Community-Based Long-Term Care

Abstract

Community-based long-term care encompasses a wide array of medical and nonmedical diagnostic, preventive, therapeutic, rehabilitative, personal, social, supportive, and palliative services in a variety of settings for individuals who have lost some capacity for self-care because of a chronic illness or physical, cognitive, or emotional impairment. Some of the support services allow the patient to remain at home (including adult daycare, home health services, home medical care, and telemedicine), whereas other services require a change of residence (such as assisted living, adult care homes, and continuing-care retirement communities). The goal of care is to build on interprofessional expertise and teamwork to promote the optimally independent level of physical, social, and psychological functioning in the least restrictive environment. In 2003, approximately 7 million older adults (aged 65 years or older) needed some form of long-term care. During the past several years, there has been a trend toward community-based services, moving away from institutional care such as nursing homes. Most patients with chronic health problems prefer to remain at home or in a homelike setting, and only approximately 20% of older adults who require long-term care reside in nursing homes. This shift was formalized by the Olmstead Decision (July 1999) in which the U.S. Supreme Court upheld the right of individuals to receive care in the community instead of in an institution whenever possible. Community-based long-term care services involve attending to the patient's medical and psychosocial needs, bringing together those services necessary to maintain or improve the patient's clinical status, preventing acute exacerbations of chronic illness, and avoiding unnecessary and costly emergency room visits and acute hospitalizations.