¶ … Health care [...] long-term care, and its' affect on the health care industry today, and in the future. Long-term care is becoming much more prevalent in our society because people are living longer, and as the Baby Boom generation ages, there will be even more elderly and infirm that will need this special type of health care. What is long-term care? "Long-term care has been described as 'a set of health, personal care and social services delivered over a sustained period of time to persons who have lost or never acquired some degree of functional capacity'" (Johnson, 1999, p. 306). Long-term care is important for a number of compelling reasons. First, our society is aging, and already there are "13.5 million Americans who need long-term care under the age of 65 and are expected to live longer than their counterparts did a generation ago. [ ... ]. By 2050, their numbers are expected to swell to perhaps 27 million" (Fox-Grage & Shaw, 2000, p. 30). Clearly, the problem is not going to fix itself. As more people age, more people will need long-term care. With a shortage of facilities and health care professionals, this may become increasingly difficult to provide, and to plan for. In addition, long-term care costs are rising, just like most other health care costs, and many elderly Americans will not be able to afford adequate long-term care. Already, "35% of Medicaid's $160 billion budget -- roughly half of which comes out of state general revenues -- goes to long-term care, most of it in institutions" (Fox-Grage & Shaw, 2000, p. 30). These are alarming statistics for professional health care, and for aging Americans. The average nursing home cost $51,000 in the year 2000 and costs have risen since then (Fox-Grage & Shaw, 2000, p. 30). As costs increase, and America ages, there will not only be a shortage of long-term care facilities and health care workers to staff them, the costs will rise so that long-term care will be out of reach of many Americans, at a time when they need it most.

Long-term care is changing the way America looks at health care. Because new ways of caring for the elderly are clearly necessary, there is more interest in this topic, and more research is being done on how to correct the problems associated with long-term care. Experts have found some alternatives to long-term care, which include in-home services, assisted living, and/or some form of assistance from family members or friends. Studies indicate that these in-home interventions, if started early enough, can reduce the need for long-term care. One study notes, "personal care services can prevent inappropriate institutionalization and that these services need to be a component of policies for future elder care because the majority of personal care services now provided for individuals are performed by female family members" (Palley & Hollen, 2000, p. 181). Other alternatives include group homes and adult day care, which are both becoming more popular, too.

Another important innovation in long-term care is the ability for patients to choose their own form of care that better fits their needs and lifestyle, rather than having their health care needs dictated by professionals and/or social workers. As one expert notes, "There is now a growing trend toward consumer direction and consumer choice in long-term care" (Batavia, 2002). This not only makes the patient more comfortable and serene in their own surroundings, it cuts the cost of Medicare and insurance claims, because in-home and assisted living care is traditionally less expensive than institutionalized care in a long-term care facility. Expert Batavia continues, " Some degree of consumer direction can be achieved under different models of long-term care, but many consumers prefer the independent living model in which they hire, train, and manage their own personal assistants" (Batavia, 2002). Thus, this form of care gives patients a feeling of choice, and a feeling of still having reasonable independence and control in their own lives.

Funding is of course one of the core issues in long-term care. In 1981, Congress established the optional Home and Community-Based Care Waiver Program of the Social Security Act, (Batavia, 2002). This Act allows states to provide in-home care when it can be shown that the in-home care costs less than institutionalizing the patient. However, expert Batavia continues, "in deviating from the traditional rigid federal Medicaid requirements, the states are subject to other administrative burdens in justifying their specified number of waiver slots (Batavia, 2002)....

One positive aspect of the program is that it does allow more choice and more options to seniors and their families who much decide about their long-term care alternatives.
Another important issue that is often not discussed in long-term care is when that care applies to the disabled or mentally impaired. Most people think of long-term care as primarily an elder issue, but it is also an issued for the disabled and mentally impaired. The same issues that face the elderly face these patients, and more alternatives are being developed, such as group homes, in-home care, and assisted living. In 2001, President Bush created a presidential executive order entitled "Community-Based Alternatives for People with Disabilities." This order states, "The Federal Government must assist States and localities to implement swiftly the Olmstead decision, so as to help ensure that all Americans have the opportunity to live close to their families and friends, to live more independently, to engage in productive employment, and to participate in community life" (Batavia, 2002). Thus, the disabled and infirm have many of the same options for health care and long-term care, and many of these solutions will continue to be important and valuable in their lives.

Historically, aging relatives were traditionally cared for within the family. As society has changed, and families have grown apart, many elderly patients who need long-term care have no families that are capable or willing to take care of them. Thus, long-term care facilities and nursing homes became more prevalent. Clearly, one of the most important issues in this topic is the growing need for long-term care facilities and staff, and how consumers will pay for their long-term care. Insurance firms are now commonly offering long-term care insurance, and many people are buying policies early, long before they see any need. For those without insurance, Medicare and other state funding may pay a portion of long-term care costs, but usually not all. Thus, a patient is not only faced with giving up their lifestyle, but with mounting medical bills, which can all add up to added stress and strain.

In addition, many other types of elder care have developed as the population has grown, including assisted living, in-home care, and personal care from friends or relatives. More of these options need to be funded and addressed, first, because they allow the elderly to remain in their homes and maintain their lifestyles, and because they are cheaper alternatives to long-term care in a health care facility, and they still provide good results.

One of the major problems with long-term care is that often, the elderly patients have little say in the decision to seek long-term care in a facility such as a nursing home. They have reached a point where they can no longer function independently, and they need help with household chores, and even personal hygiene. As little as ten years ago, there were few options available to elders who were still relatively healthy, but could not function on their own. New methods such as in-home care and assisted living facilities have begun to fill the gap between home and long-term care facility, but many seniors who need these services may not know they exist, and that they qualify for aid.

Long-term care also creates many other stresses for the elderly besides losing their home and their independence. If they enter a nursing home, chances are they will spend the rest of their life in that facility. In addition, they must deal with selling their home, moving their belongings, what to do with pets, how the facility will get paid, who their new friends will be, and many other life changes that are difficult at any age, and more difficult for the elderly. This can be stressful and even life threatening to people who have spent their entire lives living independent and fulfilling lives. Nursing homes seem to be the last stop for many elderly, and most people understand that, and that is why they resist long-term care in a facility such as a nursing home.

Long-term care can become quite complex both emotionally and financially, and so, any alternative that provides a better lifestyle while the patient remains in his or her own home, or with family, seems like a better option than institutionalization. People should be allowed to grow…