Sections
The Continuum of Caring in the Long Term: Introduction | Emerging Long-Term Care Policy in the United States:
Muddling Through | Care in the Community: A New Dynamic | Six Illustrative Innovations in Community-Based Long-Term
Care | Conclusion | Key Points | References | Suggested Readings | Web Resources
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.