mitigate the negative health outcomes that come from socioeconomic disadvantage, but that changes must be made at the sociopolitical macrolevel, in all society, in order to address the lack of organization, quality management, and funding that plagues public health organiza- tions and initiatives.
Declining funding amounts for public prevention services and the sociopolitical attitudes that ignore the need for such services create additional strain on the private health care sec- tor. The private sector historically focuses on treatment and often leaves health education and prevention to the public sector. In fact, a 2011 study published in the Archives of Internal Medicine found that many primary care physicians are reluctant to broach the subject of weight with patients, although patients are more likely to show motivation to lose weight when their doctors bring it up (Post et al., 2011). Additional problems with private sector, treatment-based health care include financial and organizational barriers that affect vulner- able groups in particular, leaving an unfulfilled need for preventive health education and services in the gap between the public and private sector access venues.
Vulnerable Mothers and Children
Preventive services are fundamen- tal for the healthy development of children. Prenatal care focuses on prevention services to sup- port healthy pregnancy and birth outcomes. Many government- funded programs support high- risk women and children through pregnancy and the early years of child-rearing (see Table 4.1).
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Title X of the Public Health Service Act focuses on providing health care and prevention services access to high-risk women and children.
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CHAPTER 4Section 4.2 Health Maintenance Through Preventive Care Services
Table 4.1: Preventive services available to high-risk mothers and children
Program Pros Cons
Maternal and Child Health (MCH)
The Program for Children with Special Health Care Needs
Title X of the Public Health Service Act
Focus on providing health care and prevention services access to high-risk women and children.
Federal funding continues to diminish by way of budget cuts and inflation.
Special Supplemental Food Program for Women, Infants, and Children (WIC)
Food Stamp Program
Provide nutrition support services for qualifying families.
Federal funding is channeled through the states in block grants, which do not guarantee exact monies for specific programs. The Great Recession of 2008 increased dependence on these programs while funding from both the federal and state levels diminished.
Maternity and Infant Care Projects
Community and Migrant Health Centers
National Health Services Corp
Planned Parenthood
Provide access to physicians and nurse practitioner clinics for low- income individuals and families.
Social attitudes about family planning and abortion services plague these groups, diminishing political support and funding.
School-based behavioral risk education programs
Encourage healthy lifestyle habits and risk prevention regarding smoking, sexual activity, and healthy eating within the structure of the educational system.
Many of the teachers are not qualified to teach some special topics. Many parents opt their children out of special topic education programs such as sex education.
Prenatal care Allows for prevention services, screenings, and treatment services simultaneously. Prenatal care is provided in physicians’ offices, and the mother often has control over her physician selection.
Though many women have health insurance to help offset the costs of prenatal care, it is expensive. Many high-risk mothers lack health care coverage and depend on public programs for prenatal care, which diminishes their autonomy.
The Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program
Covers early childhood physician services, including immunizations and screening services for Medicaid recipients.
Approximately half of eligible children receive these services. Program funding is endangered by budget cuts, inflation, and increased need.
Head Start Provides health programs, preschool access, and social services to low-income preschool-age children.
Funding for this program is diminishing. Low enrollment numbers indicate a problem with accessibility.
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CHAPTER 4Section 4.2 Health Maintenance Through Preventive Care Services
Abused Individuals
Aggression is rooted in the human social structure, where power is gained by removing the competition and those with power are able to dominate those they view as inferior. Preventive services for abused individuals lie mainly in the realm of social programming. However, many health care providers work to prevent child abuse by providing support and information to new families (see Table 4.2).
Table 4.2: Preventive services available to abused individuals
Program Pros Cons
Public media campaigns Use media, including television, billboards, and radio, to reach a great number of people with reminders about available support networks and warnings such as “Never shake a baby.”
The programs they advertise are often viewed as inaccessible to low-income families. Social stigma and fear of child welfare services also compel parents to avoid seeking help for abusive habits.
Legal deterrence Seeks to protect abuse victims and to punish and rehabilitate offenders. Mandatory reporting laws require teachers and other public servants to immediately report suspected abuse. Legislation seeks to inhibit abuse by restricting access to weapons and decreasing response times to abuse reports.
Legal deterrence is often a reaction to abuse, rather than a prevention.
Social services Provide education and counseling on family planning, resource access, and abuse prevention. Home visits by social service professionals have been found to decrease the incidents of child and elder abuse both by being a deterrent and through supporting families.
Many people may see social services and home visits as an invasion of privacy. Funding continues to be an issue in the face of a growing workload.
Chronically Ill and Disabled Persons
Prevention of chronic illness and disability focuses on healthy lifestyle choices and safety (see Table 4.3). Educational programs like the Cooper Clayton method to stop smoking that is offered by many health departments throughout the United States teach people about the risks of smoking and provide support groups for those choosing to quit smok- ing (Cooper & Clayton, 2010). Prevention during prenatal care works to prevent complica- tions like gestational diabetes in pregnant women and fetal alcohol syndrome in babies.
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CHAPTER 4Section 4.2 Health Maintenance Through Preventive Care Services
Preventive care is also critical for those who are elderly and who already have chronic illnesses. Educational preventive care for elderly patients often focuses on fall prevention to address mobility limitations that come with age. Many chronic illnesses, like diabetes, increase the risk of further problems. Preventive programs for people with chronic illness often seek to educate patients on their individual care needs to make patients active partic- ipants in their health. Teaching diabetes patients how to properly care for their feet and to cut toenails straight across reduces the risk of losing a foot due to diabetes complications.
Table 4.3: Preventive services available to the chronically ill and disabled
Program Pros Cons
Education services Encourage healthy lifestyle habits and workplace safety through education and support services.
Because many education services are provided through physicians’ offices and membership-based health clubs, these services have restricted access.
Prenatal care Can detect health concerns early on. Prenatal care reduces the likelihood of negative pregnancy outcomes by helping to ensure healthy habits during pregnancy, thereby diminishing the chances of fetal alcohol syndrome, drug addiction, and physical disability.
Prenatal care educates the pregnant mother but often falls short of offering treatments for substance abuse, alcoholism, and cigarette use. Prenatal care is also expensive, and those who most need prenatal preventive services in order to grow healthy infants often do not receive early, regular prenatal care.
