Position Statement

Long Term Care

The intent of this position statement is to acknowledge that there is a critical need to improve the long-term healthcare delivery system. This position offers key aspects of a comprehensive long-term care policy to positively affect this pressing challenge.

Position

It is the position of the New York State Nurses Association that:

Priorities of the healthcare system should focus on the client as an individual regardless of gender, age, race, ethnicity, education and income levels, disability, geographic location, sexual orientation, or healthcare setting.
Registered nurses play a central role in the delivery of care to improve the health and well-being of the long-term care patients.
Long-term care services must be available, accessible and affordable to all those who need them.
Long-term care services should be easily accessible and maintenance in the system must be simplified and streamlined.
Long-term care is becoming increasingly complex and requires attention and direction from the nursing profession.
Long-term care requires specialized health teaching and guidance to patients and caregivers.
Long-term care must be provided within a framework reflecting patients’ cultures, needs and wishes.
Long-term care must be based upon an integrated health and social model that requires nursing involvement in assessment and management of care. The model must recognize the multi-disciplinary needs of long-term care patients and provide the patient and caregivers with options related to care settings.
Long-term nursing care utilizes a holistic approach to recognizing the priorities and meeting the needs of the individual within a caring environment.
Long-term nursing care is committed to the delivery of safe, quality, patient focused, comprehensive and humane services to each patient with the goal of maximizing each individual patient’s functional capacity.

Background

Needs for long-term care present a challenge to society throughout the entire life cycle. The current population shifts, changes in medical technology and patterns of illness, and the increasing tendency toward community-based care have created an increased need for long-term care services, particularly in selected patient populations:

infants and children with birth defects;
adolescents and young adults surviving incapacitating injuries;
the able, disabled and frail elderly;
persons with AIDS, Alzheimer's and the chronically ill of all ages;
persons with mental illness or psychiatric disorders; and
persons in need of sophisticated technological supports (Hirschfield, 2004).

The current healthcare delivery system in this state and nation fails to meet the long-term care needs of these diverse populations. Policymakers struggle with an inability to decide on the best scope, mix, quality and method of financing long-term care (Feder, Komisar & Niefeld, 2000).

Chronic disability is accompanied by alteration in physical abilities, psychological challenges and/or changes, increased risk of illness, altered family relationships, social isolation and financial burdens. Previously, the financing and provision of health care has been focused on acute care and, hence, has not sufficiently recognized the needs of the chronically ill, persons with disabilities, elderly and terminally ill who require long-term care.

Long-term care embraces a wide array of medical, nursing, social and personal support services required by individuals who have never developed or have lost some capacity for self care. The multifaceted nature of long-term caregiving may result in the need to sustain caregivers and the caring environment.

A long-term plan of care must focus on physical, mental, and social health promotion; health maintenance; and illness prevention. Essential to the care planning and delivery processes is inclusion of the goals and objectives of the patient and caregivers (Hirschfield and Wikler, 2003-2004). Care should be coordinated by members of the healthcare team.

Individuals requiring long-term care each have their own level of wellness that includes their personal strengths, abilities and coping mechanisms coexisting with their care needs. This is often not acknowledged in healthcare planning, as the present long-term care system is fragmented and uncoordinated. There is confusion and a lack of information about the services that are presently available. The excessive costs of institutionalized care can quickly exhaust the individual’s, family's and system's resources. Acute care centers focus on resolving immediate medical conditions; patients actually recover elsewhere. The caregiving efforts of families and others are largely unrecognized and unsupported in the present healthcare system. Persons in need of sophisticated technological support(s) present a significant challenge to the long-term care delivery system. Lastly, due to the negative image of long-term care and disparities in pay as compared to acute care settings, it is difficult to attract professional nurses and other healthcare providers into this practice field.

Recommendations

The New York State Nurses Association recommends the implementation of a comprehensive long-term health care policy, which should include:

Universal coverage and ease of access to necessary services.
A process in which maintenance of services is simplified and streamlined.
Advocacy programs that educate the public on long-term care options and facilitate entry into the system.
Opportunity for the patient to choose which long-term care option(s) they prefer.
A coordinated, planned approach to setting priorities and making policy.
Optimal utilization of financial and other available resources.
The provision of care in the home setting for as long as it is feasible and meets safety, patient choice, resource and cost-effectiveness standards.
A systematic method of classifying needs for patients in all settings to assist in the development of reimbursement mechanisms.
Policy and financial support for preventive care.
A mechanism within which functional status constitutes the basis for determining the need for long-term care rather than specific medical diagnoses.
A process to ensure continuity and coordination of care between settings and caregivers.
Provisions to maximize support systems for family and other caregivers including community-based services and respite care.
The development of alternate long-term healthcare delivery methods and models.
Incentives to attract appropriately prepared caregivers and health professionals into this area of practice.
Funding for curriculum development which emphasizes long-term care in all healthcare professions and also provides for faculty development in this area of practice (Wunderlich & Kohler, 2001).

Note: The use of the term “patient” anywhere in this document is intended to be generic and reflects that of the patient, resident or client.

Approved by NYSNA Board of Directors on 8/30/90; reviewed 8/2/94; reviewed and revised by NYSNA Expanded Council on Nursing Practice on 12/02/05; approved by NYSNA Board of Directors on 01/11/06.

References

Feder, J., Komisar, H. L., & Niefeld, M. (2000). Long-term-care in the United States: an overview. Health Affairs, 19(3), 40-56.

Hirschfeld, M. J. (2004). Demography is destiny. Caring, 23(1), 6-9.

Hirschfield, M. J. & Wiker, D. (2003). An ethics perspective on family caregiving worldwide: justice and society’s obligations. Generations, 2003-2004 Winter, 27(4), 56-60.

Wunderlich, G. S. & Kohler, P. O. (Eds.). (2001). Improving the quality of long-term care. Washington, DC: National Academy Press.

For more information on nursing practice, contact NYSNA's Education, Practice and Research Program at 518.782.9400, ext. 282 or by e-mail.