Healthcare Reform and Long-Term Care
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Affordable Care Act
The Affordable Care Act, which is also known as Obamacare, focused on the expansion of access to health insurance coverage, implementing insurance market reforms, and addressing other healthcare-related issues. The ACA included provisions aimed at improving care coordination and expanding Medicaid coverage, which indirectly affected long-term care services for some individuals. The following are some of the essential aspects of the ACA. Medicaid Expansion (Courtemanche et al., 2019). The ACA allowed states to expand their Medicaid programs to cover more low-income adults. This expansion extended Medicaid eligibility to individuals with incomes up to 138% of the federal poverty level.
While Medicaid is primarily a healthcare program for low-income individuals, it does cover certain long-term care services, such as nursing home care and home health services, for those who meet specific eligibility criteria. Community First Choice Option. Under the ACA, states were allowed to participate in the Community First Choice (CFC) option. This option allows states to provide home and community-based services as an alternative to institutional care for Medicaid beneficiaries (Courtemanche et al., 2019). The CFC option aims to enhance access to long-term care services and supports, allowing individuals to receive care in their homes or community settings rather than in nursing homes or other institutions.
Accountable Care Organizations (ACOs). The ACA encouraged the formation of ACOs, and networks of healthcare providers working together to coordinate care for Medicare patients (French et al., 2016). ACOs aim to improve the quality of care while reducing costs. Although ACOs primarily focus on acute and primary care services, better care coordination can also benefit individuals needing long-term care by ensuring a more integrated and efficient delivery of services.
Exceptional interest viewpoints or opposing viewpoints of ACA
In the time of advocating the healthcare reforms or the provisions, there are some exceptional interest viewpoints or even opposing viewpoints of ACA—advocates for Expanded Coverage. Many advocacy groups, such as AARP (formerly the American Association of Retired Persons), have pushed for expanded access to long-term care services. They argue that affordable and comprehensive long-term care options should be available to a broader range of individuals, particularly the elderly and those with disabilities. These advocates emphasize the importance of supporting individuals to receive care in their homes and communities, promoting independence and quality of life.
Fiscal Conservatives and Limited Government. Some individuals and groups, often aligned with fiscal conservatism and limited government intervention, may express concerns about the potential costs of expanding long-term care services. They argue that the government’s role should be limited, and individuals should be responsible for their long-term care needs through personal savings, insurance, or family support. These viewpoints prioritize individual responsibility and limiting government spending.
Position on the Long-Term Care Insurance
Long-term care insurance is worth it. I would advocate more community-based long-term care services because there is independence and quality of life. The community-based care services, including day-care centres and home health services, can promote independence and help individuals maintain a higher quality of life by allowing them to remain in familiar surroundings and engage with their communities. Furthermore, there will be more Enhanced Care Coordination. In community-based care, there is often closer collaboration and communication among healthcare providers, support services, and family members. This promotes better care coordination, effectively addressing the individual’s needs and reducing the chances of fragmented or duplicated care.
Community-based care has a lot of Flexibility and Customization. Community-based care allows for greater flexibility in delivering services. It can be adapted to accommodate changing needs over time, ensuring that care remains responsive to the individuals’ evolving health conditions and preferences. This flexibility enhances the overall effectiveness of care delivery and promotes a sense of empowerment for those receiving care.
Also, community-based is Cost-Effective. Community-based care services, such as nursing homes, are often seen as a more cost-effective alternative to institutional care. Providing care in a home or community setting can reduce the need for expensive institutional care, potentially resulting in cost savings for individuals and the healthcare system.
In addition, there are Supportive Networks. Community-based care can leverage community resources and support networks, including family members, friends, and local community organizations. These networks can provide emotional and social support, particularly beneficial for individuals requiring long-term care.
Challenges Facing Long-Term Care Facilities
One of the main challenges facing long-term facilities is the Aging population. The global population is aging rapidly, increasing the demand for long-term care services. As the number of elderly individuals grows, long-term care facilities face challenges in accommodating this influx while maintaining adequate staffing, resources, and quality of care. The second challenge is Staffing shortages (Brooks et al., 2022). Long-term care facilities often need help with staffing shortages, including a shortage of qualified nurses, nursing assistants, and other healthcare professionals.
The work in these facilities can be physically and emotionally demanding, leading to high turnover rates and difficulty attracting and retaining skilled staff.
Also, the third challenge is the Cost of care. Providing long-term care can be expensive due to the high Cost of staff salaries, medications, medical equipment, facility maintenance, and regulatory compliance. Many residents rely on government programs like Medicaid to cover their care costs. However, reimbursement rates from these programs need to be increased, leading to financial strains on long-term care facilities.
Regulatory compliance is the other main challenge. Long-term care facilities must adhere to strict regulations and licensing requirements to ensure the safety and well-being of their residents. Compliance with these regulations can be complex and time-consuming, requiring significant administrative efforts and resources. Quality of care is the other challenge. Maintaining a high standard of care can be challenging in long-term care facilities, especially with limited resources and staffing constraints (Brooks et al., 2022). Ensuring residents’ physical, mental, and emotional well-being, addressing their individual needs, and preventing issues such as neglect, abuse, and infections requires dedicated efforts from the facility staff. Ethical dilemmas are another challenge since, Long-term care facilities often face ethical dilemmas related to end-of-life care, decision-making capacity, and balancing autonomy with safety. These challenges can arise when determining the appropriate level of care, implementing advance directives, or addressing conflicts between residents, their families, and healthcare providers.
Mental health and social isolation. Many residents in long-term care facilities experience social isolation and loneliness, which can negatively impact their mental health and overall well-being. Providing social engagement opportunities, meaningful activities, and emotional support are essential but can be challenging due to limited resources and staff availability (Preston & Rew, 2022). Another major problem is Infection control. Long-term care facilities are susceptible to spreading infectious diseases due to the proximity of residents and shared spaces. Outbreaks of illnesses like influenza or gastrointestinal infections can be challenging to manage and prevent, requiring stringent infection control measures and staff training.
References
Brooks, D., Beattie, E., Fielding, E., Wyles, K., & Edwards, H. (2022). Long-term care placement: The transitional support needs and preferences of spousal dementia caregivers. Dementia, 21(3), 794-809.
Courtemanche, C., Marton, J., Ukert, B., Yelowitz, A., Zapata, D., & Fazlul, I. (2019). The three‐year impact of the Affordable Care Act on disparities in insurance coverage. Health Services Research, 54, 307-316.
French, M. T., Homer, J., Gumus, G., & Hickling, L. (2016). Key provisions of the Patient Protection and Affordable Care Act (ACA): a systematic review and presentation of early research findings. Health services research, 51(5), 1735-1771.
Preston, A. J., & Rew, L. (2022). Connectedness, self-esteem, and prosocial behaviors protect adolescent mental health following social isolation: A systematic review. Issues in Mental Health Nursing, 43(1), 32-41.
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