When the phrase “long term care” is mentioned, the majority of the general public envisions a peaceful scenario in which an elderly person is relaxing and enjoying their time sipping coffee, socializing, and playing board games in their respective nursing home. Little thought is given to the quality of care that the individual may be receiving because a particular image has been strategically crafted and ingrained into our psyches by certain special interest groups. That image is a construct that portrays the notion that Nursing Facilities are the only alternative for seniors and individuals with disabilities. The truth is that nursing facilities are but one option for people with disabilities, as are community-based services (provided in your own home) that offer alternatives to institutionalization. These community-based services are viable options for many individuals because they specifically avoid the pitfalls inherent in facility based care.

The Federal Department of Health and Human Services (HHS) is responsible for the health, well being, and safety of all Americans. HHS contracts with The State Department of Health to conduct surveys that ensure Nursing Facilities are meeting particular Federal Requirements. The surveys themselves examine an array of vital fields of nursing facility care including the assessment of medical and nursing data, rehabilitative care, dietary and nutrition services, activities and social participation, sanitation, infection, and the condition of the physical environment. When a surveyor determines that one or more of the federal requirements are not being, a deficiency is cited to the facility.

Deficiencies can vary by their categorization and severity. The scope of the deficiency is determined by the volume of residents potentially affected and is categorized as isolated, patterned, or widespread. The severity of the deficiency is also factored and can range from “potential to cause minimum harm” to “immediate jeopardy to resident health and safety”. Corrective actions are required to remedy any and all deficiencies cited, and both the scope and severity of the deficiencies are incorporated when determining a corrective action.

The Inspector General acts as a reporting mechanism to the Department of Health and Human Services and has the authority to review legislation, audit, and investigate all Departmental Programs. Very recently, the Inspector General released a clinical analysis of trends apparent within Nursing Home Survey Results conducted from 2005 to 2007. Disturbingly, these trends show that over the past three years, more than 91 percent of nursing homes surveyed were cited for deficiencies, which is an increase from the last decade. Also noted was the fact that a greater percentage of For-Profit Nursing Homes were cited compared to Not-for-Profit Facilities.

The most common deficiency categories were Quality of Care and Quality of Life! These categories include specific deficiencies that correlate to real scenarios such as accidents and hazards, an inability to provide care to the resident’s highest capacity, an increase in urinary incontinence, a lack of quality housekeeping and maintenance services, a significant lack of dignity and accommodation of needs.

Many feel that the structure of long term care is shifting towards individualized community based options that can provide services to people in their own home. This shift is evidenced by such things as the growing support for the Community Choice Act and passage of the Money Follows the Person Demonstration Project.

For those of you that aren’t familiar, the Community Choice Act gives individuals who are eligible for nursing home services or other institutional care equal access to community-based services and supports such as attendant services. This piece of legislation is monumental as it will allow the individual for the first time a REAL CHOICE in where they receive the services and supports they need. As great as the philosophical underpinnings are in the Community Choice Act, more needs to be done.

To reform long term care services, the delivery system must enable individuals to live in the most integrated setting, substitute IL philosophy as opposed to emphasis on medical conditions, give consumers the ability to dictate how and when they receive services, ensure consistency statewide in the programs and services offered, increase the number of housing options for individuals with disabilities, relinquish mandatory enrollments for specific managed care populations, amend the Nurse Practice Act to allow opportunities for non-medical workers to provide previously categorized skilled services, and look to incorporate young persons with disabilities viewpoints on long term care reform.

Long Term Care has been synonymous with Nursing Facilities for decades. People with disabilities and age related medical conditions are not settling for only one choice in care options anymore. Let’s face it, competition breeds improvement in products and services and right now Home and Community-Based Services are an ever growing alternative. In the coming decades, we will hopefully see a dramatic increase in the quality of care given to residents in nursing facilities because so many people have moved into the community that the nursing facilities have only a few residents to whom they can provide care.