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Reports that under a third of the increasing numbers of US citizens needing long‐term care (LTC) in a nursing home pay their own fees; and that Medicaid (health programme for the poor) meets over half of LTC costs. Describes the rules applied to qualify for Medicaid LTC payments, the growth of “Medicaid estate planning” to shield the income/assets of the middle classes so that they can qualify and the actions taken by the government to restrict misuse of Medicaid and reduce its costs. Explains methods which are still being used to protect middle class income/assets without losing Medicaid eligibility; and the alternative of private LTC insurance, including its tax implications. Discusses efforts to develop a partnership between Medicaid and the insurance companies in some states; and the pros and cons of the plans available for both individuals and the government.

To describe, analyze, and compare two long-term care (LTC) systems for elders in Germany and Israel.

Secondary analyses of data on LTC beneficiaries, structure of service provision and content analyses of policy documents in a comparative perspective based on the Esping-Andersen welfare state typologies.

Descriptive background of demographic attributes in the two countries; discussion of LTC development laws which in Israel focuses on “aging in place” concept, where in-kind services are geared only to community-dwelling frail elders while in Germany it’s for community and institutionalized elders. Analyses of various service types provided their use, resources invested, and benefits incurred for frail elders and their family caregivers.

The advantages and shortcomings of the two systems were analyzed with recommendations for future developments. Such comparisons across nations can inform social policy debates in Germany and Israel as to how to prepare for population aging. The originality of such comparison can shed light on issues for LTC service development in other countries.

Long-term care (LTC) homes are highly regulated settings that provide care to people living with complex health conditions who are often at the end of their lives. Mental health and quality of life are important concepts in LTC given the inherent poor health and diminished autonomy of residents living in this setting. The COVID-19 pandemic had the potential to further compound these issues through lockdowns limiting movement within and outside of LTC homes, increased fear of severe COVID-19 infections, staff shortages, and impaired communication through personal protective equipment. However, the evidence describing the effect of the pandemic on mental health and quality of life is mixed, with some studies describing increased rates of mental health concerns and others presenting modest increases or decreases. Creative strategies to mitigate negative mental health consequences of lockdown included technology supported and window or outdoor visits, increased access to volunteers, and supports for families. However, the evidence in this area continues to evolve as subsequent waves of the pandemic progress. Future research may present new evidence about other strategies that became important in different stages of the pandemic.

Federal and state governments collaborate on state Medicaid nursing facility long-term care (SMNF-LTC) programs. These programs are increasingly expensive as the baby-boomers retire. Yet serious resident outcome problems continue in spite of the Centers for Medicare and Medicaid Services’ (CMS) extensive process-focused regulatory efforts. This study identifies a promising and simpler auxiliary path for improving resident outcomes.

Drawing on a longitudinal (1997–2005), 48-state data set and panel-corrected, time-series regression, we compare the effects on resident outcomes of CMS process-focused surveys and four minimally regulated program structural features on which the states vary considerably.

We find that each of these four structural features exerts a greater effect on resident outcomes than process quality.

We suggest augmenting current process-focused regulation with a less arduous approach of more extensive regulation of these program features.

To date SMNF-LTC program regulation has focused largely on member facility processes. While regulating processes is appropriate, we show that regulating program structural features directly, an arguably easier task, might well produce considerable improvement in the quality of resident outcomes.

The purpose of this study is to develop new type of reverse mortgage contract. How to provide adequate services and housing for an increasing number of people that are dependent on the help of others is a crucial question in the European Union (EU). The housing stock in Europe is not fit to support a shift from institutional care to the home-based independent living. Some 90% of houses in the UK and 70%–80% in Germany are not adequately built, as they contain accessibility barriers for people with emerging functional impairments. The available reverse mortgage contracts do not allow for relocation to their own adapted facilities. How to finance the adaptation from housing equity is discussed.

