Accessing long term care for low income geriatric patients in California

by

ACKNOWLEDGEMENT

It would not have been possible to narrate this thesis without the help and motivation of the gracious people around me, to only some of whom it is possible to give particular highlight here.

First of all, I would like to express my sincere appreciation to my advisor [professor's name] for the continuous support of my study and research, for his endurance, enthusiasm and engross knowledge. His guidance helped me in all the time of research and writing for this thesis.

Besides my advisor, I would like to thank the rest of my thesis committee [professor's names] for their encouragement, perceptive comments and difficult questions.

I thank my fellow research companions [names] for the stimulating discussions, for working together before deadlines and for the enlightening experiences.

Last but not the least I would like to thank my family: [names] for supporting me and providing me insightful suggestions and ideas for working on this diversified project.

Table of Content

Chapter 1: Introduction5

Background of the problem7

Problem Statement8

Purpose of the Study9

Significance of the Study10

Significance of the Study to Leadership11

Nature of the Study12

Research Question12

Theoretical Framework13

Definition of Terms14

Assumptions14

Scope and Limitations15

Delimitations15

Summary16

Chapter 2: Literature review17

Ronald M. Andersen's behavioral health service20

Thomas S. Kuhn's paradigm shift21

Odin Anderson's market minimized and market maximized continuum22

Milton Roemer's health care systems23

Porter and Teisberg's positive-sum competition model23

Historical overview24

Nursing home care26

In-home nursing care with skilled measures27

Hospice care27

Homemaking services27

Resistance to Change28

Lack of information29

Financial resources29

Education and support30

Lagging behind of technological facilities30

Staffing and logistic issues30

Managing the change31

Lack of leadership31

Lack of regulation understanding32

Barrier of liability32

Current Development of Community-Based Adult Services (CBAS)32

Present funding33

Governmental Mandates and Inducements toward Conformity34

Economic Impact of Long-term Care35

Lessons Learned from the present Healthcare System38

Conclusion39

Summary40

Chapter 3: Methodology41

Research design41

Appropriateness of design42

Research question45

Population47

Informed consent50

Sampling frame52

Confidentiality54

Instrumentation55

Data collection58

Validity and reliability61

Summary63

References65

Hunnicutt, S. (2010), “Universal Health Care”, Green haven Press67

Langreth, R. (2008), “Picking a Plan”, Wall Street Journal68

Accessing long term care for low income geriatric patients in California

Chapter 1: Introduction

The elderly population in the United States is growing. Individuals age 65+ will increase by 23% between 2012 and 2022 (Kaiser Family Foundation, 2012; World Health Organization, 2012). Moreover, medically frail individuals with age-related diseases, physical, and cognitive decline are at higher risk of mortality (Fulop et al., 2010). This rising population and risk factors reflects a dramatic demand for access to long-term health care. As the Baby Boomers turn 65, the elderly population growth is predominantly in the western regions of the United States (William, 2010).

This significant increase reflects a dramatic shift in the age structure. More specifically, Interim Population Projections, forecast that Californians, those age 65+ will double over the next two decades from 4.3 million in 2010 to 8.4 million in 2030 (State of California Department of Finance, 2012). This will take place as the Baby Boomer generation born from 1946 to 1964 reaches age 65 (William, 2010).

Presently the United States health insurance coverage is fragmented with various public and private insurances as well as wide-ranging gaps in coverage rates across the nation (Thomson, Osborn, Squires, & Reed, 2011). However, it is forecasted that with ...