Healthcare serves one of the primary human wants, and thus it is one of the oldest specialized human functions. In fact, even before the recording of history, some skilled people had acquired some healing art. According to the World Health Organization (WHO), health care system consists of people, organizations, and actions with the aim of restoring and maintaining a given population or society in a healthy state. A health care system is made up of at least five components, which are, places where health services are provided, providers of health services and healthcare therapeutics, the medical and pharmaceutical equipment, and institutions for training the healthcare practitioners. Today, health care systems are not only different but are also complex as compared to the previous centuries. The changes are because of social political and economic factors. The United States system is exceptional from the rest of the world as private financiers widely operate it (Wan, 2010). They do not have any dominant sector controlling the financing arrangement and means of providing care.
Long-term health care is an issue of concern in the medical systems not only in America but globally. Long-term care refers to a variety of social and medical services aimed at addressing the needs of citizens who cannot manage to carry on with their everyday activities. Some of the conditions requiring long-term care are in case someone is suffering from a terminal disease, injury, disability or infirmity of old age. The American government is working on means to provide this service without busting the bank for the taxpayers or making it unbearable for families and affected individuals. They are both formal and informal long-term care services. The organizations, which provide formal LTC services, accommodates people who are in need of a continuously supervised care.
Historical Development and Current Role in Healthcare Delivery
The history of LTC in America goes back in 17th century in the building of almshouse commonly known as poorhouses. Almshouses were government-regulated institutions where elderly, orphans, homeless and disabled could access medical services, shelter, and food. However, the poorhouse condition was squalid, and there was a need for the better living condition in these institutions. In 1935, the Social Security Act (SSA) was passed to address the needs of Americas elderly who used to spend their lifetime savings to access medical services. Later on, Old Age Assistance (OAA) was incorporated in SSA allowing the federal government to join hands with the state government in providing financial assistance to the needy and elderly persons. In 1946, the Hill-Burton Act saw the states receive federal funds to finance the construction of hospital beds as the old hospital had converted into nursing homes. By 1950, the federal government had started construction of nursing homes and procedures to increase OAA payments (Greenwald, 2010).
In 1965, the development of Medicare and Medicaid was one of immense transformation on the American healthcare landscape. Medicare covers the cost of medical services for the elderly, those with end-stage renal disease and certain disabled people. Medicaid, on the other hand, covers the health care services for the unfortunate population. At this instance, LTC became part of United States healthcare delivery system allowing the federal and state governments to become the largest financiers of LTC services. In 1981, the Home and Community Based Services waiver program was launched to enable states to offer LTC services, which are not provided by the Medicaid program (Greenwald, 2010).
Today healthcare exemption has succeeded substantially in allowing the state to expand community-based LTC services with the intention of saving money on institutional care. The beneficiaries of the waiver are the elderly, those with developmental disabilities and working-age people with disabilities. The last decade has seen the government putting an extra effort to integrate the healthcare system to give room to affordable care to all citizens regardless of their social and economic status. The year 2011 saw the first nations baby boomer turn 65 and this has attracted the attention of private investors to provide quality services to the aging population. Also, the reform in the long-term healthcare has seen improvement of both medical and social services especially to the unfortunate and the elderly. At present, eighty federal programs finance LTC facilities including the Department of Veterans Affairs, Medicare, Medicaid, Title XX Social Services and Older Americans Act.
Determining how the long-term care facilities should meet the increasing care needs in American population has become one of the sparkling topics in health policy circle. The LTC sector is facing some challenges due to slow economic growth and an increasing number of the vulnerable population. United State is reviewing the long-term care system as a whole especially its structure and financing programs. The challenges LTC is facing have demanded its restructure with a good number of Americans feeling the system no longer meets its designed obligation. Recently, the policymakers were debating on the reauthorization of the Old Americans Act to strengthen and modernize the aging services for LTC to meet the various needs of the growing older population. Among the area of concern, OAA has to work on are job training, disease prevention, health promotion and caregivers support.
