Stepping into the Breach of Federal Inaction: Reforming the Financing of Long-Term Services and Supports in the Post-CLASS Era

The growing need for long-term services and supports (LTSS) poses significant challenges to both individuals and government. This article documents the continuing failure to tackle this problem at the national level-a failure that was most recently seen in the fallout from the Affordable Care Act (ACA), which included the single piece of national legislation ever enacted to comprehensively address LTSS costs: the Community Living Assistance Services and Supports (CLASS) Act. The CLASS Act was passed as part of the ACA (Title 8) but was repealed in 2013. Following its demise, policy experts and some Democrats have made additional proposals for addressing the LTSS financing crisis. Moreover, significant government action is taking place at the state level, both to relieve financial and emotional burdens on LTSS recipients and their families and to ease pressure on state Medicaid budgets. Lessons from these initiatives could serve as opportunities for learning how to overcome roadblocks to successful policy development, adoption, and implementation across states and for traversing the policy and political tradeoffs should a policy window once again open for addressing the problem of LTSS financing nationally.

Between older adults' needs and the law: The Israeli Long Term Care Insurance Law from the Perspectives of Service Users and Providers

The Israeli Long Term Care Insurance Law (LTCIL) was one of the first long term care insurances in the world to support older adults and their family members and allow them to stay in their homes for as long as possible. The present study aimed to evaluate the perspectives of older adults, their family members and home care workers regarding the LTCIL. Views of workers of the National Insurance Institute (NII), which is directly responsible for the enactment of the law, are also integrated. Interviews were conducted between June 2016 and June 2017. Thematic qualitative analysis is based on interviews with 15 NII workers, 31 older adults, 31 family members, and 6 paid home care workers. The present study stresses the tension between the LTCIL and older adults' perceived rights and needs. It also demonstrates how even though the NII workers are engaged with various stakeholders, they often lack direct contact with older adults, their family members and paid home care workers: those most directly influenced by the LTCIL. Policy considerations are discussed.

The Proactive Patient: Long-Term Care Insurance Discrimination Risks of Alzheimer's Disease Biomarkers

Previously diagnosed by symptoms alone, Alzheimer's disease is now also defined by measures of amyloid and tau, referred to as "biomarkers." Biomarkers are detectible up to twenty years before symptoms present and open the door to predicting the risk of Alzheimer's disease. While these biomarkers provide information that can help individuals and families plan for long-term care services and supports, insurers could also use this information to discriminate against those who are more likely to need such services. In this article, we evaluate whether state laws prohibit long-term care insurers from making discriminatory or unfair underwriting and coverage decisions based Alzheimer's disease biomarkers status. We report data demonstrating that current state laws do not provide meaningful protections from discrimination by long-term care insurers based on biomarker information.

[The Development of Long-Term Care Policies and the Impact on Nursing]

The government must reform and enhance current medical and long-term care services in order to respond effectively to societal ageing and labor shortage trends and to ensure sustainable operations. The post-acute care system should be reoriented on the home and community instead of the hospital. The Long Term Care Service Act integrates long-term care services that were previously dispersed amongst different departments, sets up a long-term care development fund, and improves the quality and allocation of long-term care services. Moreover, the Long Term Care Insurance Act will implement a bundle payment system to assist disabled families. The integration of automation and information technology will make long-term care more efficient. Although nurses are more skilled at elderly care and counseling than other community care professionals, nurses generally lack training in business management. Home and community-based services thus require better-trained manpower, opportunities to set care agents, and opportunities to offer flexible caring jobs. Therefore, nurses should strengthen their capabilities in post-acute care, business management, cooperation, and coordination.

The development of Korea's new long-term care service infrastructure and its results: focusing on the market-friendly policy used for expansion of the numbers of service providers and personal care workers

One of the main reasons for reforming long-term care systems is a deficient existing service infrastructure for the elderly. This article provides an overview of why and how the Korean government expanded long-term care infrastructure through the introduction of a new compulsory insurance system, with a particular focus on the market-friendly policies used to expand the infrastructure. Then, the positive results of the expansion of the long-term care infrastructure and the challenges that have emerged are examined. Finally, it is argued that the Korean government should actively implement a range of practical policies and interventions within the new system.

