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Elderly patients (aged 65 years and older) are the most visible users of long term care making up 63% of consumers of long term care. The remainder of recipients of long term care are aged 64 and younger. In 2007, 404,000 children and 1.3 million adults under age 65 used long term services and supports. This population includes children, people of any age suffering from injuries, people with AIDS, and some of those who have some type of mental disease. Much like elderly patients, these patients rely on long term care services to help them live more independent lives (Pratt, 2016, p. 16). Children requiring long term care services typically have physical disabilities/handicaps with specific needs that are complex and intensive. A few specific diagnosis can include debilitating diseases such as spina bifida, muscular dystrophy, and cerebral palsy. Individuals with mental disabilities such as intellectual disability, can also require long term care services throughout the duration of their life. There are also a large number of young adults who require long term care services because of physical trauma such as a spinal cord/head injury or chemical accidents such as a drug overdoses (Pratt, 2016, pp. 16-17). Veterans are also a specific population that can require long term care services as a result of injuries (either mental or physical) that occurred during or even after their time in service, and this population does not just include the veterans themselves, family members of service members also qualify for long term care benefits. Unfortunately, there is often long waiting lists to get services through the VA for those veterans who did not retire from the military.
Rehabilitation plays a tremendous role in the long term care setting. Whether it be in an acute setting, subacute, or home health setting, patients receive a range of services in order to return to their prior level of function, maintain their current level of function, and promote healthy and independent lives. In occupational therapy, our focus is rehabilitating patients in activities of daily living which can include bathing, dressing, hygiene/grooming tasks, transferring, functional mobility, self feeding, and anything that promotes independence in their everyday life. Physical therapy focuses on gait training, neuromuscular reeducation, balance training, lower extremity strengthening, endurance training, transfer training, core strengthening, and provide techniques to support independence with everyday functional tasks. Speech therapy focuses on communication needs, voice articulation, voice tone control, techniques to improve cognition, techniques to improve swallowing as a result of dysphagia, and promoting safety awareness during functional tasks.
There are many ethical considerations in the long term care system. Most importantly, as health care providers, being an advocate for our patients, and ensuring their safety, autonomy, and well being is one of our most important jobs. In the current reimbursement driven long term care system, access to care is usually determined by availability of reimbursement. The result is that long term care consumers often have little real choice in deciding when, how, and where they receive their care unless they are wealthy and do not have to rely on the approval of others (Pratt, 2016, p. 346). Rationing of health care is defined as a method of distributing resources outside the market system. Everyone deserves and has a right to a basic level of health care. Health care rationing means that the government mandates by law who gets what type and what amount of health care (Pratt, 2016, p. 348). Transferring of assets/spending down is another ethical issue that is gaining considerable attention it is related to financing, and therefore to access to care. Many residents struggle with the fact, that despite all of their years of paying taxes, working hard, and saving, are stuck with having to lose everything they have essentially worked for all of their life in order to qualify for Medicaid so that they are eligible for long term care. It is a double edged sword, and leaves a question, which is more/less ethical? To take away an individuals savings, or to force the government to pay for someone who has those savings? (Pratt, 2016, pp. 348-349).
Pratt, J. R. (2016). Long-Term Care: Managing Across the Continuum (4th ed.). Burlington, MA: Jones & Bartlett Publishers.
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