In the United States, the Long-Term Care sector has evolved in the last century to serve the needs of the elderly as well as people with disabilities better. The transition has foreseen a change in the timeline from the nursing home times to the era of health reforms. Some of the changes encapsulate court decisions and vital legislations that were crucial in providing funding and improving the quality of healthcare and safety in nursing homes. The timeline of changes is grouped into three; the era of nursing homes, the era of community-based services, and the era of health reforms. The paper will focus on changes that happened in the era of community-based services, as illustrated below.
1990:
The Americans with Disabilities Act was enacted, whose purpose was to end exclusion and segregation by integrating such people into the community.
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1993:
The Clinton Health Care Plan was introduced, which included policies to expand HCBS, the establishment of minimum standards for quality improvement, as well as improving Medicaid coverage for institutionalized care.
1994:
Eight years after the law was passed, the OBRA-87's final rule was finally published.
1995:
Consumer advocated demonstrated the positive effects of Medicaid reforms, a move that nearly repealed the Nursing Home Reform Act (Kaiser Family Foundation, 2015). The repeal was however averted.
1999:
As per ADA's community integration mandate, the supreme court Olmstead rule broadened the HCBS cover for people living with disabilities.
2000:
The American Act Caregiver's Program was established, which authorized the states to receive grants to assist caregivers and family members in giving home care to their loved ones.
2001:
There was a Freedom initiative program that was introduced, whose function was to remove previous barriers in accessing medical care for the communities living with disabilities.
To develop integrated LTSS systems, there was a change in grants that the Aging Real Choice Systems, Medicare, as well as Medicaid, provided to the states and non-profit organizations.
2005:
The Deficit Reduction Act was introduced which facilitates the expansion of community based-care by providing federal funds.
2006:
The Older Americans Act included changes like evidence-based prevention programs as well as accessible consumer information for long-term care planning.
Home and Community-Based Services
One of the sectors of the American healthcare system that has undergone significant changes in the Home and Community-Based Services (CBSS). The program targeted older adults who first received federal funding in 1952 (Siegler, Lama, Knight, Laureano & Reid, 2015). Afterward, in 1965, the Older Americans Act was passed, which was coincidentally the same year that Medicaid and Medicare were introduced (Siegler et al., 2015). Consequently, the formal framework for providing CBSS with large-scale federal support was created. The Older American Act lay the foundation for the establishment of the Administration on Aging (AoA), which in turn mandated the creation of state agencies. The sole purpose of the agencies is to promote social services delivery to older Americans. As of now, in the Department of Health and Human Services, the AoA is one of the units for Administration for Community Living and is divided into five offices. They include Elder Rights, Long-Term Care Ombudsman Programs, Supportive and Caregiver Services, Nutrition and Health Promotion Programs, and Native American and Native Hawaiian Programs (Siegler et al., 2015). There have been changes in funding, as well. The OAA uses different titles to fund the services. For instance, there is Title III, which accounts for $1.2 Billion, which is almost three-quarters of the entire AoA's budget (Siegler et al., 2015). The population targeted by such funds mainly encompasses individuals above sixty years, who previously had an income that is below the poverty line. Such individuals are often in need of CBSS. The survival of CBSS is heavily dependent on the state, national, and local government's support as well as the business, philanthropic, and private contribution, unlike in the past where it only depended on federal funding.
Medicare
The other program that has dramatically evolved over the years is Medicare. The Medicare bill was enacted in 1965 when America was different than it is today (Blumenthal, Davis, & Guterman, 2015). It was during the time that segregation denied minorities the same healthcare access and privileges as white people. The first change that the bill brought was universal healthcare, where minorities were now able to access the service. In the same way, about half of American seniors did not have insurance, and this meant going without healthcare services or depending on relatives, friends, or charity organizations to cover the medical bills (Blumenthal, Davis, & Guterman, 2015). As of now, the Medicare insurance policy covers nearly all senior citizens, which has dramatically reduced the stress and improved the ability of such citizens to live worry-free lives. The Medicare benefits package has also brought changes by molding private sector insurance. Some of them include Blue Cross and Aetna's plan, specifically for federal employees (Blumenthal, Davis, & Guterman, 2015). Consequently, hospitals can now nominate a private insurance company to act as an intermediary in bill payment and being the contact point on behalf of patients. The payment methods for companies are based on reasonable costs. The purpose of having an intermediary is making sure that Medicare beneficiaries have almost as good services as privately insured patients. Therefore, the concern about straining the capacity of the healthcare system that was there when Medicare was introduced is eradicated. After its introduction, Medicare radically increased its access. The number insured by the policy in 1965 was 350 in every 1000 individuals, which rose to 76% in the 1990s, and as of today, roughly 94% of the elderly population are Medicare beneficiaries (Blumenthal, Davis, & Guterman, 2015).
References
Blumenthal, D., Davis, K., & Guterman, S. (2015). Medicare at 50—Origins and Evolution . (Pp. 479-486)
Kaiser Family Foundation. (2015, September 11). Long-Term Care in the United States: A Timeline. Retrieved from https://www.kff.org/medicaid/timeline/long-term-care-in-the- united-states-a-timeline/
Siegler, E. L., Lama, S. D., Knight, M. G., Laureano, E., & Reid, M. C. (2015). Community- Based Supports and Services for Older Adults: A Primer for Clinicians. Journal of Geriatrics , 2015 .
