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Chapter 2. Toward an Ideal System

Long-Term Care: Managing Across the Continuum

(Second Edition)

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Learning Objectives1. Identify the characteristics of an ideal

long-term care system 2. Describe what it means for the long-term

care system to be consumer-driven 3. Identify the roles of formal and informal

caregivers 4. Define the components of a full and

uniform assessment of a consumer's service needs

5. Discuss the need for incentives for providers and consumers

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The Criteria for Designing or Evaluating a Long-Term Care

System

• What are they?

• How were they developed?

• How are they used?

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Criterion I. The long-term care system should be based on recognition of the needs, rights, and responsibilities of individuals. It should:

Be consumer-driven Meet all of the needs of the consumers Focus on the individual, recognizing that individuals have unique needs Respect different cultures and cultural values

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Criterion I. (continued) Recognition of the needs, rights, and responsibilities of individuals:

Promote quality, dignity, and self-improvement for consumers.

Balance consumer rights and responsibilities

Offer consumers a choice of service providers and service delivery modalities

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Criterion II. The long-term care system should be easily accessible. It should:

Be universally accessible Be "user-friendly" Provide care in the least restrictive

environment

Encourage single-site care availability

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Criterion III. The long-term care system should coordinate professional, consumer, family, and other informal caregiver resources.

It should:

Integrate professional, community, family, and other informal caregiver efforts

Evolve from the current medical model to a holistic model of service delivery

Involve families in case management and care delivery

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Criterion IV. The long-term care system should be an integral part of the health and social system, to promote integration, efficiency, and cost

effectiveness. It should:

Include a full continuum of services Include a full and uniform assessment

(initial & ongoing) of the consumer's needs. Provide emphasis on, and reimbursement

for, illness prevention efforts as an integral part of the overall system

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Criterion IV. (continued) Promote integration, efficiency, and cost effectiveness:

Be planned and coordinated to reduce fragmentation and inefficiencies

Be based on outcome-oriented accountability

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Criterion V. The long-term care system should be

adequately and fairly financed. It should:

Utilize public and consumer resources to assure universal access to services.

Provide incentives for consumers to use services in an appropriate and cost effective manner

Provide incentives for consumers to self-finance their care

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Criterion V. (continued) Adequately and fairly financed:

Avoid causing impoverishment of consumers and families

Provide incentives for providers to develop cost effective measures

Develop payment mechanisms that allow efficient providers to adequately compensate staff and to allow for appropriate operating surplus and/or return on investment

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Criterion V. (continued) Adequately and fairly financed:

Operate within the limits of a well conceived budget

Provide significant flexibility to enable consumers to meet long-term care needs as each consumer defines those needs

Be based on uniform financial eligibility criteria

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Criterion VI. The long-term care system should include an education component to create informed consumers, providers,

reimbursers, and regulators. It should:

Include community education Include education for providers Educate young, healthy persons to better

prepare them to cope with chronic illness

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In Summary:

The Criteria provide a basis for evaluating the current long-term care

system and for developing an ideal long-term care system.