[Determinants of urgency of nursing home placement]

OBJECTS

The aim of this paper was to identify factors affecting the urgency of nursing home placement after introduction of public long-term care insurance.

METHODS

The subjects were families including at least one disabled elderly person and one another family member in two cities in Chugoku Prefecture. The measure of the urgency of placement was 0 if the family did not submit any application for placement, 1 if the care managers judged that the elderly person should enter in the future when she/he really needs placement, 2 if the care managers judged that she/he might be able to wait for a short while, and 3 if the care managers judged that she/he should enter as early as possible. Our estimation method was by ordered logit model. The dependent variable was the measure of the urgency and the independent variables were several attributes of the families. In the estimation, we considered the possibility that the coefficients depend on categories of dependent variable.

RESULTS

We obtained data for 146 waiting families and 494 others (total 640). There were differences in the urgency of placement among waiting elderly as follows "she/he should enter as early as possible" (28.8%); "she/he can wait for a while" (32.2%), "she/he should enter in the future when she/he really needs placement" (39.0%). The results of multivariate analyses showed that the urgency of placement correlated significantly with the severity of the elderly persons disabilities, the number of primary caregivers' self-symptoms, the family members' negative attitude toward caregiving, residing in city A, not having one's own house and limited use of short-stay facilities due to the circumstances of the providers.

CONCLUSION

When judging the urgency of placement, we should consider not only whether the applicant has submitted a request for a nursing home or not, but also differences among the waiting families. The urgency of placement correlates significantly with severity of disability of the elderly person, the number of primary caregivers' self-symptoms, the family members' negative attitude for caregiving, residing in city A, not having one's own house, and limited use of short-stay facilities due to the circumstances of the providers.

Self-esteem among elderly people receiving care insurance at home and at day centers for the elderly

BACKGROUND

Implementation of the Long-term Care Insurance Law of 1988 in Israel has made it possible to provide services to frail elderly people in the community. This study compares two specific services that are offered to elderly people as part of the law: (1) help offered to elderly people by homecare workers, and (2) help offered in day-care centers.

METHODS

The study sought to analyze the impact of the two social service approaches on the self-esteem of the care seekers, and included 300 elderly women (150 of whom received services at home and 150 at day-care centers).

RESULTS

The findings showed that the self-esteem of elderly women receiving services in a day-care center was higher than that of elderly women receiving the same services at home.

CONCLUSIONS

The study shows that the provision of services in a social context is important in giving elderly people proper attention which increases their self-esteem, self-evaluation and sense of mastery.

[Care and nursing in remodeling long term care insurance]

Long term care insurance was changed in 2006. The main purpose of remodeling is to support preventive care and to develop community comprehensive care center and community based services. Community based services are composed by group homes, night care services, small multi-function complex care services, day care services for dementia, satellite nursing homes. Preventive care in long term care insurance is composed of muscle training, oral care and improvement of nutrition. Visiting nurse services can provide day care at nurse stations. These arrangements are strongly expected to support care workers and visiting nurses. An assessment for dementia, Center version was developed by the Tokyo Center for Dementia Care Training and Research. It is intended to lead to person-centered care for elderly people with dementia. An act to prevent abuse of the elderly has been started in 2005. This was established to protect the property of the elderly, even if they might have cognitive dysfunction. A support doctor system has been started to educate primary care doctors and to make early diagnosis for dementia. These changes are expected to provide better care for old people.

Long-term care insurance in Japan: implications for U.S. long-term care policy

The purpose of this article is to review the long-term care insurance program in Japan and the present system of payment of long-term care services in the United States. The long-term care insurance system in Japan was implemented in 2001 for the purpose of promoting independence in older adults with functional disability. It reimburses for both home and institutional care. Several concerns expressed about the Japanese system include increasing applications for nursing home placement, lower use of home care services than anticipated, limited coverage for disabilities for those under 65, regional variations in service, educational preparation for case managers, and access to care for older adults. Revisions to the Japanese system and implications for U.S. long-term care policy are discussed.

