The United States of America has one of the best health care services systems in the world. Promotion of health and prevention of diseases are of primary importance in the health care continuum apart from curative care. In this paper, we see the different components of the US health care services continuum and discuss in detail the Long Term Care services. Long-term medical care is an integral component of the health care delivery system continuum. This paper examines the role played by LTC in providing services and transitioning patients from one stage to another. It also discusses the contribution to the overall US health care resources.
Introduction
The United States of America has one of the best health care services systems in the world. The US health care systems deliver their services from the prenatal stage till the end of life. The “womb–to–tomb” services start with prenatal care to the carrying woman, the delivery of a healthy child, prevention of primary diseases, goes through the treatment of diseases, disease prevention in the secondary and tertiary stages, treatment of acute illness, long – term care, rehabilitation and at the end, the palliative care. Promotion of health and prevention of diseases are of primary importance in the health care continuum apart from curative care.
“The continuum of health services: components” (Barton, 2007, chap.1, p.5).
Components of the US health care services continuum Prenatal care: Childbirth is an inevitable process required to ensure the sustenance of human beings. It is believed to be a simple and natural process. Prenatal care ensures the healthy delivery of the child and cares for the carrying mother. “In recent years, the United States has focused increased attention and resources on improved birth outcomes, but a significant number of pregnant women either do not have access to prenatal care or do not avail themselves of it.” (Barton, 2007, chap.11, p.320). The use of advanced technologies and knowledge in providing health care services to the carrying mothers will help to produce a healthier child.
Health promotion and Health protection: For a long period, curing diseases was the prime focus of health care services in the US. The need for a healthier population was later recognized and now more focus is given to health promotion and protection. Healthy lifestyles and behaviors prevented diseases and decreased mortality. Public health protection is a much easier task than curing illness. Prevention of outbreak of epidemics, maintaining clean and hygienic living conditions, and sanitation is the focus of health protection. Health promotion services constitute management and maintenance of physical and mental health, nutrition, restricting alcohol and drug usage, family planning, etc.
Disease Prevention: Disease prevention is divided into three stages by the US health care systems. Primary disease prevention involves defending and arresting the disease-causing agents through screening, genetic testing, and counseling. Secondary disease prevention is the detection and control of diseases in their starting stages by physical examination, laboratory tests, and medicinal treatments. Most diseases can be cured if detected and treated at an early stage. Tertiary disease prevention reduces the impact and disabilities caused by the disease by appropriate medical care.
Primary care: Primary care includes the diagnosis of a disease and the treatments given initially to the patient in the form of medicines. Routine checkups, tests, and dental cleaning are included in primary care. Clinical Physicians and general practitioners, dentists, etc are the main providers of primary care. Primary care services are accessed by all irrespective of age.
Secondary care: Inpatient hospital treatments and ambulatory care services are included in secondary care. The secondary health care service providers are usually a team of physicians and nurses. Secondary care is given to patients suffering from acute illness. Secondary care is usually longer than primary care.
Long-term Care: Long-term care is a form of secondary care and is provided by specialized therapists and nurses over a period of time.
Tertiary care: “Tertiary medical care is highly specialized care, usually extremely complex, and costly. Tertiary medical care includes, for example, liver and other complex organ transplants, treatment of diseases of the immune system, and treatment of brain and other nervous system disorders.” (Barton, 2007, chap.11, p.323). Tertiary care is generally provided by a specialized team of doctors and nurses in medical universities and academic health centers. Rehabilitative care which includes post-surgery care and treatment of mental illness comes under tertiary care.
Palliative care: Palliative care is given at the last stage of terminal illness to alleviate the pain and suffering of the patient. Palliative care providers may be family members, home care, or hospice care providers.
Long Term Care (LTC) – Role in providing health services
Long-term medical care is an integral component of the health care delivery system continuum. It provides medical and nursing care to people who suffer from chronic illness, severe injury, physical or mental disability, age-related problems, etc., who are not able to care and feed for themselves for a long time. “Regardless of the length of time, LTC is an array of services provided in a range of settings to individuals who have lost some capacity for independence due to an injury, chronic illness, or condition. LTC services assist individuals with basic activities and routines of daily living and may also include skilled and therapeutic care for treatment and management of these conditions” (Barton, 2007, chap.15, p.367).
The people who need LTC service: A vast number of Americans – almost 12 million people – require Long Term Care services. The need and extent of requirements vary from person to person. Severely disabled and chronically ill patients require more LTC services than others. LTC services are provided to people with mental instability and physically challenged individuals. Aged people and persons suffering from age-related ailments are the majority of users of LTC services. With the advancement in technology, more lives are saved from severe injuries and chronic illnesses. LTC services play an important role in providing post-treatment care to such individuals. Prematurely born babies and newborn babies with severe health issues will need LTC services for years. Extending the life span of individuals has created more elderly in the country. LTC services are indispensable for these aged people.
LTC services can be medical or non-medical. Medical services include inpatient hospital care services and nursing assistance. Non-medical LTC services are given to persons to assist them in their daily chores like taking food, bathing, changing clothes, physical mobility, and overall personal care.
The functional ability of a person determines the extent of LTC services provided to him. On this functionality, LTC services are divided into two:
- Activities of daily living – which involve the overall personal care and management of an individual like eating, bathing, dressing, using the toilet, etc.
- Instrumental Activities of Daily life – which involves assistance in important functions like reading, other social activities, and assistance in attaining self-sufficiency.
