Chapter 3
Toward an Ideal System
Learning Objectives
1. Identify the characteristics of an ideal
long-term care system
2. Describe what it means for the long-term
care system to be consumer-driven
3. Identify the roles of formal and informal
caregivers
Learning Objectives (continued)
4. Define the components of a full and
uniform assessment of a consumer's
service needs
5. Discuss the need for incentives for
providers and consumers
The Criteria for Designing or
Evaluating a Long-Term Care System
What are they?
How were they developed?
How are they used?
Criterion I. The long-term care system should
be based on recognition of the needs, rights,
and responsibilities of individuals.
It should:
A. Be consumer driven
B. Meet all of the needs of the consumers
C. Focus on the individual, recognizing that
individuals have unique needs
D. Respect different cultures and cultural
values
Criterion I (continued)
It should:
E. Promote quality, dignity, and self-
improvement for consumers
F. Balance consumer rights and
responsibilities
G. Offer consumers a choice of service
providers and service delivery modalities
Criterion II. The long-term care system should
be easily accessible.
It should:
A. Be universally accessible
B. Be user friendly
C. Provide care in the least restrictive
environment
D. Encourage single-site care availability
Criterion III. The long-term care system should
coordinate professional, consumer, family, and
other informal caregiver resources.
It should:
A. Integrate professional, community, family,
and other informal caregiver efforts
B. Evolve from the current medical model to
a holistic model of service delivery
C. Involve families in case management and
care delivery
Criterion IV. The long-term care system should
be an integral part of the health and social
system to promote integration, efficiency,
and cost-effectiveness.
It should:
A. Include a full continuum of services
B. Include a full and uniform assessment
(initial and ongoing) of the consumer's
needs.
Criterion IV. (continued)
It should:
C. Provide emphasis on, and reimbursement
for, illness prevention efforts as an
integral part of the overall system
D. Be planned and coordinated to reduce
fragmentation and inefficiencies
E. Be based on outcome-oriented
accountability
Criterion V. The long-term care system should be
adequately and fairly financed.
It should:
A. Utilize public and consumer resources
to ensure universal access to services
B. Provide incentives for consumers to
use services in an appropriate and
cost-effective manner
C. Provide incentives for consumers to
self-finance their care
Criterion V. (continued)
It should:
D. Avoid causing impoverishment of consumers
and families
E. Provide incentives for providers to develop
cost-effective measures
F. Develop payment mechanisms that allow
efficient providers to adequately compen ...
Chapter 3Toward an Ideal SystemLearning Objectives
1. Chapter 3
Toward an Ideal System
Learning Objectives
1. Identify the characteristics of an ideal
long-term care system
2. Describe what it means for the long-term
care system to be consumer-driven
3. Identify the roles of formal and informal
caregivers
Learning Objectives (continued)
4. Define the components of a full and
uniform assessment of a consumer's
service needs
5. Discuss the need for incentives for
providers and consumers
The Criteria for Designing or
Evaluating a Long-Term Care System
2. Criterion I. The long-term care system should
be based on recognition of the needs, rights,
and responsibilities of individuals.
It should:
A. Be consumer driven
B. Meet all of the needs of the consumers
C. Focus on the individual, recognizing that
individuals have unique needs
D. Respect different cultures and cultural
values
Criterion I (continued)
It should:
E. Promote quality, dignity, and self-
improvement for consumers
F. Balance consumer rights and
responsibilities
G. Offer consumers a choice of service
providers and service delivery modalities
3. Criterion II. The long-term care system should
be easily accessible.
It should:
A. Be universally accessible
B. Be user friendly
C. Provide care in the least restrictive
environment
D. Encourage single-site care availability
Criterion III. The long-term care system should
coordinate professional, consumer, family, and
other informal caregiver resources.
It should:
A. Integrate professional, community, family,
and other informal caregiver efforts
B. Evolve from the current medical model to
a holistic model of service delivery
C. Involve families in case management and
care delivery
Criterion IV. The long-term care system should
be an integral part of the health and social
4. system to promote integration, efficiency,
and cost-effectiveness.
It should:
A. Include a full continuum of services
B. Include a full and uniform assessment
(initial and ongoing) of the consumer's
needs.
Criterion IV. (continued)
It should:
C. Provide emphasis on, and reimbursement
for, illness prevention efforts as an
integral part of the overall system
D. Be planned and coordinated to reduce
fragmentation and inefficiencies
E. Be based on outcome-oriented
accountability
Criterion V. The long-term care system should be
adequately and fairly financed.
It should:
A. Utilize public and consumer resources
to ensure universal access to services
B. Provide incentives for consumers to
5. use services in an appropriate and
cost-effective manner
C. Provide incentives for consumers to
self-finance their care
Criterion V. (continued)
It should:
D. Avoid causing impoverishment of consumers
and families
E. Provide incentives for providers to develop
cost-effective measures
F. Develop payment mechanisms that allow
efficient providers to adequately compensate
staff and to allow for appropriate operating
surplus and/or return on investment
Criterion V. (continued..)
