Long-Term Care

Long-term care is a set of services delivered over a sustained period of time to people who lack some degree of functional capacity. Put alternatively, long-term care is the help needed to cope, and sometimes to survive, when physical and cognitive disabilities impair the ability to perform activities of daily living, such as eating, bathing, and toileting. Unlike the provision of general health services that are targeted toward acute medical problems, long-term care must be continually provided and is, thus, continually expensive.

Long-term care services are needed by a diverse set of individuals who receive care from an equally wide array of providers. As the result of their diminishing abilities, older individuals—especially the very old—are the primary recipients of long-term care services, but younger individuals with physical or mental limitations also require services in some instances. The primary providers of long-term care services within the United States are “informal” providers such as family members and friends. Formal providers include nursing homes, board and care homes, home health care agencies, assisted living facilities, adult foster and day care homes, and continuing care retirement communities. Across these different formal providers, there are a number of different payer types, including out-of-pocket, public insurance, and private insurance. Because consumers are often thought to lack information regarding the quality of services provided, there is an immense amount of government regulation within the long-term care industry.

Important health care management issues arise in the provision and delivery of long-term care including the fragmented system of providers and payers, the reliance on human resources, the relationship with the acute health care system, recent organizational changes such as horizontal and vertical consolidation, the role of quality assurance and regulatory compliance, and the fact that many long-term care administrators lack management training.