In most cases, health policies have a complex and multifaceted nature as they are designed to target and address problems that affect a wide range of populations with diverse characteristics and needs offering respective and effective solutions. The process of policy-making is complicated by the need to enable approaches that are helpful to the groups with different features without discriminating against anyone; as a result, the conflicting interests or overlapping requirements often contribute to the unexpected side effects of health policies (Dimick & Ryan, 2014). The policy chosen for analysis covers the provision of long-term care. According to the data presented by Genworth (2015), about 70% of older adults aged over 65 are likely to require at least one form of long-term care at some point in their lives. The services included in long-term care are very diverse and involve such forms of care as assisted living, ADC (adult day health care), homemaker services, and nursing home care.
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Description of the Issue
Long-term care can be defined as a “continuum of medical and social services designed to support the needs of people living with chronic health problems that affect their ability to perform everyday activities” (McCall, 2001, p. 3). The monthly and daily rates for these types of services have increased by 2-6% over the last several years (Genworth, 2015). The funding options include self-funding, help from family and friends, insurance, and healthcare programs, among other solutions. Caregiving is rather time- and money-consuming, and is likely to affect the lives of the receivers and providers of care; medial annual cost of different types of long-term care takes tens or even hundreds of thousands of dollars (Genworth, 2015). When unpaid long-term care is provided by friends and family members, this tendency may produce a serious negative impact on the providers restricting their time, consuming their finances, and endangering them, as well as the individuals for whom they care.
As a result, long-term care needs to be planner years before it is actually needed and should be supported by specialized policies directed at the alleviating the burden of planning and delivery of care to the people in need, taking into consideration their conditions and financial status.
In the United States, the major agency responsible for payments for long-term care is the program known as Medicaid, the other sources of payment are private or private types of insurance and out-of-pocket (The Scan Foundation, 2013; Zawadski, 2014). The expenditures of long-term care are constantly growing; when it comes to Medicaid, over 30% of its expenditures cover the population’s needs for long-term care (The Scan Foundation, 2013). Lost in a multitude of other important public health concerns, the issue of long-term care has been overlooked for quite some time. The delivery system for this type of health care is gradually moving towards self-finding and out-of-pocket or private insurance payments, thus promoting the use of alternative healthcare facilities apart from the nursing homes whose popularity is decreasing (Denson, Winefield, & Beilby, 2013).
Legislators Involved in Policy Development and Dissemination
Just like all the other kinds of policies, the one that covers the provision of and coverage for the long-term health care is complex nature in terms of policymaking agencies as it can come from many different sources. Members of Congress and the representatives of their parties meet with one another for a purpose to ensure one another’s support in regard to a policy, reach President and then hold a debate at a high-level that is finalized with a vote that establishes the future of a policy or a bill (Singh, 2014).
When it comes to the specific authorities involved in the dissemination and development of the policy, one could name the democrat Rep. Frank Pallone of New-Jersey who has been advocating for the Part E of Medicaid program that was particularly focused on the provision of the state funding to long-term health care. In addition, one could also name the republican Rep. Michael Burgess of Texas, who expressed an inclination to oppose the potential bill, emphasizing that private funding opportunities would be more appropriate solutions to the problem of long-tern health care coverage.
The Role of APRN
Ploeg et al. (2013) researched the NPs’ roles in regard to long-term health care and found that two major functions are carried out by the latter as perceived by patients and their families – the delivery of care and the provision of information concerning the issues related to this type of care. When it comes to the practitioners’ influence on the promotion or refutation of a policy, they may play a role of the public and patient advocates using their experiences and statistical data in order to make their points. The CNA (n.d.) also emphasized the practitioners’ roles as educators, communicators, and counselors in regard to the issues related to long-term care. In that way, having the first-hand experiences with the patients’ needs, challenges, and questions, the APRNs may serve as a powerful source of data helping refute or assist with a policy based on the information provided directly by the patients and communicating their most recent issues and attitudes.
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The Policy and Clinical Practice
The aspect of funding for the long-term health care revolves around the private (and out-of-pocket) or state sources of payment. Moving the dominant source to the state agencies and programs would be likely to promote standardized forms and plans of care helping the government to monitor and control the expenditures and prevent the waste of resources. In these circumstances, the quality of the provided care could decline or face limitations if the funding is restricted. At the same time, privately funded care may adjust the services and costs based on the needs of the population, thus ensuring better flexibility and diversity in the sector.
The use of interprofessional teams in the field of long-term care could increase the staff confidence and the precision of assessments (CNA, n.d.). Interprofessional approach allows examining issues from a variety of perspectives and carrying out a complex analysis, thus delivering comprehensive and coordinated care of a high quality. In addition, the collaborative practices are likely to make a positive contribution to the level of skills and the diversity of experiences and encountered practices of the nursing practitioners, expanding their scope of knowledge.
Long-term care is a complex issue whose major challenges revolve around the sources of payment – state or private. Currently, the main portion of funding comes from Medicaid, where at least 30% of expenditures are directed to long-term care. It is possible that moving the finding to private organizations and programs could improve the level of quality; however, this decision could also translate into the growth in prices that have already increased by 2-6% throughout the last several years in different forms of long-term care.
CNA. (n.d.). Nurse practitioners in long-term care. Web.
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.
Genworth. (2015). Cost of care survey. Web.
McCall, N. (2001). Who will pay for long term care?: Insights from the partnership programs. Chicago, IL: Health Administration Press.
Ploeg, J., Kaasalainen, S., McAiney, C., Martin-Misener, R., Donald, F., Wickson-Griffiths, A.,…Taniguchi, A. (2013). Resident and family perceptions of the nurse practitioner role in long term care settings: A qualitative descriptive study. BMC Nursing, 12(24), 1-6.
Singh, D. A. (2014). Effective Management of Long-Term Care Facilities. Burlington, MS: Jones & Bartlett Publishers.
The Scan Foundation. (2013). Who pays for long-term care in the U.S.? (updated). Web.
Zawadski, R. T. (2014). Community-based systems of long-term care. London, UK: Routledge.