Transcript SJSUHSCI118Chapter02.ppt [PPT]

Chapter 2. Toward an Ideal
System
Long-Term Care: Managing
Across the Continuum
(Second Edition)
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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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