To define what a long-term care facility is, it is first prudent to understand the meaning of long-term care. Long-term care can be defined as a diversity of personalized and well-harmonized full care services that enhance the fullest possible autonomy for persons with functional disabilities, and are provided over an elongated time frame. This is usually done using the suitable latest technology and appropriate evidential practices inline with a comprehensive approach while considering the quality of both the individual’s life and that of clinical care (Singh, D, 2009, p.4). A long-term care facility is therefore a specific place where long-term care is offered. As reflected in this definition, an ideal long-term care facility will encompass the following ten qualities:
Diversity of services
This entails both medical and non-medical interventions. The latter includes either social support or residential services. Long-term care encompasses a diversity of services for three main reasons: to suit the needs of different persons, to deal with dynamic needs over time and to fit personal preferences of individuals. The nature of someone’s level of functional disability determines the kind of needs to be administered to them. To address these individual differences, long-term care facilities have an amalgamation of five key services. These include medical interventional services, mental well being services, social support, residential requirements and those services that emphasize pain relief and emotional support (Singh, 2009, p.4).
Long-term care services are tailor made to suit a patient’s individual needs. They are based on the evaluation of one’s physical, mental and emotional conditions, previous history of the patient’s health and psychosocial conditions, former occupation, community participation leisure events and cultural factors such as dialect, ethnic background and religion (Singh, 2009, p.5).
Well-harmonized full care
Full care means detecting, assessing and addressing every health care need by qualified medics. Harmonized care from the available physician, dermatologist, and cardiologists among others is always important so as to avoid further intricacies or to deal with any emerging ailments right from the onset. Dynamism in basic needs and occurrence of episodes may determine the need for full care harmonization. Incase of such, Changing to acute care hospital or treatment for cognitive and behavioral impairments become essential. Thus integrating long-term care services with non-long-term ones becomes crucial (Singh, 2009, p.5).
Enhancement of functional autonomy
Long-term care facility is very significant especially when someone is unable to perform some of the normal daily chores due to functional disability. In children, functional disability may arise due to either brain and birth defects or mental impairment. Either accidents or crippling infirmities may render the young adults incapacitated. Long-term care has an aim of ensuring functional independence among the disabled in the most practical way possible. Patients are therefore taught and supported to use adaptable equipment such as wheelchairs, portable oxygen devices, among others (Singh, 2009, p.8).
An elongated time of care
Sufficient time is required to both address emerging issues and to monitor deteriorating cases in patients with chronic ailments. All this requires an extended duration of time for most long-term care services compared to acute care services that may take a few days (Singh, 2009, p.9).
Use of latest technology
The setting of long-term care determines the kind of technology to be adopted. For instance, whereas non-slip footwear and hip protectors may be used nearly everywhere, other technologies such as call systems to seek help and bathing systems are meant for specific settings (Singh, 2009, p.9).
Use of evidential practices
This means using care practices that have been ascertained through clinical research to treat specific health related conditions (Singh, 2009, p.10).
This shifts the focus of health care delivery from just the physical and mental aspects to other aspects such as the social and spiritual (Singh, 2009, p.10).
Considering the quality of care
Quality of care is only enhanced when the required clinical and satisfaction oriented outcomes have been achieved. Maximizing the quality of life is a continuous process. To improve care, regulatory measures and evident-based practices need to be actuated. Quality should be assessed to realize places that require improvement, and hence this may take time (Singh, 2009, p.10).
Considering the quality of life
Quality of life entails fulfillment that is derived and associated with the diametric living experience. Quality of life revolves around five main components: lifestyle aspects, living surroundings, palliative care, human factors, and individual choices.
The people who require long-term care vary in terms of age and clinical needs. They include children and adolescents, the youth, the elderly, victims of HIV/AIDS and people needing extra care. Of all these people, the aged are the main beneficiaries of this care.
Types of long-term care facilities
The three main kinds of long-term care facilities are “nursing homes, assisted living, and adult foster homes” (Blanchard-Fields and Cavanaugh, 2006, p.163).Nursing homes are where a majority of older people reside. The federal regulations have spelt out two major types of care for them. The first one is skilled health care that entails day and night provision of medical oriented services from nurses. The second one intermediate care that involves provision of 24 hour nursing services from a fewer number of nurses compared to the skilled healthcare (Blanchard-Fields and Cavanaugh, 2006, p.163).
