Medicaid and Medicare

Nursing homes and assisted facility homes are all examples of long term care facilities. These facilities are usually targeting individuals who are of geriatric age or need around the clock care (mental health and physical health). The residents in these communities have access to individually-tailored levels of individual or group-centered activities, programs, and assistance whether it is with home or personal care. Long term care facilities are generally for those who are unable to manage independently in the community. Specific types of long-term services include nursing homes, hospice care, home health agencies, and residential care facilities. The goal of these programs is to make sure each patient has a safe and comforting environment

Long-term care assists individuals who cannot adequately perform their routine activities of daily living. These activities include dressing, bathing, walking, meal preparation, and taking medications ( Batnitzk,A.,Hayes,D.,& Vinall,P.E. 2014,(c. 5.1). These services are typically for clients over the age of 65 years old and is used to promote independence and security for those who cannot take care of their needs due to illness or debility (c.6.1). The type of provider will depend on the type of care a client needs. For instance, some elderly people that need help with food preparations or everyday activities will request to stay at home and have a family member take care of them. This is one way that long-term care is rendered but is unpaid. Another way is through nursing facilities, skilled nursing facilities and assisted living that will handle more complex or full-time

Long-term care can be defined as a broad set of paid and unpaid services for people who are mentally or physically disabled, or whose chronic illness places them in need of medical or personal assistance for long periods of time. “It is estimated that there are more than twelve million Americans of all ages whose mix of serious disability and chronic illness places them at the high risk for functional decline, hospitalization, or nursing home placement.” (Benjamin) Several different populations require long-term care services, and the needs of these populations vary. In addition to the elderly, many of the long-term care users are younger persons with physical disabilities; persons with developmental disabilities; and persons with chronic

Long term care facilities are first established under state licensing laws and, in most cases, a granted certification that there is a need for nursing home beds in a specific community. Medical professionals and support services providing care and related functions must also operate in the nursing home under the licensing, regulatory, and standards of practice governing their areas of specialty. In addition, each long-term care facility must establish their own policies and procedures for everyday operation to stay within their operating standards and legal limitations (Brady,

Speaking to a lady who reside at Atlantic shores skilled nursing and Rehab and whom I will refer to as Mary to respect her privacy and for following the rules and guideline of Health Insurance Portability and Accountability Act (HIPPA). Mary states that with all her chronic ailments and diseases, it is good for her to live within the LTC because her illness are monitored and her medications are managed well. She further went on to say that if something goes wrong, help is always readily available.

Medicaid is a social health care program that covers nearly 60 million Americans, including children, pregnant women, seniors, parents and individuals suffering with disabilities. Medicaid is the biggest source of funding for health related services and medical needs for the people with low income in the United States. This program is funded jointly by the state and federal level governments, but it is the state’s responsibility to manage this program. The Medicaid program is not a required program that states have to use, but all 50 states have implemented this program. With the introduction of the Affordable Care Act (ACA), and its passing in 2010, the ACA unveiled its plans to expand Medicaid eligibility to nearly all low-income adults as an addition to the other groups that fall into the Medicaid eligibility. The Medicaid program had “many gaps in coverage for adults” because it was only restricted to the low income individuals and other people with needs in their own specific category. In the past, the majority of the states who had adults that did not have children dependent on those parents were not eligible for Medicaid. These low income adults without dependent children would be without medical insurance assistance before the ACA was introduced. Medicaid is now available to all Americans under the age of 65 whose family income is at or below the federal poverty guideline of “133 percent or $14,484 for an individual and $29,726 for a family of four in 2011” (NSCL).