Health and injury prevention programs for the elderly
Focus on helping the elderly understand their changing health and safety needs.
Many elderly patients have little control over their environments. Unhealthy habits, such as cigarette use, are more difficult to change with age.
Persons Diagnosed With HIV/AIDS
Lifestyle choice education pro- grams that focus on sexual behavior and drug abuse are common HIV/AIDS prevention programs (see Table 4.4). Some of this preventive education is done through public media cam- paigns that include television commercials, billboards, radio messages, and print advertise- ments that act as reminders to be selective about sexual part- ners and to use protection in the
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Needle exchanges reduce needle sharing among intravenous drug users, thereby reducing the transmission of HIV.
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CHAPTER 4Section 4.2 Health Maintenance Through Preventive Care Services
form of condoms when engaging in a sexual relationship. Some HIV/AIDS prevention programs are taught in schools in an attempt to provide HIV/AIDS prevention to entire generations.
It is important to note that HIV is not only spread through sexual contact. Needle sharing among intravenous drug users continues to spread HIV and other diseases throughout vulnerable populations. Needle exchange programs, like Clean Needles Now (n.d.) in Los Angeles, California, provide clean needles for drug users. Although such programs do not necessarily work to prevent intravenous drug use, they do work to prevent the spread of disease. Needle exchange programs were banned from receiving federal funds for 20 years because many in society worried that such programs contributed to drug abuse. The ban was lifted by Congress in 2009 (Sharon, 2009). By allowing needle exchange pro- grams to receive federal funding, such programs can expand services to include drug abuse counseling and medical care.
Table 4.4: Preventive services available to people diagnosed with HIV/AIDS
Program Pros Cons
Public media campaigns Transmit prevention education to a large audience through television, radio, and billboard advertising.
Public media campaigns are expensive, and many of the advertised programs are viewed as inaccessible by low-income individuals.
Community programs The Centers for Disease Control and Prevention National Partnerships Program supports educational and HIV prevention programming through community-based organizations.
Community programs rely on community-based organizations such as schools and churches to educate the public, thereby creating issues of accessibility and programming differences.
Street outreach programs Go directly to the communities that most need HIV prevention education and support.
Street outreach programs are costly to run and often rely on private donors and volunteers through community-based organizations. These programs are rare in most regions.
Needle exchanges Reduce needle sharing among intravenous drug users, thereby reducing the transmission of HIV.
Social attitudes that view needle exchanges as enabling drug abuse restrict funding and access.
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CHAPTER 4Section 4.2 Health Maintenance Through Preventive Care Services
Persons Diagnosed With Mental Conditions
Preventive mental health services increased in popularity after the deinstitutionalization movement that began in the 1950s. The Community Mental Health Center Act of 1963 compelled states to fund community-based mental health programs. The act, combined with the development of more effective antipsychotic drugs, enabled patients to receive mental health care from early stages and to better manage symptoms like hallucinations experienced by people with schizophrenia, thus preventing the need for prolonged insti- tutionalization (see Table 4.5).
Table 4.5: Preventive services available to people diagnosed with mental conditions
Type of Program Pros Cons
Universal Targets the entire population. Includes programs such as prenatal and early childhood intervention programs and injury reduction programs.
These programs face funding challenges that restrict availability and accessibility.
Selective Targets groups identified as having a higher risk of developing mental health disorders. Includes substance and alcohol abuse prevention and intervention programs.
Lack of funding for community- based programs targeting specific low-income, high-risk groups restricts delivery.
Indicated Targets individuals identified as having a higher risk of developing mental health disorders. Includes evaluation, education, and therapeutic programming for individuals.
For an individual to be identified as having a higher risk of developing mental health disorders, that person must come in contact with the appropriate health care workers and community program organizers.
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CHAPTER 4Section 4.2 Health Maintenance Through Preventive Care Services
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Recent studies indicate low-income areas experience higher rates of homicide, partly due to inadequate living conditions and poor educational opportunities.
Suicide- and Homicide- Liable Persons
Violence is linked to systemic poverty. Low-income areas expe- rience higher homicide rates than middle- and upper-class neighborhoods. The frustrations of poverty, including a limited ability to positively affect one’s social status, poor educational opportunities, hunger, and inad- equate living conditions all con- tribute to increased homicide and suicide rates, particularly among young adult males. Sui- cide and homicide prevention programs tend to focus on indi- viduals rather than address the social issues that create an envi- ronment that exacerbates vio- lence (see Table 4.6).
Table 4.6: Preventive services available to suicide- and homicide-liable persons
Program Pros Cons
Legal deterrence Punishes offenders and attempts to limit violence with the threat of punishment.
Legal deterrence is more reactive than proactive; research indicates that legal deterrence is ineffective at limiting violence.
Family living education programs Focus on education to support families, reduce unplanned pregnancies, and teach problem- solving skills.
Accessibility to these programs is limited, and willingness to participate is low.
Suicide prevention programs Identify high-risk individuals and provide therapy and support for both the individuals and their families.
Functional screening tools and training for those in a position to recognize the warning signs (such as teachers, social service workers, and nursing home administrators) is fundamental for suicide prevention programs to work.
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CHAPTER 4Section 4.2 Health Maintenance Through Preventive Care Services
Persons Affected by Alcohol and Substance Abuse
Laws limiting access to drugs and alcohol often emerge from a moral stance that the use of drugs and alcohol is morally objectionable. However, access-limiting laws may reduce social risks by helping to limit the number of drug and alcohol users in the general popu- lation. Preventive services that focus on risky behaviors educate people on the risks of alcohol and drug abuse. Services that seek to reduce drug and alcohol use in individuals assume a disease-oriented attitude, that addiction is a treatable medical condition (see Table 4.7).
Table 4.7: Preventive services available to people affected by alcohol and substance abuse
Program Pros Cons
Legal deterrence Limits access to illicit drugs and alcohol by intercepting disbursement and punishing offenders.
People who are addicted to drugs will find a way to get them; criminalizing drugs may cause increased antisocial behaviors. Studies have found that legal deterrence is ineffective as a means to stop drug and alcohol abuse.
Screening and counseling programs
Identify high-risk individuals and provide counseling and education of life skills and drug and alcohol avoidance.
