Abstract:

Long-term care for chronic illnesses or functional limitations poses serious threats to the economic security of all but the wealthiest older Americans due to the inevitable aging of the population. We must design health care policy that considers the changing characteristics of consumers, providers, and purchasers of care. Long-term care delivery systems will undergo structural changes that integrate the entire range of health, community-based, and in-home services into a consumer-driven capitated system that controls the costs of managing patient care and emphasizes primary-oriented medical care. Ideally, an integrated long-term care delivery system that offers several alternatives to nursing home care would offer the best care, but the realities of the marketplace probably will inhibit the establishment of such a system. Thus, nurses must continue to advocate for patients and provide data to facilitate wise policy decision-making.