DR. NILABH TIRPUDE

2. DEFINITION- LTC is a verity of services which help in
meeting both“Medical and Non-Medical needs” of people
with “Chronic illness and Disability” who can not care for
themselves for long period of time (usually 3 months or
more than 3 months).
 Medical Needs provided in the form of Physical
therapy, drug therapy, nursing, and hospice care
(chronically, terminally, or seriously ill patients) by
health professionals.
 Non Medical needs provided for the person who can not
limits their ability to carry out their basic self care
tasks called “Activity of daily livings (ADL’s)” (Such as
bathing, dressing, and eating)or “Instrumental Activity
of daily livings (IADL’s)” (such as household chores,
meal preparation, and managing money).

3.  The immediate cause of population ageing is fertility decline.
However, improved longevity contributes as well, first by
eliminating the demographic necessity of high fertility, and
second by increasing the number of survivors to older ages. By
2050, life expectancy at birth is projected to surpass 80 years in
Europe, Latin America and the Caribbean, Northern America and
Oceania; and it will approach 80 years in Asia and 70 years in
Africa.
 ••Among today’s young people, survival to age 80 is expected to
be the norm everywhere but in Africa. Worldwide, 60 per cent of
women and 52 per cent of men born in 2000-2005 are expected
to survive to their 80th birthdays, compared to less than 40 per
cent of the women and men born in 1950-1955.
 ••As populations continue to age during the post-2015 era, it is
imperative that Governments design innovative policies
specifically targeted to the needs of older persons, including
those addressing housing, employment, health care, social
protection, and other forms of intergenerational support. By
anticipating these demographic shifts, countries can enact
policies proactively to adapt to an ageing population.

5.  Informal organization – most LT care is provided by
family and friends
 Each community may be different regarding
availability of services
 Ideal system – client oriented continuum of care.
Organization of LT Care

6. Types, services and supports in ltc
Types
 1. Formal care.
 2. Informal care.
 1.Formal Care
 This is also known as paid long term care services provided by
professionals, auxiliaries (health, social, and other workers) and by
traditional caregivers and volunteers either at home or institutions.
 These facilities may go under various names, such as nursing home,
personal care facility, residential continuing care facility, etc. and are
operated by different providers.
 Long-term care provided formally in the home, also known as home
health care, can incorporate a wide range of clinical services
(e.g. nursing, drug therapy, physical therapy) and other activities such as
physical construction (e.g. installing hydraulic lifts, renovating
bathrooms and kitchens). These services are usually ordered by
a physician or other professional.

7.  2.Informal Care
 Most long term care provided unpaid by family members,
partners, friends and neighbours, who provides care out of love,
respect, obligation or friendship.
 It is estimated that 90% of all home care is provided informally by
a loved one without compensation.
 Approximately 87% of Americans who need long term care (in
2009) receive it from informal or unpaid caregivers. In 2009, 69.7
million people in the US served as informal caregivers to an adult
or child. Of these, 43.5 million provided care to an adult age 50
and older.
 According to National Survey of Families and Households (U.S
Department of Health and Human Services) 52 million Americans
(31% of the adult population age 20 to 75) provide "informal care"
to a family member or friend who is ill or disabled. About 37
million of these caregivers provide help to family members and
about 15 million provide help to friends.

9. Financial
burden on
individuals
and
households
Physical
limitations
impacting
daily activities
Lack of stable
income
Public
expenditure
on
benefits/social
services
Implication
of ageing
Social/psycho
logical
implications
Age related
ailments

10.  Chronic – permanent or indefinite period of time
 Impaired – a decrease in or loss of ability to perform
 Disabled – short or long term; varies by age group
 Functional ability – person’s ability to perform the
basic activities of daily living
Who needs LT Care

11.  Target groups
 The emphasis throughout this report, in conformity with the definition of
long term
 care, is on the care of people of all ages who have long-term health
problems and
need assistance with the activities of daily living (ADL) in order to enjoy a
 reasonable quality of life. Target groups include:
 — people who are chronically ill, whether with communicable diseases
such as
 tuberculosis or with non communicable conditions such as cardiovascular
 diseases and cancer;
 — individuals with disabilities, regardless of etiology, including
developmental
 disabilities and disabilities caused by poliomyelitis;
 — people with HIV/AIDS;
 — people disabled by accidental injuries, e.g. victims of traffic accidents;
 — people with sensory limitations;
 — mentally ill individuals, including those suffering from depression and
dementia;
 — substance-dependent individuals;

12.  — victims of natural and other disasters;
 — perhaps most importantly, informal caregivers for any of the above,
such as
 family, friends, and neighbours.
 The circumstances and conditions that dictate how and where people
live may limit
 or extend the target groups — and thus their eligibility for services —
and may
 include:
 — income levels;
 — the degree or extent of family and informal support;
 — the participation of male and female informal caregivers in the
labour force and
 the distance between homes and workplaces;
 — whether the home is permanent, transient, or even unstructured (as
with
 homeless or street people, including unattached children and
adolescents); and
 — whether the home is in an urban or rural area, the impact of climate
and
 geography, and the strength of the local community infrastructure.

