long term care and affordable care act

long-term care

regular assistance for people with chronic illness or mental/physical disabilities

can occur in nursing homes and at home

intended to help people with activities of daily life rather than treating the medical conditions

true or false: there are both temporary and permanent conditions that may require LTC

true

true or false: men tend to need LTC twice as long as women do

false

today/the future of LTC statistics

over 12 million in adults need LTC

• ~10% of people who enter an LTC stay there 5+ years

1/3 of people 65+ will need nursing home care

nursing homes spend ~$180 billion

total number is expected to double by 2060

LTC history in the 1900s

early 1900s - friends, family, elderly community care

1930s - social security act

1954 - hill burton act funding nursing homes

1972 - skilled nursing facilities

1987 - OBRA 87 - nursing home reformation

1999 - Supreme Court’s Olmstead decision promoted broader healthcare community based services for pts with disabilities

LTC history in the 2000s

2000 - americans act caregiver program established, helps family/informal caregivers

2010 - affordable care act

2015 - CMS initiates five-star quality rating system for nursing homes

home health care

wide range of healthcare services that can be given in your home

• less expensive, more convenient

• can be just as effective

can be for acute or terminally ill

provides independence and maintains self-sufficiency

assisted living facilities

independent alternative for older adults who require minimal assistance with daily living and personal care

residents do not require the medical/nursing care in a nursing home

nursing homes

local or residential facility for individuals with a disability or chronic illness

applicable to those who can’t take care of themselves on their own

aka a long-term care facility or convalescent home

true or false: nonprofit nursing homes have higher costs, but may have a higher quality of care

true

Medicaid and nursing homes

medicaid covers 6/10 nursing home residents

pts may have increased demand and nursing homes may receive less money

medicaid mortality rates ~5% higher than private pay

five-star quality rating system

created by the CMS to help consumers, their families, and caregivers compare nursing homes more easily

one overall rating, then 3 sub-ratings (health inspections, staffing, and quality measures)

skilled nursing facility

type of nursing home with patients with severe deficiencies that require constant care

goal is to make the pts better - meets needs of individuals who have the potential of functioning independently after a limited time of care

usually has RNs compared to CNAs

rehabilitation hospital

helps pts recover and may be able to return to functioning independently

can focus on physical, occupation, or speech rehabilitation

sometimes are tailored to drug/alcohol recovery

hospice care

mostly intended for terminally ill individuals

interprofessional team that assists with coordination of care

addresses pts and families for physical and emotional comfort

GA senate bill 291

GA death with dignity act

physician-assisted end of life option for terminally ill individuals

introduced in 2020, prognosis would be 6 or less months left to live

needs clearance from 2 physicians

challenges of LTC

financing - reimbursement from Medicaid may not be enough

quality of staff

quantity of staff

pharmacist role in LTC

consultant pharmacists/senior care pharmacists - reviews meds, creates recordkeeping systems for controls and ensures compliance, educates residents/providers on drug therapies

retail - compounding, pre-packing, and mail-order delivery

3 primary goals of ACA

make affordable health insurance available to more people

• provides consumers with subsidies (premium tax credits) that lower costs for household with income between 100-400% of the poverty level

expands the medicaid program to cover all adults with income below 138% of the federal poverty level

supports innovative medical care delivery methods designed to lower the costs of healthcare overall

2024 poverty levels (per year)

1 person - $15,060

2 - $20,440

3 - $25,820

4 - $31,200

5 - $36,580

6 - $41,960

individual mandate

obtained coverage through an employer, purchasing an individual health plan, or having government-sponsored coverage

those who didn’t get insurance have to pay a penalty

exemptions: religious objectors, prisoners, undocumented immigrants, native americans, and those who the lowest cost health plan is >8% of their income

state-based marketplace (SBM)

states are responsible for performing all marketplace functions for the individual market

consumers apply for and enroll in coverage through websites maintained by the states

state-based marketplace-federal platform (SBM-FP)

states are responsible for performing all marketplace functions for the individual market

consumers apply for and enroll in coverage through the federal Healthcare.gov website

federally-facilitated marketplace (FFM)

HHS performs all marketplace functions

consumers apply for and enroll in coverage through the federal Healthcare.gov website

every health plan must cover the following services

ambulatory services

emergency services

hospitalizations

pregnancy/maternity/newborn care

mental health and substance use disorder

Rx drugs

rehab services and devices

lab services

preventative/wellness services

pediatric services, including oral and vision

employer mandate

if a company with >50 full time employees does not offer healthcare coverage, they can be penalized

tax credits can be given if you have <50 and provide healthcare coverage