A key focus of Cynthia Mara's entire working life has been long-term care.
Beginning with her teen years when she provided care for a homebound elderly neighbor and her summer employment in a rest home, Mara has made a scholarly commitment to improving the quality of long-term care in the United States.
That commitment has now earned her a Fulbright Visiting Research Chair at McMaster University in Hamilton, Ontario, where the Penn State Harrisburg associate professor of health-care administration and policy will investigate Canada's long-term care system in comparison to the U.S. system.
The Fulbright Research Chair in Health, Science and the Environment at McMaster's Institute of Environment and Health will enable Mara to "study the long-term care system in Canada, particularly the ways in which the system is integrated with medical care" during the fall semester.
From her teen years, she went on to become a nurse, organize a nursing program, and teach nursing. Later, she founded and administered a hospice in Virginia's New River Valley followed by work in the U.S. Senate Subcommittee on Aging, writing health and long-term care legislation. After earning a doctoral degree in public administration and public affairs with a focus on health and long-term care, she worked for New York City government as the Department for the Aging senior long-term care policy analyst. She joined the Penn State Harrisburg faculty in 1994 and is the coordinator of its Master of Health Administration program.
"In the United States, long-term care forms a fragmented system, so much so that some people call it a nonsystem," Mara said. "A primary reason for this fragmentation is the way in which long-term care is financed. Instead of one public payer with one set of rules, there are numerous public programs with different eligibility requirements, income and asset requirements, covered services and service delivery mechanisms. In addition, there are various sources of private payment for long-term care, including out-of-pocket payments, private long-term care insurance, reverse mortgages, advance payments from life insurance companies, and financial help from family and friends of the person needing care. These multiple sources of funding contribute greatly to a long-term care system that is difficult for people with functional limitations and their families to access and navigate."
Mara will be looking at the single-payer system in Canada to see if it provides continuity of care for people who need both medical and long-term care so there is no disconnect. "The U.S. has limped through, but now with increasing longevity and the baby boomers aging, more people are in need of both types of care," she added.
In the United States, she stressed, long-term care is, to a great extent, separate from the rest of health care. "The very people who require long-term care are among those most in need of medical care services. Yet each is treated as two different people who need to conform to two disparate systems."
She concluded, "I will be looking at what we can learn from Canada's single payer system in which health care -- medical and long-term -- is provided through provincial budgets. In the U.S., there is a multiplicity of agencies dealing with health and long-term care while Canada has one covering all aspects. I'm not saying which system is better, but will be researching to see if U.S. health care policymakers and administrators can benefit from an examination of Canada's approach in an effort to identify elements that could mesh well with, and address problems in, the U.S. system."
With the 85-year-and-older cohort America's fastest-growing age group and the oldest baby boomers entering their seventh decade, Mara said demand on the long-term care system will most certainly increase, creating an even greater need for the various parts of the health-care system to work together.
When completed, she is hoping her research in Canada will help ease the fragmentation within the American delivery system while adding another chapter to her personal commitment to long-term care.