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• W75922419 abstract "The ACA has key components to provide the building blocks for a better continuum of care- one that is person-centered, offers individual control, improves quality, and integrates care across settings and providers. The passage of the Patient Protection and Affordable Care Act (ACA) on March 23, 2010, lays the groundwork for wide-ranging reform of the continuum of care. This continuum, composed of the entire realm of primary, acute, rehabilitative medical, and supportive long-term-care services, is fragmented and unsustainable in its current form. The ACA affords us a vision of a future in which care is integrated across providers and settings. Many of the ACA's provisions focus on improving the delivery of care for individuals with chronic conditions and disabilities-people who interact often with the health and longterm- care systems. In 2009, 145 million people, or almost half of all Americans, were living with a chronic condition such as diabetes, heart disease, or dementia. People with chronic conditions are the heaviest users of healthcare services and account for 84 percent of healthcare spending. Although the majority of these individuals is under age 65, the likelihood of developing such conditions increases with age. Too often, individuals with chronic conditions are subjected to care that is poorly coordinated and results in misinformation, great difficulty in navigating the healthcare system, unnecessary services utilization, and, ultimately, higher costs (Anderson, 2010). This article describes a broad range of provisions within the ACA that aim to advance a framework and foundation for redesigning the healthcare delivery system to one that is personcentered, offers individual control, improves quality, and integrates care across settings and providers. Key provisions undergird health and long-term-care reform by improving the continuum of care within four domains: long-termcare insurance, home- and community-based services (HCBS) expansion, care coordination, and workforce reinforcement. Long-Term Care with CLASS This new era of system redesign begins with the ACA's CLASS (Community Living Assistance Services and Supports) provision, which, for the first time, provides members of the middle class with an affordable opportunity to plan for and access supportive services in their choice of setting without impoverishing themselves to the level of Medicaid eligibility. The CLASS program fundamentally reframes the concept of long-term care from one of poverty, sickness, and loneliness to one of choice, community, and personal responsibility in the face of functional impairment. A major challenge of the long-term-care system in its present state has been the inability of the near poor and the middle class to access the full range of available long-term-care services. The absence of comprehensive longterm- care financing, the low uptake of often costly private long-term-care insurance, and low savings rates among those nearing retirement have made the purchase of long-term-care services prohibitive for many individuals. To illustrate, eligibility for most publicly funded programs is restricted to those with the lowest income levels. Consider private long-term-care insurance: currently around six to seven million policies are in force, accounting for only about 7 percent of all long-term-care expenditures (Mulvey, 2011). Furthermore, about 42 percent of people in the United States ages 45 and older have saved less than $25,000 for retirement (Helman, Copeland, and VanDerhei, 2010). As a result, middle-class Americans are generally not prepared to pay the $6,000 per month for nursing home care or the $1,800 per month for part-time, in-home help (Genworth Financial, 2010). With so little saved, the middle class is particularly vulnerable, given the startling reality that 70 percent of Americans older than 65 will need long-term care at some point (Administration on Aging, 2010). …" @default.
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• W75922419 date "2011-04-01" @default.
• W75922419 modified "2023-09-24" @default.
• W75922419 title "The Affordable Care Act Proposes New Provisions to Build a Stronger Continuum of Care" @default.
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