For individuals to be identified for screening and counseling services, they must come in contact with workers who are trained to recognize risk factors.
Public education programs Include media campaigns educating the public on substance abuse avoidance and available programs. These programs also include school- based curriculum and special programming to educate children early on about the risks of alcohol and drug use.
Funding can be difficult to maintain; the programs advertised by media campaigns may be viewed as inaccessible by some of the most at-risk groups.
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CHAPTER 4Section 4.2 Health Maintenance Through Preventive Care Services
Indigent and Homeless Persons
Preventing homelessness involves changing social attitudes about helping indigent peo- ple and providing affordable housing and other social welfare programs (see Table 4.8).
Support for government-funded housing has dwindled, leaving community-based programs to fill many needs. Although some community-based programs do provide housing, there are a great many that provide what they can in terms of food and clothing. Some even provide access to health care.
Preventive health care for home- less people focuses on providing preventive primary care, such as gynecological exams for women, as well as on health-related risk factors that homeless and indigent people are particularly susceptible to. Vaccination clinics for this vul- nerable population work to pre- vent illness and the spread of dis-
ease by providing preventive care in the form of vaccines against common ailments such as flu and pneumonia.
Table 4.8: Preventive services available to indigent persons
Program Pros Cons
Government-funded housing Provides three types of housing to fit individuals’ needs: emergency housing, low-income housing, and supportive housing.
Negative social attitudes about welfare programs have allowed funding to diminish for government-supported housing programs.
Health care programs Focus on health-related risk factors that indigent people are particularly vulnerable to, including gynecological care and family planning, substance abuse and mental health counseling, and HIV prevention.
These programs are more reactive to the needs of the homeless and only marginally useful for improving an individual’s living situation.
Community-based programs Provide meals and clothing for indigent people, help individuals find employment, and access programs to help them reclaim a reasonable standard of living.
There is little government funding support for many privately run community-based programs, so these programs are forced to rely on donors from surrounding areas.
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Community-based programs provide meals and clothing for indigent people.
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CHAPTER 4Section 4.2 Health Maintenance Through Preventive Care Services
Critical Thinking
“Social attitudes about health care and the free market encourage a primary focus on microlevel behav- iors and environments.” How does this statement relate to the American belief in “freedom of choice” and how it affects health care?
Immigrants and Refugees
Many refugees have little or no health care in their native countries; thus, they are drawn to the United States for its robust health care system. Once here, many immigrants face the hard reality that America’s health care system is inaccessible and unaffordable for many. Government health services are available to help meet the needs of immigrants, but many barriers exist to gaining access to such services, as we will see in later chapters. As a pro- tective measure, the government does ensure that documented refugees undergo health screening before being approved to come into the country. However, undocumented migrants are not subject to these health screenings (see Table 4.9).
Table 4.9: Preventive services available to immigrants and refugees
Program Pros Cons
Public health services Provide basic health care and health education services to low- income populations.
A myriad of unconnected agencies exist, including government-funded public health departments and private, nonprofit agencies like Planned Parenthood. This subset of the health care system is disjointed and can be difficult to navigate, especially for those who are not fluent in English. Undocumented immigrants often avoid these programs for fear of deportation.
Private health services Include traditional health services from physicians, hospitals, and other “traditional” health care providers.
Private health services are expensive and inaccessibly so for people without health insurance.
Self-Check
Answer the following questions to the best of your ability.
1. Prenatal care, which supports healthy pregnancy and birth outcomes, can be considered which type of service?
a. educational b. preventive c. child placement d. nutritional
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CHAPTER 4Section 4.3 Reclaiming Health Through Treatment Services
2. Suicide- and homicide-prevention programs tend to focus on individuals rather than address which types of issues?
a. mental b. hunger c. social d. medical
3. What reality concerning the United States health care system do many immi- grants face?
a. Health care is expensive and inaccessible for many. b. Immigrants do not receive health care. c. Only immigrants from select areas receive health care. d. Only natural-born U.S. citizens receive advanced health care.
Answer Key
1. b 2. c 3. a
4.3 Reclaiming Health Through Treatment Services
The U.S. health care system is one of the most technology-oriented health care sys-tems on the planet. This is partially driven by the free market mentality that rules America’s economy, which encourages innovations in new technology. As such, the health care system is geared not toward preventive medicine but toward treating ailments. In doing so, health care providers are able to show results that can be billed for. The same advanced technologies that improve treatment also drive up the cost of care.
Problems arise when patients present with physical, social, and psychological symptoms that their treating physicians are not versed in. The American health care system is not well integrated between delivery channels and providers. A general practitioner might miss signs of psychological trouble due to lack of knowledge of that particular type of illness. Additionally, physicians often seek a quick fix (such as inexpensive antibiotics for a sinus infection) and fail to recognize the psychosocial elements of a patient’s life that contribute to risk factors for the illness that occurs (such as a child living in a home with cigarette users). If that child is part of a vulnerable population, such as an abusive family, it is likely that the child will suffer recurrence of the presented illness until the root cause is addressed. If the physician only bothers writing a prescription and sends the family on their way, the child’s health care needs are not appropriately met.
As such, a problem arises regarding patient wellness. For a low-income family, a child with recurring pneumonia might lead to lost income, making it increasingly difficult to afford the child’s medical care. Preventive services mitigate this type of situation by reducing risky behaviors that contribute to illness. Much of America’s health care system is based on the free market and run by privately held companies. These health care cor- porations focus on treatment because treatment uses more advanced technology and is therefore billed at higher rates than preventive care. The free market focus on treatment makes health care and wellness increasingly inaccessible to vulnerable people.
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CHAPTER 4Section 4.3 Reclaiming Health Through Treatment Services
Vulnerable Mothers and Children
Treatment services for high-risk mothers and babies focus on prenatal care for the mother and postnatal care for the infant (see Table 4.10). Substance abuse cessation programs that help pregnant women to stop using drugs, alcohol, and tobacco help minimize risks to both mother and baby and limit the need for neonatal intensive care treat- ments. For those infants who are born with congenital heart or lung disorders, fetal alcohol syndrome, drug addiction, or other life-threatening complica- tions, expensive treatments are available in neonatal intensive care units.
