A defining characteristic of long-term care is that it presupposes a lengthy stay of a person in a healthcare institution or some community-based facility. Both types of long-term care have some benefits and disadvantages, so healthcare providers and patients decide between community or institutional care depending on their possibilities and needs. Institutional care tends to generalize the conditions of patient stay and care whereas community care is more person-oriented and provides a variety of opportunities for patients.
People staying at hospitals must conform to strict rules and regulations and their ability to socialize is limited. Because institutional care is focused on providers’ schedules rather than patient-specific needs, there are frequent cases of patients being alone for a long time.
Patients’ ability to communicate is undervalued, and in the majority of cases, they remain in beds instead of interacting with others. On the other hand, community care provides a wide range of opportunities for patients, enabling them to control their schedule and choose how to spend their time. Another reason that community care is considered better than its institutional counterpart is that the investment into it is proportional to the quality of care provided. The level of institutional care is known not to correlate with the expenditures dedicated to it. The current paper will discuss the implications of community care versus institutional care with a special focus on elderly patients with mental health problems.
A review article by Wysocki et al. (2015) “Long-term services and supports for older adults: A review of home and community-based services versus institutional care is focused on the analysis of institutional care as opposed to home and community-based services (HCBSs). The authors employ two methods in their research: literature identification and evidence rating. The first method involves the process of selecting the studies to be included in the review.
Wysocki et al. (2015) consider randomized control trials and quasi-experimental designs the most suitable for their analysis. All chosen articles incorporate a comparison of care provided for older adults by HCBSs and nursing homes (NHs). Wysocki et al. (2015) review the reports of studies published in English from 1995 to 2012. The authors review the articles in two steps. First, they presuppose an independent review of titles and abstracts by two investigators.
The second phase incorporates a review of the full text of each source and the establishment of whether all inclusion criteria are met. The second method employed by Wysocki et al. (2015) includes the evaluation of the methodological possibility of bias. The authors scrutinize the results qualitatively to discern the level of closeness between the populations receiving care at HCBSs and NHs and evaluate the divergences in outcomes.
As a result of their analysis, Wysocki et al. (2015) conclude that the reviewed studies do not provide sufficient data for the comparison of HCBS and NH care of elderly people. The majority of articles under investigation do not include any information about the cost and quality of care. Thus, Wysocki et al. (2015) suggest that better research should be performed to identify which type of long-term care suggests better patient outcomes.
The article by Wysocki et al. (2015) has strengths as well as weaknesses. The major advantage is that the authors make an effort to analyze a crucial issue of the modern healthcare system. However, the greatest limitation of the study is that there are no sufficient conclusions concerning the advantages and disadvantages of two types of long-term care provided for older adults. Another weak point is that not all of the reviewed papers analyze the effect of long-term care on older adults’ cognitive functions. The validity of the article is measured through the use of many scholarly peer-reviewed research papers.
A possible explanation of the study’s weaknesses is the inclusion of outdated sources instead of current articles that discuss this problem more extensively. The purpose of the article by Beerens et al. (2014) is the analysis of the quality of care and quality of life of older adults with dementia provided by home care and institutional care. Unlike Wysocki et al. (2015), Beerens et al. (2014) manage to establish some differences between the two types of care. The authors conclude that some indicators of quality of care are better in home-based care settings than in institutional care (Beerens et al., 2014).
Older adults with dementia provided with home care are reported to use fewer psychotropic drugs, have fewer inflammations in pressure, and suffer less from physical limitations. At the same time, Beerens et al. (2014) remark that patients receiving home care experience depression and loss of weight more often than those in institutional care. Callahan et al. (2012) investigate the need for transitions in care experienced by elderly patients with dementia. The authors note that the majority of care is obtained by such patients in community settings. According to Callahan et al. (2012), even those patients who spend much time in institutional care eventually return home and receive the rest of their care there.
The implications of the study by Wysocki et al. (2015) to the mental health and addictions field are not as profound as those provided by Beerens et al. (2014) and Callahan et al. (2012). Only some of the articles reviewed by Wysocki et al. (2015) focus on elderly people’s mental health. Meanwhile, two other articles investigate the impact of community-based and home care on older adults with dementia. Beerens et al. (2014) report that receiving community care has a positive impact on elderly patients with dementia. Callahan et al. (2012) note that such people prefer to return home when the disease progresses to the final stage.
References
Beerens, H. C., Sutcliffe, C., Renom-Guiteras, A., Soto, M. E., Suhonen, R., Zabalegui, A, … Hamers, J. P. H. (2014). Quality of life and quality of care for people with dementia receiving long term institutional care or professional home care: The European RightTimePlaceCare study. Journal of the American Medical Directors Association, 15(1), 54-61.
Callahan, C. M., Arling, G., Tu, W., Rosenman, M. B., Counsell, S. R., Stump, T. E., & Hendrie, H. C. (2012). Transitions in care for older adults with and without dementia. Journal of the American Geriatrics Society, 60(5), 813-820.
Wysocki, A., Butler, M., Kane, R. L., Kane, R. A., Shippee, T., & Sainfort, F. (2015). Long-term services and supports for older adults: A review of home and community-based services versus institutional care. Journal of Aging & Social Policy, 27(3), 255-279.