Disability, Long-term Care, and Health Care in the 21st Century

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Baltimore, MD: Paul H.

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Health Service Research , 42, No.

Our Principles

Individual and public budgeting. Cash for Care in Developed Welfare States.

Long-term care - Wikipedia

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Standards The highest standards of professionalism and quality are essential for caregivers and systems. This must be supported by thorough training, appropriate supervision and fair compensation. Coordination Systems should coordinate services for people with multiple needs that change over time, providing a seamless continuum of care.

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Efficiency Incentives and controls in public and private programs must maximize quality and control costs. The long term care financing issue can, and should be the next major policy question facing our lawmakers as we enter the 21st century. A rare opportunity faces our elected officials as they consider public policy in the 21st century. That opportunity is the chance to devise a system of quality health care for the millions of Americans that will face the need for long term care in the next century.

Politically, the chance to alter programs that once seemed sacrosanct appears to be at hand.

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The policy debates on Social Security reform and Medicare reform are now top priorities on both parties' agendas. Politicians are apparently eager to discuss new ways to structure these previously untouchable public entitlement programs. Oddly, however, the third large component, Medicaid and its role as the as the primary financing vehicle of long term care remains in the shadow of this new debate. Reform of Social Security and Medicare cannot realistically take place without a reform of long term care financing.

The financial link among these issues and their impact on the elderly and people with disabilities means they all must be discussed in some joint way. The current fragmentation and inadequacies of long term care financing and confusion over which programs finance care have promoted a system that does not meet the needs of the those who rely on it most. If this opportunity is missed, our current system of providing long term care for the elderly and people with disabilities will only get worse, leaving many without health care, many more with inferior care, and the looming threat of personal impoverishment.

The issue of long term care financing reform encompasses a vulnerable population that is currently utilizing an inappropriate mechanism to finance their most life-critical purchases of care. These costs are competing more aggressively every year with other priorities in state and federal budgets. Most importantly, on the immediate horizon there is a demographic explosion from the baby boomers that are reaching retirement years, which will further strain the ailing long term care delivery systems.

A new national policy based on principles of independence, access, choice, family, responsibility, affordability and efficiency must combine public and private resources to provide for long term care. Such a policy must be devised and put into place soon to be able to finance the delivery of long term care services when they are needed - peaking between and The status quo alternative of continued haphazard financing, which leads to reduced quality, an under-paid workforce and increased costs, is simply unacceptable.


Significant injuries or medical events that necessitate long term care; the birth of a child with mental and physical impairments; chronic diseases requiring long term care all have the ability to significantly affect an individual's or family's economic security. During retirement, when many of these events occur, the need for long term care can impede the best of plans and threaten financial and retirement security.

Unless we act now the rising cost of medical care, combined with our aging population and increasing number of disabilities will perpetuate a system that is heading for collapse at an increasingly rapid pace. To develop a new national policy we will need leadership from our country's most visible and respected leaders supported by the individuals and families that have had to suffer with our current financing system.