Table 4.10: Treatment services available to high-risk mothers and children
Program Pros Cons
Substance abuse cessation programs
Help get pregnant women to stop using drugs, alcohol, and tobacco.
Accessibility to these programs is limited by access to prenatal care.
Neonatal intensive care units Treat infants for a range of problems, including fetal alcohol syndrome and drug addiction.
Neonatal intensive care units are expensive to provide, and do not prevent poor outcomes, only address them.
Abused Individuals
Treatment services for abused individuals focus on emergency response, counseling, and legal ramifications for offenders (see Table 4.11). When injuries occur due to abuse, emer- gency medical services (EMS) and police are often called to the scene. Other times, the victims seek treatment at emergency rooms and outpatient medical clinics. It is common for victims of abuse to avoid medical services altogether for fear of legal intervention. When treatment is sought, it usually focuses on treating injuries and providing counseling services for both victims and offenders.
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Substance abuse cessation programs can help pregnant women stop using harmful substances and also lessen the need for intensive care treatments.
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CHAPTER 4Section 4.3 Reclaiming Health Through Treatment Services
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Emergency rooms allow for fast medical intervention for injuries and can limit the likelihood of an injury causing long- term disability.
Table 4.11: Treatment services available to abused individuals
Program Pros Cons
Emergency and outpatient medical services
Treat injuries caused by abuse and screen for abusive situations.
Many abuse victims avoid medical services for fear of intervention.
Crisis response services and hotlines
Provide emergency counseling and physical protection in the form of police, EMS, and social service responders.
These services are nonexistent in many areas; training and maintaining personnel is costly.
Mental health services Treat both the victims and offenders. These services focus on changing behaviors.
Victims and offenders must be active, willing participants.
Chronically Ill and Disabled Persons
Treatment for chronic illness focuses on symptom relief and disease management. Disability treatment involves rehabilita- tion and educating patients on relevant life skills so they can live the fullest lives possible while dealing with their disabil- ities (see Table 4.12).
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CHAPTER 4Section 4.3 Reclaiming Health Through Treatment Services
Table 4.12: Treatment services available to the chronically ill and disabled
Program Pros Cons
Care management services (managed care organizations [MCOs])
Coordinate medical care for chronically ill and disabled patients between the many facets of their health care needs, from pharmaceutical management, to treatments, to rehabilitation.
The absence of electronic health records makes it difficult for patients to manage and coordinate their own care between primary care physicians and any specialists the patient sees, so third-party care management services are often necessary.
Hospital care Emergency rooms allow for fast medical intervention for injuries and can limit the likelihood of an injury causing long-term disability.
Emergency rooms are expensive and are short-term care.
Rehabilitation programs Help patients learn to live with chronic illness and disability.
These programs can be expensive, which limits access.
Persons Diagnosed With HIV/AIDS
HIV symptoms can be reasonably well managed with antiretroviral drugs that suppress the human immunodeficiency virus (HIV). However, these life-prolonging therapies are expensive, partly due to the fact that the therapy usually necessitates the simultaneous use of multiple antiretroviral drugs taken multiple times per day. This makes these thera- pies somewhat inaccessible to America’s most vulnerable populations (see Table 4.13).
Table 4.13: Treatment services available to people diagnosed with HIV/AIDS
Program Pros Cons
Counseling Addresses the negative mental health effects of living with an HIV diagnosis and teaches skills for living with HIV/AIDS.
Accessibility is limited by insurance coverage, ability to pay, and geographical location of counseling centers. Also, the patient must be willing to participate.
Medical treatment Life-prolonging antiretroviral drugs keep patients healthier, longer.
Medical treatment is expensive and difficult to access, especially for the most vulnerable populations. Medical intervention is most effective when begun early. Many patients do not take their medications regularly (often for financial reasons).
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CHAPTER 4Section 4.3 Reclaiming Health Through Treatment Services
Table 4.14: Treatment services available to people diagnosed with mental conditions
Program Pros Cons
Outpatient mental health services
Include counseling and drug therapies; are available through a wide range of providers; many are relatively inexpensive; and some health insurance plans cover some outpatient mental health services.
Patients with severe mental health disorders may be noncompliant with outpatient programs. Can be financially inaccessible for persons without health insurance coverage.
Crisis response services Available on both an outpatient and inpatient basis; provide immediate help for patients suffering severe emotional traumas, such as psychotic episodes and nervous breakdowns.
Services can be expensive with limited accessibility to low- income individuals.
Substance abuse cessation programs
Available on both an outpatient and inpatient basis; focus on changing lifestyle habits that contribute to drug and alcohol abuse that then contribute to mental health disorders.
Inpatient programs are expensive; outpatient programs depend on the individual’s level of compliance.
Persons Diagnosed With Mental Conditions
Since the deinstitutionalization movement that began in the 1950s, most treatment programs for mental health conditions are delivered on an outpatient basis (see Table 4.14). These services include pharmacological therapies to manage symptoms like feelings of sadness and confusion in people suffering from depression and halluci- nations in people with schizophrenia. Outpatient therapy for people with mental illness also often includes regular counseling sessions and sub- stance abuse cessation programs when needed. Crisis response services are available to fill in where outpatient mental health services are unavailable (such as after hours).
Courtesy of WavebreakmediaMicro /Fotolia
Outpatient mental health services include counseling and drug therapies and are available through a wide range of providers; many are relatively inexpensive, and some health insurance plans cover some outpatient mental health services.
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CHAPTER 4Section 4.3 Reclaiming Health Through Treatment Services
Suicide- and Homicide-Liable Persons
Homicide treatment is delivered via the criminal justice system, which both removes vio- lent offenders from society and has programs in place to help rehabilitate offenders with the intention of releasing them to be contributing members of society. Suicide treatment is really suicide prevention, though often after failed suicide attempts (see Table 4.15).
Table 4.15: Treatment services available to suicide- and homicide-liable persons
Program Pros Cons
Mental health services Address the mental health needs of suicide-prone patients; educate both suicide- and homicide-prone people about how to invoke positive coping mechanisms.
Patients must be compliant in attending counseling sessions and taking medications when necessary. Mental health services can be financially inaccessible.
