FCRP Policy Statement

Due to the transformations of the health care system, the length of hospital stays of the chronically ill elderly are shrinking as are the financial resources of our elderly population. According to the Michigan Department of Community Health, Medicaid comprised 8% of Michigan's budget in 1980, 10% in 1985, and 20% in 1995. Other states are likely to face the same crisis in financing health care. Community care must be available so that families can meet the demands of care, which include direct physical tasks of care (bathing and dressing) and medical tasks of care (administration of medications, general health supervision), as well as managing the financial burden chronic illness can incur and ensuring the emotional health of the family unit.

Traditional approaches to trimming elder health care costs include restricting eligibility, cutting benefits, and/or reducing reimbursement rates to providers. Supporting the families able and willing to provide care through community services and long-term care alternatives, however, provides a probable cost-effective means of delivering health care to the chronically ill elderly.

Aside from care provided in the family's home, nursing homes are the most traditional form of long-term care. There are, however, a variety of long-term care alternatives.

Home Health Care: Care is provided in the home based on patient need and the family's financial status. This care can include nurse visits (to administer medications and provide personal care), a variety of therapies (including physical, respiratory, or occupational), homemaker services (to aid in household maintenance and perform tasks such as shopping, cleaning, and laundry).

Adult Day Care: To allow family members to continue their employment and/or to seek respite or personal time, adult day care facilities provide a temporary care setting for adults who require custodial or physical care.

Assisted Living Facilities: Such facilities are usually set up as group homes, where a number of nurses and/or physicians are available to serve the community. Residents often have their own living areas, but have 24-hour, on-site access to medical and/or physical care. These facilities often offer the same type and scope of care that nursing homes do, but residents are enabled to retain more personal freedom and their own living space.

Home Modification: Greater independence may be available to an infirm or immobilized elder through the adaptation of the home. Equipment such as lifts and hospital-style beds, along with modifications including wheelchair accommodation and larger walkways and bathrooms may ease the care a family member is required to provide, such as lifting a family member out of bed and helping him or her move around the home.

Policy Implications:

• Alternative long-term care facilities must be recognized and legitimized by local, state, and federal financial and legislative support.
• Local, state, and federal agencies must assist and support families in selecting the best long-term care to meet their financial and healthcare needs. Follow-up and reassessment must also be carried out to ensure that the long-term care decisions made are appropriate at later stages in the disease process.
• Appropriate community agencies and screening measures must be developed to ensure that the needs of those patients and their families who would most benefit from long-term care support and services are met.
• Funds must be made available to businesses to create and maintain on-site adult day care centers. Support programs and information (such as Alzheimer Association pamphlets) must be made available at a minimal cost to caregiving employees.

Sources: "Long-term care alternatives." (1997). New York: Teachers Insurance and Annuity Association. "Call for Ideas: Michigan Managed Long Term Care Initiative." (1996, October). Lansing: Michigan Department of Community Health.