Long-term care involves different services implemented to solve an individual’s personal or health care problems on a long or short period. The services help people who can no longer perform everyday activities to live safely and independently when they can. Depending on an individual’s needs, different caregivers offer long-term care in other places (Smith & Feng, 2010). The care can be given at home by unpaid friends or members of family where it includes services the like of transportation and meals services. Sometimes these services are provided for a fee. It can also be provided in nursing homes or the community, such as in adult daycare centers.
Unpaid family caregivers give most care services, while most of the formal long-term care services are catered for by government agencies. Personal care is one of the common types of long-term care, which involves helping a person with daily activities, or the activities of daily living including eating, moving around, grooming, dressing up, using the toilet, and bathing(Smith & Feng, 2010). Individuals usually need long-term care if they have a severe and ongoing disability or health condition. The long-term care need can suddenly arise, especially after conditions such as heart attacks or stroke (Madas & North, 2016). The need might also arise gradually when an illness gets worse or when people get frailer and older.
The services and programs that make up long-term care continue to evolve significantly with time as time goes by. Due to these changes, more challenges emerge in the long-term care delivery system. (Fogarty et al., 2014) Among these challenges are securing enough finance, medicare coverage, long term care insurance, increasing cost, in-home care, improving quality of care; including reducing boredom and isolation, challenges with culture change and shift to person shift-centred care. The ageing of the population and its effects on the long-term care industry is also a challenge and staffing shortages in the health care workforce.
Securing adequate financing
Securing adequate financing has been a significant challenge in the long-term care industry. Currently, long-term care is mainly financed through private payments and Medicare. There are not many available alternatives that could include joint private-public arrangements and social insurance. Direct families of the patient almost exclusively provide long-term care. The population requiring long-term care is more significant on average in low-income than in high – and middle-income families. In low-income families, long-term care is primarily due to ageing and the high prevalence of chronic diseases, such as physical and mental disability caused by violence (Madas & North, 2016). Most of such conditions affect young people who are in the productive age groups. As a result, it reduces the capacity of the caregiver even more than in high-income families. Notably, public financing schemes very little cover long-term care in the middle- and low-income families.
In low-income families, if the community or the family networks are not in a position to give long-term care, it ends up being underprovided or outsourced on the private market (Fogarty et al., 2014). This increases the risk of catastrophic spending since it directly affects the health system efficiency by raising the levels of poorly met or unmet needs. As the demand for long-term care continues to further, the government is called upon to invest in health prevention and promotion programs to bring down the levels of chronic disability and disease and reduce the health care demand in general, including long-term care. Secondly, the government is called upon to invest more in cost-effective community-based care development, especially long-term care. The government should also include home-based long-term care programs in benefit packages financed by the public to elevate access to long-term care services equitably and fairly. In general, long-term care should be covered by public financing projects to reduce the burden to the communities, especially the middle- and low-income families who struggle with offering long term care to their loved ones.
Medicare coverage
Medicare is a publicly funded health program covering people in need of long-term care, but unfortunately, it is coordinated poorly. There exist gaps in different Medicare services, and notably, there is overlap in others. When this happens, it results in inefficient services delivery and confusion among those receiving the program and providers (Feng et al., 2020). Although an increasing number of individuals receives community-based and home services paid for by the program, there are many variations among target groups and across states.
There is a need for structural reform in the system of long-term care. Although community-based and Medicare services have rapidly grown, wide differences in spending and participants are seen across regions (Feng et al., 2020). Variation in spending and participants rates for different people also hints that differences in accessing services exist within and across different regions. One significant concern is that the size of the whole home-based and community services spending is below institutional expenditures. Different places have different efforts to divert institutional spending to home-based and community services, which may indicate differences in the region’s commitments to rebalancing.
Long term care insurance,
Long-term care insurance gives long term care, nursing-home care coverage, and adult day care for people age 65 or older, including those with disabling or chronic conditions that need full-time supervision. Long-term care insurance provides more options than most public assistance programs. While the costs of this insurance may differ by place, it is primarily costly. In 2020, for instance, the estimated cost of a nursing home or room in a skilled nursing facility was $105,850 a year, according to the USA (Cohen, 2016). In America, Medicaid provides for low-income people or those who spend down investments and savings because of care and exhaust their assets. Each region has its eligibility and guidelines requirements. In most cases, the cost is too high that most people, especially the middle- and the low-income individuals, cannot afford. Most of them struggle with medical and long-term care bills when one of their loved ones gets into such a problem.
