Health Care: Long Term Care, Research Paper Example

Abstract

Many researchers contend that long-term care in America is a catastrophe for the elderly in the sense of making the poor poorer and the rich impoverished. The elements pertaining to long-term care accessibility and sustenance clearly, create a crisis for the elderly or disabled. In the following pages of this document the writer will explore the foregoing assumption further in declaring to what extent it is true picture of long-term care in America.

Introduction

Definition

Long term care within the United States of America health system can be described as a concept encompassing series of services that will assist in managing chronic diseases. From research findings chronic diseases such as diabetes, hypertension, heart failure, cancer, COPD; sickle cell anemia among others require lifelong treatment considered to be long term care (U.S. Department of Health and Human Services, 2012).

Services defining long term care include medical and non-medical interventions. Custodial or non-skilled care involves bathing, dressing, assisting with medication management; casual exercise and grooming. These services can be provided at the client’s home or at an assisted living facility. Mostly needed medical and skilled interventions include physical therapy, dialysis, chemotherapy and blood transfusions. These are provided as outpatient treatment or at- home services (U.S. Department of Health and Human Services, 2012).

US Health Care Delivery system

Research has shown where the American health care system is the most expensive in the world. A 2006 research revealed that there was over $3 trillion on health care expenditures (Kao-Ping, 2006). It further indicated that 15% of all products made in the United States of America were health related. The prediction is that it will increase towards the point of escalation (Kao-Ping, 2006).

Four dimensions of health care are operative in America. They embody the practice of medicine; medical education and advancement through research. Next is the development of the hospital system; thirdly an historical public health component and fourthly health insurance. The practice of medicine in itself revolves around a number of regulations regarding certification, specialization and applications of health insurance coverage. The hospital system functions for emergency services and immediate medical/surgical intervention. Public health address disasters health related situations in the community in relation to epidemiological data analyses. Health insurance coverage is the means by which citizens, legal residents, visitors and undocumented immigrants pay for health care while living in United States of America (Kao-Ping, 2006).

Primary issues in Long-term Care

Eligibility

The first eligibility encompassing long term care in America is adequate insurance coverage. If aperson does not have coverage then alternatives such as Medicaid can be applicable. If the person is over 65 then Medicare may cover these costs. In situations where people are ineligible for Medicaid or Medicare they will not receive care expect if paying out-of-pocket.

These include illegal immigrants, international students and people with certain type of chronic diseases not covered under Medicaid or Medicare. Besides, for long term case intervention of any kind the patient must be referred either by the primary care physician or a

Specialist.

Health Insurance Implications

A 2003 long-term care health insurance implications survey revealed that62% of non-elderly Americans received private employer-sponsored insurance, 5% purchase their own;15% in public programsand 18% were uninsured (Feder et.al, 2012). Long term care requires long term financing.

Many private insurance companies do not cover long term care for an undefined period especially, when no one can predict how long the client/patient will require that care. Hence, persons can be left without coverage and subsequently die due to lack of quality care (Kao-Ping, 2006).

The real issue is that long term care in context of American health care system, which is the most expensive in the world; is costly to federal and private insurance providers. Due to escalating costs of health care insurance premiums are rising and the federal input is focused on cutting cost. Therefore, quality of long term care is being challenged due to inadequate insurance coverage public or private (Feder et.al, 2012).

Alternative studies have proven where the cost of insurance for long-term care could be greatly reduced if persons were cared for in their homes by relatives or at lower nursing care level institutions. Precisely, these studies have shown where 15% of persons admitted to   nursing homes could be adequately taken care of in their own dwellings. Nursing home costs accounts for 70% of long-term care expenditure(Kao-Ping, 2006).

Medicaid and Medicare

Medicaid is a government program that pays for basic health services and nursing home care for older people; children and younger ones with disabilities. Long term care can affect any age group, but most importantly, the elderly over 65 years old. The eligibility is defined according the poverty level of the individual. If the person is poor there is no alternative but to provide the funding through federal financing. However, if a person has or property cash in the bank this has to be liquidated in order to enjoy long-term care coverage through Medicaid (Feder et.al, 2012).

Medicare does not pay for long-term care. It pays for medically skill nursing facility services such as hospitals and home health care for a short period of time. There are criteria for these eservices as well, which must be recommended by the primary care physician or specialist. Patients must be discharged from hospital after 3 days of admission and transferred to a skilled rehabilitation facility. The coverage is for 100 days. Custodial or non-skilled care is not covered (Kao-Ping, 2006).

Conclusion

Rawls Theory of Justice

Rawls’ (1999) theory of justice applied the liberty and difference principle to justice as being fairness in a social contract mechanism. The Americanhealth care system when considered within this theoretical framework is a social contract between the United States government and people living in this country. Social justice is executed in fairly distributed health care services be it long or short term.

Medicare does not cover long term care even for in house services over and above a certain period of time. Private insurances cover for a limited period. Is this justice for people who are taxpayers? More importantly, when a person’s private insurance coverage is over he/she is discharged and left to die or measures of mercy killing induced as end of life care interventions to speed up the dying process. Many people do not know about this system until they become ill and are caught in the middle of a tragedy.

If persons have property and become ill they must surrender it to the state to be eligible for health care through Medicaid. There is no liberty of choice. The difference is health care or poverty. Why could not another system exist whereby people can pay for their health care without losing assets? Why is the cost of health care in America so high and inaccessible?Where is the fair distribution of services principle as espoused by Rawls (1999). In Rawls (1999) theory of justice health care in America is an unfair system (1999).

References

Feder, J. Komisar, H., & Neifeld, M. ( 2012).Long-Term Care in the United States: An

Overview. Health Affairs,19(3),40-45

Kao-Ping, C. (2006). Overview of the US Health Care System. AMSA Jack Rutledge Fellow

Rawls, J. (1999). The Theory of Justice. New York. Harvard University Press

U.S. Department of Health and Human Services. (2012) AHCPR Research on Long-term Care. Agency for Health Care Research and Quality