Long-Term Care: the Pros and Cons of the System in USA

Long-term care refers to all those medical and non-medical services given over a duration of time to a person suffering from a chronic disease or disability, or those who have experienced an accident. It basically aims at helping a person meet their daily needs such as bathing, dressing and feeding. The care can be given at home, in nursing homes or in the community. The care is normally given at whichever age since the disabling conditions normally occur at whichever age, requiring the affected individual to get long-term care services. About one million elderly men in the United States need long term care, while studies show that in the year 2020, about twelve million elderly Americans will need long term care services, with more than half this number be cared for at home by other family members (Medicare, 2009).

Long-term care can be in many forms and does not necessarily imply that the care has to be given by an individual. For instance, it can also refer to the special aid provided by a wheelchair or just the meager stay in a nursing home (Tumlinson, Woods and Avalere Health LLC, 2007). At the moment, about ten million people in the United States are in need of long-term care. Part of this group is those that need assistance to undertake the daily living activities such as using the bathroom and the toilet, eating and movement within the house, while others need assistance with instrumental activities such as using the phone, meal preparation, management of finances, proper usage of medication and shopping for household items. About half of the long-term caregivers are the family members of the patient and only a small percentage of the caregivers are paid to do so. Therefore, they are only able to serve a limited number of patients most of which are those with a lot of needs and the care is normally given in a nursing home or in a community-based facility. A survey done in the recent past by Spillman and Black showed that about 28% of the elderly people with long-term care receive no care at all and that about 47% of the people with long term care needs normally get care from family members and friends and well-wishers (informal caregivers); the research also showed that about 84% of these caregivers are either a spouse or a child (Tumlinson, Woods and Avalere Health LLC, 2007).

There are various types of long-term care services available to the patient and for this reason, some of the patients normally prefer both family assistance and formal care, while others will prefer going the formal care option alone. These long-term care services include adult daycare, home care, assisted living and nursing home care. The service chosen normally depends on the gravity of the care needed, the availability of family support and the availability of finances. Nursing home care normally handles the most serious cases such as patients suffering from Alzheimer’s disease. The homes normally provide assistance with medication; they offer help with the ADLs (Assistance with Daily Living activities) as well as recreational activities. There are both private and semi-private rooms in the homes with the private rooms being slightly more expensive.

There has been a decline in the number of people using the homes and this is as a result of an increase in the number of alternatives to nursing homes, there has also been a reduction in the number of disabilities and disabling conditions and a change in Medicare payment policy that now covers skilled rehabilitative care in nursing homes for a short time when the patient is in hospital (Tumlinson, Woods and Avalere Health LLC, 2007). The other form of long-term care is referred to as assisted living which is normally owned by the government and normally provides residential or home-based care.

The government regulation about assisted living requires that the patient should be given assistance with ADLs and IADLs which are the Instrumental Activities of Daily Living, The presence of 24-hour staff, housekeeping; assistance with meal preparation, recreational activities, management of medication and assistance with the movement from one place to another. Assisted living is normally given to people with a lot of resources and is normally provided by Medicaid and not Medicare. Medicaid normally provides assisted living services in forty-one states and it normally covers the costs of the services provided. Senior housing is another form of long-term care that has come up as a result of technology, market changes and senior preferences. It is normally in two forms i.e. senior independent living facilities and continuing care retirement communities (CCRC).

Independent living is an apartment that employs the use of simple techniques and technologies and is normally meant for older people only. It normally provides group meals, washing of clothes, planning of one’s activities and assistance with movement. It gives no medical assistance or even with ADLs and hence, this makes it a long-term care option suitable for those who are healthy and financially stable so as to cater for their own health care and the housing cost, although other needs can normally be covered by Medicaid or Medicare. CCRC provides independent living in one place and also consists of assisted living and skilled nursing care. They can also be described as apartments having independent residents and normally have or are normally positioned close to a nursing home. Members of the CCRCs who join them when they are still healthy tend to sign long-term contracts with the CCRCs because they normally provide them with the best accommodation options that fit their changing needs as they age. Medicaid and Medicare normally provide financial assistance to the CCRCs for specific health and long-term services they provide.

Home-Based care is a form of long-term care that provides the required support services in one’s own home and provides services such as companionship, assistance with movement, and assistance with the ADLs and IADLs. Homecare services are either financed by the individual privately or by the government to the low-income earners. Adult daycare services are normally provided by adult day care centers and they normally provide social services such as recreation and healthcare to adults with disabilities or to people with brain impairment. Medicare does not cover adult day care while Medicaid allows individuals in some states to pay for adult day care under special community-based waiver programs.

Hospice and Palliative Care is a unique long-term health care provider that normally assists the caregiver by managing the pain that the patient is feeling. They also offer medication as well as helping the patient accept and prepare for death. The services are normally provided in one’s own home, in an assisted leaving the apartment or in a nursing home by a group of professionals who may include nurses, clergy, physician, home health aides and social workers.

Assistive technology refers to an array of equipment and facilities that help the patient in reducing their dependence on the caregivers. These technologies include wheelchairs, walkers, specialized vehicles, spoons and bathrooms among others. These technologies help in increasing the patient’s ability to do a number of things on their own without the necessary need for a caregiver.

The American health care system is currently one of the best in quality all over the world except that it has become quite expensive and unaffordable to most of the low-income earners in the recent past. This could have been caused by the increased demand for health care services; it may also be as a result of peoples demand for the latest medication, equipment of very high quality and the most highly trained physicians and caregivers; and all these simply lead to the cost of the health care being quite high. A good number of Americans do not know the full cost of the health care that they are provided with because the employees have their health covered by the employer. In this kind of arrangement, the employer normally pays more than half the total cost of the cover while the employee only pays for a small portion of the total cover, which has resulted in most employees claiming that the insurance cost surges due to unnecessary health care cover. It may not be easy to find a solution to the American health care problems since, for instance, the single-payer model designed to find a solution to the problem only transfers the cost to the government which in turn will tax people heavily so as to meet the cost. The government could also consider limiting the services that it caters for so as to reduce the unnecessary demand for the best health care. If the health care is to be solely run by the government, then it means that people will be limited to Medicare and Medicaid which are normally associated with misappropriations. The possible way of solving this is a crisis is through increased competition in the provision of services, technological innovations and Increasing communication and transparency about health care costs (Robinson, 2009).

Long-term care has become a necessity to most individuals and is important in providing the old with a proper environment for resting. It also helps in lifting the burden off the shoulders of families with old or sick members who require specialized care. Since part of it is normally taken care of by the state, it makes it an affordable health solution to the low earners. Long-term care also has a lot of undesirable things that discourage people. There is always the limitation of movement in the facilities, control of activities and restrictions on diet and lastly, there is limited privacy (Robbins, 2008).

Despite these drawbacks, long-term health care is still a necessity to most individuals and families since it normally provides the medication and a suitable environment that will enhance healing. The government should employ strategies to make it affordable and efficient at all times.


.Medicare. (2009). Long-Term Care. Medicare. Web.

Robbins, J. B. (2008). Long Term Care Concerns: Disadvantages of Nursing Homes. Web.

Robinson, O. B. (2009). The future of health care in America. Web.

Tumlinson, A. et al. (2007). Long Term Care in America. Web.

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