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Chapter 32. The Continuum of Caring in the Long TermMovement Toward the Community

George L. Maddox, Ph.D.; Elise J. Bolda, M.S.P.H., Ph.D.
DOI: 10.1176/appi.books.9781585623754.399474

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Excerpt

Among health care policy analysts, care providers, and consumers in the United States, the conversation about the role of communities in chronic care over the long term has changed significantly over the past two decades. A primary stimulus for this change has been increased awareness of how badly the currently dominant medical model of hospital care is mismatched with the increasingly obvious needs for more effective care of chronic conditions in nonhospital settings. This mismatch has been illustrated dramatically by a report of the Institute of Medicine of the National Academy of Sciences, Crossing the Quality Chasm: A Health System for the 21st Century (Institute of Medicine 2001), which emphasizes the importance of multidisciplinary care in community settings and the necessary involvement of patients in that type of care. Involving the community in caregiving becomes increasingly necessary as well as desirable as populations age. In recent decades, federal policies guiding the provision of long-term care have devolved to give states and communities increasing responsibility for how that care is provided. How this devolution of long-term care policy, which began as a requirement, has become an opportunity for innovation is the issue of interest here.

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