The other challenge faced by the long term care industry in terms of long term care insurance is the exhaustion of insurance benefits. After insurance benefits are used up, most people need a long-term care service paid for out of their pocket, by the Medicaid program for those with little assets and incomes or by private insurance (Cohen, 2016). This turns out to be a bigger problem among most people who cannot afford the expensive long term care insurance. Notably, most long-term care policies only cover a specific amount of money for each day or period you spend in a long term care facility or for each long term care home visit. Therefore it becomes hard for most people to consider insurance since it will not fully cover their needs and the needs of their loved ones.
Increasing cost
Long-term care has grown more expensive over the years. People are paying more for care options such as assisted living communities and home health aides, not forgetting adult daycare. Nursing homerooms come with massive bills that are a real burden to long-term care patients (Wang & Tsay, 2012). The costs of coverage have also risen, and many people struggle to meet such needs. For the average family, it is becoming more and more challenging to purchase long-term care insurance. For the government, financing the cost of long term care has become more difficult due to the number of people in need of long term care. The long-term care trend indicates that the government will go on with funding most of the future long-term care services (Wang & Tsay, 2012). The Medicare burden will elevate in the next few years due to the ageing of the population, the increasing health care costs, and the increasing demand for long-term care services.
The increase in Medicaid payers and pressure will continue to be more challenging to handle. Government budgets will be responsible for more heavy burdens on long-term care spending needed to cater to the services. The question remains whether public funding to the states should be added to cater for the services, and if there should be more responsibility transferred to the private sectors to reduce the burden on the government. One part of solving or fighting this challenge is considering incentives and policies to improve the affordability of long-term care insurance and make the market for purchasing private long-term care insurance better and easier to afford (Chen, 2013). Tax credits and other incentives meant to buy personal long-term care insurance and promote personal caregiving systems of people who tirelessly look after their loved ones might alleviate some of the public sector’s economic burden.
Long-term care needs to be funded by different sources, just like the other health care services. The method selected determines the level to which the people are protected against fairness in financial contribution and financial risks of long-term care needs (Chen, 2013). Health insurance premiums and other prepaid contributions should allow selected services to be provided free or at lower prices at the point of delivery (Madas & North, 2016). By doing this, members would be protected from the risk of unforeseen health expenditure due to incapacity or illness, and they would get financial access to the services. Another significant challenge in long term care as far as cost is concerned is that all income groups, including the low, the middle and the high-income groups pay the same proportion of their income. Financing bodies based on direct pocket payments, including direct patient payments, co-payments and user fees, elevate the risk of unexpected health expenditure. Bodies based on such prices are unfair and regressive, as they place a more significant financial burden on the vulnerable and poor that often uses the services most (Wang & Tsay, 2012). Insurance bodies based on flat rates are also regressive.
The target for prepaid contributions as a proportion of total health expenditure does change with time and place. Depending on the defined priorities by the country, raising enough public funds for long-term care poses an increasing risk for most regions. When it comes to long-term care, direct payments should be regularly and closely monitored, also after seemingly minor amendments to the scheme. For instance, many regions with public financing schemes for long-term care don’t include accommodation and food costs.
Improving the quality of care
Long-term care policies and programs in most regions suffer from a significant problem. The procedures are all balanced toward a theory of nursing home care that tends to be related to a poor life quality for patients (Rodrigues, 2017). The quality-of-life domains, including relationships, autonomy, comfort, security, enjoyment, privacy, dignity, functional competence, and spiritual well-being, are essential for improving quality of life. Today, such types of quality-of-life results are reduced in the current assessment quality and offered credence only after safety and health outcomes are considered.
The cultural shift is difficult in most long-term care organizations since every culture is deeply linked in the system and is, therefore, more difficult to change (Rodrigues, 2017). Such an organization’s culture has interlocking goals, values, processes, roles, assumptions, attitudes and communications practices. Most long-term care facilities face challenges when transitioning from an institutional medical model to a person-centred care model. Efforts to reduce boredom and isolation in care plans face numerous challenges due to differences in patients’ preferences and tastes.
In-home care
In-home long-term care includes personal support and health services to help individuals stay at home and live independently. Most of this type of care is provided in the patient’s home or at the home of a family member. Over the years, in-home care has become more popular since more and more people choose to recover from surgery in place or age within the comfort of their homes (Kocarnik & Ponzetti, 2016). However, long term in-home care has been facing challenges just like other healthcare departments. There are a few common challenges and problems within in-home health care that nurses face.
