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Health Policy: Long-Term Care in Nursing


Health policy is a highly complicated issue as it deals with a whole variety of problems that have to be taken into consideration. Policies can affect both separate individuals and organizations determining their access to certain health care services, availability of medications and technology, etc. (Shi, & Singh, 2014). There is no single framework for policy-making as well as no strategy to achieve planned goals. In many cases, policies may produce undesirable and unexpected side effects (Dimick & Ryan, 2014).

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The paper is going to investigate the background of long-term care policy and assess its perspectives in order to suggest possible methods of addressing the issue.

Definition and Description of the Issue

Most policies choose a specific group of the population as a target audience: they may intend to affect health care professionals, children, the elderly, the poor, immigrants, etc. However, some policies encompass several groups simultaneously (Harris-Kojetin et al, 2016). The scope of long-term care policies is broad since they usually concern both care-receivers and care-providers: the elderly, the disabled, hospitals, nursing homes, centers of senior care, and other organizations. This type of care includes a lot of services: home-based (home assistance provided by nurses), community-based (daily care for the elderly), and facility-based (nursing homes). Long-term health care is usually controlled at the state level (even when it deals with private long-term insurances) due to the complexity of the issue: it usually involves many areas including funding, access, personnel and information systems development, evidence-based practices, etc. High costs of long-term care account for the fact that it may rely on a number of funding sources: individual funds, insurance programs launched by the government, and investments made by private businesses (Zawadski, 2014).

Background of the Issue

The evolution of long-term care policy (which goes back to the 17th century when first hospitals and houses for the poor were built) did not follow any particular design. Neither did it have any specific approach or strategy – on the contrary, the policy developed in accordance with the issues it had to address at this or that period of time (Crocker et al., 2013). All long-term care institutions were initially operated by local governments and were aimed at providing medical and social aid for the homeless, the sick, the disabled, orphans, and former prisoners. The concept was borrowed from the Elizabethan system of social charity and adapted to the needs of American society. It was Dorothea Lynde Dix who did a tremendous job in the field and managed to persuade the government to pass a number of laws in Massachusetts (subsequently introduced in other states) that guaranteed long-term care to various disadvantaged groups including the insane who were to be treated separately (Zawadski, 2014).

The Social Security Act passed in 1935 (as well an Old Age Assistance program as its major part) was a landmark for the policy as it came immediately after the Great Depression that left a lot of elderly and disabled people without any chance for survival. It provided state governments with access to the federal budget for the purpose of assisting people in need of long-term care, which marked an end to the system of poor houses (Zawadski, 2014). However, the policy had a side effect: in the 1950s, it led to the development of the industry of private nursing homes, which have gained great popularity nowadays. They are required to have state licensure but can have their own standards of practice (Harris-Kojetin et al., 2016).

The introduction of Medicaid in 1965 brought about the most considerable transformations of the policy since it encompasses services for the elderly, the disabled, and the poor making the US government one of the largest payer of long-term care services across the world (Harris-Kojetin et al., 2016).


As it has already been mentioned, the policy is commonly financed by the government that can interfere even with privately-run programs. Other stakeholder groups of long-term health care include residents of nursing homes (the elderly, the poor, the disabled, etc.), their family members (if any), physicians, therapists, registered nurses, other hospital staff, financial officers and other representatives of the authorities, insurance agencies, private investors, volunteer groups, etc. (Denson, Winefield, & Beilby, 2013).

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Current State of the Issue

Since there are currently a lot of other pressing health care problems addressed by other policies, long-term care policy has remained unattended for rather a long period of time. Against this background, private insurances have been promoted by various agencies. The delivery system gradually moves towards self-financing relieving the state authorities from the burden of expenditures. Moreover, other facilities besides traditional nursing homes are gaining popularity (Denson, Winefield, & Beilby, 2013).

Goals and Recommendations for Changes

The major current goals of the policy, as well as recommendations for changes, include (Gottlieb & Mitchell, 2015):

  • To improve the stability of the staff. Job satisfaction strategies should be implemented to reduce turnover rates.
  • To provide adequate financing in order to reduce costs.
  • To promote consistent care. Health care providers should focus on their residents to facilitate the process of planning and problem-solving.
  • To reduce hospitalization cases. It can be achieved with home monitoring systems or home visits to patients from risk groups.
  • To ensure proper administration of drugs. This is possible in both clinical and home settings.
  • To increase the mobility of the elderly promoting a healthy lifestyle.
  • To prevent infections. Vaccination-promoting programs can be a good option.

The Impact on Health Care: Risks and Benefits

The proposed changes can have a great impact on the health care system as they would involve all aspects including staff, patients, technology, finance, and government regulation. Since the number of people over 65 will reach 88 million in 2-3 decades, it will help solve the issue of elderly care. However, the major risk associated with changes is financial: the policy may fail if no reliable source of funding is found (De La Maisonneuve & Martins, 2013). Currently, the costs of services continue to rise. With modernization and the introduction of new technologies and services, the tendency will aggravate changing the nursing practice dramatically as it will make long-term care an option for the upper-middle and higher class leaving the poor in crisis (Wieland, Kinosian, Stallard, & Boland, 2013).


Crocker, T., Forster, A., Young, J., Brown, L., Ozer, S., Smith, J.,… Greenwood, D. C. (2013). Physical rehabilitation for older people in long‐term care. The Cochrane Library, 8(4), 3-37.

De La Maisonneuve, C., & Martins, J. O. (2013). Public Spending on Health and Long-term Care. Jama, 23(2), 3-35.

Denson, L. A., Winefield, H. R., & Beilby, J. J. (2013). Discharge‐planning for long‐term care needs: the values and priorities of older people, their younger relatives and health professionals. Scandinavian Journal of Caring Sciences, 27(1), 3-12.

Dimick, J. B., & Ryan, A. M. (2014). Methods for evaluating changes in health care policy: the difference-in-differences approach. Jama, 312(22), 2401-2402.

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Drummond, M. F., Sculpher, M. J., Claxton, K., Stoddart, G. L., & Torrance, G. W. (2015). Methods for the economic evaluation of health care programmes. Oxford, UK: Oxford university press.

Gottlieb, D., & Mitchell, O. S. (2015). Narrow framing and long-term care insurance. New York, NY: National Bureau of Economic Research.

Harris-Kojetin, L., Sengupta, M., Park-Lee, E., Valverde, R., Caffrey, C., Rome, V., & Lendon, J. (2016). Long-term care providers and services users in the United States: data from the National Study of Long-Term Care Providers, 2013-2014. Vital & Health Statistics,22 (38), 1-118.

Shi, L., & Singh, D. A. (2014). Delivering health care in America. Burlington, MA: Jones & Bartlett Learning.

Wieland, D., Kinosian, B., Stallard, E., & Boland, R. (2013). Does Medicaid pay more to a program of all-inclusive care for the elderly (PACE) than for fee-for-service long-term care?. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 68(1), 47-55.

Zawadski, R. T. (2014). Community-based systems of long-term care. London, UK: Routledge.

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