It should:
G. Operate within the limits of a well-
conceived budget
H. Provide significant flexibility to enable
consumers to meet long-term care needs
as each consumer defines those needs
6. I. Be based on uniform financial eligibility
criteria
Criterion VI. The long-term care system should
include an education component to create
informed consumers, providers, reimbursers,
and regulators.
It should:
A. Include community education
B. Include education for providers
C. Educate young, healthy persons to better
prepare them to cope with chronic illness
Summary
The Criteria provide a basis for evaluating
the current long-term care system and for
developing an ideal long-term care system.
Slide 1Learning ObjectivesLearning Objectives
(continued)Slide 4Slide 5Criterion I (continued)Slide 7Slide
8Slide 9Criterion IV. (continued)Slide 11Criterion V.
(continued)Criterion V. (continued..)Slide 14Summary
Long-Term Care: Managing Across the Continuum, Fourth
Edition
7. John R. Pratt
CHAPTER THREE: TOWARD AN IDEAL SYSTEM
CHAPTER HIGHLIGHTS
Introduction
The basis for our discussion is a document titled Criteria for
Designing or Evaluating a Long-
Term Care System developed by Saint Joseph’s College of
Maine. Use the Criteria as a
foundation for construction of a long-term care system as it
should be.
only when taken as a whole
that they represent an optimum system.
overlapping of criteria, but that serves
to emphasize the importance of certain aspects of long-term
care.
inst which a
long-term care system should
be measured.
identifying the benchmarks a system
9. C. Focus on the individual, recognizing that individuals have
unique needs
It should be flexible enough to recognize those needs, including
the psychological, social,
and financial limitations of recipients of services.
D. Respect different cultures and cultural values
The system should recognize these differences and attempt to
accommodate them.
E. Promote quality, dignity, and self-improvement for
consumers. In doing this, it should
1. Value older adults and those with chronic disabling
conditions
2. Promote a positive approach to living with chronic illness
and dependency
3. Allow care recipients to continue to contribute to life and
society
4. Promote the highest achievable level of functioning
F. Balance consumer rights and responsibilities
Consumers of long-term care services and their families should
be allowed and
encouraged to participate in the continuum of care, including
making care-related
11. delays in service.
C. Provide care in the least restrictive environment
The long-term care system should facilitate the provision of
care in the setting and
service modality that will provide the best combination of
appropriate care, quality of
life, and cost-effectiveness.
D. Encourage single-site care availability
The system should be designed to provide, to the degree
possible, all necessary services
without requiring the consumer to access multiple sites and/or
providers.
Criterion III. The long-term care system should coordinate
professional, consumer, family,
and other informal caregiver resources. It should
A. Integrate professional, community, family, and other
informal caregiver efforts
The various sources of support should be coordinated to take
fullest advantage of their
availability.
Chapter 2
14. 2. A focus on results as they affect quality of life rather than a
focus on documentation
3. Incentives to improve quality of services rather than
inspecting for quality
4. Consistent development and application of standards
5. Outcome-oriented versus process-oriented accountability
6. Flexibility that encourages innovation and change
Criterion V. The long-term care system should be adequately
and fairly financed. It should
A. Utilize public and consumer resources to assure universal
access to services
All available resources, public and private, should be
considered in providing services for
current and future consumers.
B. Provide incentives for consumers to use services in an
appropriate and cost-effective
manner
The overall cost of the system can be controlled by avoiding
excessive and unnecessary
use.
C. Provide incentives for consumers to self-finance their care
16. staff and to allow for appropriate operating surplus and/or
return on investment
Both the for-profit and not-for-profit sectors should continue to
have significant roles in
the long-term care system.
G. Operate within the limits of a well-conceived budget
H. Provide significant flexibility to enable consumers to meet
long-term care needs as each
consumer defines those needs
The financing of the system should reflect the needs of
individuals (as reflected in
Criterion I).
I. Be based on uniform financial eligibility criteria
Criterion VI. The long-term care system should include an
education component to create
informed consumers, providers, reimbursers, and regulators. It
should
A. Include community education
The public should be informed about long-term care, including
available service options,
limitations, and access methods.
Chapter 2
18. Page2
Sample A. This sample reflects on a personal research
experience and analyses how that research may be improved
given the knowledge gained from the unit.
