Writing: Services

Long-Term Care: Managing Across the Continuum, Fourth Edition John R. Pratt

CHAPTER THREE: TOWARD AN IDEAL SYSTEM

CHAPTER HIGHLIGHTS

Introduction

The basis for our discussion is a document titled Criteria for Designing or Evaluating a Long-

Term Care System developed by Saint Joseph’s College of Maine. Use the Criteria as a

foundation for construction of a long-term care system as it should be.

 While each of the criteria is important in its own right, it is only when taken as a whole

that they represent an optimum system.

 It is recognized that there is some duplication and overlapping of criteria, but that serves

to emphasize the importance of certain aspects of long-term care.

 The criteria are stated as general precepts against which a long-term care system should

be measured.

 Each of them is accompanied by several statements identifying the benchmarks a system

must accomplish to meet that particular criterion.

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

Availability and utilization of long-term care services should be based on the needs (not

necessarily the wants) of consumers of those services, rather than on the needs of

providers or reimbursement agencies.

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B. Meet the needs of the consumers

The long-term care system should address the full range of consumer needs, rather than

meeting only some of them. Otherwise, it will be neither complete nor effective.

C. Focus on the individual, recognizing that individuals have unique needs

It should be flexible enough to recognize those needs, including the psychological, social,

and financial limitations of recipients of services.

D. Respect different cultures and cultural values

The system should recognize these differences and attempt to accommodate them.

E. Promote quality, dignity, and self-improvement for consumers. In doing this, it should

1. Value older adults and those with chronic disabling conditions

2. Promote a positive approach to living with chronic illness and dependency

3. Allow care recipients to continue to contribute to life and society

4. Promote the highest achievable level of functioning

F. Balance consumer rights and responsibilities

Consumers of long-term care services and their families should be allowed and

encouraged to participate in the continuum of care, including making care-related

decisions and taking responsibility for lifestyle choices and financing when appropriate.

G. Offer consumers a choice of service providers and service delivery modalities

The consumer’s right to choose should be respected and encouraged.

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

A. Be universally accessible

Services should be available to all who need them, based on uniform functional criteria.

B. Be user-friendly

The long-term care system should be uncomplicated for the consumer to access and use,

with minimal paperwork, simplified financing and approval processes, and no excessive

delays in service.

C. Provide care in the least restrictive environment

The long-term care system should facilitate the provision of care in the setting and

service modality that will provide the best combination of appropriate care, quality of

life, and cost-effectiveness.

D. Encourage single-site care availability

The system should be designed to provide, to the degree possible, all necessary services

without requiring the consumer to access multiple sites and/or providers.

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

The various sources of support should be coordinated to take fullest advantage of their

availability.

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B. Evolve from the current medical model to a holistic model of service delivery

The system should encourage broader involvement of nonmedical personnel in problem

solving.

C. Involve families in case management and care delivery

The system should facilitate caring at home by providing resources to family caregivers.

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

Those services should meet the needs of all with chronic illness, not just the elderly.

B. Include a full and uniform assessment (initial and ongoing) of the consumer’s needs

The assessment should reflect an understanding of chronicity.

C. Provide emphasis on, and reimbursement for, illness prevention efforts as an integral part

of the overall system

Although preventive services are not usually seen as part of a long-term care system,

their impact on such a system must be considered.

D. Be planned and coordinated to reduce fragmentation and inefficiencies

The system should integrate systemwide coordination with local and regional autonomy.

E. Be based on outcome-oriented accountability

To attain this accountability, the system must include

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Long-Term Care: Managing Across the Continuum, Fourth Edition John R. Pratt

1. Elimination of unnecessary paperwork

2. A focus on results as they affect quality of life rather than a focus on documentation

3. Incentives to improve quality of services rather than inspecting for quality

4. Consistent development and application of standards

5. Outcome-oriented versus process-oriented accountability

6. Flexibility that encourages innovation and change

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

A. Utilize public and consumer resources to assure universal access to services

All available resources, public and private, should be considered in providing services for

current and future consumers.

B. Provide incentives for consumers to use services in an appropriate and cost-effective

manner

The overall cost of the system can be controlled by avoiding excessive and unnecessary

use.

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

Consumers and their families should be encouraged to pay for their own care when

possible.

D. Avoid causing impoverishment of consumers and families

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Although consumers and families should be encouraged to contribute to the cost of their

care, that contribution should be limited to prevent causing undue hardship.

E. Provide incentives for providers to develop cost-effective measures

Providers of long-term care services can improve the cost-effectiveness of the system,

given incentives to do so.

F. Develop payment mechanisms that allow efficient providers to adequately compensate

staff and to allow for appropriate operating surplus and/or return on investment

Both the for-profit and not-for-profit sectors should continue to have significant roles in

the long-term care system.

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

The financing of the system should reflect the needs of individuals (as reflected in

Criterion I).

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

The public should be informed about long-term care, including available service options,

limitations, and access methods.

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B. Include education for providers

The system should provide for more geriatric education for physicians and others dealing

with the elderly.

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

A better understanding of chronicity will lead to better acceptance of chronic illness in

individuals and family members and more effective, efficient use of available resources.

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