The long-term care challenge: Rationalizing a continuum of care for chronically impaired elderly

The reality of discontinuity reflects the lack of an operational continuum of care: that is, a system of identification and placement that assures, with a reasonable degree of certainty, that a chronically impaired individual's need for health and social services is met at the level appropriate to the extent of the incapacity, over an extended period of time, with the appropriate type and intensity of intervention. This paper reviews the historical context that has shaped the nonsystem of care and defines how a continuum of care can be rationalized with the objective of providing patient-centered, cost-effective, long-term care services. Finally, it reports how a joint Mount Sinai School of Medicine/Hunter College planning effort has been initiated to address the issues raised.