Palley Howard A
School of Social Work, University of Maryland, Baltimore, MD 21201-1777, USA.
J Health Soc Policy. 2003;16(3):7-18. doi: 10.1300/J045v16n03_02.
This paper deals primarily with social policy considerations relevant to the development of long-term care policy for the frail elderly in the United States. However, it also includes some commentary on meeting the acute care needs of the frail elderly. It defines chronic care treatment as a mix of "short-term" and "long-term" modes of care. Furthermore, it explores the need for treatment of such long-term illnesses to recognize the importance of alternative modes of caring which include strategies, both medical and nonmedical, delivered within and outside of hospitals and nursing homes. The paper includes an analysis of public and private sector priorities based in data published by the U.S. Health Care Financing Administration. It also includes some discussion of the PACE program in the United States and some other efforts to stimulate more in-home and community-based alternatives to nursing home care. Furthermore, it includes a discussion of the policy goal of "appropriateness" in developing long-term care (as well as general health priorities) and provides a critical discussion of problems with utilizing "cost/benefit analysis." The study concludes that too exclusive a focus on nursing home care for the elderly in the United States is unfortunate-both in terms of the desires of the elderly, their families and friends and in terms of focusing on "appropriateness" as a legitimate policy goal in the development of long-term care policy for the elderly in the United States.
本文主要探讨与美国体弱老年人长期护理政策发展相关的社会政策考量。然而，它也包含了一些关于满足体弱老年人急性护理需求的评论。它将长期护理治疗定义为“短期”和“长期”护理模式的结合。此外，它探讨了治疗此类长期疾病的必要性，以认识到替代护理模式的重要性，这些模式包括在医院和疗养院内外提供的医疗和非医疗策略。本文基于美国医疗保健财务管理局公布的数据，对公共和私营部门的优先事项进行了分析。它还讨论了美国的PACE项目以及其他一些旨在推动更多居家和社区护理替代疗养院护理的努力。此外，它讨论了长期护理（以及一般健康优先事项）发展中“适当性”的政策目标，并对使用“成本/效益分析”的问题进行了批判性讨论。该研究得出结论，在美国，过于排他地关注老年人的疗养院护理是不幸的——无论是从老年人及其家人和朋友的愿望来看，还是从将“适当性”作为美国老年人长期护理政策发展的合理政策目标来看。
