Long Term Managed Care
Over time, health management plans have evolved to encompass new services that were
initially considered a home affair. With the work environment and tight schedules making it hard
for care provision at home for people with chronic diseases or conditions, the long-term managed
care has emerged. This issue is further elaborated in the essay below.
According to the New York State Department of Health (NYDH) (2011), managed long term care is a health service designed for people who need a long-term care services. These services offer flexibility to the people and further provide choice since the individuals can choose which services to go for and from whom they should get it. Therefore, this essay will work with the assumption that managed long term care services are a basic necessity for people with long term specialized needs and offers them custom made services.
The first step in this process was to establish the people who need the long term care services. These people were defined and put into categories as described by the New York Department of Health (2011). They include people with disabilities, chronically ill individuals or people who need health and long-term care services. This last group can comprise people in home or adult day care services. These people stay at their homes and communal settings for as long as possible, only being admitted if there is a major problem. The USDH (2005) asserts this statement by citing that the home and community based services (HCBS) offer case management, but does not proceed to the hospital or nursing home once the individual is admitted.
There are various services that the MLTC offers to the beneficiaries in different settings. These, according to the USDH (2005) include but are not limited to day centers, hospitals, doctor’s office, home or nursing home. The services provided cannot be provided by one individual or a single organization, therefore the services are divided among different stakeholders. The services provided, as noted by the NYDH (2011) offer flexibility to the beneficiaries. This is because there are various services on offer by different caregivers. This leads to the success of the MLTC services. The myriad services provided under MTLC include a wide selection of social and health services, hence almost everybody can get a service that is tailored for his needs.
The future of the MLTC services seems bright. This is because the Medical Modernization Act of 2003 was written due to the demand for long-term care arose from state developed programs in nine states of the US. The scope of the managed care benefit package has continued expanding and the geographical scope has been evolving with time, with the major focus on urban centers. The target populations have also become more defined with time, and if the trend continues, then the services will expand even more.
This health management plan is not perfect; it has some advantages and disadvantages. The concept of long term managed care has had to change from time to time to accommodate new trends. The government has had to modify the policy in the past. This trend is not likely to stop anytime soon. This is because the project is still being fine tuned to keep in tune with realities of the present day. Some problems with the system have been highlighted below and proposed solutions to them itemized.
Policy makers should, as a matter of urgency, formulate laws guiding the provision of long term managed care to elderly Americans. The seemingly lack of political will might be as a result of the level of importance attached to it. If policy makers see it as a dire need for a lot of elderly Americans, they would take this issue
Another problem that has arisen with long term managed care plan is the issue of soaring health insurance costs. In recent months, the premium of health insurance has seen an increased which is not matched by a present increase in health care cost because health care costs have not changed. However, operators in the industry simply said they were trying to keep pace with projected increase in cost of health care. When asked the source of their projection, they cited the belt-tightening policy of the government which is trying to trim down on operating cost. But the real issue is that the increase was only based on speculation. This means that they might be ripping people off by speculatively increasing the premium cost without seeing the real increase in health care cost (Paduda 2011).
Policy makers have to step in to protect the people of America who would definitely be affected by this speculation. They are paying for a projected increase in cost which has not actually been proven. This can be the way which these companies want to make more profit from people without necessarily improving their quality, or without a concomitant increase in the health care cost which they are actually been covered for.
Another problem that has arisen is the recession in the economy actually affected the health sector too. There is now an increase in the amount of deductibles and co pays that contributors have to make to the health insurance policy. This is giving rise to a situation whereby forgoing care is now becoming an option for those accessing long term managed health care (Paduda 2011). This is being done so as to cut back in these costs. However, this could have dire consequences of people skip appointments, therapies and medication just because they are trying to cut cost. This might have dire consequences on their health (New York Health Access 2011).
The people should be enlightened about the consequences of cutting back costs because they want to save more money, emphasizing on the fact that they might be doing themselves more harm than good on the long run.
Long term managed care is definitely a dynamic project that needs to be constantly modified to accommodate modern day trends. Implementing the above recommendations would go a long way in ensuring that long term managed care keeps in tune with the realities of today. It will ensure that people get real value for their health which they really deserve in their old age.
The shortcomings of the healthcare management plans should be critically assess and reviewed. Although it has many strengths the stakeholders should still look at the areas that need to be reviewed. The benefit of these plans to Long-term managed care cannot be overstated. With the high projections on those who will need this in future, there is need to ensure that the plans are workable and of maximum benefit to the parties involved. LMTC is a huge responsibility to those families who need it.