[Reconstruction of the long term care insurance system in Japan]

The Japanese long term care insurance has started since 2000. After 5 years' experience, it is scheduled to change in 2006, the most important point is preventive care which means to stop the deterioration of ADL or cognitive function. Prevention is thought to be best way to cut the cost of care services. The preventive care system will start in April, 2006, over 1 million people with supportive care needs will receive muscle training or oral care and nutritional support from care workers in the community. New comprehensive community centers will open and these should which make assessments for preventive care, and provide consultations for care givers and families, and comprehensive care management in the community, and protect the dignity of the elderly will newly start. To improve quality of care services is important, and each prefecture has to evaluate all services and to publish the data with internet, so that everybody can see it and select the most appropriate care or company. Also, the government will start a new system of community based services including group homes, small and multifunctional care services, and day care services for people with dementia. These services should have one room available for each individual.

Long-term care: long-term care insurance--2005. End of Year Issue Brief

As the "Baby Boom" generation approaches retirement, state and federal lawmakers are struggling to ensure that the nation's long-term care system will provide adequate services for the growing number of senior citizens. A 2003 Administration on Aging report predicted that the elderly population will double by 2030. Accordingly, policymakers must prepare for the impending squeeze on public health and Medicaid resources. Many consumers are exploring private long-term care insurance options as a means of preparing for the cost of eldercare. Yet, a lack of market uniformity has rendered the long-term care insurance industry somewhat difficult for consumers to decipher. In addition, senior care insurance is often costly, particularly for those over age 50.

The Israeli Long-Term Care Insurance Law: selected issues in providing home care services to the frail elderly

The paper describes and analyses selected issues related to the provision of home care services to frail elderly people following the Israeli Long-Term Care Insurance Law (1988). The goals and principles of the Law, which mandates the provision of home care services to frail elderly people, are presented. The paper also evaluates its contribution toward enhancing the well-being of elderly clients. Several major dilemmas that arose following implementation of the Law are analysed and evaluated in comparison with other countries that have enacted and implemented similar laws. These dilemmas are community vs institutional care; services in kind vs monetary allowances; service provision through contracting out with nongovernmental agencies; unstable and unskilled labour force; and service quality. Finally, policy implications are discussed, mainly in the following areas: investment in human resources as a condition for achieving high service quality, and the need for coordination between the agencies that provide long-term care services to elderly people.

[Osteoporosis prevention in the reform of the long-term care insurance system]

The reform of the long-term care insurance system is being discussed at the Ministry of the Health, Labor and Welfare in Japan. The key issue in the process is to transform the system into prevention-oriented one. Prevention of osteoporosis will play major role in it.

An Overview of Regular Dialysis Treatment in Japan (as of 31 December 2002)+

The Japanese Society for Dialysis Therapy (JSDT) has annually conducted a nationwide statistical survey of all dialysis facilities in Japan. The Society conducted this survey of 3625 dialysis facilities at the end of 2002, and responses were received from 3612 facilities (99.61%). Based on the survey investigation results tabulated at the end of 2002, the population of dialysis patients in Japan was 229,538. The gross mortality rate was 9.2% for the year extending from the end of 2001 to the end of 2002. The mean age of patients beginning dialysis was 64.7 years. The mean age of the overall dialysis population in the study year was 62.2 years. In the patients who began dialysis in 2002, the number of patients with diabetic nephropathy as the primary disease increased to 39.1% of patients. 6.5% of 40-64-year-old dialysis patients had taken out long-term-care insurance, but 31% of 65-year-old or older dialysis patients had taken out this insurance. 65.7% of the three-times-weekly facility hemodialysis patients underwent daytime dialysis, while 11.9% of patients underwent evening dialysis.

Differences in facilities' acceptance of patients under long-term care insurance in Japan

OBJECTIVES

In April 2000, Japan launched a public, long-term care insurance (LTCI) plan for elderly people who need support. This study describes how medical support for the elderly is delivered at LTCI care facilities in Japan now and gaps between system goals and current activity. Recommendations are made for enhancing the implementation of LTCI.

METHODS

We mailed questionnaires to all health service facilities for the elderly (HSF) and special nursing homes for the elderly (SNH) located in the Kyushu area of Japan, asking whether they would accept patients with nine specific conditions.

RESULTS

We found that HSFs, which are required to employ a full-time doctor and are reimbursed at a higher rate, accept significantly fewer patients with four conditions that need medical support than are accepted by SNHs, which are not required to employ a full-time doctor.