The authors have extended the existing loan reverse mortgage model. Actuarial methods based on the equivalence of the actuarial present values and the multiple decrement approach are used to evaluate premiums for flexible longevity and lifetime long-term care (LTC) insurance for financing adequate facilities.

The adequate, age-friendly housing provision that is appropriate to support the independence and autonomy of seniors with declining functional capacities can lower the cost of health care and improve the well-being of older adults. For financing the development of this kind of facilities for seniors, the authors developed the reverse mortgage scheme with embedded longevity and LTC insurance as a possible financial instrument for better LTC services and housing with care in assisted-living facilities. This kind of facilities should be available for the rapid growth of older cohorts.

The numerical example is based on rather crude numbers, because of lack of data, as the developed reverse mortgage product with LTC insurance is a novelty. Intensity of care and probabilities of care in certain category of care will change after the introduction of this product.

The model results indicate that it is possible to successfully tie an insurance product to the insured and not to the object.

The introduction of this insurance option will allow many older adult with low pension benefits and a substantial home equity to safely opt for a reverse mortgage and benefit from better social care.

While currently available reverse mortgage contracts lapse when the homeowner moves to assisted-living facilities in any EU Member State, in the paper a new method is developed where multiple adjustments of housing to the functional capacities with relocation is possible, under the same insurance and reverse mortgage contract. The case of Slovenia is presented as a numerical example. These insurance products, as a novelty, are portable, so the homeowner can move in own specialised housing unit in assisted-living facilities and keep the existing reverse mortgage contract with no additional costs, which is not possible in the current insurance products. With some small modifications, the method is useful for any EU Member State.

Long-term care (LTC) organizations have struggled to protect their vulnerable clients from the ravages of the COVID-19 pandemic. Although various suggestions on containing outbreaks in LTC facilities have gained prominence, ensuring the safety of residents is not just a crisis issue. In that context, the authors must reasses the traditional management practices that were not sufficient for handling unexpected and demanding conditions. The purpose of this paper is to suggest rethinking the underlying attributes of LTC organizations and drawing insight from the parallels they have to high-reliability organizations (HROs).

The authors analyzed qualitative data collected from a Canadian LTC facility to shed light on the current state of reliability practices and culture of the LTC industry and to identify the strengths and weaknesses of the traditional management approaches.

To help the LTC industry develop the necessary crisis management capacity to tackle unexpected future challenges, there is an urgent need for adopting a more systemic top-down approach that cultivates mindfulness, learning and resilience.

This study contributes by applying the HRO theoretical lens in the LTC context. The study provides the LTC leaders with insights into creating a unified effort at the industry level to give rise to a high-reliability-oriented industry.

The purpose of this article is to clarify the social burden of Japan’s three major diseases including Long-term Care (LTC) burden.

A modification of the Cost of Illness (COI)—the Comprehensive-COI (C-COI) was utilized to estimate three major diseases: cancer, heart disease, and cerebrovascular diseases (CVD). The C-COI consists of five parts: medical direct cost, morbidity cost, mortality cost, formal LTC cost and informal LTC cost. The latter was calculated by two approaches: opportunity cost approach (OC) and replacement approach (RA), which assumed that informal caregivers were substituted by paid caregivers.

The C-COI of cancer, heart disease and CVD in 2017 amounted to 10.5 trillion JPY, 5.2 trillion JPY, and 6.7 trillion JPY, respectively (110 JPY= 1 US$). The mortality cost was preponderant for cancer (61 percent) and heart disease (47.9 percent); while the informal LTC cost was preponderant for CVD (27.5 percent). The informal LTC cost of the CVD in OC amounted to 1.8 trillion JPY; while the RA amounted to 3.0 trillion JPY.

The LTC burden accounted for a significant proportion of the social burden of chronic diseases. The informal care was maintained by unsustainable structures such as the elderly providing care for the elderly. This result can affect health policy decisions.

