What is a continuum of care?

A continuum of care is a model which strives to serve the needs and supports of the people – this is a holistic approach, respecting and honoring the person and their choices. In my mind, this is the logical and just model but it is a continual fight to try to educate and enlighten others to the benefits to ALL by providing a continuum of care. Supporting a continuum of care does not deny people the needed supports and services nor does it coerce or threaten people to make choices which would endanger their safety and lives.

Researching issues with the recent audit by Washington State Auditor of the Developmental Disabilities Service System, I learned of the North American Industry Classification System (NAICS). The North American Industry Classification System was developed under the direction and guidance of the Office of Management and Budget (OMB) as the standard for use by Federal statistical agencies in classifying business establishments for the collection, tabulation, presentation, and analysis of statistical data describing the U.S. economy.

I found something very interesting which actually describes a continuum of care very well:

Sector 62 — Health Care and Social Assistance

The Sector as a Whole

The Health Care and Social Assistance sector comprises establishments providing health care and social assistance for individuals. The sector includes both health care and social assistance because it is sometimes difficult to distinguish between the boundaries of these two activities. The industries in this sector are arranged on a continuum starting with those establishments providing medical care exclusively, continuing with those providing health care and social assistance, and finally finishing with those providing only social assistance. The services provided by establishments in this sector are delivered by trained professionals. All industries in the sector share this commonality of process, namely, labor inputs of health practitioners or social workers with the requisite expertise. Many of the industries in the sector are defined based on the educational degree held by the practitioners included in the industry.

Below are some examples of what are included in this category – it’s odd that the auditors did not include any of these in their recommendations –

62 Health Care and Social Assistance

621 Ambulatory Health Care Services

6211 Offices of Physicians

6212 Offices of Dentists

6213 Offices of Other Health Practitioners

62133 Offices of Mental Health Practitioners (except Physicians)T

62134 Offices of Physical, Occupational and Speech Therapists, and Audiologists

62139 Offices of All Other Health Practitioners

6214 Outpatient Care Centers

6215 Medical and Diagnostic Laboratories

6216 Home Health Care Services

6219 Other Ambulatory Health Care Services

622 Hospitals

6221 General Medical and Surgical Hospitals

6222 Psychiatric and Substance Abuse Hospitals

6223 Specialty (except Psychiatric and Substance Abuse) Hospitals

623 Nursing and Residential Care Facilities

6231 Nursing Care Facilities (Skilled Nursing Facilities)T

6232 Residential Intellectual and Developmental Disability, Mental Health, and Substance Abuse Facilities

6233 Continuing Care Retirement Communities and Assisted Living Facilities for the Elderly

6239 Other Residential Care Facilities

624 Social Assistance

6241 Individual and Family Services

62412 Services for the Elderly and Persons with Disabilities

6242 Community Food and Housing, and Emergency and Other Relief Services

6243 Vocational Rehabilitation Services

The organizations which did the audit and wrote recommendations did not consult with the professionals in the field, nor are they themselves experts in the fields listed above. BERK & Associates (523930 – Investment Advice) and Human Services Research Institute (HSRI) (541720 – Research and Development in the Social Sciences and Humanities) only looked at one part of the continuum and tried to fit all people into that section.

For being researchers, HSRI really misunderstands people and the supports and services they may need to keep people healthy and safe.

It is shameful that HSRI is recommending changes in a service system which they clearly are not experts in and clearly do not understand the impacts their recommendations will make to not only the people who utilize those supports and services, but the community as a whole.

Below is a list of the areas of expertise of the BERK & Assoc. and HSRI contracted people for this audit: Where are the healthcare professionals on this panel?

M.A. – Public policy

B.S. – Finance

MBA – Business Administration

B.A. – Politics

M.A. – Urban Design

B.A – Art History

M.A. – Urban and Regional Planning

B.A. – Geography

B.S. – Mathematics and Economics

M.A. – Urban and Regional Planning

B.A. – Sociology

Ph.D. – Special Education and Rehabilitation

M.A. – Psychology

B.A. – Political Science

M.A. – Public Policy Administration

B.A. – Business Administration and Management

B.A. – Special Education

M.S. – Public Policy and Administration

B.A. – Management of Human Services

B.A. – Psychology

M.A. -Public and Non-Profit Management

B.A. – International Relations

MSW – Social Work

B.A. Health Care Management

M.A. – Administration of Higher Education

B.S. – Family and Human Services,

M.S. – Special Education,

MSW – Social Work

B.A. – Social Work

4 comments on “What is a continuum of care?”

Don Putnam says:

09/15/2013 at 5:19 AM

con·tin·u·um

noun \kən-ˈtin-yü-əm\

: a range or series of things that are slightly different from each other and that exist between two different possibilities

The medical-social continuum you mention is a one form of a continuum, no question. However, I don’t see it as a complete answer to the question, What is …?

As a fellow advocate for persons (family members) with ID/DD I typically use the word to describe the range of disabilities within the population, i.e. moderate to profound, and the range of residential settings I support (home – facility, and everything in between).

I have found that as we use the term “continuum” we need to carefully include our definition of our concept of the end points or “two different possibilities”. Our adversaries will and have embraced the word and used it for their own purposes. They simply use it without defining their different end points. They exclude facility based residences. This almost makes the word useless unless we always define our own end points.

Thank for the work you do and for your voice in the marketplace.

Don Putnam

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Because We Care - Beyond Inclusion says:

09/15/2013 at 3:46 PM

Thank you, Don, you are correct that the end-points of the continuum need to be defined too.

Recently, the Advocacy and Outreach Coordinator for the Arc of King County, Parent Coalition and member of our state’s DD Task Force, stated that he supported a continuum of care. I wrote and asked him if he had changed him mind and now supported the ICF/ID as a choice for people. He replied:

Cheryl,

To be clear, I do not support a continuum of care including the RHC’s. They are currently a part of the continuum of services offered by DDD and are still an entitlement in our state.(Lance Morehouse, January 3, 2013)

I do not see the model I wrote as a “medical model” – one end of the continuum has more medical/nursing and healthcare but the other end does not – it is strictly social services – I though the description defined the continuum well and how these two services are connected and intertwined – they need to work together to have model which provides healthy living, and safe,stable environments.

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