Changing the face of long-term care.

Long-term care (LTC) for older persons is based on the wrong foundations. It is too wedded to protection and not directed enough to maximizing personal goals. Tinkering at the margins will not suffice. Bigger, bolder steps are needed. A first step is to re-examine the goals of such care and the tools we have at hand to meet them. We need to re-examine the major elements of what we have taken for granted. A number of forces must be harnessed, and in some cases effort must be redistributed. Effective collaboration will depend on shared goals. Unless LTC is viewed as something that is desired, we will never receive more than reluctant support from any quarter. Good care must be seen as making a difference; that difference can be in function or in quality of life; it may be as subtle as slowing decline, but it must be made apparent to be appreciated.