The Inevitability of Reimagining Long-Term Care

Abstract

Long-term care has been reimagined for as long as it’s been recognized, which in part explains the multitude of options that emerged during the mid-20th century growth of formal long-term care support in the United States and other developed nations.1Rowles G.D. Teaster P.B. Long-Term Care in an Aging Society: Theory and Practice. 2016Google Scholar The articles in JAMDA’s special issue on Reimagining Long-Term Care propose ways to further reimagine care going forward; this editorial calls the question as to whether we’ll ever stop reimagining long-term care, and posits that we won’t, for better and for worse. For better, because there’s always room for improvement and consumer desires will continue to evolve. For worse, because the absence of a “system” of long-term care virtually ensures different visions between factions and partial progress at best. On that point, let’s correct 2 erroneous beliefs. Long-term care—services delivered over a sustained period of time to persons with cognitive or functional limitations—is not a “continuum” nor a “system.” As but a few examples, if it were a continuum, we’d expect the prevalence of functional impairment to be less among persons receiving adult day services than among persons in assisted living, when in fact the percentage of persons with 3 or more limitations in activities of daily living is virtually identical (64% and 61%, respectively).2Lendon J.P. Singh P. Adult Day Services Center Participant Characteristics: United States, 2018. NCHS Data Brief, no 411.2021Google Scholar,3Caffrey C. Sengupta M. Melekin A. Residential Care Community Resident Characteristics: United States, 2018. NCHS Data Brief, no 404.2021Crossref Google Scholar Or, we’d expect the percentage of persons with arthritis, diabetes, heart disease, or hypertension to be lower among home health agency users than among assisted living or nursing home residents, which it isn’t.4Harris-Kojetin L. Sengupta M. Lendon J.P. et al.Long-term care providers and services users in the United States, 2015–2016. National Center for Health Statistics.Vital Health Stat. 2019; 3: 43Google Scholar And if long-term care were a system—by definition, “a set of things working together as parts of a mechanism or an interconnecting network”5Oxford University PressEncyclopedia.com.https://www.encyclopedia.com/medicine/anatomy-and-physiology/anatomy-and-physiology/system#:∼:text=a%20set%20of%20connected%20things,%E2%88%8E%20PhysiolDate accessed: December 20, 2021Google Scholar—we’d not have the situation in which hospital costs to Medicare and nursing home costs to Medicaid were on a different ledger, or that specific models of care would be needed to improve and reduce transitions across care settings.6Chong E. Zhu B. Tan H. et al.Emergency Department Interventions for Frailty (EDIFY): front-door geriatric care can reduce acute admissions.J Am Med Dir Assoc. 2021; 22: 923-928Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar, 7Gardner R.L. Pelland K. Youssef R. et al.Reducing hospital readmissions through a skilled nursing facility discharge Intervention: a pragmatic trial.J Am Med Dir Assoc. 2020; 21: 508-512Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar, 8Robert B. Sun A.H. Sinden D. Spruin S. Hsu A.T. A case-control study of the Sub-Acute care for Frail Elderly (SAFE) unit on hospital readmission, emergency department visits and continuity of post-discharge care.J Am Med Dir Assoc. 2021; 22: 544-550Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar, 9Welberry H.J. Brodaty H. Hsu B. Barbieri S. Jorm L.R. Impact of prior home care on length of stay in residential care for Australians with dementia.J Am Med Dir Assoc. 2020; 21: 843-850Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar, 10Song J. Zolnoori M. McDonald M.V. et al.Factors associated with timing of the start-of-care nursing visits in home health care.J Am Med Dir Assoc. 2021; 22: 2358-2365Abstract Full Text Ful