Disgruntled Patients is an exceptional challenge in-home care. Some people may not like the presence of a home health care nurse. These people usually see home care nursing as an invasion of their privacy or a threat to their independence (Kocarnik & Ponzetti, 2016). Although it is rare, the patients might violently lash out at their caregivers, especially if provoked by a painful experience, such as an injection. The other challenge is hazardous conditions where in-home care nurses have little or no control over the homes they go in. hazardous materials, cloudy conditions, and pets with diseases can all put a home health nurse’s safety at risk. The other challenge is inadequate medical equipment when it comes to in-home care. Nurses are working in homes without sharps containers risk experiencing things like a needle stick injury after administering medication. Violence may also be a part of a patient’s home life, putting the safety of the in-home care at risk. However, in-home health care, nurses should know their environment and alert their managers of unsafe situations. Lastly, lack of enough support is a common challenge in-home care where nurses, especially new ones, do not get access to a robust support network that they can turn to with concerns and questions. Most nurses feel that this is lacking in the in-home care environment due to the solitary nature of the profession.
The ageing of the population and the effects it will bring to the long-term care industry
The number of the elderly in society has grown since the medical, social, and economic advances have improved life expectancy. Middle- and low-income families are also experiencing an increase in life expectancy, but the process is slower than high-income families. For these reasons, concern about the ageing population and the expected number of older people in need of long-term care cannot be underestimated. According to Ruggiano & Edvardsson, 2013, approximately seventy per cent of people over the age of 65 will need some long-term care at some point in their life. A good percentage of these people will need care in a setting with skilled care nursing.
The combination of longer life expectancies and an ageing population will elevate the need for all types of long-term care services in the years to come (Ruggiano & Edvardsson, 2013). Some factors with the capacity to bring down the available informal care amount to the elderly from friends and family are the higher rates of divorce, the trends of smaller family sizes, and higher care provision costs to a family member. Therefore, it is essential to develop solutions for the expected increase in demand for long-term care among the ageing population. Governments should come up with programs that cater for these demands in society.
Staffing shortages in the health care workforce
Staffing shortages in the health care workforce is a trending challenge as far as long term care is concerned. The demand for long-term care exceeds the number of trained nurses qualified to deliver long-term care, which leads to more significant percentages of notable workforce shortages. The shortage of health care nurses has already hit different areas of the world, as there are fewer qualified applicants to fill vacant positions for long-term caregivers (Ruggiano & Edvardsson, 2013). Most long term care facilities have difficulties hiring and retaining competent long term care nursing staff, leading to higher numbers of patients being hospitalized.
One historical factor contributing to the shortage of long term care nurses is because long-term care workers have been poorly paid compared to workers in other health care settings. The trending nurses’ turnover common in most long-term care settings also contributes to less than inadequacy in staffing levels and affects the quality of care (Madas & North, 2016). Nurses and especially long-term care nurses staff members need opportunities for continuing education, better working conditions, and a better competitive wage than they have been receiving if the significant rate of turnover is to be brought down (Ruggiano & Edvardsson, 2013). Long-term care nurses work in challenging environments. They must care for different clients with different medical requirements and disabilities to manage and go through the hectic dynamics of family that mostly come with working in such environment.
Factors contributing to shortages in the health care workforce includes small salaries, stressful working conditions due to inadequate staffing and numerous turnover. Other factors include tiny benefits and the absence of social support such as transportation. Little job security and high rates of injuries are the major problems that must be addressed to raise job satisfaction and improve employee retention in the long term care world. Besides, long-term care providers must start acting now to attract more health care personnel into their facilities. This is possible by offering more attractive benefits and competitive wages, by joining hands with institutions that train long term care nurses and other related professionals.
Conclusion
Long-term care is a broad range of social and medical services available to compensate for functional disabilities and meet the needs of persons of different ages. However, this care usually serves older people who cannot survive independently. The specialization and evolution of residential, home, and community-based health care services will go on. The longer life expectancies, rise in the ageing of the population, rising cases of chronic diseases, improvements in medical technology and public health will result in vast numbers of individuals in need of long term care services in years to come. The trend will continue even when there is a shortage in long term health care personnel.
Therefore, the long-term health care industry is called upon to start to work tirelessly to bring down the long-term continuum care services and payment system fragmentation for such services. Long term health care managers should stay attentive and current on data trends. They should be collaborative with other long-term care providers within their societies, be ready to expand current programs quickly, and serve a more significant number of people by giving affordable, efficient, effective, and accessible care.
