Long-Term Care Challenges

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Long-Term Care Challenges

Long-Term Care Challenges

According to the Population Reference Bureau (2016), by the year 2060, there will be nearly 100 million Americans, age 65 and older, living in the United States. This increase in the aging population is expected to present several challenges to society, and it will likely disrupt many systems that are already in place. One problem that will be prevalent in the coming years as the population shifts towards a higher number of older adults is that older adults who need a higher level of care will be transitioned back into the community from hospitals or skilled nursing facilities due to a lack of available and appropriate housing. Inadequate income compounds this problem to pay for long-term care facilities, and a lack of funding by agencies such as Medicaid, since these programs will also be taxed by the increased population demand.

Knickman and Snell (2002) modeled the socioeconomic impact of the increase in older adults in the year 2030, and highlights the problems that will be faced by older adults and the systems that house and fund those with increased medical and personal needs. Specifically, these researchers note that the systems in place to address health and well-being will be specially taxed as the number of older adults in society increases.   Reports show that there will be an increased demand for the Social Security system, health and medical insurance costs will increase, pharmaceutical costs could pose a problem for those with gaps in their insurance, and the costs of long-term care will increase, all because of greater demand on the system. Furthermore, the reality that is hurting this population is estimating that as individuals age there are out-of-pocket costs that will create financial hardships, and one major need is long-term-care coverage.   In the year of 2002, there were reports that indicated that the typical 65-year-old, might expect to pay $44,000 for long-term care.

At present, the main sources of funding long-term care for older adults include Medicare, Medicaid, private insurance, and out-of-pocket payments, and Medicaid tends to handle most of this economic burden (Knickman and Snell, 2002).  Researchers identified some barriers to funding in long-term care for older adults. The first barrier of funding was evaluated to examine the possibility of increase for long-term care, people will stop using their own savings to fund this matter. Second, they note that if public services like Medicare and Medicaid are increased, taxes will increase, and the general population is averse to tax increases since they do not see direct and immediate benefit from their contributions.

The focus of the following discussion is to examine how cultural, social, and societal factors influence the challenges that will be prevalent for older adults in the coming years. Specifically, the problem that will be examined is the tendency for hospitals and skilled nursing facilities to send older adults home to live independently when they are genuinely in need of a higher level of care. The cultural and economic factors that contribute to this problem needs to be analyzed, and how social workers can intervene at multiple levels of the system to help this population along with some potential barriers that can be addressed.

Addressing the Needs of Older Adults

Older adults will be needing increased care and increased options as the entire population ages.  For engaging diverse populations, the first task is to start where the population is at their present state.  In other words, it is necessary to develop humility regarding this population, and it is also imperative that the agent of change develops knowledge of the different perspectives, even if it can be overwhelming. The second step or task is to assess the impacts. Specifically, this means exploring possible routes of discrimination or oppression and assessing implications of intersectionality. This means that there may be a subset of the population who faces new challenges in the years to come. What comes to mind may be the intersection of older adulthood and gender identity issues. One could easily imagine how this could be surrounded by controversy in terms of long-term care and housing options. Third, the next task is to search for professional knowledge while identifying issues with growth and development. Additionally, it is important to assess the impact of social relationships and the social structure of the United States. Finally, developing strategies to address these issues is critical, and the main tasks here are to work collaboratively and to create opportunities for participation.