Assisted living homes on the other hand provide personal supportive services mainly to individuals who need this care only during some times. Compared to nursing homes, assisted living homes are smaller in size and have minimal costs (Blanchard-Fields and Cavanaugh, 2006, p.164). Adult foster homes are suitable for adults who may not necessarily require an all time attention. Their operations are not really controlled by the Federal guidelines. They are smaller in size and appropriate for individuals who have chronic ailments but are in a fairly better state of health (Blanchard-Fields and Cavanaugh, 2006, p.164).
Set-ups in long-term care facilities and its flaws
Statistics reveal that there has been an increase in the use of home care facilities in many countries. In Luxembourg, long-term care has been part of the total health expenditure (OECD publishing, 2008, p.110). Introduction of long-term care insurance has brought about a demarcation between financing and provision of long-term care. This has in turn helped to enhance both transparency and cost-effectiveness in heath care. Prior to the reform, long-term care patients used to be in regular hospitals, which could lead to a strain in the bed capacity. Due to this strain, most of them had to be taken to less costly nursing homes (OECD publishing, 2008, p.110).
However, the increased use of the facilities has led to inefficiencies in the new insurance system making the whole entire reform unsustainable. Demographic projections have it that the number of the aged is likely to escalate in the coming decades. This calls for an increase in demand for long-term care hence a rise in total health care spending in Luxembourg (OECD publishing, 2008, p.110).
The current mechanism of financing long-term care in the United States is quite exorbitant (Blanchard-Fields and Cavanaugh, 2006, p.163). Given that both Medicare and private insurance do not fully cater for the costs, the residents themselves therefore shoulder a bigger percentage of the expenses. This becomes challenging since impoverished residents heavily rely on Medicare, which does not contribute fully to the long-term care costs (Blanchard-Fields and Cavanaugh, 2006, p.163).
An alternative is therefore the private sector where various long-term services can be procured. Such services may include long-term insurance, retirement arrangements, health maintenance, and alternative housing programmes. Most of these alternatives are burdensome and as such, trigger people to explore other methods of meeting expenses for their own care (Blanchard-Fields and Cavanaugh, 2006, p.163). In a bid to overcome these hurdles brought by the long-term care model, attempts are being made to come up with a better way for working and living in a real home setting.
The Household model
A household model is a model that entails a transformational revolution from the culture and setting of long-term care and the confines of nursing homes to a totally new framework of providing a real home for the frail and elderly (Shields and Norton, 2006). It is about putting up a new platform for home term care. This encompasses homemaking rather institutionalization, regarding persons rather than the system, redefining what should be done and to do it, both intrapersonal and interpersonal socialization. Rather long-term care being a loss of purpose, identity and home, this model aims at making long-term care be a gain of these aspects.
It is converting a nursing home from a place where individuals await their demise to a place of life and meaning. It is actually moving long-term care to a place where the elderly can find a deep sense of association, life, belonging, work and self-actualization. In the household model, small teams of workers are supposed to be in charge small teams of elders who interact to not only determine the course of their own lives but also establish a community (Shields and Norton, 2006).
Why long-term care facilities should be converted into the household model
It is so unfortunate that long-term care facility that are meant to be homes for the old do not really provide a conducive home atmosphere as such. Elders like any other people in the society deserve the privilege of benefiting from the comfort, security, and serenity that a home environment provides. They have the prerogative of charting forward the course that their lives should take, and what exactly their position in the society should be.
They should therefore like anyone else, enjoy choice in what to do in their day-to-day lives, the mutual nature of relationships that generate purpose and meaning to them and basically a place they proudly refer to as home (Shields and Norton, 2006).Sad enough, contemporary long-term care facility does not provide all these. It so artificial to the core and mere modifications do not meet the expected standards of good well being, full living, wealthy communal life and the ability to enhance self-actualization. The contemporary system betrays not only the elders but also the caretakers, and their attributes: compassion and service.
Another reason for the household model is that the kind of care that the long-term care facilities accord to the old and fragile is not commensurate to their place in the society, the roles they have played in our lives while they were still young, and generally their respect as senior people in our society. Most of them are our friends, relatives, former co-workers, parents, and neighbors. They played vital roles in our lives like paying our school fees, and counseling us.
They also played other national roles like serving in the public service, building the transport network, learning institutions and health facilities. They did what was demanded and required from them. They did this up to the point of passing the baton to us, with hopes that we will improve. Reciprocatively, what we are offering through the nursing homes is far less than what they deserve. If this does not change then once we also become elders, we should be ready to receive what the long-term care is offering them.
Hierarchical organizational patterns in long-term care institutions are designed in such a manner that they deny residents, members of their families and caretakers the opportunity to make radical and appropriate decisions that influence very crucial aspects of their day-to-day lives. Power is therefore vested in administrators and directors who then give directives to the supervisors and caretakers on what they should do and how they should do it. This in turn leads to creation of departmental silos where most sections of the organization begin to rival. This causes them to drift away from the bigger sole purpose of service.
