Insurance for long-term care. Some definitions, problems, and guidelines for action

The Application of Modern Diagnostic and Therapeutic Techniques to Aged Patients

The availability of high technology designed to preserve human life, places medical practitioners in a set of ethical dilemmas. In particular the use of Intensive Care Units to sustain acutely seriously ill elderly people is a matter of widespread debate. An examination of the medical research literature suggests that such interventions are largely successful and wished for by the patient, but the quality of surviving life is for some, unacceptable. It is concluded that the maintance of life should remain the predominant rule, but that where patient and clinical judgement indicates it, death should be accepted as the natural course.

Private long-term care insurance: a look ahead

The author's objective is to summarize and synthesize what is known about the private long-term care insurance market and its impact on public expenditures, policyholders, their families, and providers. Primary data were compiled from national studies and published and nonpublished information from the long-term care insurance industry. The study design was the review and analysis of empirical data. Data were collected from in-person, mail, and telephone interviews, as well as from a review of the literature. The market is growing rapidly in part due to the vast improvements in product design and to federal and state public policies. Growth in the market should result in modest reductions in public long-term care expenditures. Most claimants are satisfied with their policy, but many still do not feel that their needs are being met. Service delivery and provider issues are critical to making money work for disabled persons and insurers will be increasingly called on to help address this issue. The market for long-term care insurance will continue to grow. Over time, this insurance will likely play a more meaningful role in meeting the needs of disabled elders and their families.

"Lifecare": a viable option for long-term care for the elderly

In the absence of any coherent US long-term care policy, the "lifecare" or "continuing care" retirement community (CCRC) has emerged as one viable model, providing housing, health care, social supports, and long-term care insurance to about 300,000 elderly Americans. Some CCRCs have also demonstrated the cost-effectiveness of a health care philosophy targeted to the maximum functional independence (MFI) of residents. Broad dissemination of the CCRC model and the philosophy of MFI depend on development of new approaches to the role of government and private health insurance along with a new understanding of, and commitment to, risk management.

William F. Forbes, Jennifer A. Jackson and Arthur S. Kraus, Institutionalization of the Elderly in Canada. (Cdn. $15.95)

Le 7ième monographe dans la série Butterworth sur le vieillissement au Canada traite des soins offerts aux personnes âgées résidant dans des centres hospitaliers à long terme. Les auteurs tracent le profd démographique des personnes âgées hospitalisées et décrivent les services qui retardent ou empêchent l'hospitalisation. Les problèmes qu'éprouvent les patients sont passés en revue et au terme du livre les auteurs décrivent les problèmes persévéant au sein des milieux hospitaliers etproposent des avenues de recherche et de développement futures.

An evaluation of increased mortality rates in Wisconsin nursing homes

We reviewed mortality data from 80 nonprofit and government-owned skilled nursing facilities (SNFs) to evaluate previously reported increases in deaths occurring in Wisconsin nursing homes since 1983. Comparing nursing home mortality data for 1982 and 1985, we found a 16.6% increase in overall nursing home mortality rates. The increased mortality rates occurred in the sample SNFs regardless of ownership, Medicare certification, bed size, metropolitan area and hospital affiliation. There were two explanations for the increased mortality rates. First, the number of residents dying within 30 days after nursing home admission increased 59%. The majority of these short-lived residents had been discharged from hospitals indicating a transfer of terminally ill patients into nursing homes just prior to death. Second, there was a 27% increase in the mortality rate of residents living in the nursing home for 1 to 5 years suggesting that the population had become sicker between 1982 and 1985. These data reflect both the impact of Medicares Prospective Payment System (PPS) on the study nursing homes and an increase in the severity of illness of Wisconsin's nursing home population between 1982 and 1985. The findings document an increased role for nursing homes in caring for more acutely ill patients since the passage of the PPS, and have implications for nursing home reimbursement policies and quality of care.