Having a frail or chronically-ill or elderly person at home requires doing utmost care and attention – physically, socially, and medically. A significant number of people and families, however, are not ready for such weighty obligations and if some people are willing to do such responsibilities, they are just too busy and preoccupied by work and other priorities. Today’s generation, with the advancement of modern technologies, is characterized with people who are grossly engaged with a great range of technologically-related jobs and activities. With these factors comes the importance for managed long-term care or MLTC. (Chi, Mehta and Howe 2002, p. 54-55) explained that the need for long-term care is brought by “interrelated factors in demography, prevalence of disability, and the role of informal caregivers vis-à-vis formal services.”
The demographic trend in the U.S. sees the rapid population growth of elders. The U.S. Bureau of the Census projected that the future population of the country will be composed mostly of Americans aging 65 or older. Between 2010 and 2030, the baby boomers will join the older population that will account 20% of the total population or 69.4 million. In addition, the 85+ population is seen as the most rapidly growing group, doubling in number by 2025 and increasing fivefold or reaching 18.2 million in 2050 (Chi, Mehta and Howe, 2002, p.54-55).
Expectedly, as the percentage of people in advanced age surge, the morbidity rate and the count that needs daily assistance also increase. Considering these aspects, the government itself is doing extensive efforts to render professional care to everyone who needs it as much as possible.
Once a program afforded only by people having bigger income, the managed long-term care package already include care services and options designed to cater the special needs of the needing adults, which means the family does not have to pay for a comprehensive package but according to the family members’ choosing.
The role of professional care versus non-professional ones is also an important factor. Employing informal or substandard care giving may pose added health concerns. Without professional guidance, an ailing person would receive incorrect treatment that may result to the multiplication of one ailment to multiple others.
Over the years, the program for long-term care has undergone modifications in policies and benefits. These changes have brought high-quality and cost-effective care and services. Data showed that at least one family member needs long-term care in about 80% of American families, and the long-term care policy reforms are now helping them afford the high medical costs for sustained care for their elders.
One relevant change in the policy is the integration of long-term care into the health services with the option to choose if long-term care would be done at home or at health institutions. Home care gives families the opportunity to be with their elders while ensuring that
The best care is given to their loved ones.
As some cases involve special services like care transitions, some policies, like the Affordable Care Act, offers extension of transitional care services through a number of programs. According to the New York State Nurses Association (2011, p. 2), transitions of care are vulnerable periods that contribute to unnecessarily high rates of health service use and healthcare spending; transitions of care expose chronically ill people to lapses in quality and safety, have been associated with increased rates of potentially avoidable hospitalizations. NYSNA (2011, p. 2) also pointed out that the knowledge and skills of the registered professional nurse must be ideally suited to the effective management of care transitions.
With diverse services already available, the family can select aptly what services their elders specifically need – inpatient or outpatient care, primary or specialty care, or home health care for acute medical services; nursing home care, respite, adult day care, or home care services for long-term care services; and counseling or housing services, among others, for social services.
Managed long-term care program ensures that there is continuity of care for the elder and that they receive professional medical care and proper counseling. Government efforts to improve the quality of care in nursing and other care institutions also give families significant comfort.
Another factor that sees the need of long-term care is the reality that those days when both poor and wealthier Americans could get affordable health care – the not-so-poor having fee-for-service insurance and the poor having Medicaid – were gone. But as developments came in including medical technology, the health budget has to be reduced and health care cost has to be
increased. Consequently, family funds are getting tight because of medical expenses. And as long-term care is foreseen as one big concern for all, the wiser way to spend for medical needs is to integrate it in one’s health care. The program is especially important for the elderly as they need medical assistance four times that of the youths and eight times that of children.
The growth of number of elders needing long-term care also means an “increasing number of families who will also face the daunting challenge of providing long-term care for their frail older relatives alongside other familial and job-related responsibilities” (Chi, Mehta, Howe, 2002, p. 55). It is in this reality that managed long-term care is of great importance.
Chi, I., Mehta, K., & Howe, A.L. (2002). Long-term Care in the 21st Century: Perspectives from
Around the Asia-Pacific Rim. New York, NY: Routledge
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New York Health Access (2011). Managed Long Term Care. http://wnylc.com/health/entry/114/ Accessed 19th January, 2012
New York State Nurses Association (2011, September 19). Comments to the Managed Long
Term Care Implementation and Waiver Redesign Work Group public hearing on behalf of the New York State Nurses Association. Retrieved from http://www.nysna.org/images/pdfs/advocacy/medicaid/longTermCareComments.pdf
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Yin, S (2011). More long-term care patients join managed care plans. Fierece Healthcare:Daily news for healthcare exdecutives. http://www.fiercehealthcare.com/story/more-long-term-care-patients-join-managed-care-plans/2011-02-22 Accessed 19th January, 2012