SJSUHSCI118Chapter02.ppt [PPT]
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Transcript SJSUHSCI118Chapter02.ppt [PPT]
Chapter 2. Toward an Ideal
System
Long-Term Care: Managing
Across the Continuum
(Second Edition)
1
Learning Objectives
1. 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 selfimprovement 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 selffinance 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 longterm care system.
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