3.2 Long term Care Services

PHLT 313

long term care (LTC) is needed under 3 main circumstances

physical or mental deficits(cognitive impairment), continuity of care after hospitalization, and care in specialized environments

the primary clients of LTC services are…

the elderly, but most elderly do not need LTC

some young adults may need

LTC

LTC services are provided in both…

institutions & community based settings

most LTC is provided informally by

family and friends

aging process leads to

chronic ailments, comorbidity, disability, and dependency

the progression of the aging process increases…

the probability that a person will need LTC

the # of Americans w/ chronic conditions is expected to…

rise

other developed nations also face…

aging related issues

nearly 95% of adults 60 and older have…

at least one chronic condition

nearly 80% of adults of adults 60 and older…

have 2 or more chronic conditions

7 essential characteristics of LTC

1. includes a variety of health care services 

2. services are individualized 

3. services must be well coordinated 

4. goal is to promote max possible functional independence 

5. services are needed over an extended period of time

6. patients’ physical, mental, social, and spiritual needs must be met 

7. patients’ quality of life must be maximized

for services individual needs…

differ

needs for individuals change….

over time 

LTC must interface with….

various non LTC services

both therapeutic and preventive services are…

necessary 

individual services are based on…

assessment

individualized services have what kind of plan…

individualized plan of care 

coordinated services must be well…

coordinated

in coordinated services the mere availability of a variety of services in NOT…

sufficient

the health care delivery system can be difficult to…

navigate

difficulties compound in case of…

the elderly and disabled

functional ability is assessed using the 

ADL scale & IADL scale 

adaptive equipment and environmental modification promote…

independent living

motivate and assist the patient to do…

as much as possible

compared to acute care LTC is sustained over a longer period of time 

weeks, months, years

short term LTC

90 days or less

4 dimensions in holistic approach

physical, mental, social, and spiritual

the total living experience that results in…

overall satisfaction w/ one’s life 

5 factors of quality of life

1. lifestyle pursuits

2. living environment

3. clinical palliation

4. human factors

5. autonomy and independence

first objective of community based LTC services

to deliver LTC in the most economical and least restrictive setting

second objective of community based LTC services

to supplement informal caregiving

third objective of community based LTC services

to provide respite to family members 

fourth objective of community based LTC services

to delay or prevent institutionalization

elderly services offered through an administrative network

the federal administration on aging, state units on aging, area agencies on aging(BVAAA)

sources of funding for community based LTC services

Medicare and Medicaid, Title III of the Older Americans act, Title XX Social Services Block Grants, State and local government funds, private savings, private donations

Medicare the largest…

single payer

must meet requirements to qualify for…

home care under Medicare 

requirements for home care under Medicare

be homebound, have a plan of treatment that is periodically reviewed by a physician, have intermittent or part time skilled nursing/rehab therapies

under Medicaid, states can develop services for…

people who would otherwise end up in an institution (Texas Health and Human Services: Waiver programs)

other examples of community based LTC services 

adult day care, adult foster care, senior centers, home delivered/congregate meals, homemaker services, case management 

institutional LTC services is for patients whose needs…

cannot be adequately met in community based settings

different type of institutional LTC services

retirement(independent living) facilities, residential (personal care) facilities, assisted living facilities, skilled nursing facilities, subacute care facilities, specialized care facilities

skilled nursing facilities provide…

a full range of clinical LTC services

skilled nursing care includes 

medically oriented care, plan of treatment authorized by a physician, direct ADL assistant, rehab/therapeutic diets/nutritional supplements, multidisciplinary assessment 

nursing homes are heavily..

regulated through licensure and certification requirements

a nursing facility without a license is…

illegal to operate

license of nursing home to operate a facility is issued by..

the state

standards for licensure of nursing home…

vary from state to state

one exception to license of nursing home..

the Life Safety Code is a national standard

Compliance w/ standards of nursing home license is verified how often?

yearly through inspections 

who has the oversight responsibility of licensing nursing homes?

a state’s department of health

certification of nursing home allows it to…

admit patients who are one public assistance(Medicare and Medicaid)

nursing homes must first be licensed by..

the state 

to serve Medicaid/Medicare clients…

the Centers for Medicare and Medicaid Services(CMS) must certify the home

a non-certified facility can only…

admit private pay patients

3 distinct federal certification categories 

SNF certification(Medicare) 

NF certification:(Medicaid)

ICF/IID certification: for intellectually/developmentally disabled clients  

most facilities have what certification

dual SNF/NF

other LTC services

respite care and restorative care

types of restorative care

restorative care, maintenance rehabilitation, adaptive rehabilitation

hospice(end of life care)

services for the terminally ill(life expectancy of 6 months or less), emphasizes dignity and comfort, a cluster of comprehensive services

The ACA and LTC

community first choice-increased federal matching funds for Medicaid, elder justice act of 2010, comply with a quality assurance performance improvement program

# of nursing homes, bed capacity, and # of residents have continued to…

decline 

growing need for…

LTC services

the industry is dominated by…

nursing home chains

private for-profit nursing homes

Medicaid 

main source of financing for nursing home care

Medicare

pays for eligible beneficiaries under Part A, but the coverage is for a short duration

LTC insurance

expensive; few have it

FYI

Medicare Home Health Compare

Medicare Nursing Home Compare