Crisis intervention centers and hotlines
Are provided by many separate agencies, which increases accessibility; are vital resources for at-risk people and families.
Lack of coordination between agencies complicates quality assurance.
Persons Affected by Alcohol and Substance Abuse
Substance and alcohol abuse treatments vary from pharmacological therapies to counsel- ing services. Many patients do best with a combination of therapies, but ongoing support is vital for prolonged recovery (see Table 4.16). Programs like Alcoholics Anonymous (AA) provide support groups and self-help methods to lead to recovery. Methadone clinics exist that allow people who are addicted to opiates, like heroin, to gain access to methadone in place of opiate drugs. Some such clinics also provide counseling and medical services to support treatment and improve outcomes.
Table 4.16: Treatment services available to people affected by alcohol and substance abuse
Program Pros Cons
Pharmacological therapies May be used to replace a harmful, addictive drug; may be used to block the effects of a drug, which supports weaning from drug use; or may be used to relieve withdrawal symptoms.
Pharmacological therapies must be tailored to the individual patient and can be expensive; patients must be medication-compliant.
Behavioral therapies Are available on both inpatient and prolonged outpatient basis, can be tailored to meet individual needs and evolve with patient needs.
Patients must be compliant with counseling session attendance, and counseling can be expensive; many patients lapse.
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CHAPTER 4Section 4.3 Reclaiming Health Through Treatment Services
Table 4.17: Treatment services available to indigent persons
Program Pros Cons
The Robert Wood Johnson Foundation Health Care for the Homeless project (now The Health Resources and Services Administration Health Care for the Homeless program)
Directly addresses the needs of homeless people, including a holistic approach that considers social, economic, and health care needs; recognizes the relationship between wellness and the need for resources, including food and shelter. The program includes outreach programs to improve service accessibility, case management, and a multidisciplinary approach.
Funding is in danger; all involved personnel must be well trained on an ongoing basis.
Veterans Administration Homeless Chronically Mentally Ill and Health Care for Homeless Veterans programs; The National Institute of Mental Health Community Mental Health Services Demonstration Program; the Access to Community Care and Effective Services program
Address specific needs of specific homeless populations; many use the same holistic approach taken by the Robert Wood Johnson Foundation Health Care for the Homeless project; receive federal funding.
Social attitudes and constrained budgets cause federal funding for these programs to diminish.
Indigent and Homeless Persons
Treatment services for home- less people focus on addressing health care needs and providing resources for preventive ser- vices (see Table 4.17).
Courtesy of Oleg Kozlov/Fotolia
The Health Resources and Services Administration Health Care for the Homeless program includes outreach programs to improve service accessibility, case management, and a multidisciplinary approach.
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CHAPTER 4Section 4.3 Reclaiming Health Through Treatment Services
Critical Thinking
The example was given earlier of a child who is prescribed antibiotics for a sinus infection. This may seem like a simple and obvious treatment for an infection, but one wonders if the doctor would have modified the treatment in any way if the doctor had known about the contributing factors to the child’s illness, such as the fact that the child was consistently exposed to secondhand smoke in the home environment. Based on the information provided in this example, do you think that physicians have an obligation to investigate the environmental and socioeconomic risk factors that may play a part in their patients’ illnesses?
Immigrants and Refugees
Documented immigrants and refugees to the United States experience the same hurdles attempting to access appropriate health care that the rest of the population faces. Undocu- mented immigrants have less access to health care for financial and legal reasons (see Table 4.18).
Table 4.18: Treatment services available to immigrants and refugees
Program Pros Cons
Emergency and inpatient medical services
An increasing number of hospitals and emergency clinics employ workers who speak languages other than English to better serve the immigrant population. Immigrants receive the same level of care as U.S. natives.
Accessibility is based on financial ability, and language barriers do still exist.
Outpatient medical and mental health services
Patients with health insurance or who can otherwise afford their care have the ability to select their health care providers. More affordable options include public health departments and privately run, not-for-profit clinics.
Financial accessibility and physical accessibility barriers can be prohibitive. Many undocumented immigrants avoid routine health care for fear of deportation.
Dental and vision services Many refugees have never experienced specialized dental and vision care and the health benefits thereof.
Financial and physical accessibility are barriers; many immigrants do not use dental and vision services because they are not familiar with the practices.
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CHAPTER 4Section 4.4 Maintaining Quality of Life Through Long-Term Care
Self-Check
Answer the following questions to the best of your ability.
1. Disability treatment involves rehabilitation and teaching which of the following skills to enable patients to live the fullest lives possible while dealing with their disabilities?
a. life skills b. vocational skills c. social skills d. coping skills
2. HIV symptoms can be reasonably well managed with what type of drugs? a. antibiotics b. opiates c. antiretroviral drugs d. amphetamines
3. What is considered to be the most vital aspect in alcohol and substance abuse treatment?
a. ongoing support b. pharmaceutical therapies c. faith-based support d. incarceration
Answer Key
1. a 2. c 3. a
4.4 Maintaining Quality of Life Through Long-Term Care
The Substance Abuse and Mental Health Services Administration (SAMHSA) esti-mates that one-quarter to one-half of all homeless people suffer from a mental dis-order (National Coalition for the Homeless, 2009). In many cases, the disorder is the root cause of the homelessness, as some psychological illnesses can make it nearly impossible to maintain employment and close social connections. For this vulnerable sub- group, the long-lasting movement to deinstitutionalize people who need long-term care increases the risk for negative outcomes.
Long-term care facilities that specialize in rehabilitation, behavioral health, and nurs- ing facilities for the elderly and infirm were once fairly common in the United States. Specialized facilities existed for patients with mental disorders and long-term illnesses. However, the deinstitutionalization movement had certain detrimental effects on the homeless population.
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CHAPTER 4Section 4.4 Maintaining Quality of Life Through Long-Term Care
Although the move to deinstitutionalize patient care was born both out of concern about the effectiveness of long-term facilities and the economic costs of running them, mass deinstitutionalization did not see the majority of evicted patients placed into loving, capa- ble homes. Even those who did return to family environments suffered from a lack of community resources to support the families caring for them at home.
