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Reforming long-term care in the United States: findings from a national survey of specialists
- Authors:
- MILLER Edward Alan, MOR Vincent, CLARK Melissa
- Journal article citation:
- Gerontologist, 50(2), April 2010, pp.238-252.
- Publisher:
- Oxford University Press
Theories of the policy process recognise that policy proposals are typically generated, debated, redrafted, and accepted for consideration through the gradual accumulation of knowledge within communities of specialists. This study, designed to inform long-term care (LTC) reform efforts, consisted of a Web-based survey of 1,147 LTC specialists within the United States. Participants included consumer advocates, provider representatives, public officials, policy experts, and others with experience in LTC. Findings showed that although differences could be discerned, group views converged in several areas: there was general agreement that LTC financing needed to be socialised more and that impediments to organisational change needed to be overcome; respondents felt that LTC needed to be rebalanced toward home- and community-based settings, though few supported doing so by limiting nursing home (NH) bed supply; most believed that the approaches used to oversee NHs should also be applied to assisted living. Payment incentives were highlighted as the most effective strategy for improving quality even though it suffers from the same informational deficits compromising consumer reporting. The authors conclude that by giving voice to those who know LTC very well, and identifying areas of agreement and disagreement, this study should prove useful in promoting LTC reform where it might otherwise remain politically intransigent.