Task One: History of the Population and Developing Cultural Humility

from the time of mid-1930’s and 1940’s during the New Deal old age pensions that we now know as Social Security was introduced (Karner Ph.D., 2002, p. 20). Through the Social Security legislation, these individuals were categorized as “old” and given the right to retire from employment (Myles, 1984, 1991). Thus, this population became our first group of older individuals who were formally recognized by the government as different from citizens in other phases of their lives (Kohli, 1988).   Our current structure of aging programs stems from these social notions of “old age” and the moral economy prevalent during that historical era. Recent adjustments to accommodate diversity and delay institutionalization have not changed the basic structure of aging services (Karner Ph.D., 2002). My personal experience working with older adult populations in the past has been rewarding, but as a young person, I must acknowledge that there is no way I can truly know now what it is like to be a senior within our current society, and as such, I must approach this task with an open mind.  From my observation older adults are often neglected within our society, and many, or most of us, may hold biased attitudes and ageist beliefs. These biases can sometimes be blind spots, whereas we are oblivious of other biases. In terms of my own self-identities and attitudes, I feel a great sense of empathy for this segment of the population, and I would bring energy and a positive attitude towards working with this population. Aside from this, I know that as an adult, I as well by no intenutilize some of the engagement strategies addressed in the textbook material.  Also, critically analyzing my own beliefs and values and thinking about how this may influence my work with older adults. Furthermore, older adults within our society are not afforded much power and as a young person, I am given a lot of power from society. I must realize that this could influence my interactions with older adults and their level of perceived safety with me in disclosing their displeasures and needs.

Task Two: Search the Professional Knowledge Base on the Target Population

In task two of assessing a community in the text frameworks, it discusses that to assess the older adult community you must identify important data and gather information on the target population needs.  Older adults have been known traditionally to be an under-studied population, but emerging research has begun to address the societal problems that are likely to emerge from the demands on the healthcare system and financial systems within the United States.  As discussed in the Knickman and Snell (2002) article, there are frameworks to address the long-term care needs of older adults, but these are often limited by societal factors such as a lack of desire to pay more in taxes to support this segment of the population. Research to date has clearly identified the structural factors that affect this population, and changes in health care, insurance premiums, long-term care costs, and ageism have been identified as important topics in the literature.   There is the scholarly support that has been computed by gender-specific transition probabilities across five care settings for the 98% of 65-year-olds who are medically eligible to purchase LTC insurance.   This study showed that women were more likely than males to utilize a nursing home (44%–27%), assisted living (20%–12%), and home health care (35%–29%; Brown & Finkelstein, 2008).


Impact of Difference, Discrimination, and Oppression

Task three of assessing a community requires that the researcher focuses on community assets.  In addition, a community assessment entails that you determine the population’s strengths, values, and differences.  (Netting et al., 2017) refers to community values as beliefs that are strongly held by persons who make up the community.  In addition, value conflicts are equally important to understand the communities’ level of how they perceive oppression and discrimination (Netting et al., 2017, p.174).  Before working with the older adult population, it is not only important to explore my own biases but to explore societal prejudices, stereotypes, and assumptions since these are likely playing a role, whether overt or not, in policy decisions. Specifically, when working with this population, there may be an intersection of oppressive thoughts and behaviors. For instance, individuals may hold ageist beliefs that are compounded by differences in the older adults’ sexual orientation, race, or sex. As such, older adults could be thought of as being equally oppressed.   Most older adults experience some loss of family, friends, other close acquaintances as well as experiencing changes in physical functioning along with a change in available activities that they can participate.  Majority of older adults prefer to age in place which means remain in their homes for as long as possible. The need for Long Term Support Services (LTSS) is a high importance to a great deal of older adults and society as a whole.   Long Term Support Services include a wide varied of services which are “assistance with activities of daily living (ADLs) and/or instrumental activities of daily living for older adults (65+) and individuals with disabilities who cannot perform these activities on their own due to a cognitive, physical, or chronic health condition” (Nguyen, 2017).  The LTSS provide the ability for individuals to live in their community or remain employed.

Task Four: Develop Strategies for Authentic Engagement

A long-term plan is highly necessary when advocating for change with this important segment of the community. This would involve identifying who is needed to help bring about change, what principles can help with the process, and what methods could be used to engage this part of the population. With the problem arising it would benefit the community by advocating for the population, speaking with politicians and senators may be a good option to evoke meaningful change. Furthermore, having older adults in the community advocate for themselves to their representatives could evoke greater change with increased demand.  This can be enacted by getting the local councils of aging to get the community of seniors involved as well as caregivers.