Reflective essay
I conducted a research on maternal health of the women in
Nepal. The overall goal was to improve the maternal health in
Nepal. I think that I was a positivist researcher. I worked on the
research by assuming lack of proper health care at local level as
the reason behind the public health issue. Firstly, I collected the
data of total number of women of age group 15-45 age from the
local government, visiting the local health post and find out the
number of pregnant women visiting for ante-natal check-ups,
collect the record of women suffering from pregnancy related
complications from local hospitals, number of deliveries
conducted in health facilities by skilled birth attendant and so
on. Furthermore, I had selected deductive method and visited
some family of the specific area and organize one to one
structured interview with the pregnant women. My questionaries
for interview would be (a) Are you satisfied with the health care
which you get in your area? (b) How many times you are
planning to visit health post for ante -natal check-ups? (c) Are
you facing any reproductive problem? After the detail
information, I made the conclusion that lack of access to health
facility is the main reason of poor maternal health of Nepal and
report the issue to the local government and with collaboration
with the local authority and improve the quality of maternity
care in local health posts, increase the number of health facility
in local areas and provide free treatment of the pregnancy
complications.
But, as a result of my learning in Participatory Health Research
19. unit in my second semester of Master of Public Health, I found
my previous research concept as ineffective approach for the
main goal of the project to improve the maternal health of
women in Nepal by ground root level. Now, I feel that…
THE STUDENT GOES ON TO LIST THE
LIMITATIONS OF THE RESEARCH APPROACH
SUPPORTING THESE LIMITATIONS WITH EVIDENCE
TAKEN FROM THE UNIT READINGS.
From the knowledge and practice on the research pursued in the
second semester of my Master’s degree, I realized that my
research process was not appropriate and choose the
participatory health research design to address the issue of poor
maternal health in Nepal. In my concept, maternal health is not
only affected by availability of health facility in the area but is
affected by variety of factors like awareness, education, money,
culture, power, empowerment, and status of women. First, I
would…
THE STUDENT THEN PROPOSES A RESEARCH
DESIGN INCLUDING A DESCRIPTION OF RESEARCH
ACTIVITIES SUPPORTED BY EVIDENCE TAKEN FROM
THE UNIT AND ADDITIONAL READINGS.
From the learnings, readings, lectures, and practice in
Participatory Health research unit, I came to know that same
research approach and method are not effective in every
community and group of people. So, it is necessary to choose
the appropriate research approach, design according to the need
of community considering culture, lifestyle, behaviour, history,
and nature. In the same way, I would like to conduct research
project among the indigenous community by being flexible and
adopting the cooperative method which is acceptable by them…
LIKE ABOVE, THE STUDENT EXPLAINS THE
PROCESSES TAKEN TO CONDUCT RESEARCH WITH AN
INDIGENOUS COMMUNITY.
20. Sample B. This sample reflects on concepts learned in the unit
and how these concepts may be applicable in the future.
RESEARCH POSITIONALITY PAPER
Researcher positionality is identified as a result of their
paradigms. Paradigms include the ontology, epistemology, and
axiology of the researcher. What the researcher thinks the
nature of the reality, how they position themselves in the
research, and what they think inherently valuable in their life
comes under their positionality. The positionality of the
researcher influences the whole research design, process, and
interpretation of the research findings. Therefore, the researcher
must be aware of their values, beliefs, and experiences to know
the type of research they want to conduct.
Frankly speaking, a paradigm was a new term for me when I
started to learn about it during this term. Previously, I haven’t
read and thought that the position of the researcher can also
determine the whole research process. But if I have to say about
my paradigm before commencing this term, I would say I
believed in realism and had an etic approach. I was more
exposed to the traditional research approach. Therefore, I used
to think that the research is conducted only to find the cause-
and-effect relationship, what cause the problem and find
solutions to those problems existed in society (Baum, 2016)…
THE STUDENT THEN GOES TO UNPACK AN
EXAMPLE OF AN EPIDEMIOLOGICAL STUDY, NOTING
THE QUALITIES THAT REFLECT A POSITIVIST
PARADIGM.
After learning the participatory health research, my
positionality as a researcher is changed. I understand that the
participation of the people is very important and their voices
should be heard in order to make any research meaningful
(Heron, 1997). Now, I have a paradigm and
21. my positionality
is
relativist ontology and an
emic epistemology.
THE STUDENT PROPOSES A RESEARCH
PARADIGM INCLUDING A DESCRIPTION OF RESEARCH
ACTIVITIES SUPPORTED BY EVIDENCE TAKEN FROM
THE UNIT AND ADDITIONAL READINGS
The anti-oppressive approach helped me to understand that the
voice of the people needs to be heard to eliminate the hegemony
that exists in society. Community members can be empowered
to bring any changes, their similarities and the differences of
the community experience can be recognized with this
approach. We need to develop a culturally safe lens as a
researcher to consider the unique needs and strengths of every
people in the community. Brooks (2014) mentioned that the
cultural safety lens views the individual in their location,
related to colonial marginalization, moving beyond cultural
sensitivity to an analysis of power imbalance.
THE STUDENT EXPLAINS AN APPLICATION OF
AN ANTI-OPPRESSIVE APPROACH TO CONDUCT
RESEARCH WITH AN INDIGENOUS COMMUNITY WITH
EVIDENCE TAKEN FROM THE UNIT READINGS.
