Long-term care

This article is about a type of health and social care service. For specific information on providers of such services, see for example Personal care assistant and Geriatric care manager.

Long-term care (LTC) is a variety of services which help meet both the medical and non-medical needs of people with a chronic illness or disability who cannot care for themselves for long periods of time.

It is common for long-term care to provide custodial and non-skilled care, such as assisting with normal daily tasks like dressing, bathing, and using the bathroom. Increasingly, long-term care involves providing a level of medical care that requires the expertise of skilled practitioners to address the often multiple chronic conditions associated with older populations. Long-term care can be provided at home, in the community, in assisted living facilities or in nursing homes. Long-term care may be needed by people of any age, although it is a more common need for senior citizens.^[1]

Types of long-term care

Long-term care can be provided formally or informally. Facilities that offer formal LTC services typically provide living accommodation for people who require on-site delivery of around-the-clock supervised care, including professional health services, personal care and services such as meals, laundry and housekeeping.^[2] These facilities may go under various names, such as nursing home, personal care facility, residential continuing care facility, etc.

Long-term care provided formally in the home, also known as home health care, can incorporate a wide range of clinical services (e.g. nursing, drug therapy, physical therapy) and other activities such as physical construction (e.g. installing hydraulic lifts, renovating bathrooms and kitchens). These services are usually ordered by a physician or other professional. Depending on the country and nature of the health and social care system, some of the costs of these services may be covered by health insurance or long-term care insurance.

Informal long-term home care is care and support provided by family members, friends and other unpaid volunteers. It is estimated that 90% of all home care is provided informally by a loved one without compensation.^[3]

Needs for long-term care

Life expectancy is going up in most countries, meaning more and more people are living longer and entering an age when they may need care. Meanwhile birth rates are generally falling. Globally, 70 percent of all older people now live in low or middle-income countries.^[4] Countries and health care systems need to find innovative and sustainable ways to cope with the demographic shift. As reported by John Beard, director of the World Health Organization's Department of Ageing and Life Course, "With the rapid ageing of populations, finding the right model for long-term care becomes more and more urgent."^[1]

The demographic shift is also being accompanied by changing social patterns, including smaller families, different residential patterns and increased female labour force participation. These factors often contribute to an increased need for paid care.^[5]

In many countries, the largest percentages of older persons needing LTC services still rely on informal home care, or services provided by unpaid caregivers (usually nonprofessional family members, friends or other volunteers). Estimates from the OECD of these figures often are in the 80 to 90 percent range; for example, in Austria, 80 percent of all older citizens.^[6] The similar figure for dependent elders in Spain is 82.2 percent.^[7]

The US Centers for Medicare and Medicaid Services estimates that about 9 million American men and women over the age of 65 needed long-term care in 2006, with the number expected to jump to 12 million by 2020.^{[citation needed]} It is anticipated that most will be cared for at home; family and friends are the sole caregivers for 70 percent of the elderly. A study by the U.S. Department of Health and Human Services says that four out of every ten people who reach age 65 will enter a nursing home at some point in their lives.^[8] About 10 percent of the people who enter a nursing home will stay there five years or more.

Long-term care funding

Governments around the world have responded to growing long-term care needs to different degrees and at different levels.

Europe

Most Western European countries have put in place a mechanism to fund formal care and, in a number of Northern and Continental European countries, arrangements exist to at least partially fund informal care as well. Some countries have had publicly organized funding arrangements in place for many years: the Netherlands adopted the Exceptional Medical Expenses Act (ABWZ) in 1967, and in 1988 Norway established a framework for municipal payments to informal caregivers (in certain instances making them municipal employees). Other countries have only recently put in place comprehensive national programs: in 2004, for example, France set up a specific insurance fund for dependent older people. Some countries (Spain and Italy in Southern Europe, Poland and Hungary in Central Europe) have not yet established comprehensive national programs, relying on informal caregivers combined with a fragmented mix of formal services that varies in quality and by location.^[3]

In the 1980s, some Nordic countries began making payments to informal caregivers, with Norway and Denmark allowing relatives and neighbors who were providing regular home care to become municipal employees, complete with regular pension benefits. In Finland, informal caregivers received a fixed fee from municipalities as well as pension payments. In the 1990s, a number of countries with social health insurance (Austria in 1994, Germany in 1996, Luxembourg in 1999) began providing a cash payment to service recipients, who could then use those funds to pay informal caregivers.^[3]

In Germany, funding for long-term care is covered through a mandatory insurance scheme (or Pflegeversicherung), with contributions divided equally between the insured and their employers. The scheme covers the care needs of people who as a consequence of illness or disability are unable to live independently for a period of at least six months. Most beneficiaries stay at home (69%).^[1] The country's LTC fund may also make pension contributions if an informal caregiver works more than 14 hours per week.^[3]

North America

Canada

In Canada, facility-based long-term care is not publicly insured under the Canada Health Act in the same way as hospital and physician services. Funding for LTC facilities is governed by the provinces and territories, which varies across the country in terms of the range of services offered and the cost coverage.^[2]

United States

In the US, Medicaid is a government program that will pay for certain health services and nursing home care for older people. In most states, Medicaid also pays for some long-term care services at home and in the community. Eligibility and covered services vary from state to state. Most often, eligibility is based on income and personal resources.

Generally, Medicare does not pay for long-term care. Medicare pays only for medically necessary skilled nursing facility or home health care. However, certain conditions must be met for Medicare to pay for even those types of care. The services must be ordered by a doctor and tend to be rehabilatative in nature. Medicare specifically will not pay for custodial and non-skilled care. Medicare will typically cover only 100 skilled nursing days following a 3 day admission to a hospital.

A 2006 study conducted by AARP found that most Americans are unaware of the costs associated with long-term care and overestimate the amount that government programs such as Medicare will pay.^[9]

Residents of LTC facilities may have certain legal rights depending on the location of the facility.^{[citation needed]}

See also

• Activities of daily living
• Assisted living
• Caregiving and dementia
• Dynamic treatment regimes
• Geriatric care management
• Home care
• Long term care insurance
• List of companies operating nursing homes in the United States

References

External links

• US Government: Medicare - Long-term care.
• California Partnership for Long-Term Care
• Medicare Part D Information University of Florida/IFAS Extension Department of Family, Youth and Community Sciences
• The SCAN Foundation (US-based foundation)
• Family Factors Involved in Making Long-Term Care Financing Decisions University of Florida/IFAS Extension Department of Family, Youth and Community Sciences
• Family Caregiving Financial Resources List of county/state departments or local agencies for long-term caregivers in the US
• Long Term Care Medical Directors Association of Canada - Association canadienne des directeurs médicaux en soins de longue durée Canadian-based association of medical directors in the Long Term Care setting
• White Paper: Planning Guide for Long Term Care PDF (1.58 MiB) — guide from The US Department of Health and Human Services.
• How much does long term care cost?
• Latest Cost of long term care survey conducted for Genworth Financial
• Health-EU Portal Long-term Care in the EU