The Heart of Long-term Care

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Oxford University Press, 1998 - Medical - 328 pages
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Long-term care in the United States has taken the nursing home as its benchmark, but the monetary, social, and psychological costs of nursing home care are all too high. This book challenges the current dominance of nursing homes as the principal institution of long-term care. It offers a series of alternative models where both services and housing can be provided in a way that allows long-term consumers to enjoy dignified, "normal" lifestyles. It addresses the political and economic consequences of making this decision.
The authors start with the premise that long-term care is designed to assist people who lack the capacity to function fully independently. They argue that no disabled person of any age should be required to forsake his/her humanity in exchange for care. The book rejects the artificial dichotomy between social and medical care, asserting that both play important roles in psychological and physical well-being of long-term care patients. The authors consider the need for competent and compassionate medicine and discuss the methods for improving both its coordination of care and its effectiveness. The book redefines the meaning of safety and protection in long-term care, and how this goal can be accomplished without sacrificing quality of living.
As the new millennium and the aging of baby boomers approaches, more creative approaches to providing better long-term care are required. This volume outlines a useful framework for the provision of effective and humane community-based programs that are both feasible and affordable. It will be an invaluable guide for geriatricians, public health professionals, family physicians, nurses and others who care for elderly patients.
 

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Contents

Nature and Purpose of LongTerm Care
3
Who Gives LongTerm Care?
14
Spectrum of Care
31
The HCBS Service Spectrum
49
Summary
59
Federal Policies Favoring Nursing Homes
77
Federal Matches
86
State Variation in HCBS Programs
94
Medical versus Social Approaches
190
Approaches to Quality Assurance
203
Summary
210
Fragmenting Forces in Medical Care
217
Interdisciplinary Teams
223
Concluding Comment
229
Managed Care and LongTerm Care
235
Forms of Managed Care
241

Varying Demand for StateSupported Services
104
Varying Organizational Structures III
111
Home Care and Personal Assistant Services
119
PAS versus Agency Services
127
Persuading Consumers to Use InHome Services
136
Case Management
143
Cash and Counseling
149
Combining Housing and Services
159
Adult Foster Homes
169
Assisted Living
176
Concluding Comment
184
Effects on Consumers
247
Managed LongTerm Care
254
Concluding Comment
262
Common Themes
268
Lessons for the United States
278
The Heart of the Matter
285
Preferences
291
Principles for Change
303
Index
323
Copyright

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About the author (1998)

Rosalie A. Kane and Robert L. Kane are both at the University of Minnesota School of Public Health. Richard C. Ladd is President of Ladd and Associates.

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