美國長期照顧體系之發展趨勢

The Trends of Long-Term Care System in America

李宗派(Isaiah C. Lee)

《臺灣老人保健學刊》 9卷1期 (2013/06) Pp. 1-19

摘要

這一篇文章之目的係為探討美國長期照顧體系之發展趨勢與問題。在前言界定長期照顧之概念。第一部分描述美國老年人口之社會經濟特徵；人口特性與地理分佈、種族、教育、語言、工作收入與醫療給付概況。第二部分討論長期照顧的需要者。第三部分討論長期照顧之提供者，包括非正式與正式照顧者。第四部分討論長期照顧之付費者，包括照顧費用、公共財政支援、現金花費、長期照顧保險、家庭照顧者與監察仲裁人之角色。第五部分討論長期照顧之服務場所：以家庭與社區為基礎的服務、居住生活協助照顧與機構式之療養院所。第六部份探討長期照顧之發展趨勢；照顧需求大量增加、女性老人增多、照顧成本與照顧費用大幅提升、照顧人才缺乏需雇外勞、長期照顧保險昂貴、政府醫療救助加倍、重視家庭與社區照顧、醫療保健與社會服務體系之協調整合。結論則強調長期照顧體系與全民健康保險制度必須改革，產官學之長期照顧專才與民意代表必須合作，來制定適合現代化之照顧法令與政策，營利財團與慈善社團必須學習現代之服務哲學與倫理、照顧方法與技術、爭取被照顧者家屬之合作，才能提供符合人性之照顧服務。

關鍵字

嬰兒潮 ； 正式照顧者 ； 老人醫療保險 ； 醫療救助 ； 金錢跟人走方案 ； 老人照顧綜合方案

並列摘要

The purpose of this paper is to discuss the trends of long-term care system and services in the United States. The definition of long-term care is described as a variety of services that includes medical and non-medical care to people who have a chronic illness or disability. Long-term care helps meet health or personal needs. Most long-term care is to assist people with support services such as activities of daily living like dressing, bathing, and using bathroom or preparing meals, managing money or shopping etc. (ADLs and IADLs). The first section presents social-economic characteristics of aging population. There are 315,556,673 people in the United States. In 2010, there were 40.3 million Americans age 65 and older accounting for about 13% of the total U.S. population. The geographic, racial, education and income distribution of aging population as well as the Medicare and Medicaid payments will be discussed in this section. The second section discusses who needs and who uses long-term care? Over 12 million Americans need long-term care to assist them with daily activities; this includes 10.9 million community residents and 1.8 million nursing home residents. The third section discusses who provides long-term care? Approximately 87% of Americans who need long-term care receive it from informal, or unpaid, caregivers. Between 70% and 80% of paid long-term care in the U.S. is provided by direct care workers, which include home health aides, certified nursing assistants, and personal care aides. The fourth section discusses who pays for long-term care in the U.S.? In fiscal year 2010, the total spending (public, out-of-pocket and other private spending) for long-term care was $207.9 billion, or 8% of all U.S. personal health care spending. The long-term care costs in 2012, public financing, out-of-pocket spending, private long-term care insurance, and the roles of family care givers as well as LTC Ombudsman will be discussed. The fifth section discusses where is long-term care provided? The majority (89%) of Americans age 50 and older want to remain in their homes for as long as they can. The Home-and Community - Based Services has been emphasized. When those individuals cannot stay at their homes would be sent to residential care facilities, such as assisted living facilities. When they need more intensive care, they would be admitted to Institutional Long-Term Care settings. As of March 2012, there were 15,690 nursing homes in the U.S. There were about 1.4 million residents in certified nursing homes. The sixth section presents the trends and demands for long-term care services. Baby boomers (those born between 1946 and 1964) will turn 65 between 2011 and 2029. During this time, 10,000 Americans will turn 65 every day. The growing demand for long-term care in the U.S. is overwhelming great. The cost of long-term care becomes higher and higher. The long-term care insurance becomes expensive and the large majority of Americans cannot afford to buy and they have to depend on Medicaid. The conclusion emphasizes that long-term care system with health care reform needs the joint efforts of policy makers, professional practitioners, care-givers, and general public to work together to reform it.

並列關鍵字

Baby boomer ； formal caregiver ； Medicare ； Medicaid ； MFP ； PACE