Disability, Long-Term Care, and Health Care in the 21st Century.

Intro -- DISABILITY, LONG-TERM CARE, AND HEALTH CARE IN THE 21ST CENTURY -- DISABILITY, LONG-TERM CARE, AND HEALTH CARE IN THE 21ST CENTURY -- CONTENTS -- Part I PICTURING THE PROBLEM -- Part II CHARTING THE COURSE -- Part III FORECASTING THE NEED -- CONFUSION AND MISPERCEPTIONS -- ATTITUDES AND PREFERENCES -- POSTELECTION VIEWS -- LACK OF POLITICAL AND PUBLIC WILL -- NEW LANGUAGE AND DEFINITIONS -- HEALTH OUTCOMES-ANOTHER REASON FOR REFORM -- Part IV DRAGGING ANCHOR -- HISTORY AS PROLOGUE -- EVOLUTION OF AMERICAN CULTURE AND ITS PHILOSOPHY OF CARING-1800S -- EARLY SETTLEMENT AND PAUPER LAWS -- 20TH CENTURY-FROM CHARITY CARE TO FOR-PROFIT CARE -- Part V INTRODUCING THE CAPTAIN -- MEET MARY -- PEOPLE USING LONG-TERM SERVICES AND SUPPORTS -- OVER AGE 65 -- UNDER AGE 65 -- ENTRANCE REQUIREMENTS -- CHALLENGES OF USING ADLS AND IADLS -- UNEMPLOYMENT AND ADLS AND IADLS -- RECIPIENTS OF SUPPLEMENTAL SECURITY INCOME AND SOCIAL SECURITY DISABILITY INSURANCE -- SOCIAL SECURITY DISABILITY INSURANCE -- SSDI RECIPIENTS -- SUPPLEMENTAL SECURITY INCOME PROGRAM -- SSI RECIPIENTS -- SOCIAL SECURITY REFORM -- CHRONIC ILLNESS AND THE NEED FOR LONG-TERM SERVICES AND SUPPORTS -- DUAL ELIGIBILITY-RECIPIENTS OF BOTH MEDICAID AND MEDICARE -- MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES POPULATION -- ONE SIZE DOES NOT FIT ALL -- BACK TO MARY -- Part VI MEETING THE CREW -- CAREGIVER CREW -- WORKFORCE CHALLENGES -- FEDERAL DECISION-MAKING CREW -- STATE CREWS -- Part VII FUELING THE ENGINE -- MEDICAID AND MEDICARE -- Medicaid Program -- Medicaid Home- and Community-Based Services Waiver Program -- Medicare Programs (Part A and Part B) -- Medicare Part A-Hospital Insurance Component -- Medicare Part B-Supplementary Medical Insurance Component -- MEDICAID AND MEDICARE -- OTHER QUALITY-OF-LIFE DOMAINS -- HOUSING -- TRANSPORTATION -- NUTRITION.