13.  Matches resources to patient’s condition
 Monitors the client’s condition and changes services
as needs change
 Coordinates care across disciplines
 Integrates care in a range of settings
 Enhances efficiency, reduces duplication, streamlines
patient flow
 Maintains comprehensive record keeping
What is Continuum of Care?

14.  Extended care
 Acute inpatient care
 Ambulatory care
 Home care
 Outreach
 Wellness
 Housing
NOTE: Not all LT care clients get this full range of care.
This is ideal that may offset or delay chronic illness.
Categories of Continuum of Care

15.  Institutional Long Term Care
 ‘As per WHO’ Institutional or residential long-term care is
defined as the provision of such care to three or more
unrelated people in the same place.
 It includes medical care, nursing care, physical therapy,
personal care, drug therapy etc.
 Community services
 This support services include adult day care, meal
programs, senior centres, transportation, and other
services. These can help people who are cared for at
home-and their families. For example, adult day care
services provide a variety of health, social, and related
support services in a protective setting during the day.
This can help adults with impairments such as ”Alzheimer's
disease” continue to live in the community, and it can give
family or friend caregivers a needed "break."
Services and Support

16.  Home care
 It can be given in own home by family members, friends, volunteers,
and/or paid professionals. This care can range from help with shopping
to nursing care.
 Some short-term, skilled home care provided by a nurse or therapist
called "home health care."
 Another type of care that can be given at home is hospice care for
terminally ill people.
 Supportive housing programs (SHELTER SERVICES)
 It offer low-cost housing to older people with low to moderate incomes.
The Federal Department of Housing and Urban Development (HUD) and
state or local governments often develop such housing programs. A
number of these facilities offer help with meals and tasks such as
housekeeping, shopping, and laundry.
 Continuing care retirement communities (CCRCS)
 It provide a full range of services and care based on what each resident
needs over time. Care usually is provided in one of three main stages:
independent living, assisted living, and skilled nursing.

17.  Nursing homes
 It offer care to people who cannot be cared for at home or in the
community. They provide skilled nursing care, rehabilitation
services, meals, activities, help with daily living, and supervision.
Many nursing homes also offer temporary or periodic care. This can
be instead of hospital care, after hospital care, or to give family or
friend caregivers some time off.
 intermediate care facilities
 It is home-like settings for mentally retarded. They provide a wide
variety of services to mentally retarded and developmentally
disabled people from youth to old age. Services include health care
services and treatment to help residents become as independent as
possible.
 Hospice & respite care
 Hospice is a program of care and support for people who are
terminally ill. It helps people who are terminally ill live comfortably.
The focus is on comfort, not on curing an illness.
 Respite care is a very short inpatient stay given to a hospice patient
so that their usual caregiver can rest.

18.  Hospitals
 Nursing homes (average costs $4,500 per month)
 Home health agencies
 Hospices
 Adult day service programs
 Housing organizations
Providers of LT Care

19.  WHAT W.H.O IS DOING
 Systems of LTC ( including palliative care) are
needed in all countries to met the needs of
older people. WHO has identified
3 approaches that will be crucial there are-
1.Establishing the foundation necessary for LTC.
2.Building and maintaining a sustainable &
appropriate work force.
3.Ensuring the quality of LTC.

20. TO SUPPORT THESE APPROACHES
1.Devlop guidelines , provides evidence based guidelines on
how to devlop expand & improve the quality of LTC services
with focus on less resouced settings.
2.Provides technical assistance & support to countries that are
introducing and expanding LTC services.
3.Devlpoing tools & training packages to streghtening formal
and informal caregivers.

21.  UK is on an extreme end of the spectrum, where healthcare is
predominantly financed by the government and delivered through
private facilities. There are experiences and learning that can be
drawn from this model.
 • Government’s role in both medical and non-medical care: UK is
one of the few countries with a structured financing mechanism by
the government for both medical (through NHS) and non-medical
care (through local bodies).
 However, the out-of-pocket component is higher for non-medical
care and is based on need
 • Income and need based approach to distribute funds: The means
assessment ensures that tax funds go to those most in need,
thereby
 ensuring effective allocation of resources and bringing parity in the
treatment available across the population.
 • Limited integration with private payers to drive elderly care: Lack
of private payers specifically for elderly and long term care has
resulted in limited Opportunities for govt. to share burden of care.

