Global health has been focused on prevention and acute care. The reasons are obvious: the tragic outcome of not being able to access these services and the extent to which it could be avoided by allocating resources are all too obvious. However, in this blog, I would like to draw attention to a neglected area, that of long-term care (LTC).
LTC has been defined by the Institute of Medicine as “a variety of ongoing health and social services provided for individuals who need assistance on a continuing basis because of physical or mental disability.” Sometimes LTC must be provided until the person dies, so that LTC overlaps with end-of-life care. In contrast to health care, the goal in LTC is not to cure the disease, but to maintain autonomy. Technical skills are required for evaluating the level of support that is needed and for deciding the most appropriate method of providing support. The focus of attention is divided into activities of daily living (ADL), such as bathing, walking, and eating, and indirect activities of daily living (IADL), such as preparing meals and cleaning. The levels of assistance have been conceptually defined by the International Classification of Functioning, Disability and Health (ICF).
LTC should not be left solely to the responsibility of the family. In order to maintain the autonomy and dignity of those requiring LTC, governments should allocate resources to measure the LTC needs, educate families on how to provide care that would best maintain the subject’s independence, and decrease the care burden by providing health and social services. Resources should also be made available for providing care and support to the family.
The need for LTC is increasing in high-income countries because of the rapid aging of the population. Elders are generally healthier than in the past, but as their age advances, functional capacity will decline. Moreover, it would be difficult for those in their nineties to rely on their children, as they would be in their seventies. LTC is also needed so that the acute care sector functions appropriately. Prolonged stays in acute hospitals because of the lack of LTC services is not only inefficient but also detrimental to the patient’s health.
In middle-income countries, aging is progressing more rapidly than in high-income countries, leaving less time to build the infrastructure that is required to deliver LTC services and provide financial support. In low-income countries, although the proportion of elders is low, the young are migrating to the big cities, which has weakened the informal support in rural areas. Regardless of the income level, war and conflict would also increase the prevalence of disability and the need for LTC.
Although allocating resources to LTC would not lead to a more productive workforce or provide dividends from intellectual property, it would directly impact the daily lives of the people needing LTC and the families providing it. The cost of LTC would be lower than acute health care. What is needed is the commitment of the government and of international agencies in promoting LTC.
