Term Paper on "Public Policy and or Program"

Term Paper 17 pages (4884 words) Sources: 10

[EXCERPT] . . . .

Home and Community-Based Care

Today, we face many challenges in society. Some of these relate to the costs of living, while others relate to political, social, educational, and a myriad of other issues. One major challenge facing society today, and for which we are somewhat ill prepared, is the increasing number of years an average human being might expect to live. Medical technology and greater attention to longevity-increasing lifestyle habits have created a major demographic shift towards what is referred to as an "aging" society. This means that most people alive today face a situation in which they will probably reach extreme old age. This, in turn, means that many more people than in the past will be in need of long-term care, either at home or in an institutional setting. This challenge has created a great economic burden on states to fund such care for the citizens most in need.

Although all states have systems in place to deal with the care needs of their citizens, few of these are uniform. Some states, for example, emphasize institutional care in terms of their funding, while others have begun to place increasing emphasis on providing high-quality home and community-based long-term care for people who prefer those. In order to better address the needs of citizens in a truly person-driven way, states, professionals, and services users need to enter into partnerships to obtain solutions to funding challenges, as well as obtaining the best ways to provide the highest quality of care resources for citizens across the country.

Background: The Current Situation

Today, the older, disabled, and otherwise in need of care person has a choice of two basic options: Receiving care in the home setting or receiving care in an institution. According to the AARP (2013), for example, today's person in need of services has the option of long-term services and supports (LTSS). These include assistance with routine daily activities such as bathing, eating, and shopping. When a cognitive or chronic health condition affects daily life in the long-term, this is a type of long-term service that might interest a person. Long-term assistance might also include equipment such as wheelchairs or environmental modifications.

The most-used health care systems in the United States today include Medicaid and Medicare. Currently, these systems provide support for people in need of both short- and long-term care. Long-term services and support listed for Medicaid fall under institutional or home and community-based services, as mentioned above (Medicaid.org, 2013). While both options have their benefits and drawbacks, most people today, especially when facing age-related challenges, prefer to remain at home for as long as possible before being institutionalized.

The ideal for home and community-based care, of course, is to provide the optimal quality of care a person might be able to expect. According to Medicaid, this would include several ideals in terms of long-term care in the home setting. At the basis of this is the partnership paradigm, according to which service providers and institutions work in partnership with states, consumers, and advocates in order to promote an optimal level of care to individuals who need it.

The specific effects of this paradigm aim to provide services that are person-driven. This means that people in need of long-term care services should have choices regarding issues such as who would be involved in care, where the care setting should be, the level of participation and community life, and other general decisions relating to their care. Another ideal is inclusiveness, where all users are supported and encouraged to live where they wish while having access to all the services and professionals they need. Effectiveness and accountability mean that a high quality of service is provided, while all partners involved ensure accountability and responsibility in terms of level of care and usage of funding, whether from private or public sources. Also in terms of costs, the system provided should be sustainable and efficient, where economy and efficiency are balanced by means of coordinated care provisions and payment. He system should also be transparent, making effective use of tools such as information technology to provide consumers, providers, and tax payers with fully disclosed information regarding the application of funding.

While these ideals look very good on paper, the reality is often that the system remains somewhat less than streamlined, especially as far as costs are concerned on a state level. This is not to say that services are not provided to a level that is promised. The simple reality of the matter is, however, that today's health care system in the United States tends to be somewhat overwhelmed by the increasing needs, especially among the aging population, for services that were unforeseen mere decades ago.

Today, an estimation device known as "Scorecard" serves towards stabilizing the current divide among states regarding the quality, amount, and costs of services provided. The current Scorecard focuses on state services provided for older people and adults suffering from physical disabilities.

The main purpose of the Scorecard, then, is to measure the ability of states to provide "high-performing" or "excellent" LTSS to individuals within that state. Various characteristics have been identified in terms of excellence for these services.

The first of these is affordability and access. According to this requirement, long-term care services provided at the state level need to be both affordable and accessible to those who need it. It should be easy for consumers to both find and afford these services.

The second requirement is the choice of setting and provider. As mentioned, it is today an increasing choice among consumers to receive long-term care services in their homes. Hence, this requirement concerns the ability of states to provide consumers with a range of at-home and institutional settings to choose from when in need of long-term care. These serves also need to take a person-centered approach, regardless of setting, as well as offering consumers a choice of caregivers to provide services.

A third requirement is quality of life and quality of care. According to this requirement, services are required not only to offer maximum positive outcomes, but also include respect in the treatment of individuals. Whenever possible, personal preferences of care recipients should be respected.

In many cases, family members act as caregivers, especially where the care of older people is concerned. In such a case, the needs of caregivers that are not in fact medical professionals should be taken into account by state services. Concerns that need to be taken into account in this regard include the fact that family caregivers are in danger of being overburdened, especially where here are issues such as jobs and children involve.

According to the Scorecard, states are also required to offer effective transitions and organization of care. This means that long-term care services need o be coordinated or integrated with other health services and social supports. Where an older person already receives care from a social worker, for example, this person needs to be involved when the long-term care needs of the client changes.

In this, the Scorecard offers a valuable tool in order to determine both the current level of services provided at the state level and to determine the needs still existing among clients in the state. In addition, the organization, delivery, and financing of these services can be streamlined much more effectively with the inclusion of the Scorecard or similar estimation devices. This, however, is a major challenge, since services currently offered by states and policies to support them are widely divergent, as will be seen.

The Role of the Registered Nurse

One issue of great concern in the choice between home care and institutional care is he quality and type of care the individual would be able to obtain. For this reason, advocates who promote increased home and community-based long-term care services have also promoted the ability of these individuals to enlist the services of professionals such as advanced practice registered nurses (APRNs) (Brassard, 2011, p. 4). According to Brassard (2011, p. 4), there are several benefits to allowing nursing practitioners to practice in the home setting. In addition to the professional service received at home, such a service will also allow the individual to receive institutional care once this becomes necessary.

Although a prolonged home setting for the long-term care of an aging, ill, or disabled person has become the increasing norm, and indeed the choice within many families, it is also a fact that this setting can become unviable in terms of the ability of the home setting to meet the needs of such an individual. Involving a nursing practitioner has the advantage of helping patients and their family members make sound decisions regarding their health and he specific needs regarding their continued care in the home setting or in alternative care settings.

Indeed, proposed legislation to allow advanced practice registered nurses to certify home health services also has the advantage of taking the burden from formal institutions by streamlining both the decision of certification and the provision of home services to… READ MORE

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