Vincent Mor, Edward Alan Miller, Ph.D.,
E. A. Miller, V. Mor, and M. Clark, "Reforming Long-Term Care in the United States: Findings from a National Survey of Specialists," The Gerontologist, published online July 13, 2009.
Long-term care specialists—including consumer advocates, providers, public officials, and policy experts—who participated in a national survey generally agreed on the need for long-term care reform. Despite some differences, key constituent groups supported the establishment of government-sponsored financing strategies, a shift toward home- and community-based care, offering payment incentives to improve quality, and more effective regulation of nursing homes, home health care agencies, and assisted living facilities.
An estimated 10 million older Americans with moderate to severe disabilities have long-term care needs, accounting for a large proportion of health care spending. Furthermore, demand for long-term care services is only expected to increase as the population ages. There is a growing consensus that some type of reform is needed to meet this demand. Giving voice to key stakeholder groups allows those with specialized knowledge of the long-term care system to communicate the importance of this issue to policymakers and the public, say the authors.
Consumer advocates and provider representatives had diverging views about long-term care reform. Consumers were more likely to favor public payment for family members who provide care, higher staffing requirements, and more aggressive regulatory enforcement as effective quality improvement strategies. There was substantial agreement on many fundamental issues, such as the need for more effective regulation of nursing homes, home health care agencies, and assisted living facilities, the desire to transition toward home- and community-based services, and the importance of payment incentives. Recognizing areas of agreement and disagreement should prove useful in promoting long-term care reform and focusing on solutions that are viable from a policy perspective.
The authors conducted a national survey of 1,147 consumer advocates, provider representatives, public officials, policy experts, and other long-term care specialists. The survey was administered between September 2007 and March 2008 and addressed quality and challenges, financing and insurance, individual and family support, organizational change and innovation, and quality improvement and regulation.
Long-term care specialists agree on many strategies for reform: establishing government-sponsored financing strategies, shifting toward home- and community-based care, offering payment incentives to improve quality, and formulating more effective strategies for regulating providers.