Chapter 2. Toward an Ideal System

1. Chapter 2. Toward an Ideal System Long-Term Care: Managing Across the Continuum (Second Edition)

2. Learning Objectives • Identify the characteristics of an ideal long-term care system • Describe what it means for the long-term care system to be consumer-driven • Identify the roles of formal and informal caregivers • Define the components of a full and uniform assessment of a consumer's service needs • Discuss the need for incentives for providers and consumers

3. The Criteria for Designing or Evaluating a Long-Term Care System • What are they? • How were they developed? • How are they used?

4. Criterion I.The long-term care system should be based on recognition of the needs, rights, and responsibilities of individuals. It should: • Be consumer-driven • Meet all of the needs of the consumers • Focus on the individual, recognizing that individuals have unique needs • Respect different cultures and cultural values

5. Criterion I. (continued) Recognition of the needs, rights, and responsibilities of individuals: • Promote quality, dignity, and self-improvement for consumers. • Balance consumer rights and responsibilities • Offer consumers a choice of service providers and service delivery modalities

6. Criterion II. The long-term care system should be easily accessible.It should: • Be universally accessible • Be "user-friendly" • Provide care in the least restrictive environment • Encourage single-site care availability

7. Criterion III. The long-term care system should coordinate professional, consumer, family, and other informal caregiver resources. It should: • Integrate professional, community, family, and other informal caregiver efforts • Evolve from the current medical model to a holistic model of service delivery • Involve families in case management and care delivery

8. Criterion IV. The long-term care system should be an integral part of the health and social system, to promote integration, efficiency, and cost effectiveness. It should: • Include a full continuum of services • Include a full and uniform assessment (initial & ongoing) of the consumer's needs. • Provide emphasis on, and reimbursement for, illness prevention efforts as an integral part of the overall system

9. Criterion IV. (continued) Promote integration, efficiency, and cost effectiveness: • Be planned and coordinated to reduce fragmentation and inefficiencies • Be based on outcome-oriented accountability

10. Criterion V. The long-term care system should be adequately and fairly financed. It should: • Utilize public and consumer resources to assure universal access to services. • Provide incentives for consumers to use services in an appropriate and cost effective manner • Provide incentives for consumers to self-finance their care

11. Criterion V. (continued) Adequately and fairly financed: • Avoid causing impoverishment of consumers and families • Provide incentives for providers to develop cost effective measures • Develop payment mechanisms that allow efficient providers to adequately compensate staff and to allow for appropriate operating surplus and/or return on investment

12. Criterion V. (continued) Adequately and fairly financed: • Operate within the limits of a well conceived budget • Provide significant flexibility to enable consumers to meet long-term care needs as each consumer defines those needs • Be based on uniform financial eligibility criteria

13. Criterion VI. The long-term care system should include an education component to create informed consumers, providers, reimbursers, and regulators. It should: • Include community education • Include education for providers • Educate young, healthy persons to better prepare them to cope with chronic illness

14. In Summary: • The Criteria provide a basis for evaluating the current long-term care system and for developing an ideal long-term care system.