Also, the senior programs are considering cutting their funds. For instance, the budget cuts for the last few years have affected the older adults increasing their demand for economic assistance as only a few of them can manage to meet their wants. Limited funds have affected the innovation sector as well since they are fewer advancements taking place. For instance, combining voice-activated personal computers with robotics is helping disabled people to carry their daily activities without assistance. However, lack of funds to finance this project is calling for attention from the legislature where the state and federal governments have to weigh the benefits and limitation of some projects under government funding. On top of financing the senior disease prevention and health promotion, the Congress continuous to repeal the cut of other preventative benefits. For example, Prevention and Public Health Funds are under repeal. Also, the Senate recently proposed the repeal of healthcare reforms to eliminate the Medicare annual wellness visit which would increase copayment of preventive services which are currently free under Medicare (Greenwald, 2010).
Spurred on by changes in technology and increase life expectancy there are increased cases where professionals overlook some ethical conducts. Recently, they were a discussion on whether those suffering from terminal illness should have the right to refuse resuscitation assistance and medications. The focus has intensified to whether such people should receive life support and life sustaining nutrition. The whole issue is now taking a different path to determine if it would be ethical to use suicide machine to conduct mercy killing especially in circumstances where the patient is suffering. For example, the state of Oregon was trying to control the high-cost benefits such as organ transplant for those under Medicaid program. The Oregon effort has forced the state policy arena to consider the issue. The current debates on ethical conducts are when and whether healthcare facilities should limit life-sustaining and life-saving acute care. In an attempt to address this menace, Affordable Care Act had proposed Community Living Assistance Service and Support Program (CLASS), which was a voluntary LTC insurance program to help people plan for long-term services as they age. However, CLASS was suspended by the opposition in the Congress who believed the program was not effective but have offered nothing to replace it despite the increasing number of people struggling in the country.
Development of family policy is predominately becoming a public policy debate. Relatives and informal caregivers are providing a considerable amount of care to people especially those with chronic disabilities. A good number of individuals with disabilities resides in the communities with the help of family caregivers and some recognized services for those who are lucky to receive some help from health facilities. Among the most affected population serving as informal caregivers are women and adult children. The informal caregivers who get into a precarious financial and health situations. The policymakers are considering how the Long-term care system sh23ould find its way to support this person.
Quality, Safety, and Competition
The quality of care patients are receiving courtesy of the LTC has gained attention from various stakeholders. With the increasing number of people indeed of these services, the government aims at providing an optimal level of care within constraints of limited resources. For the last few years, several changes in LTC system in the United States has influenced the quality of nursing care in these facilities. Today, the process of developing measurable quality standards for nursing homes care has taken a new turn aimed at ensuring that patients receive quality services. To improve the quality of healthcare facilities, the use of clinical information to identify cases where quality improvement (QI) is needed is under review. QI will contribute to improving clinical care for a precise population by comparing public reports. It means that those facilities offering LTC services will have to work on internal quality improvement efforts, as consumers will choose providers of LTC services based on the public reports published in public media. Also, QI has helped to develop a platform where the best providers of these care receive awards. All the healthcare facilities are easily monitored which is for the good of the patients.
Psychologists have identified means in which physical environment impacts human security and performance. In the design of healthcare, the environment affects the performance of nurses and other caregivers. If the model of the healthcare setting is appropriate, patients are likely to receive safe and quality services. Safety may include applying improving standards and availability of assistive strategies to prevent patient falls. Also, using all the available resources to control and avoid the spread of infections and preventing patients and providers injuries are essential in offering safe care for patients. Other factors LTC centers consider in safety are timeliness, which includes response to patient need, eliminating inefficiency in delivering of care and facilitating the clinical work of nurses. All this care measures aims at providing equality for all patients regardless of their financial status.
In the business, world competition is encouraged, as consumers are likely to buy quality goods and services as compared to monopoly market. Healthcare is not different in any way as competition is one of the mechanisms used to increase value for patients. As the healthcare centers compete, the effect is directly reflected in the quality of healthcare and the cost of the services provided. For instance, the emerging of private long-term care financing and delivery policies means there is growth in the LTC sector. The fact that they are more firms taking advantage of the increase in demand for long term care services it is for the benefit of the of the patients. The competition has affected access, quality and cost of the care services. Competition and safety have changed...
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