As the baby boomer generation matures to old age, the number of institutionalized patients is increasing, and not just of the elderly. Skilled nursing facilities (SNFs), once associated only with caring for the elderly and a few seriously handicapped or activities of daily living (ADLs) aid-dependent patients, are now accepting an increasing number of vulnerable patients from many at-risk populations, including those affected by drug dependence and HIV. Nationwide programs through Leading Age and the American Health Care Associa- tion (AHCA) have been undertaken to improve the education of all SNF staff to enhance care and quality of life for those outside of the previous core constituency of long-term care providers. This education includes caring for the at-risk populations specific to needs and is focused on continuum of care and quality of life. Each new population introduced to the long-term care community has a unique plan of care, has a specific needs set, and demands their quality of life not diminish despite institutionalization. At the same time that more individuals are being institutionalized, adult caregivers of their own elderly parents are increasingly seeking support from community- or home-based resources. This is creating a refreshed focus on community-based programs and services that provide long-term care and support for patients and families across all populations.
Vulnerable Mothers and Children
Long-term care for high-risk mothers and babies is gener- ally provided on an outpatient basis and focuses on parenting skills, social support, ongoing medical care, and case man- agement to help them access the resources available to them (see Table 4.19). Home-visit programs through local health departments and social services provide long-term care for new mothers and babies by sending nurses or social workers to visit families with new babies in their own homes. A home visit allows the worker to build a relationship with the family while providing information on parenting skills and available resources.
Courtesy of Dalia Drulia/Fotolia
Medical care addresses ongoing health and wellness of the healing mother and new infant.
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CHAPTER 4Section 4.4 Maintaining Quality of Life Through Long-Term Care
Table 4.19: Long-term care services available for high-risk mothers and children
Program Pros Cons
Medical care Addresses ongoing health and wellness of the healing mother and new infant. Medical care also provides immunizations and screenings for health issues and abuse risk.
Many high-risk mothers are unaware of the available resources and are unfamiliar with the fragmented delivery system.
Social services Include home visits that provide social support, encouragement, and resources for high-risk mothers and babies.
Some mothers may decline help from social service workers for fear of unwanted intervention.
Abused Individuals
Long-term care for abused individuals includes counseling for victims and offenders, pro- tection for victims, criminal punishment for offenders, and shelters for battered women and children (see Table 4.20).
Table 4.20: Long-term care services available to abused individuals
Program Pros Cons
Counseling services and peer support self-help groups
Support victims through the emotional ramifications of abuse; work with offenders to alter abusive behaviors.
These services and groups can have the negative effect of enabling a victim to prolong the relationship.
Protective services and welfare agency programming
Identify and intervene with abusive situations. Child protective services have the ability to immediately remove a child from a home if they believe the child is being harmed.
Funding and staffing are uneven and inadequate.
Shelters and safe houses Provide safe housing for women and children escaping from abusive relationships. They also connect victims with other resources.
Most are privately funded and have small operating budgets.
Criminal justice system Provides some protection of abuse victims and punishes repeat offenders.
Domestic disputes are handled differently by different responders and departments.
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CHAPTER 4Section 4.4 Maintaining Quality of Life Through Long-Term Care
Chronically Ill and Disabled Persons
Long-term care of both chronically ill and disabled people involves managing different types of care and resources from many agen- cies. Care managers can be vital in helping both a patient and the fam- ily coordinate care (see Table 4.21). Long-term care facilities, including assisted living and nursing care facilities, are expensive. Many fam- ilies choose to avoid that expense and to keep their loved ones nearby or care for them in their own homes. In-home care can also be very expensive and can put a lot of stress on care providers. Services
exist to help with in-home nursing and to give caregivers breaks so they can run errands or even have a night off without worrying about the loved one left at home.
Table 4.21: Long-term care services available to the chronically ill and disabled
Program Pros Cons
Nursing homes and independent living communities
Provide varying levels of care to meet the differing needs of patients in different stages of life.
These communities are costly; furthermore, much of the expense of these homes is not covered by Medicare.
Hospices and in-home care Allow terminally ill patients to remain at home with support from a medical team.
Hospice receives some government funding but mostly relies on insurance payments and private donations. Other in-home options are paid for by insurance or out of pocket.
Social health maintenance organizations (S/HMOs) and the Program of All-Inclusive Care for the Elderly (PACE)
These consolidated health care models deliver long-term, primary, and preventive services through comprehensive delivery systems. S/HMOs are designed to keep people out of medical institutions.
S/HMOs are a form of private health insurance; PACE is dependent on federal funding.
U.S. Department of Education, Office of Special Education and Rehabilitative Services
Funds state programs for special education of disabled children to age 21.
Resources stop at age 21; federal funding is always in danger.
The Basic Vocational Rehabilitation Service Program
Funds state programs to help disabled individuals find gainful employment. There is no age limit.
Federal funding is always in danger.
Courtesy of Lisa F. Young/Fotolia
Hospices allow terminally ill patients to remain at home with support from a medical team.
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CHAPTER 4Section 4.4 Maintaining Quality of Life Through Long-Term Care
Persons Diagnosed With HIV/AIDS
Most nursing homes are not prepared to care for dying HIV/AIDS patients. Therefore, specialized AIDS hospices and community-based programs exist to help ailing HIV/AIDS patients (see Table 4.22). Some palliative, or end-of-life, care facili- ties do not accept HIV/AIDS patients because the palliative period is difficult to predict. Specialized hospices, like Project Transitions (n.d.) in cen- tral Texas, go beyond palliative care and include housing, counseling, and support groups for HIV/AIDS patients nearing the end of their lives.
Courtesy of mangostock/Fotolia
Volunteers provide meals, transportation, housekeeping, and other services free of charge or at very low rates to HIV/AIDS patients.
Table 4.22: Long-term care services available to people diagnosed with HIV/AIDS
Program Pros Cons
AIDS hospices Provide specialize palliative care for people dying of AIDS.
AIDS hospices depend largely on volunteers and private donors.
Home health care services Provide licensed home-based health care for AIDS patients.
Home health care services are very expensive; access depends on private health insurance coverage and the individual’s ability to pay.
Volunteer services Include community-based services that depend on volunteers to provide meals, transportation, housekeeping, and other services free of charge or at very low rates to HIV/AIDS patients.
These services depend on private donors and volunteers to function.
