Universal Coverage of Long-Term Care in the United States


Book Description

As millions of baby boomers retire and age in the coming years, more American families will confront difficult choices about the long-term care of their loved ones. The swelling ranks of the disabled and elderly who need such care—including home care, adult day care, or a nursing home stay—are faced with a strained, inequitable and expensive system. How will American society and policy adapt to this demographic transition? In Universal Coverage of Long-Term Care in the United States, editors Nancy Folbre and Douglas Wolf and an expert group of care researchers assess the current U.S. long-term care policies and exercise what can be learned from other countries facing similar care demands. After the high-profile suspension of the Obama Administration’s public long-term insurance program in 2011, Robert Hudson and Howard Gleckman provide concrete suggestions for lowering the cost and improving the quality of long-term care coverage in America. In a deeply personal and empirically rigorous analysis, family care expert Carol Levine draws crucial lessons from her experience as a caregiver for her ailing husband. She sheds light on the often fraught interactions that occur between the formal care system and family caregivers and analyzes how public policy can best support long-term family care. The volume next examines recent reforms in other developed countries and finds valuable lessons for American policy-makers. Contributors David Bell and Alison Bowes discuss the provision of personal care services in Scotland, which have been publicly financed since 2002. Their analysis shows that the new program reduced costs improved efficiency and allowed more recipients to receive care. The volume assesses the political and institutional prospects for moving towards a truly universal long-term care system in the United States. Robyn Stone provides a sobering overview of the formal, paid long-term care workforce in America, which is in crisis due to increasing demand and a shortage of qualified workers. Economist Leonard Burman focuses on public finances of the long-term care system, which will come under increasing strain as more Americans rely on Medicaid to pay for their long-term care. In the volume’s concluding chapter, Folbre and Wolf summarize criticisms of existing long-term care policies and outline particular reforms that can move the United States toward a universal system of long-term care insurance. Universal Coverage of Long-Term Care in the United States provides an essential resource on how to improve the long-term care sector in America and helps advance the national debate on this pressing topic. This volume is available for free download on the Foundation’s website, as are the volume’s individual chapters.




Improving the Quality of Long-Term Care


Book Description

Among the issues confronting America is long-term care for frail, older persons and others with chronic conditions and functional limitations that limit their ability to care for themselves. Improving the Quality of Long-Term Care takes a comprehensive look at the quality of care and quality of life in long-term care, including nursing homes, home health agencies, residential care facilities, family members and a variety of others. This book describes the current state of long-term care, identifying problem areas and offering recommendations for federal and state policymakers. Who uses long-term care? How have the characteristics of this population changed over time? What paths do people follow in long term care? The committee provides the latest information on these and other key questions. This book explores strengths and limitations of available data and research literature especially for settings other than nursing homes, on methods to measure, oversee, and improve the quality of long-term care. The committee makes recommendations on setting and enforcing standards of care, strengthening the caregiving workforce, reimbursement issues, and expanding the knowledge base to guide organizational and individual caregivers in improving the quality of care.




Health-Care Utilization as a Proxy in Disability Determination


Book Description

The Social Security Administration (SSA) administers two programs that provide benefits based on disability: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. This report analyzes health care utilizations as they relate to impairment severity and SSA's definition of disability. Health Care Utilization as a Proxy in Disability Determination identifies types of utilizations that might be good proxies for "listing-level" severity; that is, what represents an impairment, or combination of impairments, that are severe enough to prevent a person from doing any gainful activity, regardless of age, education, or work experience.




Long-Term Care Insurance


Book Description

Long-Term Care Insurance: Oversight of Rate Setting and Claims Settlement Practices




Care Without Coverage


Book Description

Many Americans believe that people who lack health insurance somehow get the care they really need. Care Without Coverage examines the real consequences for adults who lack health insurance. The study presents findings in the areas of prevention and screening, cancer, chronic illness, hospital-based care, and general health status. The committee looked at the consequences of being uninsured for people suffering from cancer, diabetes, HIV infection and AIDS, heart and kidney disease, mental illness, traumatic injuries, and heart attacks. It focused on the roughly 30 million-one in seven-working-age Americans without health insurance. This group does not include the population over 65 that is covered by Medicare or the nearly 10 million children who are uninsured in this country. The main findings of the report are that working-age Americans without health insurance are more likely to receive too little medical care and receive it too late; be sicker and die sooner; and receive poorer care when they are in the hospital, even for acute situations like a motor vehicle crash.