As we become older, issues with our health begin to take affect and finding ways to fund for that care is becoming even more difficult. In the article “Some Elders Must Take Drastic Measures to Obtain Long-term Care”, national magazine journalist Mary A. Fischer (2011) states that many Americans must face demeaning and disempowering choices in order to qualify for Medicaid or Medicare—federal funded health insurance programs— such as refusing to pay for a spouses institutionalization, divorce, and spending down assets. The author argues that these choices leave the healthy spouse with decreased funds to plan for their own retirement expense (Fisher, 2011). Working in the health care field for 4 years, along with my family’s own personal experiences I can relate to this article, since I have seen a variety of ways that federal funded health insurances have been unable to meet the expectations and demands of its beneficiaries.

The Continuum of Care is the variety of health care services provided to numerous individuals who are in need of it. All the various Long Term Care providers work as a unit, helping an individual handle their disability with various health care amenities accessible. The Continuum of Care, as stated in Long Term Care: Managing Across the Continuum (2010), is “comprehensive, integrated, and client-oriented”. All the services offered should be client-based and cater to the client’s needs and suitable care. The client’s should be able to obtain services when it is needed from the provider, making it comprehensive. All the different Long Term Care providers should be interconnected between one another, because their goal is all the same. Their goal is to care for the client’s needs. The Continuum of Care consists of: nursing facilities, sub acute care, assisted living, residential care, elderly housing, and a variety of community-based services (Pratt, 2010). All these different providers work together to care for the individuals within the health care industry, creating the continuum and making it integrated. The continuum has many positive attributes, along with many barriers. The range of barriers are: poor transitions from Long Term Care setting to setting for the clients, the continuum is reimbursement-driven, it is fragmented and uncoordinated, it is under staffed with medical professionals, and there are major language and literacy problems.

Medicare doesn’t pay the largest part of Long Term Care services or personal care. Medicare will pay for a short stay at a Skilled Nursing Facility, hospice care, or home health if an individual meets these conditions:

Throughout the early 1980’s and 1990’s the Federal Medicaid program was challenged by rapidly rising Medicaid program costs and an increasing number of uninsured population. One of the primary reasons for the overall increase in healthcare costs is the

Another part of the continuum is health care resources available to the patients. Long-term care does contribute to the management of these resources. Without LTC, these resources would not be in such high demand. According to Medicare.gov, there are many resources that go along with long-term care that need to be used, such as drug and health plans, doctors, hospitals, formulary finder, long-term planning, home health agencies, nursing homes, medical equipment suppliers, dialysis facilities, forms, and publications (Medicare.gov, Resource Locator). These resources will help the patients and their families find the best collaboration of services to meet their needs.

This paper will review the many aspects of long-term care problems and many challenges there are within Long-Term care. We will look at rising costs within long-Term Care, patient abuse, will look at the quality of life, shortages of nurses and demand that the elderly are putting on the medical field. The type of care that Long-Term Care had been giving to its patients and the changes within Long-Term Care.

Long term or chronic care includes a much broader range of services than acute care, emphasizing social as care well as medical services. While acute care is usually confined to specialty providers, the providers of long term care are more wide ranging. They include traditional medical providers such as physicians and hospitals, formal community caregivers such as home care agencies, facility providers such as nursing homes and assisted living facilities, and informal caregivers such as friends or family members.

Changes in access to health care across different populations are the chief reason for current disparities in health care provision. These changes occur for several reasons, and some of the main factors that contribute to the problem in the United States are: Lack of health insurance – Several racial, ethnic, socioeconomic and other minority groups lack adequate health insurance coverage in comparison with people who can afford healthcare insurance. The majority of these individuals are likely to put off health care or go without the necessary healthcare and medication that is needed. Lack of financial resources – Lack of accessibility to funding is a barrier to health care for a lot of people living in the United States

US health care expenditures have been rising quickly over the past few years; it has risen more than the national financial system. Nonetheless a number of citizens in the US still lack appropriate health care. If the truth be told, health care expenditures are going to continue to increase; in addition numerous individuals will possibly have to make difficult choices pertaining to their health care. Our health system has grave problems that require reform, through reforming, there is optimism that there will be an increase in affordable health care and high-quality of care for America. Medicaid, Medicare and private sector insurances are all going through trials and tribulations because of