Ten percent of the Texas population is 65 and older. The state has a large, rapidly growing elderly population, estimated to reach 4.4 million, or 16.1% of the state's total population in 2025. Medicaid spending for long-term care in FY2001 was $3.3 billion -- 28.5% of all Medicaid spending. Medicaid spending for institutions was more than 70% of Medicaid long-term care spending and more than 20% of all Medicaid spending in F Y2001. Spending for home and community-based services has increased rapidly in recent years and represented 29.2% of Texas long-term care spending in FY2001, primarily due to increased use of the Medicaid Section 1915(c) home and community based waiver program. From FY1990 to FY2001 spending for this program increased from less than 1% to over 21% of all Medicaid long-term care spending in Texas. Texas provides a wide range of services in the home and community to about 100,000 adults with disabilities. Despite this, the state has significant overcapacity in its nursing home industry. As a result, the nursing home occupancy rate is quite low -- 68.5% in 2000. The state continues to serve many persons with developmental disabilities in large state institutions and has no plans to close any facilities in the foreseeable future. Interviews with state officials and a review of state reports highlighted a number of issues including: an imbalance in Medicaid financing favoring institutional care, rather than home and community-based care; a shortage of frontline long-term care workers; and waiting lists for home and community-based services.

Among the issues confronting America is long-term care for frail, older persons and others with chronic conditions and functional limitations that limit their ability to care for themselves. Improving the Quality of Long-Term Care takes a comprehensive look at the quality of care and quality of life in long-term care, including nursing homes, home health agencies, residential care facilities, family members and a variety of others. This book describes the current state of long-term care, identifying problem areas and offering recommendations for federal and state policymakers. Who uses long-term care? How have the characteristics of this population changed over time? What paths do people follow in long term care? The committee provides the latest information on these and other key questions. This book explores strengths and limitations of available data and research literature especially for settings other than nursing homes, on methods to measure, oversee, and improve the quality of long-term care. The committee makes recommendations on setting and enforcing standards of care, strengthening the caregiving workforce, reimbursement issues, and expanding the knowledge base to guide organizational and individual caregivers in improving the quality of care.

An enlightening review of the successes and failures of several federally funded community-based projects that offered elderly persons an alternative to nursing home care. Policymakers, caregivers, and students of public administration and gerontology must read this valuable book.

Covering the full spectrum of long-term care, Pratt’s Long-Term Care: Managing Across the Continuum, Fifth Edition is an ideal introduction to management in this dynamic industry. Concise, yet complete, it begins with a look at recent changes in long-term care and health care reform, before examining the various long -term care providers and their interaction with competition, payment systems, quality, and ethical issues. It moves on to explore managing in the long-term care system looking at administration, leadership, culture change, technology and community relations, and concludes with a look at future trends and managing continuing change. The Fifth Edition is a comprehensive revision reflecting new Federal Requirements of Participation from CMS for skilled nursing facilities and changes the Medicare-fee-for-service payment system (PDPM). It also addresses the Affordable Care Act and its impact on long-term care, as well as the growth of technology in care, and more.