long-term care - Legislative Reference Bureau

LONG·TERM CARE SERVICES
Long-Term Care Services -- A Continuum: The notion of using a continuum of services
-- as opposed to discrete, unrelated services -- to address long-term care needs is, by now, a
standard concept. One practitioner observes: 21
A continuum of chronic care services is the purposeful association of health and
social services, each having varying elements responsive to the multiple and
diverse needs of a chronically ill person and members of that person's family.
Most services vary by level of care and apply to persons in multiple populations with
similar long-term care needs. Other services in the continuum address the specific needs of
certain populations and not others. For example, special education, job training, and housing
assistance may be appropriate for developmentally disabled adults seeking jobs in the
community. But they may not be necessary or appropriate for the disabled elderly. The
former may require more help to get and keep a job while the latter may need help only with
the social and functional aspects of community living. On the other hand, supported living,
including personal care services, may be appropriate for both these populations. For example
a young adult with cerebral palsy and a frail elderly individual may both be mentally
competent but wheelchair-bound and require personal care several times a week. Both may
need food stamps, special travel arrangements, vocational rehabilitation, and emotional
counseling.
In some states, services along the entire long-term care continuum can be used to
fashion a care plan package. For example, Maine and Wisconsin both avoid defining
allowable services under their Home Based Care Program and the Community Options
Program, respectively. Almost any service package is possible. Both "explicitly state that
there are no disallowed services; only disallowed settings (Le., services provided in an
institution). "22
Addressing only services to the elderly, an Indiana report describes long-term care
services as falling within three basic categories in a range or continuum as follows: 23
Community -- These services are designed to help the elderly maintain
independence and to encourage their continued involvement in their communities.
These are often not services provided to the elderly, but rather opportunities for
independence. At this level, non-governmental agencies and funding sources are
primarily involved and often include community groups, service clubs, churches,
and senior centers.
In-Home -- As capabilities diminish during the second phase [the first phase of
aging being independent, and second, semi-independent, and the third, dependent]
and the elderly person becomes more homebound and less able to participate fully
in the community, services shift to the home setting. These services seek to
support, not supplant, the existing informal support network.
Institutional -- Significantly diminished capabilities can warrant institutional
placement when the elderly person requires a level of nursing care, medical
supervision, and supportive services that are impractical or not feasible in the
home.
A similar range of categories for long-term care, from the least restrictive to the most
restrictive is offered below: 24
(1) Community Service Model: Individuals live at home but services are
delivered elsewhere, e.g. adult day health center or senior center where the
emphasis is on daytime social wellness activities.
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