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Home and Community-Based Care: The U.S. Example

Published online by Cambridge University Press:  29 November 2010

Robert F. Clark
Robert F. Clark
Affiliation:
U.S. Department of Health and Human Services
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Abstract

In 1985 there were about 5.5 million functionally disabled elderly persons (65 +) in the United States (U.S.) living in the community and an additional 1.3 million in nursing homes. By 2020, these figures are expected to almost double to 10.1 million and 2.5 million respectively. The long-term care system (LTC) in the U.S. is large and complex. Fundamentally, it consists of: (a) informal care, provided voluntarily by one's family, friends, neighbours, and community organizations; (b) home and community based care, covering formal (paid) services provided in one's own home or other community based settings; and (c) nursing homes, which provide specialized medical, nursing, and social services in an institutional setting. Home and community based care includes a variety of services and financing streams, including (a) Medicare home health care, (b) Medicaid home health services, (c) Medicaid home- and community-based services, (d) programs and services under the Older Americans Act, (e) state sponsored social services funded by the Social Services Block Grant, (f) Supplemental Security Income payments, and (g) a range of supportive housing arrangements. Data on the LTC system are available from several key sources: national surveys, administrative records, inventories, state and local data systems, and demonstration programs. The LTC system remains decentralized. The frail elderly want dignity and independence in the latter years, plus access to needed services and an acceptable quality of life. In policy terms, their caregivers and the taxpaying public continue to struggle to find the appropriate mix of public and private support to meet the needs of the LTC population.

Résumé

En 1985, il y avait quelque 5, 5 millions d'aînés souffrant d'un handicap fonctionnel, âgés de 65 ans ou plus qui vivaient dans la communauté, plus 1,3 million d'entre eux qui résidaient dans des centres d'hébergement. D'ici l'an 2020, ces chiffres devraient pratiquement doubler, passant respectivement à 10,1 millions et à 2.5 millions. Le système des soins de longue durée aux États-Unis est vaste et complexe. Il comprend essentiellement: (a) les simples soins prodigués bénévolement par un membre de la famille, par des amis, par des voisins et par des organismes communautaires; (b) les soins communautaires et les soins à domicile, comprenant les services (payés) officiellement donnés au domicile des bénéficiaires ou dans des établissements communautaires; (c) les services médicaux, infirmiers et sociaux spécialisés en milieu institutionnel fournis par les centres d'hébergement. Les soins à domicile et les soins communautaires comprenent une diversité de services et de sources de financement, dont: (1) les soins de santé à domicile de Medicare; (2) les services de santé à domicile de Medicaid; (3) les services à domicile et les services communautaires de Medicaid; (4) les programmes et les services en vertu du Older Americans Act; (5) les services sociaux parrainés par chaque état et financés par le Social Services Block Grant (SSBG); (6) les indemnités de supplément de revenu (SSI); (7) un éventail de logements avec services de soutien. Les données sur le système de soins de longue durée proviennent de diverses sources dont les principales sont les enquêtes nationales, les dossiers administratifs, les inventaires, les systèmes de données des états et les systèmes de données locales ainsi que les programmes-pilotes. Le système de soins de longue durée est encore largement décentralisé. Les aînés fragiles souhaitent, dans leurs vieux jours, vivre dans la dignité et l'autonomie; ils désirent aussi avoir accès aux services dont ils ont besoin et jouir d'une bonne qualité de vie. En ce qui a trait aux mesures à envisager, leurs soignants et les contribuables poursuivent leur recherche du juste équilibre entre le soutien public et le soutient privé qui permettra de répondre aux besoins de la population exigeant des soins de longue durée.

Keywords

Long-term CareHome and Community Based CareMedicareMedicaidOlder Americans ActHome Health Care.Soins de longue duréesoins à domicile et soins communautairesMedicaireMedicaidOlder Americans Actsoins de santé à domicile.
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 15 , Issue S1 , Automne/Fall 1996 , pp. 91 - 102
Copyright
Copyright © Canadian Association on Gerontology 1996

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