long term care research papers

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Save to Library. Create Alert. Share This Paper. Tables and Topics from this paper. Citations Publications citing this paper. Nursing home report card and performance gap. Ae-Sook Kim. A Good Life in Old Age? Psychometric testing of the therapeutic self-care scale in home health care Angela Arnold Richard. Yun-Hee Jeon , Judy M.

Does regulating private long-term care facilities lead to better care? A study from Quebec, Canada. References Publications referenced by this paper. Ageing and long-term care: National polices in the Asia-Pacific pp. Prince M. Brodaty H. Uwakwe R. Acosta D. Ferri C. Guerra M. Huang Y. Jacob K.

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Llibre Rodriguez. Salas A. Sosa A. Williams J. Jotheeswaran A. Strain and its correlates among carers of people with dementia in low-income and middle-income countries.

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International Journal of Geriatric Psychiatry 27 7 Redondo N. Institutional care for older people in developing countries: Repressing rights or promoting autonomy? The case of Buenos Aires Argentina. Journal of Population Ageing 2 : Romero D. Marques A. Barbosa A. Internacoes de idosos por cuidados prolongados em hospitais do SUS no Rio de Janeiro: Uma analise de suas caracteristicas e da fragilidade das redes sociais de cuidado. Scheil-Adlung X.

Recent Resolution and Position Statementss

ILO Geneva. Sinunu M. Yount K. El Afify N.

Long-Term-Care Utility and Late-in-Life Saving

Informal and formal long-term care for frail older adults in Cairo Egypt: Family caregiving decisions in a context of social change. Journal of Cross-cultural Gerontology 24 1 : UN Population Division World population ageing: New York: United Nations Publications. August World population ageing New York United Nations. A long-term care futures tool-kit; pilot edition. WHO World report on ageing and health. WHO Geneva. Yanxia Zhang W.

Shifting boundaries of care in Asia: An introduction. All of these demonstrations, in varying degrees, have provided opportunities to test policy options, develop practical program experience, and establish networks of researchers and committed practitioners who are experts in the area. Policy simulation models have been developed explicitly to estimate the effect of policy changes, particularly their impact on government expenditures. For example, in the mids Rivlin and Wiener developed a microsimulation model to project future need for LTC, its cost, and the distribution of cost among payers under alternative policy options.

Later during the Clinton health care reform effort, this LTC financing model provided estimates of the cost of a wide range of options—from subsidizing private LTC insurance to universal public LTC insurance—and played a major role in refining these many options and the ultimate policy proposed. Research on behavior contributes to policy by determining what factors are related to outcomes of interest such as cost and quality. This understanding of behavior helps to identify where and how to intervene with government policy—that is, to identify policy options—and to predict how people will respond to policy changes.

This understanding, in turn, has been the basis for developing eligibility criteria for HCBS programs and pre-admission criteria for nursing home care, as well as models of LTC use and cost. Methodology has no immediate payoff for policy but can have significant long-term benefits. Perhaps the best example is the Public Health Service's investment in the late s in Katz, Ford, Moskowitz, Jackson, and Jaffe's work on disability measurement. The resulting measure of ability to perform activities of daily living ADLs has been used in eligibility criteria for HCBS programs and nursing home care under Medicaid, requirements for private LTC insurance to qualify for tax deductibility, case-mix payment for nursing homes, and estimating the size of the population needing LTC—not to mention its pervasive importance in practice.

The ultimate importance of this research for policy could not possibly have been seen at the time it was funded.

Health/Long-Term Care | Center for Retirement Research

It illustrates that investments in basic research with uncertain outcomes can have important unanticipated payoffs for policy decades later. Investments in data collection also are without immediate benefit for policy, but national databases have been the foundation for countless contributions to policy. They have been used for analyses of behavior, comparison data for policy interventions, model development, and estimates of the scope of LTC problems. Indeed, any briefing book on LTC policy is certain to draw population estimates from the national LTC data infrastructure.

Examples of other significant ongoing national databases that play similarly important roles, each with its own special sample or content, include the Health and Retirement Survey, the National Nursing Home Survey, the Medical Expenditure Panel Survey, the Medicare Current Beneficiary Survey, and Medicare and Medicaid claims databases.

The path from basic research to policy making is especially long, indirect, and difficult to see.


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  • Nonetheless, investments in basic research—particularly, methodological research and data infrastructure—well in advance of specific policy needs have important payoffs. For example, as indicated above, the Clinton health care reform effort relied on cost estimates from the LTC financing model. That simulation model was built on the foundation laid by a number of investments in basic research see Figure 2. Starting with an existing model of income and savings for retirement, the LTC model added the need for LTC, service use, financing, and behavioral assumptions about LTC.

    Measures of need for LTC were drawn from the work of Katz among others. The choice of factors to include in modeling behavior was based on prior research on behavior, for example, the determinants of nursing home use. Policy makers in the Clinton administration who saw only a table with cost estimates from this model had no way of knowing about the history of investments in basic research that lay behind the estimates. Yet, investments in nursing home studies over many years, in microsimulation modeling in the mids, in the NLTCS beginning in , and in Katz's development of ADL measures starting in the late s all had payoffs later in the capacity to estimate the cost of policy alternatives in The LTC financing model would not have been on the shelf when the Clinton administration officials needed it to make cost estimates if the underlying research had not begun decades earlier.

    In short, research investments must anticipate the needs of policy makers. Where are research investments needed to inform LTC policy in the future? How can the research infrastructure be strengthened to support the contribution of LTC research to policy? Given the long lead time from investments in research to policy payoffs, these questions should be addressed in advance of the expected growth in demand over the coming decades. Eight policy issues for which research is needed are outlined below. In developing the list, the author drew in part on the responses from the in-depth telephone interviews and Internet survey about the most important questions to address in the next decade.

    Survey responses typically were more specific, and many are incorporated under these policy issues. Given the breadth of LTC and its myriad related policy problems, many potential research initiatives would be useful for future policy, and other research agendas have been articulated e. It is clear there is no shortage of growing LTC policy problems that call for additional research.

    Eligibility, payment, and regulatory policy concerning nursing home, assisted living, and community-based services varies greatly across states. However, we do not know which combinations of policies are the most cost-effective. For example, some states have increased funding for both institutional and community care, whereas others have emphasized community over institutional spending. Similarly, financial eligibility for HCBS programs varies substantially across states. What are the effects of these alternative policies?

    A research initiative that provides state policy makers with information on which policies are effective might, for example, exploit these state policy variations as natural experiments to determine their effects on cost and outcomes, develop databases to support analysis of state variation, and create a Web repository of current evidence on state policies and what works.

    As acute care gives way to chronic care and people survive with disabilities, saving life gives way to quality of life as the goal of care. This raises important societal questions. How do we define the LTC problem?

    How to admit a patient into a long term care facility for nurses!

    What do individuals and their families want? How much are we willing to invest in improving quality of life for persons with disabilities and decreasing levels of stress experienced by their family caregivers? Research is needed to frame the discussion of the LTC policy problem, articulate the goals of LTC, provide information on societal values about LTC, and expand the range of outcomes that are discussed in policy debates.

    Although LTC policy decisions inevitably are political, research that frames the problem and clarifies societal values has the potential to reorient thinking about the goals of LTC and remove an impediment to policy debate.


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    A great deal of LTC policy is focused on people with limited financial resources, but LTC needs are not limited to the poor. At least under current policy, the middle and upper classes must rely on private savings, family caregiving, and private LTC insurance for their care.