Explaining Divergent Levels of Longevity in High-Income Countries


Book Description

During the last 25 years, life expectancy at age 50 in the United States has been rising, but at a slower pace than in many other high-income countries, such as Japan and Australia. This difference is particularly notable given that the United States spends more on health care than any other nation. Concerned about this divergence, the National Institute on Aging asked the National Research Council to examine evidence on its possible causes. According to Explaining Divergent Levels of Longevity in High-Income Countries, the nation's history of heavy smoking is a major reason why lifespans in the United States fall short of those in many other high-income nations. Evidence suggests that current obesity levels play a substantial part as well. The book reports that lack of universal access to health care in the U.S. also has increased mortality and reduced life expectancy, though this is a less significant factor for those over age 65 because of Medicare access. For the main causes of death at older ages-cancer and cardiovascular disease-available indicators do not suggest that the U.S. health care system is failing to prevent deaths that would be averted elsewhere. In fact, cancer detection and survival appear to be better in the U.S. than in most other high-income nations, and survival rates following a heart attack also are favorable. Explaining Divergent Levels of Longevity in High-Income Countries identifies many gaps in research. For instance, while lung cancer deaths are a reliable marker of the damage from smoking, no clear-cut marker exists for obesity, physical inactivity, social integration, or other risks considered in this book. Moreover, evaluation of these risk factors is based on observational studies, which-unlike randomized controlled trials-are subject to many biases.




Coverage Matters


Book Description

Roughly 40 million Americans have no health insurance, private or public, and the number has grown steadily over the past 25 years. Who are these children, women, and men, and why do they lack coverage for essential health care services? How does the system of insurance coverage in the U.S. operate, and where does it fail? The first of six Institute of Medicine reports that will examine in detail the consequences of having a large uninsured population, Coverage Matters: Insurance and Health Care, explores the myths and realities of who is uninsured, identifies social, economic, and policy factors that contribute to the situation, and describes the likelihood faced by members of various population groups of being uninsured. It serves as a guide to a broad range of issues related to the lack of insurance coverage in America and provides background data of use to policy makers and health services researchers.




Crossing the Global Quality Chasm


Book Description

In 2015, building on the advances of the Millennium Development Goals, the United Nations adopted Sustainable Development Goals that include an explicit commitment to achieve universal health coverage by 2030. However, enormous gaps remain between what is achievable in human health and where global health stands today, and progress has been both incomplete and unevenly distributed. In order to meet this goal, a deliberate and comprehensive effort is needed to improve the quality of health care services globally. Crossing the Global Quality Chasm: Improving Health Care Worldwide focuses on one particular shortfall in health care affecting global populations: defects in the quality of care. This study reviews the available evidence on the quality of care worldwide and makes recommendations to improve health care quality globally while expanding access to preventive and therapeutic services, with a focus in low-resource areas. Crossing the Global Quality Chasm emphasizes the organization and delivery of safe and effective care at the patient/provider interface. This study explores issues of access to services and commodities, effectiveness, safety, efficiency, and equity. Focusing on front line service delivery that can directly impact health outcomes for individuals and populations, this book will be an essential guide for key stakeholders, governments, donors, health systems, and others involved in health care.




Caring for Our Own


Book Description

Caring for Our Own inverts an enduring question of social welfare politics. Rather than ask why the American state hasn't responded to unmet social welfare needs by expanding social entitlements, this book asks: Why don't American families view unmet social welfare needs as the basis for demands for new state entitlements? The answer, Sandra Levitsky argues, lies in a better understanding of how individuals imagine solutions to the social welfare problems they confront and what prevents new understandings of social welfare provision from developing into political demand for alternative social arrangements. Caring for Our Own considers the powerful ways in which existing social policies shape the political imagination, reinforcing longstanding values about family responsibility, subverting grievances grounded in notions of social responsibility, and in some rare cases, constructing new models of social provision that transcend existing ideological divisions in American social politics.




Real People, Real Problems


Book Description




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