Long Term Care in America can be improved through looking at the processes used in other countries, and determining how effective those processes are in relation to established outcomes. Four countries were chosen for comparison: England, Germany, Japan and Australia.
• England: England is very similar to the United States, as it relies on regulation to impose national standards on nursing homes. Localities may or may not provide additional regulations.
• Australia: Australia relies on consultation and collaboration to assure quality in their nursing homes. Inspections are carried out by quasi-governmental agents; however, enforcement of standards are solely a governmental function. Broad, generalized standards are written, which provide a direction, but not a ‘how to’ book for providers, and leaves providers with discretion on how and when to implement.
• Japan: Japan recently provided more resources for its nursing home and home health services. Additionally, it continues to rely on education and training as an integral part of its quality assurance program. Regular communication is on going between the government and providers to motivate and disseminate best practices. Care managers are critical to helping individual clients and assuring quality services are provided.
• Germany: Germany utilizes ‘sickness funds’ in negotiations with providers. These funds act as incentives for the providers in meeting structure and process standards. Broad expectations are also used to help providers establish monitors to review compliance with standards.
Advantages and disadvantages of the above systems are identified below:
• The additional resources Japan provided for its public long term care insurance provided more care providers for home health care. The competition serves to maintain quality while stabilizing costs. However, nursing homes now have waiting lists for their services, which has significantly reduced the ‘competitive edge’ home health has, and reduced incentive for maintaining costs, or improving quality.
• Inspection and regulation are corner stones of quality in all four countries surveyed. However, the dissatisfaction from all key stakeholders in the current monitoring system has led to changes; i.e. Australia has broadened its standards, and allowed individual discretion in mechanisms to achieve; England has increased the time between inspections, while retaining the yearly inspections for poor performers. In the future, rewards for high performers is likely to be an objective of all four countries.
• All of the countries are realizing that improving quality does not mean adding regulations. More regulations increases cost, but not necesswarily quality of services. Therefore, more training for providers, more information to consumers, and mechanisms to communicate best practices among providers is being utilized more in all four countries. All of the countries except Germany now provide at least some information about the quality of services on the Internet.
• Staffing resources remains one of the biggest challenges in all four countries. All of the countries are experimenting with methods to alleviate staffing shortages; i.e. Germany is paying family caretakers, while Japan is paying agencies so their women are liberated from the burden of care giving.
Life factors valued by all countries, and how to achieve:
To summarize, all of the countries, including the United States are questioning how key components of long term care can be measured, purchased, or regulated to assure quality. For instance, how can the following life factors be implemented for the individual?
• Autonomy
• Security
• Dignity
• Meaningful activity and relationships
• Comfort
• Individuality
• Spiritual well-being
To achieve what matters most in maintaining valuable life factors, the United States will have to work collaboratively with other developing nations of the world. We all have much to learn from each other as we plan to meet the needs of our aging population.
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