Long-Term Care: the United States and Costa Rica

The cases of the United States and Costa Rica are interesting because of the startling differences in the quality of life of people in different economic positions and the countries’ varying views on social support. In the U.S., six in ten adults have a chronic disease (NCCDPHP, 2019). The leading issues include heart disease, diabetes, cancer, kidney and lung diseases, stroke, and Alzheimer’s disease (NCCDPHP, 2019). Raghupathi and Raghupathi (2018) state that the number of chronically ill adults continues to grow – chronic conditions are considered the main cause of disability and death. In Costa Rica, the prevalence of chronic conditions also continues to grow, with cancer, ischemic heart disease, and chronic obstructive pulmonary disease being major causes of concern (PAHO, 2020).

Similarly, the number of older people who need and use long-term care (LCT) increases as well. According to Harris-Kojetin et al. (2019), in 2016, more than 85% of all long-stay residents of LTC facilities were over 65 years old in the U.S. The majority of this population is White, and women are almost twice as likely to use these services as men (Harris-Kojetin et al., 2019). The diagnoses as depression, Alzheimer’s disease or other types of dementia, osteoporosis, arthritis, diabetes, and heart disease are highly prevalent. However, two of the most common chronic conditions are hyper- and hypotension. These numbers are expected to continue expanding, as around half of all women and men over 65 will require LTC in several years (Barczyk & Kredler, 2019).

Costa Rican elderly population mostly lives at home with family members, with about 70% living with their adult children (Lloyd-Sherlock et al., 2017). As such, most older adults receive home LTC and get help from community care networks (Lloyd-Sherlock et al., 2017). The most prevalent characteristics of elderly LTC recipients are the diagnosis of diabetes, hypertension, cancer, heart disease, and, most commonly, chronic respiratory disease (PAHO, 2020). As the population of Costa Rica grows and ages, the trend for more LTC is visible.

In the U.S., nurses, care aides, and LTC facilities are the main institutional caregivers. Unpaid caregivers are mostly relatives of the older adult in need of assistance – and a large part of them is over 65 years old (USDHHS, 2020). Paid help comes from both government and private institutions, and it is subject to upholding quality standards. The standards of care and aids’ scope of responsibilities depending on the state legislation and healthcare policy. Some of the LTC types are covered by Medicare and Medicaid, or by private insurance. Medicare pays for a limited stay in a nursing home and skilled home health, while Medicaid covers people with low income and other eligibility requirements (USDHHS, 2020).

In Costa Rica, families are expected to take care of elderly members, and the services of nursing homes are not as developed as they are in the U.S. However, nursing homes exist for the elderly with low income or funds and no family support (Knaul et al., n.d.). As such, community care services are much more prevalent in the country than hospitalization or skilled help. According to Lloyd-Sherlock et al. (2017), volunteers play a great role in elderly LTC. It is difficult to address the cost of such services – volunteers work for free, and primary care is covered by government health insurance (Rosero-Bixby & Dow, 2016).

The difference in economic development, cultural, and societal norms between the United States and Costa Rica has led to two unique systems of LTC. In the U.S., the number of older adults in LTC facilities presents an overwhelming majority, and such problems as heart disease, diabetes, and cancer continue to progress. The developed country has major health care coverage issues, as many people have to pay for skilled support if they do not have private insurance. In Costa Rica, the traditional approach to home-based, family-supported care is still upheld, although national coverage helps older adults to receive basic care. In the developing nation, the central issue is introducing more facilities and resources and reaching out to the increasingly vulnerable older population.

References

Barczyk, D., & Kredler, M. (2019). Long‐term care across Europe and the United States: The role of informal and formal care. Fiscal Studies, 40(3), 329-373. Web.

Harris-Kojetin, L., Sengupta, M., Lendon, J. P., Rome, V., Valverde, R., & Caffrey, C. (2019). Long-term care providers and services users in the United States, 2015–2016. National Center for Health Statistics. Vital Health Statistics, 3(43), 1-78.

Knaul, F., Nigenda, G., & Zuñiga, P. (n.d.). Case-study: Costa Rica. WHO. Web.

Lloyd-Sherlock, P., Pot, A. M., Sasat, S., & Morales-Martinez, F. (2017). Volunteer provision of long-term care for older people in Thailand and Costa Rica. Bulletin of the World Health Organization, 95(11), 774-778. Web.

National Center for Chronic Disease Prevention and Health Promotion [NCCDPHP]. (2019). Chronic diseases in America. Centers for Disease Control and Prevention. Web.

Pan American Health Organization [PAHO]. (2020). Costa Rica. Web.

Raghupathi, W., & Raghupathi, V. (2018). An empirical study of chronic diseases in the United States: A visual analytics approach to public health. International Journal of Environmental Research and Public Health, 15(3), 431.

Rosero-Bixby, L., & Dow, W. H. (2016). Exploring why Costa Rica outperforms the United States in life expectancy: A tale of two inequality gradients. Proceedings of the National Academy of Sciences, 113(5), 1130-1137. Web.

U.S. Department of Health and Human Services [USDHHS]. (2020). Who pays for long-term care? LongTermCare.gov. Web.