As a social worker, it would be important to gather data and share this with older adults within my community. Furthermore, it would mean involving other segments of the population who may be willing to advocate for their older adult loved ones. At an organizational level, contacting hospitals and long-term care organizations would be necessary since they will also be impacted by the concerns of safety for older adults who are discharged home when they truly need a higher level of care. Contact with home health agencies may also be a good step since home health services may be a more economically sound solution to the increased demand for higher levels of care. Furthermore, organizations who advocate for older adults may be a good avenue for change, and organizations such as American Association of Retired Persons (AARP), local Area on Aging organizations, and local Rotary Clubs may have contacts and resources that could be helpful. Finally, focus groups of older adults, healthcare organizations, and long-term care facilities could help with further brainstorming potential solutions within safe environments.

Community and Organizational Problems

To evoke systems-level change, gathering information, exploring the knowledge base, and developing working hypotheses are critical steps (Netting, et al., 2017). This could be conducted at a community level first, where I explore the number of older adults in the community, data on the number of older adults who receive long-term care, and the number of older adults who are discharged home without services from local hospitals. This data would need to be thoroughly organized, and hypotheses could be derived from this data.

Community Considerations

Most effective way for changes to be seen, it seems plausible to interpret the current issue of lack of available placement for those older adults in need of higher levels of care as a factional system.   This systems theory assumes that systems are composed of competing factions, which fits with the problem at hand (Netting et al., 2017). Specifically, there is a greater need for long-term care and increased levels of care for older adults, but this comes at a financial cost to the rest of society. This theory also assumes the system is rapidly changing, and this fits with recent changes in healthcare and new evolutions of the healthcare laws with government leaders taking charge. This theory expects contentious behaviors among different parts of the system. When changing long-term care, there is expected to be a contentious battle among fiscally conservative and liberal individuals since the costs of caring for older adults will likely be immense. Finally, this model assumes that there will be constant disruptions and conflict is expected.



Overall, there is a need for society to address the current crisis with older adults and healthcare. Specifically, many older adults are being discharged home without supportive services because long-term care facilities are in high demand and the costs to care for older adults is high. As a social worker, cultural, ethnic, and ageist factors need to be considered to evoke change. One possible solution would be to work with community organizations to increase in-home services for this population at a lower cost to society.



Kohli, M. (1988). Ageing as a challenge for sociological theory. Ageing and Society, 8, 367-394.

Knickman, J.R., & Snell, E.K. (2002). The 2030 problem: Caring for aging baby boomers. Health Service Research, 37(4), 849-884.

Myles, J. F. (1984). Conflict, crisis, and the future of old age security, pp. 168-176, in Readings in the Political Economy of Aging (M. Minkler & C. Estes, eds.), Amityville, NY: Baywood Publishing Company, Inc.

Myles, J. (1991). Postwar capitalism and the extension of Social Security into a retirement wage, pp. 293-309, in Critical Perspectives on Aging (M. Minkler & C. Estes, eds.), Amityville, NY: Baywood Publishing Company, Inc.

Netting, F.E., Kettner, P.M., McMurty, S.L., & Thomas, M.L. (2017). Social work macro practice (6th ed). Boston: Pearson.

Nguyen, V. (2017, March). Retrieved October 15, 2017, from http://www.aarp.org/content/dam/aarp/ppi/2017-01/Fact%20Sheet%20Long-Term%20Support%20and%20Services.pdf

Population Reference Bureau (2016). Fact sheet: Aging in the United States. Retrieved from: www.prb.org

Tracy X. Karner Ph.D. (2002) Caring for an Aging Society, Journal of Aging & Social Policy,

13:1, 15-36, DOI: 10.1300/J031v13n01_02

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