The principle of long-term care has become more widespread in the States in recent years. The Long-Term Care Program is part of the government’s Medicaid initiative, which aims to help people living below the poverty line. As a result of the increased use of the program, there has been a certain opposition between the two types of care – home or community-based, and care in special facilities, such as nursing homes. Both ways of caring, external and domestic, have their advantages, but the flexibility of the home approach seems more relevant in today’s situation.
In general, the need to expand a long-term care program is a sign of an ever-increasing problem in modern society. We live in a society in which most older people are unable to provide their own treatment. This is a social problem that affects the population of all generations. It is no less difficult for grown-up children of the elderly generation, who are forced to support the elders and raise the younger at the same time. Empowering long-term care can allow these unfortunate people to take some of their heavy burdens off. The care of vulnerable members of society should primarily be under the control of government-funded professionals.
It is important to be aware of the surrounding times and the current situation in which it is necessary to consider the possibility of introducing more mobile options for the provision of medical services. The era of pandemic, in which society is even more segmented than it was, requires a more private and thorough approach to long-term care. Nursing homes or hospices in a situation of spread of infection, even with all prevention, seem to be institutions dangerous for vulnerable groups of the population. Of course, one must understand that a good nursing home can provide a person not only with the necessary care, but also a human attitude, ways to intellectually and physically keep fit. However, a flexible, that is, home-based approach to serving a vulnerable patient seems much less risky in this situation.
Speaking in more detail about the fate of nursing homes in our time, one should dwell on the issue of the economic difference between the types of such institutions. All nursing homes charge a fairly high price for their stay, but not all are capable of providing quality care. Also, in the light of the pandemic, numerous problems of these institutions were revealed. Low-skilled staff, forced to do double work and at the same time not receiving enough money, very bad measures to counter infection, sometimes even abuse and neglect are the stigma of such establishments.
At the same time, caring for an elderly person at home certainly has its own difficulties. As a rule, the problem of qualification in the provision of medical care may be the most pressing at home. Of course, the patient’s family is capable of performing some manual tasks, but it is not uncommon for the care to be insufficient or unprofessional. This type of care is thorough and ongoing, and therefore requires more skilled professionals. Most of the work can be done by relatives or social services, but a doctor in such conditions must be multi-skilled in order to be able to solve any problem the patient has.
There is also an intermediate option between a nursing home and taking care of an elderly person at home, and this is an assisted living facility. However, these establishments are not guaranteed to have sufficient qualifications. There is a possibility that, while sending a patient to an assisted living facility, his treatment will not correspond to any standards, even common sense. There is a high risk that such a facility is a purely commercial establishment, the purpose of which is to raise money from the weak. Poor treatment of patients and lack of professionalism of staff are frequent problems in these institutions. Moreover, the rating systems of nursing homes also provide covert information about the quality of service, since these ratings are assigned by the workers themselves.
Medicaid is a program that focuses on flexibility, therefore it exists in a decentralized form, that is, each state itself regulates the rules for the application of the program. The state of Illinois is introducing its own version of this program, and it has some results, as hundreds of thousands of residents of the state have signed up to the program. However, it also has its drawbacks, the first of which is the inability to find a qualified specialist. The number of skilled workers per capita in Illinois is one of the lowest in America (Probst et al., 2019). Thus, it can be said that the presence of professionals in the medical environment is a key health issue. Despite the fact that insurance premiums cover treatment and the financial issue does not seem to be very problematic, the very receipt of professional medical care is called into question.
Last but not least, the American medical community is concerned about the financial side of the problem, as long-term care in the states is in a recognized crisis. The need to find money from somewhere to cover the cost of long-term care has resulted in new forms of lawmaking. To cover financial gaps in Illinois, a law was drafted to gradually increase the income tax, which will now increase in parallel with the person’s age (Anderson, 2018). This system seems to make some sense, as every contributor will have a sense of regularity. The closer they are to the age at which they may not be able to serve themselves, the more they invest in making this future as painless as possible.
Speaking about the financing of medical programs, one should not forget about the need for government intervention in pricing policy. The pandemic reality has opened the eyes of the medical community to the many shortcomings of the healthcare system, one of which is its prohibitive cost (Glied, 2021). In the context of the global economic and political crisis, taking into account unemployment and all kinds of life shocks, reducing the cost of medical services seems necessary.
Thus, it can be argued that the alliance of the state and state administrations does not occur without the presence of various problems at the macro and micro levels. In general for the United States, the main threat is the lack of qualifications of many establishments and their commercial orientation. Mobile institutions still need to calibrate their mobility and flexibility. Low pay for volunteers is also a negative incentive for them. At the State of Illinois level, the challenge of organizing long-term care in a pandemic is primarily the small number of professionals forced to work in an overburdened medical system.
References
Anderson, Z. (2018). Solving America’s long-term care financing crisis: Financing universal long-term care insurance with a mandatory federal income tax surcharge that increases with age. Elder Law Journal, 25(2), 473-514.
Glied, S. (2021). Continue moving forward on the Affordable Care Act path. American Journal of Public Health, 111(4), 612-613.
Probst, B. D., Walls, L., Cirone, M., & Markossian, T. (2019). Examining the effect of the Affordable Care Act on two Illinois emergency departments. Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health, 20(5), 710-716.