22.  In India, apart from government program,
various Non-government Organizations and
Trusts with collaborations with international
organizations and individuals from other
countries plays an important role for LTC in
term of palliative care, hospice, old age home,
etc.
LONG TERM CARE IN INDIA

23. The need for elderly care in India
Limited healthcare facilities
focusing on the elderly
Need of
elderly care
in India
Few avenues
(facilities/seats) providing
geriatric care training
Limited government
healthcare expenditure
on the elderly
Increase average life
expectancy
Limited flexible
insurance offerings
for the elderly
Shifting disease burden
towards those who
require prolonged
support
Changing family pattern
Lack of trained manpower
resources

24.  In India, apart from government program, various Non-government
Organizations and Trusts with collaborations with international
organizations and individuals from other countries plays an important
role for LTC in term of palliative care, hospice, old age home, etc. Pain
clinic and palliative care service under the department of
Anesthesiology at Gujarat Cancer and Research Institute , Pain clinics at
the Regional Cancer Centre, Trivandrum, with the assistance of a WHO
subsidy, Kidwai Memorial Institute of Oncology, Bangalore, Cipla
Cancer Palliative Care Centre in Pune, Guwahati Pain and Palliative
Care Society (GPPCS) in Assam, Can-support in Delhi, hospice like Shanti
Avedna Ashram, in Mumbai, Karunashraya Bangalore Hospice Trust,
and Bhakti Vedanta hospice are important organizations who plays an
important role in LTC’s.
 New concept of friendly neighbors who have been trained in palliative
care leads to “Neighborhood Network of Palliative Care (NNPC”) was
formed in 2001, provides holistic care.

25.  1. 1 LONG-TERM CARE AS A CENTRAL PART OF NPOP.
 2. 2 MULTI-MINISTERIAL COORDINATION
 At present, the draft national health policy 2015 (Para. 4.3.7.9) addresses long-term
care in the following manner:
 The elderly i.e. the population above 60 years comprise of 8.6 [per cent] of the
population (103.8 million) and they are also a vulnerable section. Those above 75
years (20.52 million) are most vulnerable and almost 8 per cent of the elderly
population is bed ridden or homebound (NSSO). India would need to develop its own
cost effective and culturally appropriate approach . . . to addressing the health and
care needs of the elderly. It would necessarily be a more community-centered
approach where care is provided in synergy with family support, with a greater role
for community level caregivers with good
 continuity of care with higher levels. A closely related concern is the growing need
for palliative care where in life threatening illness or in end of life contexts there [are]
active measures to relieve pain and suffering and provide support to the patient and
the family. Increasing access to palliative care would be an important objective, and
in this like for all geriatric illness, continuity of care across levels will play a major role.
 Recommendations to improve the focus on long-term care of older persons in India.

26.  3 INTEGRATING LONG-TERM CARE AS A COMPONENT OF UNIVERSAL
HEALTH CARE
 As India moves towards the goal of universal health coverage,
which is a goal of national policies and the 2030 Agenda for
Sustainable Development, there is an opportunity to integrate
long-term care within it from the outset. A number of countries
have addressed long-term care within universal health care
systems, whether tax-funded or through social insurance.
 This could be replicated in India to the extent possible and
allowed by resources.

27.  4 HUMAN RESOURCES TO ADDRESS THE NEEDS OF OLDER PERSONS
PARTICULARLY LONG-TERM CARE
 As long-term care needs grow with the ageing of the population, the care
economy will also grow. This care economy will require more workers with
specific human resource skills. In addition to an increased number of
geriatricians and stronger geriatric components in medical and nursing
curricula, the care economy will also require workers with skills in
rehabilitation and physiotherapy, as well as social workers, counselors, care
workers and care coordinators.
 As the number of older persons grows, the care economy could be a significant
sector of the labor force.
 5 BUILDING INTERGENERATIONAL SOLIDARITY
 A number of countries in the region have acknowledged the important role of
intergenerational solidarity in providing long-term care and support for older
persons, as reflected in the schemes and programmes they have implemented.
Volunteers from youth clubs as well as “younger” older persons are engaged in
providing volunteer care services at home for older persons. Intergenerational
support is a key element of a viable community-based long-term care system.