long-term care - Legislative Reference Bureau

SINGLE ENTRY POINT FOR LONG-TERM CARE SERVICES
client by authorizing a reduced amount of support services based on the degree of informal
support already available to the client. However, screeners, assessors, and case managers
routinely take this into account in fashioning a care plan. Nonetheless,3?
Family caregivers are recognized as the primary provider of long term care
services, and as such are the target for increased state efforts to provide them with
non-monetary support in order to sustain their efforts. State policies explicitly
establish linkages between informal supports and several aspects of formal service
delivery systems. For example, family supports are one factor used in assessing
an individual's need for publicly assisted community care services. They are also
acknowledged in the frequently articulated care planning goals of "building the
formal system of care around existing informal supports." And their views are
solicited as part of the preadmission screening process. All of these policies relating
to informal supports have become universally accepted principles that are relatively
easy to implement. [Emphasis added]
Although the role of informal caregivers is recognized, some government officials are
reluctant to pay family caregivers due to philosophical concerns over using public funds to
subsidize what are believed to be family obligations: 38
Where such payment is made it is unvariably [sic] the option of last resort.
Usually payments are linked to financial hardships resulting from caregiver
activities, such as being unable to seek paid unemployment.
In four of the six states studied by Justice, et aI., family caregivers can be paid as
providers under some of the major long-term care programs. 39
Home Care -- Personal Care and Homemaker Services: Where home care in the form
of unpaid informal support is unavailable or inadequate, community care programs usually
authorize personal care and homemaker services. This is the first major component of homeand
community-based long-term care. As noted before, these services address both ADL and
IADL-impairments and can go by different names. Depending on the state and the target
population, these services may be administered by state or local units or by private non profits
or even for-profit agencies. Actual services can be contracted out to home care agencies or
other private providers.
Personal care and homemaker services enable individuals who need help with one or
more ADLs or IADLs to continue living at home or in a community setting. Trained staff go to
the impaired person's home to perform various care services. For example, personal care
attendants may help clients to eat, bathe, dress, tOilet, and get around inside or outside the
home. Homemakers or chore assistants may help the the client manage the household
budget, prepare meals, and do the shopping, laundry, and housekeeping. Their services may
be paid for directly by the authorizing program or by the client through a subsidy. Some
states offer these services to private-pay clients on a sliding-scale fee basis. Typically, clients
not ordinarily eligible for Medicaid are assisted by these private pay programs. The rationale
is that these services either delay or prevent their entry into more expensive nursing homes.
Adult Day Care and Adult Day Health Centers: Non-residential adult day care centers
(ADCC) and adult day health centers (ADHC) comprise a second major component of longterm
community- and home-based care for the elderly. Elderly who are functionally impaired
travel from their homes to a care center to receive services. In general, ADHCs offer more
services, including a medical component, than ADCCs.
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