ASSISTIVE TECHNOLOGY -- CAREGIVER SUPPORT -- CONCLUSION -- Part VIII PUSHING TUGBOATS -- CASH AND COUNSELING DEMONSTRATIONS -- ESTABLISHMENT OF AGING AND DISABILITY RESOURCE CENTERS -- REAL CHOICE SYSTEMS CHANGE GRANTS -- INDEPENDENCE PLUS INITIATIVE -- CONCLUSION -- Part IX HARNESSING FAVORABLE WINDS -- AMERICANS WITH DISABILITIES ACT -- THE OLMSTEAD DECISION -- NEW FREEDOM INITIATIVE -- Part X GATHERING CLOUDS -- NEW TYPES OF MEDICAID SERVICE ARE NOT REQUIRED FOR THOSE SEEKING HOME CARE -- Rodriguez v. City of New York (1999) -- INSTITUTIONALIZATION IS NOT A PREREQUISITE FOR INDIVIDUALS TO BE COVERED BY TITLE II: REDUCING BENEFITS TO THOSE OUTSIDE OF INSTITUTIONAL SETTINGS WHILE MAINTAINING BENEFITS TO THOSE IN INSTITUTIONAL SETTINGS: FISHER V. OKLAHOMA HEALTH CARE AUTHORITY (2003) -- ACCESS TO QUALITY CARE IN COMMUNITY SETTINGS: BALL V. BIEDESS (2004) -- Part XI RECHARTING THE COURSE -- CONCLUDING THOUGHTS -- CHECKLIST OF CHALLENGES -- FORECAST SUMMARY -- Forecast: Ask the Hard Questions -- Forecast: Don't Forget the Beneficiaries -- Forecast: Prepare to Navigate Choppy Waters and Difficult Storms -- Forecast: Look for the Favorable Winds -- Forecast: Keep the Deliberations Fair -- WORDS FOR SAFE TRAVEL -- Appendix 1.A. COMPARING CAREGIVER CHARACTERISTICS BY AGE OF RECIPIENT -- Appendix 1.B. DEMOGRAPHIC PROFILE OF CAREGIVERS BY AGE OF RECIPIENT -- Appendix 1.C. FEDERAL DEMONSTRATIONS -- Appendix 1.D. OVERVIEW OF CASH AND COUNSELING DEMONSTRATIONS -- Appendix 1.E. 50 STATES, THE DISTRICT OF COLUMBIA, AND U.S. TERRITORIES WITH INITIATIVES TO IMPROVE ACCESS TO LONG-TERM CARE SERVICES -- Appendix 1.F. FEDERAL TABLES (CONTINUED ON NEXT PAGE) -- Appendix 1.G. CONGRESSIONAL OVERSIGHT OF FEDERAL PROGRAMS -- INDEX -- Blank Page.

Some people say that a picture is worth a thousand words. The field of management often uses a "rich picture" systems methodology, "an innovative tool that encapsulates knowledge relevant to strategic reform". It is often described in the management literature as a "soft systems methodology" for linking hard and soft facts in a cartoon-like representation to illustrate a complex problem simply and clearly. The following research is presented using the rich picture methodology to capture the current long-term care and long-term services and supports (LTSS) crisis. The picture and narrative rely on expert research from the past and present, as well as on one-on-one open-ended interviews with key stakeholders in the fields of disability, long-term care, and health care. The setting for the rich picture is the ocean, with the current LTSS ship heading toward an iceberg that represents the barriers and challenges to systems reform. The "cast" for this rich picture will provide the substantive descriptions and body of research and analysis about the barriers and challenges of navigating through the current system of LTSS.The presentation of the research is purposeful, so that the reader and the researcher can begin the voyage together with a snapshot of the problem. The purpose of this research is to produce new knowledge and understanding of current experience with and future need for affordable LTSS for people with disabilities. This research on the State of LTSS Financing and Systems Reform is the first part in a five-part series that will tell the story of the current LTSS system to set the stage for the exploration of future market demands and current gaps in supply; to explore promising state practices and challenges; and to picture what the 21st century's comprehensive, consumer-responsive system might look like and make policy recommendations.

The research is based on five assumptions. First, people with disabilities, whether young or old, desire and deserve choices when seeking assistance with daily living that maintains their self-determination and maximum dignity and independence. Second, the current financing mechanisms (public and private) will become unsustainable in the near future without significant reform.The system must be affordable to all Americans regardless of income levels and must consider opportunities to leverage public and private support in new ways without impoverishing beneficiaries. Third, there is an opportunity with the changing demographic picture of the United States to explore the possibilities of a universal approach to the design and financing of services and supports that is responsive to individuals under the age of 65, as well as seniors with disabilities, without sacrificing individual choice and flexibility. Fourth, formal and informal caregiving must be sustained, examining family needs and workforce recruitment and retention challenges. Fifth, the approach to quality must examine consumer direction and control of resources in addition to traditional external quality assurance mechanisms.

Description based on publisher supplied metadata and other sources.

Electronic reproduction. Ann Arbor, Michigan : ProQuest Ebook Central, 2024. Available via World Wide Web. Access may be limited to ProQuest Ebook Central affiliated libraries.