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CHAPTER 4Section 4.4 Maintaining Quality of Life Through Long-Term Care
Persons Diagnosed With Mental Conditions
Although private psychiatric hospitals still exist, many emotionally disturbed patients are cared for at home with the help of outside resources (see Table 4.23). Partial-care centers act as daytime care for adults with mental illnesses who cannot be left alone while family members go to work. Unfortunately, partial-care centers are not available in all regions. Community-based programs are available from a wide range of organizations, including the National Institute of Mental Health (NIMH). Such programs provide access to ser- vices, including education and counseling, for both the patient and the caregivers. Case managers are useful in helping families find the right combination of resources to best meet their needs.
Table 4.23: Long-term care services available to people diagnosed with mental conditions
Program Pros Cons
Institutionalization Few government-run psychiatric institutions still exist, but private institutions do still fill the need for full-time care. Nursing homes care for a large number of elderly patients with dementia and other mental conditions. Jails and prisons act as de facto institutions for people with mental disturbance when they are arrested for breaking laws. Satellite housing, halfway houses, and other board and care homes also exist as institutionalization options.
All these resources together are not enough to provide safe, secure housing for people with severe mental conditions in this country.
Home care A resource that provides for mentally ill patients to remain home with family.
The caregivers need a lot of resources and support.
Partial-care centers A resource for families caring for a mentally disturbed loved one who cannot be left alone during the day when the caregivers must go to work.
Affordability can be a barrier to access.
Community-based care including:
The National Institute of Mental Health Community Support Program, the Child and Adolescent Service System Program, and the Program of Assertive Community Treatment
Various resources for educating, housing, and supporting mentally ill people. These resources focus on coordinated, comprehensive care continuums for those with mental disorders.
A case manager is often needed to help families and individuals with mental conditions access the many disjointed resources.
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CHAPTER 4Section 4.4 Maintaining Quality of Life Through Long-Term Care
Table 4.24: Long-term care services available to suicide- and homicide-liable persons
Program Pros Cons
Criminal justice system Removes violent offenders from society.
Prisons are violent environments, and studies indicate that they are not effective rehabilitation centers.
Residential treatment centers Treat violent and suicidal youth. Treatment and funding are uneven.
Community-based programs Include social services and private and volunteer programs that provide counseling and support services for violent offenders, suicide-prone individuals, and their families.
Most community-based programs do not interface with other programs to create a continuum of care.
Persons Affected by Alcohol and Substance Abuse
Long-term care and treatment services for alcoholism and substance abusers go hand in hand (see Table 4.25). While detoxification helps remove substances from the body, ongo- ing counseling and support is usually necessary for ongoing rehabilitation.
Suicide- and Homicide-Liable Persons
Long-term “care” of violent offend- ers focuses on removing them from society rather than on rehabilita- tion. Reports on the effectiveness of programs designed to alter violent behaviors indicate that the social situations that propagate violence must be addressed to reduce the risk level for homicide-prone indi- viduals. Inpatient mental health services and vocational rehabilita- tion programs exist to help suicide- and homicide-liable persons (see Table 4.24).
Courtesy of Alexander Edmonds/Fotolia
Prisons are violent environments, and studies indicate that they are not effective rehabilitation centers.
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CHAPTER 4Section 4.4 Maintaining Quality of Life Through Long-Term Care
Table 4.25: Long-term care services available to people affected by alcohol and substance abuse
Program Pros Cons
Medical detoxification Uses pharmaceuticals given in a hospital or other type of inpatient medical facility to remove the drug from the patient’s body.
Medical detoxification needs to be followed with long-term counseling to be effective.
Social detoxification Allows the body to clean out the drug naturally while the patient is in a specialized facility under the watch of trained personnel.
Social detoxification is not covered by all insurance plans; physicians may be called in but are not always on the premises.
Rehabilitation and recovery Includes programs that enable the patient to recover from a drug addiction and restore functioning needed for a healthy lifestyle.
These programs are not covered by all insurance plans; patient must be compliant for the program to work.
Custodial programs Provide shelter, food, and support on an ongoing basis, but the patients may come and go at will (usually within set hours).
Many of these programs are supported through donor funding and nonprofit organizations.
Nonresidential programs Include therapy sessions, both in groups and on an individual basis, that provide treatment and recovery services to patients.
Patients must be compliant with session attendance.
Indigent and Homeless Persons
Long-term care of homeless people involves getting them off the streets and treating the factors that contributed to their homelessness (see Table 4.26).
Courtesy of elavuk81/Fotolia
It is estimated that 50% of homeless people in the United States have some type of significant mental condition.
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CHAPTER 4Section 4.4 Maintaining Quality of Life Through Long-Term Care
Table 4.26: Long-term care services available to indigent persons
Program Pros Cons
Inpatient mental health programs
It is estimated that 50% of homeless people in the United States have some type of significant mental condition. Inpatient mental health programs offer a way to get these patients off the streets and address the mental disorders that may have led to their homelessness.
Some inpatient institutions will reject patients perceived to be problematic; all inpatient programs must be paid for somehow.
Housing placement Outreach programs are key components to placing homeless people in long-term housing. Some programs, like the Veterans Administration, have developed creative programs to place individual patients in board and care homes. Some private agencies and local governments support free and low-income housing for which many homeless people are eligible.
Case management services offer a more effective method of placing homeless families and individuals in the right type of home. Funding for all of these programs is dependent on government budget decisions and individual donors.
Immigrants and Refugees
Long-term care for immigrants and refugees focuses on community-based support to help them access resources (see Table 4.27).
Table 4.27: Long-term care services available to immigrants and refugees
Program Pros Cons
English as a Second Language (ESL) courses
Help immigrants by teaching them to speak, read, and write English. The programs are often available free of charge.
Program funding can be difficult to maintain.
Social assistance programs Aid with housing, transportation, securing employment, and connecting refugees with available resources.
Many of the programs are disconnected from the others, making the system difficult to manage.
Voluntary refugee assistance programs
Provide sponsorship and support for refugee families through networks of volunteers. Many are supported by churches.
Some groups may engage in illegal activity by acting as an underground railroad for undocumented immigrants.
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CHAPTER 4Section 4.4 Maintaining Quality of Life Through Long-Term Care
Self-Check
Answer the following questions to the best of your ability.
