196248 Restructuring long term care: Past lessons and current opportunities

Wednesday, November 11, 2009: 8:45 AM

David Barton Smith, PhD , Department of Health Management and Policy, Drexel University, Philadephia, PA
Zhanlian Feng , Center for Gerontology and Health Care Research, Brown University, Providence, RI
The current long term care system in the United States, similar to an archeological site, is composed of past layers now jerry-rigged together and on the verge of collapse. The bulk of the nation's nursing home bed stock is reaching the end of its useful life and the boom in private assisted living that began in the last decade now face a wave of bankruptcies in the current financial crisis. This paper explores the lessons from the history of past efforts to design a long term care system and the opportunities they provide for restructuring. The U.S. long term care system was constructed in five phases, in roughly twenty year intervals. Efforts in each of these phases focused on often contradictory organizing principles: (1) indoor welfare relief (1910-1930), (2) outdoor income security (1930-1950), (3) indoor health care support (1950-1970), (4) regulatory control (1970-1990) and (5) market control (1990-2010). The resulting long term care system combines many of the contradictory organizing principles and structures of all five phases, frustrating families, the frail elderly and their providers. The past lessons suggest a restructuring that would synthesize the best of each of these previous periods: (1) support for the family informal care system, (2) an emphasis on outdoor relief through income supports, (3) financing that supports a one class system of care within a fully integrated health system, (4) adequate regulatory oversight and (5) responsiveness to the consumers permitting them, as much as possible, to age in place in their own homes.

Learning Objectives:
1. List five distinctive stages in the development of the U.S. long term care system. 2. Analyze the current organizational conflicts posed by the historical accumulation of these stages. 3. Describe a synthesis that can combine the best characteristics of each these prior stages in the design of the future long term care system.

Keywords: Aging, Long-Term Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Ph.D. Health Policy and Management The University of Michigan. Three books: Long Term Care in Transitio: The Regulation of Nursing Homes, Reinventing Care: Assisted Livining in New York City, Health Care Divided: Race and Healing a Nation, more than 30 peer reviewed journal articles related to topic.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.