long-term care - Legislative Reference Bureau

LONG-TERM CARE SERVICES
A similarly worded definition is given by the Maryland Health Resources Planning
Commission that can be considered generic for the term:?
[Long-term care is] the array of medical, social and support services needed by
individuals who, because of chronic illness or disability, need another person's help
in caring for themselves over an extended period of time. This includes both
institutional and community-based services for persons of all ages.
That state's Long-Term Health Care Committee gives the definition a slightly different
cast. Emphasis is placed on financing, organization, and delivery of services as well as the
otherwise good health of individuals who need help functioning in its definition of long-term
care: 8
[Long-term care is the] financing, organization, and delivery of a wide range of
medical and human services to people who are severely disabled or limited in their
functional capacities for a relatively long and indefinite period of time. In medical
terms, long-term care is chronic care: the aim is management, control of symptoms,
and maintenance of function. But long-term care also has a vast non-medical
dimension, and many individuals requiring long-term care are not sick. They may
have been injured, or were born with a developmental disability that limits their
activities, but otherwise may be perfectly healthy.
Long-Term Care Populations: Long-term care populations, then, extend beyond the
elderly to include the disabled of all ages. Whether or not a state wishes to formally include
all possible populations in its long-term care programs is a policy issue. First, the way
categorical programs and funding for different populations have developed historically within a
state will probably heavily influence policy. For example, adequate funding for a designated
but limited population may make it unnecessary to include that group within a larger long-term
care population for funding. Conversely, funding may be inadequate but categorical
restrictions may prevent their inclusion in a larger group. The patchwork development of
funding and programs makes it hard to minimize service overlaps and prevent service gaps.
Second, the degree to which categorical group advocates contend or cooperate will
also make a difference. Advocates for an established majority population may feel the
inclusion of minority populations (such as AIDS-disabled persons, Alzheimer's patients, the
chronically mentally ill, post-trauma patients undergoing rehabilitation, the chemically
chronically dependent) may dilute their focus. Minority, majority, or plurality group advocates
may wish to augment their roles, perhaps at the expense of other group advocates. Even in
an all-inclusive long-term care population group, funds must be allocated in some way among
the different sub-groups. (Wisconsin's response to this problem is to require its Community
Options Program to serve persons from the major target groups in proportions which
approximate the percentages ("significant proportion ") served in nursing homes prior to the
program's inception.j9
Third, because "public funds are still inadequate to address all long term care needs
... states have had to make painful choices in selecting population groups to cover."i0
States like Maryland have recognized that "a fundamental policy question is whether services
should be limited to the most impaired or whether a broader group of persons should receive
services that only partially meet their needs."11 The upshot is that for most states, including
the six studied by Justice, et aI., (1988), long-term care programs will usually "opt to meet the
more intensive needs of the most impaired, recognizing that those persons not served may
also have significant functional limitations."12
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