This leaves the caregivers with the discretion of making decisions that affect very essential aspects of the residents. Since caregivers do not posses sufficient judgment to make very fundamental decisions regarding the organization, unorthodox mechanisms are then put in place to regulate them. This, they adhere to, based on their own proper judgment. Succinctly put, it is believed that caregivers can make sound organizational and yet this may not be fully certain.
The problem with current long-term care facilities is their over involvement in a centralized system of power. The organization system in the household model gives plenty of room to decentralization of power, where the residents and caregivers reserve the right to make decisions pertaining to, and affecting their day-to-day lives. This is because they have the potential to do this and giving them an opportunity to exercise it, will go a long way to restore the sense of life, self-actualization, and wellbeing that long-term care institutions have failed to offer them.
Additionally, the physical environment in a nurse home is similar to that of an office, an industry, or hospital. It does not reflect the home atmosphere at all. All tasks by nurses, nurse aides, and dieticians are done hurriedly in order to fulfill the requirements of a non-flexible regimented system. Residents live in halls with their bedrooms on each side. Intimate conversations among close relatives are not very possible since only curtains separate their rooms.
They have to queue up when going to the dining hall or when attending to games and other group activities. They spent much of their time at the nurse aid points or in other public areas as if preparing to be taken to destined points. This is a herd-like notion in long-term care centers. Such unfriendly approach to care can only be changed through the conversion of these facilities to take after the household model.
Another reason for conversion of long-term care facilities into the household is simply because the system of the former facility is broken. It does not put into consideration the material, psychological and social needs of those whom it is supposed to care for. Although people remain the same through childhood, adulthood, and elderly hood, their material needs do not remain the same. This is the sense that the long-term care facility seems callous about. It tends to emphasize on the purposes of the institution rather than those of the individual. The need for privacy, warmth, and human contact is not met as expected.
Logistics of implementing the household model
The household model is therefore indispensable if the elderly and frail have to live to the fullest. This is because “the household model provides an environment that is immediately understandable to residents and visitors as a setting that has been a natural part of everyday life. Individuals intrinsically know how to act within a household. All activities of daily living occur within closely related private or semi-private zones that are discrete from other portions of the facility” (Nelson, 2008).
Three factors determine the size of a household model, which include the number of people living in it, the physical dimensions of the surrounding and the staff proportions required to dispense their care services. Developing a good living environment requires deliberately working to eradicate or modify the numerous clinical components found in nursing home. Even for reduced environments, there should be sufficient room left for vital staff activities such as chatting, giving out of medicines, cleaning untidy items, and bathing the clients (Nelson, 2008). To enhance privacy, household models, have both the private and semi-private places.
On the other hand, the quality of life is still enhanced through semi-public and public zones to enhance interaction with the wider community (Nelson, 2008). Even though household models accommodate a few residents, the cost of putting up one is likely to be enormous to meet the required varied needs of the residents. This include risk management for most households that is normally absent in most households with a weak fiscal back-up (Rampini and Viswanathan, 2009, p.2). Financing the household model residents can be effective through provision of cash, especially for non-medical services. However, further research on approximated costs is yet to be done (Stone, 2010).
The long-term care facility is devoid of very vital ingredients that enhance the quality of life for its residents. It lacks proper decentralized organization, privacy, sensitivity, and respect in meeting the needs of its clients. The primary motive of long-term care is usually to ensure that the beneficiaries enjoy the best care services at all times. Conversion of this facility into the household model is a step towards restoring the home environment that that the former model does not offer. This ought to be the way forward even though the anticipated costs are substantial.
Blanchard-Fields, F. and Cavanaugh, J. (2006). Adult Development and aging. New York: Cengage Learning. Web.
Nelson, G. (2008). Architecture and design for aging: House hold models for nursing home environments. Web.
Publishing OECD Publishing. (2008). OECD Economic Surveys: Luxembourg 2008. MA: OECD Publishing. Web.
Rampini, A. and Viswanathan, S. (2009). Household Risk Management. Web.
Shields, S. and Norton, L. (2006). In Pursuit of the Sunbeam: A Practical Guide to Transformation from Institution to Household. New York: Manhattan Retirement Foundation. Web.
Singh, D. (2009). Effective Management of Long Term Care Facilities. West Sussex: Jones & Bartlett Learning. Web.
Stone, R. (2010). Health affairs: Providing Long-Term Care Benefits in Cash: Moving to a Disability Mode. New York: Project Hope. Web.