Long-Term Care Facilities II

Introduction

Long term care is an essential program that needs to be implemented with almost immediate effect. Once implemented, this program will be beneficial to the society as it will assist in taking care of the elderly suffering from long-term ailments such as dementia. This paper consists of a detailed description of the proposed long-term program. It will include a description of the sources of finance, administrative departments and roles, ethical concerns as well as control mechanisms in order to control management, financing, and quality in the long-term care systems.

Roles and Responsibilities of the Administration in Each Department

The adult day centers will be made of various departments. The first department will be in charge of receiving elderly patients into the centers and ensuring that all their information is well captured into the system.  This data department will be staffed with specialized nurses that will check incoming patients` blood pressure and sugar levels. They will also collect all health history data of patients, especially those suffering from long-term illnesses. This information will be kept and retrieved in future. Data is also important as it can help to understand any future complications that a client may develop. The second department will be the counseling department. This department will cater for the mental health of patients especially those suffering from dementia. The administrative role of this department will be to identify the patients who need mental support. Professional counselors will be assigned to offer personalized mental treatment to such patients. Another department that is included in adult day care centers is the emergency department that offers emergency services. An adult care center is a complimentary healthcare center and not a substitute for a medical center. For this reason the adult center will have an emergency center to provide first aid help and take any emergency patient to the nearest medical center if necessary. A sports and creativity department will be also included in these adult care centers. This department will be in charge of the physical wellbeing of clients. The sports and creativity department will offer light exercises, physiotherapy and creative therapy such as music, art and dance. Behavior management department will be charged with the responsibility of assisting patients with behavioral issues such as poor speech, inconsistency, sleeping problems and forgetfulness. A personal care department will be included in the adult care center to assist clients with toileting and grooming. The adult care center will also include a health center department. This department will offer health services such as regular checkups including eye, ear and dental examinations. The health center will also administer regular medications such as insulin and cancer drugs to patients. Another facility under the proposed long-term care program is in-home health care. This center will offer long-term care to elderly clients at their homes instead of confining them to a care center. This facility will be divided into two departments only: medication and personal departments. The medication department will be in charge of distributing medical assistance to clients in their homes. The personal care department will regularly visit clients and offer them personal services such as grooming, toileting, art therapy and physiotherapy. The finance department is also necessary to control all funds coming into the centers and to control spending. The administrative role of this department is to come up with possible sources of funds for the care centers and to control these funds for the smooth running of the organization’s operations. There will also be HR and staffing department. This department will be in-charge of meeting the employees` needs, and recruiting and hiring the correct professionals to meet these needs (McKenzie, Pinger, & Kotecki, 2012).

Sources of Finance

Consumers will be able to access the long-term care through different forms of financing. These will include the use of personal insurance as payments. Personal insurance including life insurance is a proper form of financing long-term care as it is part of clients’ health. It also saves them the agony of borrowing more funds for treatment from friends and relatives. Security funds from lifelong savings can also be used to finance long-term care. Elderly clients, who have neither security finds nor personal insurance, can seek financial assistance from the government. The government always sets aside funds to cater for elderly people with dire needs. These funds can be accessed through registration at a local social services office. Private donors can also fund the organization. These are non-governmental organizations who are concerned with the welfare of elderly people in the society. They always finance medication and care provided to the elderly. The centers can also generate funds from projects aimed at provision of care to the elderly at the centers. These income generating projects can range from art to any other products that can be sold to generate funds. These funds can then be brought into the facility by funding a project aimed at provision of care to the elderly. Financial support can also be sourced from family and friends. Capable children can assist in paying their parents’ medical care bills. Friends and other willing donors can be allowed to donate money to such centers to enable them to provide long-term care. Charity events can be organized by such people to mobilize the society to donate money to programs aimed at provision of long-term care of elderly citizens in our communities (McKenzie, Pinger, & Kotecki, 2012).

Key Sources of Reimbursement

There are public and private sources of reimbursement for long-term care. One of the public sources is Medicaid. This program caters for the medical needs of long-term patients with low income. The government substitutes medical expenses through this program to assist its citizens. Another public source of reimbursement is Medicare. It is a government substituted insurance program mainly targeted at the citizens aged 65 or older and who have been saving throughout their lives. This publicly funded insurance also reimburses young children diagnosed with long-term illnesses such as disability. Another public funding provided to long-term care patients is the federal grants allocated by the central government to the states for providing care to long-term patients within a community. The state forwards these funds to its agencies that then transfer the same to all the local agents available who channel them to long-term care providers. Another public fund is the social services block grant. This grant is also allocated by the central government to all states based on their population. This fund can also be used to provide long-term care to all citizens who lack income. Another public form of long-term reimbursement is the Veterans Affairs (VA) program. The VA program does several activities. For instance, it operates several adult day care centers across the country where long term care patients can access free services. They also have a free in-home care services such as visiting and serving long-term care patients in their homes. The VA program also has a funding scheme that reimburses long-term patients all costs accrued during treatment and care in private run adult day care centers. Those who cannot access the adult care centers are also assisted by the VA and provided with pension supplements which they can use to pay for informal care (Singh, 2010).

