Federal and State Policies

Regarding specific populations of patients utilizing long-term care (e.g. elderly, disabled), research and discuss the roles of federal and state governmental regulations on long-term care.

The purpose of this paper is to provide a brief overview of current issues in long-term care policy as they relate to older adults with disabilities. This will be accomplished by reviewing some basic concepts related to aging and disability; discussing how these two factors interact within the context of health services utilization; examining the impact that government policies have had on access to long-term care for persons with disabilities; and finally, providing an analysis of what can be done to improve future outcomes for individuals who are at risk or already receiving long-term care. In addition, recommendations regarding future directions for research and policy development will also be provided.

Discussion/Conclusions: As we move into the 21st century, it becomes increasingly clear that our society has entered a new era where there is no longer any question about whether people will live longer than ever before. It seems almost certain that life expectancy will continue to increase over time. However, while many Americans may expect to enjoy more years of good health during their lifetime, few would anticipate being able to remain independent throughout those additional years. Thus, one of the most important questions facing us today concerns the extent to which we will be able to maintain independence as we age. While much attention has been paid to the issue of longevity, relatively little consideration has been given to the quality of remaining years. Indeed, if we look back historically, it was not until recently that the focus began shifting from simply living longer to living better. For example, when President John F. Kennedy declared his goal of extending the average American’s lifespan by ten years, he did so without making any reference whatsoever to improving the quality of those extra years. Similarly, although Medicare was enacted nearly 50 years ago, its primary objective was to ensure adequate medical coverage for all seniors rather than to promote healthy lifestyles among them. The fact that Medicare does include provisions designed to encourage preventive medicine suggests that policymakers recognized early on that prevention could play a role in promoting healthier lives. Unfortunately, however, even though Medicare now includes several programs specifically targeted toward preventing disease and maintaining physical fitness, such efforts still represent only a small fraction of overall spending on health promotion activities. Moreover, despite the growing recognition that lifestyle choices contribute significantly to morbidity and mortality rates, public education campaigns aimed at encouraging positive changes in behavior have yet to become widespread. Finally, while recent studies suggest that increased use of prescription drugs contributes substantially to improved survival rates, the same cannot necessarily be said for other types of medications used to treat chronic conditions. Clearly, then, the need exists for greater emphasis on developing strategies to help prevent illness and injury in order to maximize the number of productive years enjoyed by each individual. To date, however, very little progress has been made towards achieving this goal. Instead, the majority of resources currently devoted to addressing the needs of older adults tend to emphasize either increasing longevity or reducing costs associated with caring for the frail elderly.

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