Healthcare consumerism is the system that allows the participant to make decisions on their choices in regards to their health plan. Long term care consumers are generally those with a disability or the older generation. Thus, consumerism in long term care is centered on giving a greater sense of choice to the consumers.
Current policy with regards to long term care in this country is centered on the use of both Medicare and service. The emerging policy alternatives presents several options including less institutional care, day care services, community-based alternatives, cultural changes and a combination of medical and social services to ensure better service provision in the sector. This section will seek to understand both sides of the coin and investigate if consumerism and the new policies will boost or hurt the users of long-term care.
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The application of Medicare and Medicaid policies largely provide care in different ways. Medicare will provide for the healthcare needs of older persons above the age of 65 and those under 65 but that has a disability. According to the US Department of Health and Human Services, Longer Term Care section Medicare in most cases does not pay for long term care services, Activities of Daily Living (ADL’s) or personal assistance services (Holt, 2017). Medicaid on the other hand, is the program that works to support low income individuals to cover doctor and hospital visits. It also caters for long-term care provided through nursing homes or at home by nurses that visit patients to offer personal assistance services.
Greater attention is being paid to the government provided services with the options for long term care being availed. The services range from home care services, community support services like transportation or adult daycare, nursing homes, assisted living facilities and even retirement homes. To bring in the element of consumerism the “Participant Directed Services” allow the user to choose aspects of their care such as the caregiver, schedule and foods to eat.
The current policies provide long term care to very disadvantaged people or in situations of extreme circumstances like hospice care of 6 months or less. The other available options leaning towards home based care through the assistance of family members of the elderly or disabled. These leave room for plenty of issues in the delivery of quality and quantity of care provided (Holt, 2017). The case for home based care largely came from the school of thought that home based care was more cost effective. It was also assumed that it would give the consumers greater quality of life as it would pay closer attention to their preferences.
The cost effectiveness came about from lowered overhead costs associated with operating or living in nursing homes. Quality of life was pushed to the forefront because of nursing home scandals that got reported in the news. However, quality of care was questioned based on the fact that those requiring more specialized care may not consistently access the services away from the nursing home. The main limitation is the wanting professional qualification of the home based care giver. Relatives who play of the care giver role may also lack the necessary equipment to facilitate their patient’s comfort (Krahn, Walker & Correa-De-Araujo, 2015). The preference of the older persons is ranked high in accordance to 1999 Supreme Court ruling which requires that care services are provided in a setting with as little restriction as possible.
Cash and Counseling policy is among the policies that were first conceptualized as a result of heightened consumerism and home-based care. The policy gave the consumer direct control of the money that would be allocated for payment for personal assistant services and ADL’s. This essentially provided the consumer with an opportunity to choose and control their care services including the period, personnel and mode through which services are provided. The consumer not only received the money but also received counselling services about how to use the funds (Mahoney et al., 2017).The results that were documented, indicate that Cash and Counselling may have resulted in better quality of care, greater consumer satisfaction and increased quality of life.
However, the case for lower costs could not be met consistently. This is because the funding regulations on Medicaid were handled by both the federal and state authorities. This was done in state to state. As a matter of fact, according to Chari et al. (2015), it was found that it was ultimately more expensive to the state government to use the Cash and Counselling policy. Therefore, it was left to the individual states to determine if they were willing to take up the policy based on its positive influence on consumer satisfaction and caregiver wellbeing.
Though the consumerist policy is a great policy, it does not provide options to patents. Patients have no capacity to make choices regarding their preferred service providers especially during medical condition that may require emergency care. Consumerism does not account for the times when no prior arrangements had been made and the choice of caregiver must be made in a split second (Chari et al., 2015). In addition, the inference that giving the power to consumers to choose their service providers causes the market prices to lower due to increased competition is unlikely. A good example in the pharmaceutical sector where prices of drugs have steadily increased even when there have been various alternatives that could be used to ensure similar results. It is because of this that consumerism as a policy may not be as advisable to the greater wellbeing of the patients.
