Long-Term Care Continuum: Family Roles and Services

Introduction to Long-Term Care

The concept of long-term care (LTC) has existed in societies at the global level for decades. It has been practiced in different ways by families and institutions alike. Historically, LTC was primarily a responsibility of the family and the broader community. However, contemporary society and the pressures of urban life have made it increasingly difficult for individuals to find time to care for the elderly or terminally ill at home. As a result, institutions emerged to fill this gap, and the LTC continuum gradually shifted from family- and home-based care to an institutionalized system (McCall N., 2018). As the American population continues to age, the pressure on LTC institutions keeps increasing, underscoring the need for legislation that supports these institutions and promotes the delivery of quality services.

Long-term care is broadly understood as a continuum of social and medical services customized to meet the needs of people living with chronic health conditions that impair their ability to carry out daily activities. LTC is not limited to contemporary medical services alone; it also encompasses traditional medical services, housing, and social support. The goals of long-term care are more complex than those of acute care. While acute care aims to restore a patient to their previous level of functioning, LTC focuses on preventing further deterioration and promoting social adjustment to progressive decline. This distinction means that LTC—particularly for chronic conditions—involves a much broader range of services than acute care, with emphasis on both social and medical dimensions. Whereas acute care typically confines itself to specialty providers, LTC draws on a wide network including traditional medical providers such as hospitals and physicians, formal community caregivers such as home care agencies, informal caregivers such as family members and friends, and facility-based providers such as assisted living facilities and nursing homes (Stevenson D.G. & Wiener M.J., 2018).

Skilled vs. Custodial Care

According to Pfau W. (2016), there are two primary types of care: skilled care and custodial care. Skilled care refers to situations where intensive medical attention is necessary; it generally lasts fewer than 100 days because the patient is expected to recover from the medical condition. Custodial care, by contrast, is intended for patients with chronic conditions from which recovery is not anticipated. Also referred to as non-skilled care, custodial care is designed primarily to assist patients with activities of daily living rather than to provide specific medical treatment. The majority of long-term care falls under the custodial care category and is therefore expected to last longer than 100 days.

The Role of Family in Long-Term Care

The natural starting point of any LTC arrangement is the home—the place where an individual typically receives care before funds are arranged and a transition to adult day care or community centers is considered. Home care is most often provided by unpaid family members, though home health aides and other paid providers may also deliver care in this setting. The family unit is widely regarded as a critical component of LTC because family members possess an intimate understanding of the individual. The patient tends to feel most psychologically comfortable with family, making the transition into long-term care more bearable. Family members are also well positioned to notice behavioral or psychological changes and to respond to them appropriately.

Care provided by family members also has qualitative advantages over institutional care. The involvement of multiple family members creates variety and reassurance for the patient, in contrast to the more monotonous care that may be delivered by a single assigned staff member in an institution. Indeed, the aging in place movement has argued that it is ultimately less costly for individuals to remain at home longer than to move into institutional settings. Proponents suggest that homes can be retrofitted to better support people with terminal or chronic illnesses, making the home environment safer and more accommodating (Koenig J., 2018).

Whether care is provided at home or within an institution, effective LTC must meet three core criteria: the services must fit the needs of the individual, must address those needs as they change over time, and must align with the individual's personal preferences. These needs vary considerably among people requiring LTC services, even among the elderly, who represent the largest group of LTC consumers. The nature and severity of functional disability, along with the presence of other medical conditions, typically determines the specific type of service required (Presutti M., 2007).

References

AARP. (2010). All about adult day services. Retrieved April 05, 2018, from

Assisted Living Federation of America. (2016). What is assisted living? Retrieved April 05, 2018, from http://www.assistedlivinginfo.com/Assisted-Living-Care/What-is-Assisted-Living

Koenig, J. (2018). The need for family support groups in long-term care of Alzheimer's patients. Retrieved April 05, 2018, from

McCall, N. (2018). Long-term care: Definition, demand, cost, and financing. Retrieved April 05, 2018, from

Pfau, W. (2016). The continuum of long-term care. Retrieved April 05, 2018, from https://www.forbes.com/sites/wadepfau/2016/01/07/the-continuum-of-long-term-care/

Presutti, M. (2007). Supporting families through the nursing home transition. Retrieved April 05, 2018, from https://www.iadvanceseniorcare.com/article/supporting-families-through-nursing-home-transition

Stevenson, D. G., & Wiener, M. J. (2018). State policy on long-term care for the elderly. Retrieved April 05, 2018, from https://pdfs.semanticscholar.org/bc7a/f025b164efb97c2b42899d9c4a4ef7a2c66b.pdf