1. Which of the following do shelters and safe houses provide to victims of abuse? a. housing and connections to support b. counseling c. legal advice d. a contact point for police investigations
2. It is estimated that ____ of homeless people in the United States have some type of significant mental condition.
a. 30% b. 42% c. 50% d. 67%
3. Which of the following groups provide sponsorship and support for refugee families through networks of volunteers?
a. churches b. state government c. local businesses d. professional organizations
Answer Key
1. a 2. c 3. a
Critical Thinking
Many discussions about the future of health care address the importance of long-term care. Given the fact that the population of the United States is aging, why is this such an important issue?
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CHAPTER 4Chapter Summary
Chapter Summary
An effective continuum of care sees a patient through all phases of life. Prevention ser- vices begun when young lessen a person’s risk of developing a need for treatment and long-term care services later in life. Even when preventive services are accessed in later life stages, programs that help people quit smoking, lose weight, and maintain a healthy diet lower their risk of negative health outcomes. Even so, everybody gets sick at some point, and treatment services are necessary to restore health and functioning. When health cannot be fully restored, long-term care services must be accessible to help patients and families with health and mental care needs. Accessibility to prevention, treatment, and long-term care services is limited for America’s most vulnerable.
Case Study: Health Insurers Support Preventive Services
Humana, one of the nation’s largest health insurance companies, launched HumanaVitality© in 2012. The program is available to Humana members at no additional charge. HumanaVitality rewards mem- bers who log exercise, weight loss, and other healthy lifestyle habits with points that can be redeemed for merchandise from various partner retailers. The program is similar to credit card rewards, but in addition to points to spend, members gain a healthier lifestyle and Humana saves money on medical treatments and long-term care (HumanaVitality, 2012).
Many athletic clubs and gyms offer similar rewards systems. Some YMCAs throughout the country have instituted FitLinxx programs that allow members to log workouts and earn points. Rewards range from YMCA water bottles and T-shirts to gift cards for local restaurants. The more workout points a member earns, the better the rewards become. Using rewards systems to encourage healthier lifestyles is fairly new because society’s focus on health care has changed from treating illness to preventing it.
Only in the last few decades have preventive services become popular in health care settings. Due to the skyrocketing cost of health care in the United States, patients, the government, and health insurance companies all have a vested interest in the propagation of preventive services. Insurers, including Medi- care and Medicaid, are increasingly covering preventive health care services with no patient co-pays. The Patient Protection and Affordable Care Act of 2010 mandates that insurers cover many preventive services at no co-pay charge to the patients. This was a move by the federal government to mitigate the costs of America’s obesity epidemic and other chronic diseases in the face of rising health care costs.
Many health insurance companies support the mandate as a way to encourage customers to use less expensive preventive services instead of waiting and costing the insurers more money on treatments and long-term care. In addition to dropping patient co-pays for preventive care services, many insurers created programs that encourage their clients to make healthy lifestyle choices and use the covered preventive services.
Critical Thinking
Discuss with supporting examples the need for a continuum of care that comprises a comprehensive approach to health care for vulnerable populations.
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CHAPTER 4Self-Check
Self-Check
Answer the following questions to the best of your ability.
1. A solid continuum of care should be available throughout a person’s life. a. True b. False
2. Which of the following caused millions of Americans to lose their jobs and their homes—and increased the strain on underfunded social welfare programs?
a. the War on Terror b. the Y2K Glitch c. the Great Recession of 2008 d. the Swine Flu Epidemic
3. The American health care system is not well integrated between which of the fol- lowing groups? (Select two.)
a. older generations b. delivery channels c. providers d. corporations
4. Problems arise when patients present with which of the following symptoms that their treating physicians are not versed in? (Select three.)
a. orthopedic b. physical c. social d. oncological e. psychological
5. Mass ______________________ did not see the majority of evicted patients placed into loving, capable homes.
a. deinstitutionalization b. decentralization c. immigration d. inflation
Answer Key
1. a 2. c 3. b and c 4. b, c, and e 5. a
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CHAPTER 4Web Exercise
Additional Resources
Visit the following websites to learn more about the topics covered in this chapter:
Patient Centered Medical Home
http://www.gilbertcenter.net/home.html
The American Health Care Association
http://www.ahcancal.org/Pages/Default.aspx
The website for the National Association of Community Health Centers and their mis- sion to fill the gaps in health care services
http://www.nachc.com/
Web Exercise
Watch the following videos and script your own video (you do not have to produce the video, just write a script) about preventive health care. You may use other video sources but remember they must be reliable and valid (YouTube and Wikipedia do not count as valid), and you must cite your source(s).
• Andrew Weil discusses preventive medicine in a short on Discovery.com: http://dsc.discovery.com/videos/curiosity-is-preventative-medicine-becoming-
more-important-in-healthcare.html • First Lady Michelle Obama and others discuss preventive health care in the
health care reform act: http://www.whitehouse.gov/photos-and-video/video/preventive-health-care-
coverage-under-health-reform • An example of how Medicare covers preventive health care:
http://www.dailymotion.com/video/xkebvp_medicare-made-clear-preventive- health-care-services_people
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CHAPTER 4Key Terms
Key Terms
continuum of care The combination of preventive health services, treatment services, and long-term care services that spans a patient’s lifetime and provides for the best health outcomes.
free market economy An economy based on open competition among corporations with a lack of government regulation.
inflation Loss of currency value.
insurance underwriters Companies that evaluate the risk and exposure of potential clients, decide how much coverage the client should receive, and determine how much the client should pay for it.
long-term care Care that focuses on con- stant, ongoing health care needs.
Occupational Safety and Health Admin- istration (OSHA) Established by the Occupational Safety and Health Act of 1970, this group was created to ensure safe and healthful working conditions for working men and women by setting and enforcing standards and providing train- ing, outreach, education, and assistance.
preventive care services Medically related and medically based services that focus on maintaining health.
socioeconomic classes A combined eco- nomic and social measure of a person’s work experience and family economic position in relation to others.
treatment services Services intended to restore health to ailing individuals.
workers’ compensation A form of insur- ance that provides wage replacement, medical treatment, and rehabilitation services to employees injured in the course of employment.
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