Long-Term Care in North Carolina

Abstract

Much of long-term care is not considered health care, as it is custodial, social, and supportive. But excellent longterm care is also preventive, timely, and accessible, and it provides space for long-term care recipients to find joy and meaning in their lives. This issue of the NCMJ provides a broad overview of long-term care, practical information about programs in our state, and tips for how to make use of these programs. Commentaries and sidebars in this issue also highlight new ideas, innovation, and transformation.This issue brief sets the stage by describing major events that have shaped the current framework of long-term care services and supports. It also discusses current trends that are influencing long-term care, including the emphasis on quality improvement methods, culture change, health care reform, the influence of geriatrics in primary care, and the desire for home-based care. Although we are not yet where we want to be in North Carolina, we are moving toward a long-term care system that will serve all North Carolinians well. Long-term care is an important aspect of health care, and the need for long-term care is increasing. The projected growth rate (as a percentage of the 2012 population) for individuals 85 years of age or older in North Carolina is 97% from 2012 to 2032, and 269% from 2032 to 2050; both of these estimates are well above projected national rates, which are 69% and 224%, respectively [1] (see Figure 1). In addition to the frailty and disability that are prevalent among these "oldest old" individuals, other factors that affect the need for long-term care services include living alone and the frailty of family caregivers, many of whom are spouses and who experience high rates of emotional and physical stress. Older people are less likely than children and working-age adults to have household incomes below the federal poverty guidelines, but many of them, especially those aged 85 years or older, have incomes low enough that they qualify for public assistance with respect to long-term care supports and services.Ideally, long-term care should be defined broadly to include medical and nonmedical care that is provided in the community, in congregate housing, in a residential care facility (eg, assisted living), or in a nursing home. It should include transportation services, congregate and in-home meal services, social supports, and medication support services. Currently, the scope and nature of these services are changing to meet the needs of a diverse older adult population, and services are facing economic, regulatory, and alignment pressures as health care reform continues. Sadly, our medical schools, nursing schools, pharmacy schools, and other health professional training programs provide little exposure, experience, or explanation to prepare graduates to assist patients in navigating and utilizing these services.The articles in this issue of the NCMJ cover a lot of ground, and much of the content is practical information that can be shared with older adults and their families (...