An estimated 51 million persons in the United States will require long-term services and supports (LTSS) during their lifetime. LTSS encompass services for people who can no longer independently care for themselves due to cognitive decline, functional limitations, chronic illness, or associated sequelae. Though crucial, the nation’s system for providing these services has long experienced challenges with financing, effective care delivery, and regulation.
In the Annals of Internal Medicine, a position paper for the American College of Physicians Ethics, Professionalism, and Human Rights Committee authored by Dr. Mark A. Unruh, associate professor of population health sciences, and colleagues examines the ethical implications of current LTSS business models and practices, as well as their effect on vulnerable persons receiving care in these settings.
Researchers find that the nation’s LTSS system needs to address inadequate staffing and innovation, inequities in quality and access, and inconsistent regulations and oversight. Strategies employed by owners and operators of LTSS facilities and agencies have increasingly used complex business models that make it difficult to identify the individuals involved in or responsible for care practices that may adversely affect patient well-being and quality of life. This was evident during the COVID-19 pandemic when strategies used by nursing homes conflicted with patient preferences. When visitation restrictions ended, many facilities did not implement protocols to ease social isolation or allow family caregiving and support.
Researchers emphasize the importance of improving LTSS to create a more compassionate, equitable, and high-quality system. They recommend prioritizing patient-centeredness, sufficient direct care staffing, resources for innovation, transparency, and accountability—all informed by ethical and evidence-based practices. Moreover, collaboration among policymakers, health care systems, researchers, and other stakeholders is paramount in ensuring that the nation’s LTSS system fosters ethical care, quality, safety, and respect for individuals across their lifespan.
- Highlights