The C-COI is more appropriate for estimating the social burden of chronic diseases including the LTC burden and can be calculated using governmental statistics.

The purpose of this paper is to find the key innovative principles for evaluating the long-term care (LTC) cloud system by exploring contradictory and complex points in its development.

The theory of inventive problem solving (TRIZ) and the decision-making trial and evaluation laboratory (DEMATEL) approaches are integrated to resolve complex contradictions in the system. The heuristic reasoning of TRIZ is applied to obtain innovation principles for an LTC cloud mining system. However, the importance and feasibility of these innovative principles require further assessment. In this study, DEMATEL is employed to clarify the complex relationships among the principles and evaluate their key influences.

This paper identifies six primary contradictions and derives 25 innovative principles for the resolution of these conflicts. Further analysis confirms three key innovative principles. First, the government should consider the overall planning of the cloud system platform, followed by the participation of other medical and LTC institutions. Second, the information capability of LTC institutions should be unified by recording the pathology data of care recipients to create an information exchange system. Third, LTC institutions should act in cooperation with medical institutions to provide professional medical capabilities.

The contributions of this paper are two-fold. First, this study provides an integrated methodology integrating the TRIZ and DEMATEL approaches to resolve LTC problems. Second, this research identifies the key innovative principles for developing an LTC cloud system in Taiwan.

The purpose of the article is to assess the effectiveness, compliance, adoption and lessons learnt from the pilot implementation of a data integration solution between an acute care hospital information system (HIS) and a long-term care (LTC) home electronic medical record through a case report.

Utilization statistics of the data integration solution were captured at one-month post implementation and again one year later for both the emergency department (ED) and LTC home. Clinician feedback from surveys and structured interviews was obtained from ED physicians and a multidisciplinary LTC group.

The authors successfully exchanged health information between a HIS and the electronic medical record (EMR) of an LTC facility in Canada. Perceived time savings were acknowledged by ED physicians, and actual time savings as high as 45 min were reported by LTC staff when completing medication reconciliation. Barriers to adoption included awareness, training efficacy and delivery models, workflow integration within existing practice and the limited number of facilities participating in the pilot. Future direction includes broader staff involvement, expanding the number of sites and re-evaluating impacts.

A data integration solution to exchange clinical information can make patient transfers more efficient, reduce data transcription errors, and improve the visibility of essential patient information across the continuum of care.

Although there has been a large effort to integrate health data across care levels in the United States and internationally, the groundwork for such integrations between interoperable systems has only just begun in Canada. The implementation of the integration between an enterprise LTC electronic medical record system and an HIS described herein is the first of its kind in Canada. Benefits and lessons learnt from this pilot will be useful for further hospital-to-LTC home interoperability work.

The purpose of this study was to explore long-term residential care provided by people other than the facilities’ employees. Privately hired paid “companions” are effectively invisible in health services research and policy. This research was designed to address this significant gap. There is growing recognition that nursing staff in long-term care (LTC) residential facilities experience moral distress, a phenomenon in which one knows the ethically right action to take, but is systemically constrained from taking it. To date, there has been no discussion of the distressing experiences of companions in LTC facilities. The purpose of this paper is to explore companions’ moral distress.

Data were collected using week-long rapid ethnographies in seven LTC facilities in Southern Ontario, Canada. A feminist political economy analytic framework was used in the research design and in the analysis of findings.

Despite the differences in their work tasks and employment conditions, structural barriers can cause moral distress for companions. This mirrors the impacts experienced by nurses that are highlighted in the literature. Though companions are hired in order to fill care gaps in the LTC system, they too struggle with the current system’s limitations. The hiring of private companions is not a sustainable or equitable solution to under-staffing and under-funding in Canada’s LTC facilities.

Recognizing moral distress and its impact on those providing LTC is critical in relation to supporting and protecting vulnerable and precarious care workers and ensuring high-quality care for Canadians in LTC.