There are also several private sources of reimbursement for long-term care. These are out of pocket funds and long-term personal insurance among others. The latter is a form of reimbursement that is available to all individuals who insured themselves against occurrences of long term illnesses and old age complications. Private insurance reimburses patients up to 6% of all costs associated with long-term care and medical assistance. However, this figure varies depending on the insurance providers and the type of policy taken. Other private sources of reimbursements include the out of pocket funds where children and friends of a long-term patient reimburse all costs associated with care provided to a patient (Gottret, Schieber, Waters & World Bank, 2008).

The Role Played by Managed Care and Its Impact on Long-Term Care Reimbursement

The government has designed and implemented this program so as to cut cost of health care and improve quality of services. Managed care employs different forms of techniques to ensure that cost of care is kept as low as possible. These techniques involve advancing payments and giving incentives to patients and caregivers respectively so that they can in return select less costly care programs. Managed care also runs regular auditing of medical services to review the necessity of some of the services offered. Those that are deemed to be unnecessary are slowly edged out or integrated into other major services. Managed care also crusades for sharing of beneficiary costs. This reduces the costs of reimbursement. Managed care also controls the necessity and length of stay of patients in medical facilities and care centers. Other efforts include cost sharing, contracting and elimination. The impacts of managed care are diverse. The supporters of this program propose that it has increased the quality of care as all unnecessary costs are eliminated and the available funds are then channeled towards the real needs. This has increased efficiency especially of public funds since they are used to cater for costs of real cases and not symptomatic cases. Citizens have also understood the relationship between costs of medical care and quality of service. By eliminating unnecessary costs the quality of services improves. This is because low quality of medical services is caused by the overuse, misuse and waste of funds on unnecessary or overcharged services. However, it is also argued that managed care has brought negative effects on long-term care. This is because it has increased the number of uninsured long-term care patients, scaring away care givers. This has in return led to low quality of care. Managed care has also had a negative effect on reimbursement. Most patients with long term needs are currently not getting any insurance as they depend on managed care. Reimbursement is not available to clients without insurance policies (Singh, 2010).

Quality Development, Maintenance and Control

There are public and private means of ensuring quality of services. One such public means is the Centers for Medicare and Medicaid Services (CMS), Center for clinical standards and quality and the privately owned Health and Human Services. Professionals from various medical departments assess quality of services provided in these facilities and submit a report for actions to be taken. Health and Human Services (HHS), on the other hand, is run by private insurance providers. These insurance providers run regular quality checks to ensure that cost of reimbursement meets the actual quality of services offered. These checks ensure that day care and in-home care service providers maintain high quality of services (James & American Health Information Management Association, 2004).

There are two types of cost control mechanisms. External mechanisms such as managed care are government initiated. Managed care ensures quality and cost control. Internal costs control is done by finance departments of these facilities. The finance department collects funds and minimizes operation costs so that the funds are sufficient to run operations. Costs are controlled by minimizing all expenditures on short term services. Goods and products are also acquired on a large scale basis which saves money as compared to making small purchases. The finance officer also ensures that all services and human resources are necessary. Any redundant resources should be eliminated to avoid unnecessary costs and charges. Regular internal audits are carried out to identify the necessary services and eliminate unnecessary ones. It also helps to run cost cutting programs through sharing and elimination of unnecessary ones (Pratt, 2010).

Ethical Aspect of Access to Care

There are several ethical concerns of access to care in adult day care facilities and in-home care services. The first is rationing issues that arise due to overcrowding as more patients seek care from the already overcrowded facilities. Overcrowding in these facilities hinder the intake of more patients. Privacy is another important ethical concern. This is due to overcrowding in these long term care facilities. Overcrowding reduces privacy since basic facilities such as bathrooms are shared. This lowers the moral dignity of many patients who prefer privacy. More ethical concerns have risen from managed care. For example, pressuring patients to use cheaper sources of care is unethical. Cost sharing and rationing of basic services are also against basic rights. Long-term patients should be treated singularly since their needs are unique. This is because every patient has unique needs that should be catered for individually (Ferreira, Erasmus & Groenewald, 2009).

Conclusion

Long-term care facilities such as adult day care and in-home care services are important. These facilities assist patients with long-term needs such as the disabled, the elderly and the terminally ill. These facilities are funded by government, donors, NGOs and individual volunteers. Quality in these facilities is controlled through CMS and HHS programs. Cost in these facilities is controlled through internal and external mechanisms. Internal mechanisms include the finance department while external ones include the managed care program. Ethical concerns such as rationing of basic needs and services, overcrowding, refusal to take new patients and lack of privacy are some of the most important ethical concerns that face these facilities. Citizens can seek reimbursement from personal insurance, out of pocket funds, Medicare and Medicaid programs. NGOs also provide patients with funds to access long-term care.

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