DISCUSSION

In this study, we find discrepancies between system goals and current activities at LTCI care facilities. For the Japanese LTCI system to work well in the limitation of medical resources, we must understand how it really works and to reform the system continuously.

Elder law, medicare, and legal issues in older patients

Elder law is a specialty area of law directed at the specific needs of older clients and clients with disabilities. This review discusses major legal issues faced by older patients, their families, and their health care providers, including the capacity to consent to treatment, advance directives, and surrogate decision-making. In addition, public benefit programs such as Medicare, Social Security Disability Insurance, Medicaid, and Supplemental Security Income are examined. Available options for long-term care, both institutional and community-based are also highlighted. Finally, elder abuse is discussed. All who provide care to an elder must be aware of the potential signs of abuse and the remedies available.

[Effects of nursing insurance on caregiving daughters--the role of professional nursing care]

In view of the demographic development the topic of "Nursing of elderly relatives" is gaining more and more importance within nursing research. The object of the investigation described in this paper was to assess the measures of the Pflegeversicherung [Long Term Care Insurance] with regard to its effects on care-giving daughters. This publication assesses one of the questions of the study--what part professional services play in the support of care-giving daughters. The data was collected by individual biographic-narrative interviews in the private household of care-giving daughters. The data was then evaluated according to the method of biographical case reconstruction developed by Gabriele Rosenthal. This way we were able to gain a deeper insight into the situation of care-giving daughters and analyse the consequences of the Pflegeversicherungsgesetz [Long Term Care Insurance Law] from an "inner perspective". The results of the study point to both the positive effects of the Pflegeversicherungsgesetz and its limits. We were able to show that the expansion of out patient services leads to an enhanced nursing infrastructure. In view of the part that professional nursing services play, however, the biographical access also made it clear that the Pflegeversicherung will not lead to far-reaching changes in nursing arrangements. In spite of Pflegeversicherung caregiving relatives still suffer from personal and emotional strain. Also the legal requirements are too narrow and allow hardly enough space for the consideration of the family environment and the history of life of relationship between daughter and mother.

Finance issue brief: long-term care insurance: year end report-2003

A 1996 federal law made it more attractive for states to consider long-term care insurance, and states have responded by implementing policies to make the purchase of these long-term care coverage more affordable and consumer-friendly. At present, policymakers continue to debate the future role of private long-term care insurance in subsidizing the increasing demand for long-term care services.

Funktionale Kompetenz und Pflegebedürftigkeit nach SGB XI bei Hundertjährigen

The maintenance of autonomy and independence in the oldest old population is at high risk due to the inevitable aging process, which primarily affects functional and cognitive capacities. In this study, we investigate centenarians to assess the extent in which they have lost their ability to live independently. This is done with a classification system for dependency that considers both functional and cognitive limitations and determines the level of functional competence in this population. Based on this system, we evaluate the necessity for nursing care and investigate to which extent their actual needs are covered by the German Long-term Care Insurance. An important and relevant question is whether this system even addresses the evaluation of cognitive impairment. For this reason, 85 centenarians and their proxies were assessed with standardized instruments and the results show a severe loss of independence. The necessity for at least daily contact with nursing care was identified in 91 percent of the centenarians due to their dramatically limited capacities. Forty-four percent of the centenarians need more support than they actually receive from the German Long-term Care Insurance. Therefore, considering cognitive impairment is a crucial component in the evaluation, which would lead to more support by the official system in 20 percent of the centenarians. The considerable differences between the granted and the necessary nursing care demonstrate that co-operation from family members must be heavily relied upon.

[Change of dementia care management after implementation of long-term care insurance]

Dementia health care management has changed completely since implementation of long term care insurance in Japan. Physicians made diagnosis of Alzheimer's disease and collaborated with care manager. Then people with dementia can have care services like short-stay, day services and also institutional care, if they want. Long term care insurance can help or substitute health insurance in old age. But still many old people or families want to stay longer in institutions. Now government support preventive care including dementia. We studied reminiscence therapy on cognitive function for dementia for 2 months. Cognitive function was improved after months compared to control group. The results showed stimulation by old goods, therapists or collaborators is useful for dementia. Reminiscence is one of good activities for dementia at every care services.