Incapacitated patients often pay for emergency services through alternative payment models. These include cash, credit or debit cards and other installment methods. The consumerism policy has put mechanisms in place for more regions to access their funds through reimbursement. However, this plan is not as inclusive as it should be. Several regions have to settle for payment methods that are that are not part of medical plan. This further contributes to the lowered quality of emergency visits. Apparently, long term care patients often tend to choose the most affordable service, rather than opting for the most appropriate services (Platts-Mills et al., 2019). Value addition in the consumerist policy could change this dynamic for the better.
Additionally, majority of patients are not well informed of their conditions. They do not know which symptoms are warning signs because the care givers do not carry out any education. The patient then relies entirely on the discretion of the care giver. Unfortunately, the care giver is limited by the information the patient communicates. Decisions are made based on this feedback. This is part of the reason why emergency situations arise. Emergency visits then occur catching both the patient and the care giver by surprise. The consumerism policy on continuity is limited on emergency protocol. Experts advise that continuity and consistency of care would ensure that emergency visits were fewer (Marshall et al., 2016). Regularity of care givers would also improve the communication between patient and care giver.
Handling of patient information is also wanting in long term care. The transition between long term care and emergency care is often problematic because of the gap in information. There are numerous cases of treatment without adequate background information or at least basic documentation explaining previous treatment regimes. The gap in transitionary conduct has seen several mistakes arising from misinformation. Another problem that occurs is inadequate handling of documentation during patient attendance. Consumerism only accelerates this problem because consumers do not consider such factors while choosing their service providers. Often, factors such as cost and proximity take preeminence.
A favorable alternative to the conventional consumerism models is dwellings for people with special needs. Facilities exist to cater for those with special needs such as physical disability, mental issues, addiction and other issues that require support. Majority of these facilities are privately owned and managed. This makes them offer services of varying quality and preference. Consumerism then allows some autonomy in the facility of choice. The consumerism policy also disadvantages consumers in this aspect. Consumers will choose a facility that accommodates their tastes, preference and lifestyle choices. Some of these facilities extend patient care unnecessarily in order to boost profit margins. This increases costs of long-term care because qualified personnel may need to spend more on rectifying prolonged damage.
The main advantage of prolonged care in dwellings is the emotional well being of the patient. The patient who is in such a situation willingly is in a better state of mind as opposed to conventional care. The situation is even better if the person is receiving the medical care they need. The main disadvantage is that the costs of such care get higher (Chari et al., 2015). Policy should be aimed at striking a balance between patient centered needs, affordability and a bit of consumer preference.
References
Chari, A. V., Engberg, J., Ray, K. N., & Mehrotra, A. (2015). The opportunity costs of informal elder‐care in the United States: new estimates from the American time use survey. Health services research, 50(3), 871-882.
Harry, M. L., Mahoney, K. J., Mahoney, E. K., & Shen, C. (2017). The Cash and Counseling model of self-directed long-term care: Effectiveness with young adults with disabilities. Disability and health journal, 10(4), 492-501.
Holt, J. D. (2017). Navigating Long-Term Care. Gerontology and Geriatric Medicine, 3, 2333721417700368.
Krahn, G. L., Walker, D. K., & Correa-De-Araujo, R. (2015). Persons with disabilities as an unrecognized health disparity population. American journal of public health, 105(S2), S198-S206.
Marshall, E. G., Clarke, B., Burge, F., Varatharasan, N., Archibald, G., & Andrew, M. K. (2016). Improving continuity of care reduces emergency department visits by long-term care residents. J Am Board Fam Med, 29(2), 201-208.
Platts-Mills, T. F., Zimmerman, S., & Sloane, P. D. (2019). Increasing the value of emergency visits for long-term care patients: When less is more and more is more. Journal of the American Medical Directors Association, 20(8), 927-928.
