Long-term Care: Managing Across the Continuum By John R. Pratt; 1999; Gaithersburg, MD: Aspen; 615 pages; hard cover; $70.00
This text provides a rational and comprehensive description of longterm care across the continuum with its component parts and strengths and weaknesses. At home with systems theory and fully versed in analyzing the effects of both internal and external forces of health care in America, Pratt takes a positive view of long-term care as it continues to evolve in response to the turbulence and dynamics occurring in the health care industry. The text is framed around the underlying reasons for downsizing that have occurred in acute and long-term care settings, with expert strategies for planning efficient and qualified care to satisfy consumers, policy makers, and regulatory bodies.
Such strategies address the interrelated issues of the long-term care continuum (e.g., regulatory issues, trends in long-term care reimbursements, market forces, staffing issues, end-of-life issues, autonomy, confidentiality). In-depth discussions of hospice, adult day care, assisted living and residential care, and subacute care are included. For those still unclear about the concept of subacute care, a lengthy, yet accurate definition is provided by the author.
Assisted living, which has taken on different names in different states and is another concept not well understood by the general health care community or the public, is dealt with thoroughly. Of particular interest is the author's discussion of the legal implications of "negotiated risks" of assisted living, with respect to the debate surrounding demands for autonomy on the part of older adults and their families, pitted against concerns for safety.
Students of long-term care administration will find this text to be a primer on organization theory, addressing the financial realities of current health care industry interwoven with issues of quality assurance, ethics, governance, leadership, goal setting, decision- making, and staffing. The author demonstrates how these factors have resulted in the growth and development of new levels of care, with particular attention to quality of care, while addressing new regulations.
Readers will find an astute discussion of the debate over who should measure quality, and who the players are in the regulatory arena. The role of information technology in meeting the requirements for documenting quality of care :s included in this discussion.
The book's 19 chapters are wellorganized with respect to these varied issues of long-term care. The author's style is both reader-friendly and academic, inviting all readers, whether students or professionals, to learn and to be inspired to participate in the transformation of longterm care into an innovative, integrated health care system.