LTC services are provided by trained specialists or formal providers of long-term care which include nurses, doctors, home health care service providers, etc., or by informal providers like family members and other individuals who take care of patients for charity. “Major services may include transportation, assistance with shopping and other household chores, financial management, personal care, and assistance with obtaining medical care and following the regimen, including medications, which the provider prescribes.” (Barton, 2007, chap.15, p.371).
Role of LTC services in transitioning patients from one stage to another:
Informal service providers give LTC services to patients in their homes and just provide basic assistance for routine chores. For individuals receiving formal long-term care services, the role played by LTC services in transitioning patients from one stage of life to another is immense.
- For the aged: As people grow older, they face activity limitations in life. Helping these people in their daily life gives them a more sense of living. Assisting old people in walking and reading gives them more pleasure. Long-term care prevents aged people from being bedridden. The small assistances they get in jobs like cooking, bathing, and other personal care change their lives and help them to lead a normal social life.
- For the mentally challenged: Mentally challenged individuals suffer from problems like the inability to comprehend and attend deficit disorders. People suffering from disorders like Alzheimer’s, schizophrenia, bipolar diseases, etc find it difficult to lead a normal life. Some mental health issues may be due to substance abuse, physical, sexual or mental tortures, mental shocks, or head injury. LTC service providers can transform the lives of a small portion of mentally ill persons. LTC services in this category include counselors, psychiatrists, nurses, etc. Long-term counseling provided to people suffering from mental illness due to external facts like tortures and mental shocks can be brought back to lead a normal life.
- For the severely injured: Advanced technologies have now helped in saving and prolonging life spans. People who have suffered severe injuries due to accidents are now given long-term care services to bring them back to life. People who become physically disabled are given assistance in LTC services which help them. Therapists and specialists in the fields provide LTC services for these people. Long-term physical therapies and the like have helped people who have suffered injuries to their limbs, to walk and lead a normal life.
LTC services providers also provide post-acute care and sub-acute care services. Post-acute care program improves the transition from hospital to community and “provide services to patients needing additional support to assist them to recuperate after the discharge from hospital due to a chronic illness” (Pratt, 2009, p.98). Subacute care is given to hospitalized patients who suffer from chronic illness or injury and provides medical treatment to minimize the suffering. It is an intensive treatment program that requires a thorough assessment of the disease or injury condition and treatment until the condition of the patient is stabilized.
Contribution to the overall management of health resources:
Although long-term care is not perfect in its services and delivery systems, it has proved to be one of the most efficient health care systems in the US. With the increasing number of aged and physically disabled individuals, the services provided by long-term care to help and assist the patients to walk back to normal life is immense. The health care continuum in the US would be incomplete without LTC services.
LTC services have risen to the growing needs of health care and have responded to the changes in health service systems. LTC services are recognized throughout the country irrespective of geographic and social differences and are doing their best to meet the requirements of all people equally, which is not possible for other health service systems. With the changing need of the consumers, LTC services have designed various cost-effective and innovative types of services to cater to the needs of all. Multilevel facilities are provided according to the patients’ profile and need of care.
In recent times, LTC services have started trying out integration of services to help and assist the growing patient needs more effectively. Horizontal and vertical integrations are done to provide the best health care services, though it is primarily done to attain market gain. Although LTC services have their advantages, there exist some flaws in the system. Most of the LTC services are reimbursement-driven. “Providers come forward to meet the needs for which there is reimbursement” and is reluctant to provide services for which they will not be paid for or for which reimbursement is limited.” (Pratt, 2009, p.26).
Most of the patients who take LTC services avail of Medicare or Medicaid services. But Medicare services were not designed and developed to provide long-term care services. The funding for LTC services by Medicare is limited and this is a serious issue. Availing LTC services after the Medicare period is very expensive and can be afforded only by the rich. “Part of the problem today is that few persons are given an incentive to provide long term care and, thus, to privately meet the costs” (O’Brien, & Flannery, 1997, p. 42). In most cases, LTC services are often mistaken as or mixed with community and charity services. Although LTC services are flexible and accommodating, it lacks uniformity and coordination.
Conclusion
Long term medical care is an integral component of the health care delivery system continuum which provides medical and nursing care to people who suffer from chronic illnesses, severe injury, physical or mental disability, age-related problems, etc., who are not able to care and feed for themselves for over a long time. A vast number of Americans require and avail themselves themselves Long Term Care services. Although long-term care is not perfect in its services and delivery systems, it has proved to be one of the most efficient health care systems in the US.
References
Barton, P L. (2007). Understanding the U.S health services system: Overview of the U.S. health service system. 3rd ed. HAP: AUPHA. 5.
Barton, P L. (2007). Understanding the U.S health services system: Prenatal care. 3rd ed. HAP: AUPHA. 320.
Barton, P L. (2007). Understanding the U.S health services system: Tertiary medical care, including rehabilitative care. 3rd ed. HAP: AUPHA. 320.
Barton, P L. (2007). Understanding the U.S health services system: Defining long term care. 3rd ed. HAP: AUPHA. 367.
Barton, P L. (2007). Understanding the U.S health services system: Informal LTC providers. 3rd ed. HAP: AUPHA. 371.
O’Brien, R C., & Flannery, M. (1997). Long- term care: federal, state, and private options for the future: Long- term care. Routledge. 42.
Pratt, J. (2009). Long- term care: managing across the continuum: What is postacute care? 3rd ed. Jones & Bartlett Publishers. 98.
Pratt, J. (2009). Long- term care: managing across the continuum: A reimbursement-driven system. 3rd ed. Jones & Bartlett Publishers. 98.