THE CRITICAL shortage of adequate and wellcoordinated facilities and services for long-term treatment and care has emerged as one of the major health problems of the present decade. Factors contributing to this growing problem include:

1. The increasing prevalence of chronic disabilities and long-term and degenerative diseases in all age groups, which is accentuated by the growing number of the elderly in our population, with their greater proneness to chronic illness, higher incidence of multiple impairments, and greater severity of disability.

2. The failure of community planning and organization for health care to keep pace with

the changing needs of our population. Although a wide variety of new services and agencies have emerged, few attempts have been made to develop comprehensive patterns of treatment and care within coordinated community health programs.

3. The growing obsolescence of our existing facilities and programs, emphasized by the recent advances in medical science, which now make possible new and more effective approaches to the treatment, care, and rehabilitation of long-term patients.

If the increasing demands for more appropriate long-term facilities and services are to be met, coordinated area wide planning is essential.

LONG-TERM PATIENTS have a wide variety of chronic illnesses and disabilities. While their primary needs for service are not fundamentally different from those of acutely ill patients, the distinctive characteristics of long-term illness require that the long-term patient be viewed not only as an immediate medical problem but as a total person whose long-range needs for services extend beyond direct medical and nursing care.

In general, the needs of long-term patients may be grouped into the following categories:

1. Preventive services, including both primary and secondary prevention.

2. Patient management, involving medical and social evaluation and treatment and the

provision of nursing, supportive, personal, and protective care.

3. Restorative services.

The organization of services within a specific community will depend upon the extent of need and the availability of resources. Services may be provided on a specialized basis in separate facilities or in combinations of several types of services in a more generalized facility. The complex of facilities and services necessary to meet the needs of the long-term patient includes nursing homes or units providing skilled nursing services, facilities for custodial and sheltered care, outpatient clinics, and organized home care programs, as well as the diagnostic and intensive treatment services of an acute general hospital.

SERVICES FOR long-term patients are currently provided in a wide variety of facilities, including specialized units of general hospitals, institutions for treatment of mental illness or tuberculosis, and an increasing number of rehabilitation centers and hospital departments of restorative medicine. The growing demand for service to patients who do not require the specialized services of a hospital has resulted in the development of a wide range of facilities designated as nursing homes, convalescent homes, and homes for the aged. Services provided by these facilities range from skilled

nursing care to personal services and sheltered

care.

For those long-term patients who would not need extended institutional care if services outside the hospital were available, home care services of some type have been established in many areas. However, only a few communities have developed the type of coordinated home care programs characterized by central administration and coordination of medical, nursing, social and related services-that might improve utilization of existing resources.

cal guidance. The planning group should have the endorsement of the State Hill-Burton agency, and it should have sufficient authority to develop a plan and to report directly to the community. The program of such an agency should include plans to meet the needs for all types of health care facilities, with due regard for their relationships to each other.

The agency should be a continuing organization which will work toward developing community support, including financial, for its ongoing activities and, finally, it should recognize its responsibility for the implementation of the programs developed.

To aid areawide planning groups in planning and programing long-term care facilities, basic principles were developed which, in general, may be considered in terms of scope of planning, cooperative relationships, and optimum use of facilities and staff.

Scope of Planning

Principles relating to the scope of planning reflect the need for a wide gamut of facilities and programs, including preventive treatment and rehabilitative services for the long-term patient. Home care and community health programs, as well as services provided by hospitals and other types of facilities, are among the planning aspects considered in the principles which follow:

Planning should include the entire complex of facilities and services for the longterm patient.

The concept of preventive and restorative care should be incorporated in all long-term treatment programs.

Home care services should be an integral part of areawide planning for facilities and services.

Programs for supervision and maintenance of health of persons residing in homes or housing for the aged are essential elements of areawide planning for long-term

care.

Community programs for early detection, treatment, and rehabilitation of persons with mental illness should be an integral part of areawide planning programs.

The need for tuberculosis facilities and programs should be considered as part of planning for long-term care.

Cooperative Relationships

The importance of developing cooperative working relationships among facilities and programs is emphasized by the following principles, which relate to such matters as formal agreements between institutions, continuity of care, accessibility of facilities, and proper patient placement:

The general hospital and its organized medical staff should accept responsibility for providing long-term treatment and care, either through the construction or allocation of its own facilities or through relationships with one or more established facilities.

Facilities and services for long-term care should be coordinated through formal agreements.

Facilities should be organized to promote continuity of patient care.

Physical transfer of long-term patients should be minimized.

Facilities for long-term care should be so located that the services of an organized medical staff are readily accessible.

Optimum Use of Facilities and Staff

Important corollaries to optimum use of facilities and staff are high quality of care and efficient operation. Thus, the following principles may be considered in this category:

Existing community resources should be utilized at maximum efficiency.

Patient placement should be in accordance with need for service.