By Geralyn Magan
A special issue of JAMDA provides a plethora of ideas for reimagining long-term care. Robyn Stone is a co-author of two articles.
We may never stop reimagining long-term care—”for better and for worse,” according to an editorial featured in a special issue on Reimagining Long-Term Care released in February 2022 by the Journal of Post-Acute and Long-Term Care Medicine (JAMDA).
“For better, because there’s always room for improvement and consumer desires will continue to evolve,” suggests the editorial, The Inevitability of Reimagining Long-Term Care. “For worse, because the absence of a ‘system’ of long-term care virtually ensures different visions … and partial progress at best.”
Robyn Stone, co-director of the LeadingAge LTSS Center @UMass Boston, is a co-author of both the editorial and an article in the special issue entitled “The Imperative to Reimagine Assisted Living.”
The special issue will be available to readers at no cost throughout 2022.
“While the articles in this special issue do not provide prescriptions for solutions, they are food for thought as providers go through these trying times and also engage in strategic planning about where to go in the future,” said Stone. “Some might find the special issue useful for their boards, for example, as they plan for the short and long term.”
A WIDE RANGE OF TOPICS
The authors of the editorial define a system as “a set of things working together as parts of a mechanism or an interconnecting network.” If long-term care were a system, they suggest, we would not have a situation in which “hospital costs to Medicare and nursing home costs to Medicaid were on a different ledger, or that specific models of care would be needed to improve and reduce transitions across care settings.”
The lack of a system makes long-term care incredibly complex, write the authors. The wide-ranging and interconnected collection of articles included in the special issue attests to that complexity.
“Each article in JAMDA’s special issue highlights a different topic, yet every article points to the interrelatedness of all topics,” the editorial points out.
The editorial groups the special issue’s articles into five categories and describes the range of topics discussed within each of those categories. Those topics are listed below.
Workforce
- Developing a national direct care workforce strategy that could be incorporated into federal funding and accountability mechanisms.
- Revisiting the availability of nurses in long-term care and augmenting their capacity by employing foreign-educated nurses.
- Creating a decisive role for nurse practitioners, after changing restrictive practice acts.
- Reimagining the role of physicians in assisted living.
- Encouraging technology use by families.
- Embracing a more family-centric perspective in residential long-term care.
- Focusing on respite for family members who provide care at home.
Societal Issues
- Addressing racial and ethnic disparities in long-term care.
- Using culture change to build trust and move away from a fear-based work culture.
- Creating a “just culture” that focuses on behavioral choices as well as outcomes for residents and clients.
Models of Long-Term Care
- Exploring broad recommendations and emerging international models of long-term care.
- Investigating the potential for collaboration of long-term care settings with hospitals and primary care providers.
- Reimagining assisted living.
Financing, Payment, and Regulation
- Envisioning a new federal long-term care benefit and its essential features.
- Providing a new vision for regulations related to architectural design.
Services in Residential Long-Term Care
- Reimagining infection control, relocations within long-term care, nutrition care and mealtimes, and palliative care.
THE NEVER-ENDING NEED TO REIMAGINE
The authors conclude their editorial by identifying what they feel is the most fundamental reason to focus “forever” on reimagining long-term care. Care and outcomes can never be optimal regardless our best efforts, they suggest, due to the physical, cognitive, and emotional challenges care recipients face. But that’s no reason to stop trying,
“Given these realities of the population served, how can we not want to reimagine the impossible?” they ask. “And so, we’ll forever be swimming upstream against a current of disability and loneliness, wanting to achieve what cannot be fully achieved and striving to create a system that better merges science, caring, and resources.”
READ MORE
Visit the JAMDA website to download the full special issue on Reimagining Long-Term Care or to read individual articles.