1 Chapter 2. Toward an Ideal System Long-Term Care: Managing Across the Continuum (Second Edition)

2 Learning Objectives 1.Identify the characteristics of an ideal long-term care system 2.Describe what it means for the long-term care system to be consumer-driven 3.Identify the roles of formal and informal caregivers 4.Define the components of a full and uniform assessment of a consumer's service needs 5.Discuss the need for incentives for providers and consumers

3 The Criteria for Designing or Evaluating a Long-Term Care System What are they? How were they developed? How are they used?

4 Criterion I. The long-term care system should be based on recognition of the needs, rights, and responsibilities of individuals. It should: Be consumer-driven Meet all of the needs of the consumers Focus on the individual, recognizing that individuals have unique needs Respect different cultures and cultural values

5 Criterion I. (continued) Recognition of the needs, rights, and responsibilities of individuals: Promote quality, dignity, and self- improvement for consumers. Balance consumer rights and responsibilities Offer consumers a choice of service providers and service delivery modalities

6 Criterion II. The long-term care system should be easily accessible. It should: Be universally accessible Be "user-friendly" Provide care in the least restrictive environment Encourage single-site care availability

7 Criterion III. The long-term care system should coordinate professional, consumer, family, and other informal caregiver resources. It should: Integrate professional, community, family, and other informal caregiver efforts Evolve from the current medical model to a holistic model of service delivery Involve families in case management and care delivery

8 Criterion IV. The long-term care system should be an integral part of the health and social system, to promote integration, efficiency, and cost effectiveness. It should: Include a full continuum of services Include a full and uniform assessment (initial & ongoing) of the consumer's needs. Provide emphasis on, and reimbursement for, illness prevention efforts as an integral part of the overall system

9 Criterion IV. (continued) Promote integration, efficiency, and cost effectiveness: Be planned and coordinated to reduce fragmentation and inefficiencies Be based on outcome-oriented accountability

10 Criterion V. The long-term care system should be adequately and fairly financed. It should: Utilize public and consumer resources to assure universal access to services. Provide incentives for consumers to use services in an appropriate and cost effective manner Provide incentives for consumers to self- finance their care

11 Criterion V. (continued) Adequately and fairly financed: Avoid causing impoverishment of consumers and families Provide incentives for providers to develop cost effective measures Develop payment mechanisms that allow efficient providers to adequately compensate staff and to allow for appropriate operating surplus and/or return on investment

12 Criterion V. (continued) Adequately and fairly financed: Operate within the limits of a well conceived budget Provide significant flexibility to enable consumers to meet long-term care needs as each consumer defines those needs Be based on uniform financial eligibility criteria

13 Criterion VI. The long-term care system should include an education component to create informed consumers, providers, reimbursers, and regulators. It should: Include community education Include education for providers Educate young, healthy persons to better prepare them to cope with chronic illness

14 In Summary: The Criteria provide a basis for evaluating the current long-term care system and for developing an ideal long- term care system.