Long-Term Care and Public Policy in an Era of Austerity

Abstract

N the past twenty years, considerable progress has been made in the control and treatment of disease. There has been a dramatic improvement in life expectancy and a decline in mortality, particularly infant mortality. Ime n proved standards of living and medical advances in the cDsA prevention and control of formerly fatal infectious diseases have made it possible for an increasing number of persons to live a longer life. In addition, the passage of Medicare (Title XVIII) and Medicaid (Title XIX) in 1965 has made a substantial contribution to these improvements by making health services available to millions of older persons. An aging population raises many important socioeconomic issues relevant to an adequate and equitable health and long-term care policy. Intergenerational issues are raised at the community, state, and national levels in the course of developing a long-term care policy which meets the multiple needs of the elderly and encourages healthy aging, independence and autonomy in old age (1). The concept of healthy aging in our society involves a movement upstream against the tide of prevailing values wlich regard older people as an economic burden. It involves movemenit upstream against the tide of national politics of austerity and retrenclhmclnt in domestic social programs illustrated most recently by the attacks oIn Social Security and Medicare-two major sources of well--ei,g for older A mericans (2). It also involves movement upstream againct the vcry iiifluciitial medical-industrial complex whose emphasis is on acute, cpisodic care within a biomedical paradigm resulting in rising costs and a divcrsioii of resources to institutions. The development of a comprehensive long-term care policy is a formidable task, given the complex interaction between the public and private