Long Term Care System Review Flashcards

A set of 30 question-and-answer flashcards covering key legislative milestones, legal precedent, the long term care continuum, and caregiving dynamics from the lecture transcript.

What major legislative expansion occurred in government programs for older adults and needy groups between 1935 and 1965?

The 30-year period from 1935 to 1965 saw significant expansion in government programs designed to support older adults and other needy groups.

What were the main developments in long term care from 1970 to approximately 2000?

This period saw increased federal oversight and regulation of long term care, alongside significant pressure across the health care system to reduce spiraling costs.

When was the Medicare prospective payment system enacted in long term care, and which providers did it initially target?

It was enacted under the Balanced Budget Act of 1997, starting with nursing homes and home health agencies.

In what year did Medicare implement the prospective payment system (PPS) and Diagnosis-Related Groups (DRGs) in hospitals?

Medicare implemented PPS in hospitals in 1983.

How is prospective payment defined under Medicare?

Prospective payment is a system where Medicare determines reimbursement rates in advance annually for grouped patient conditions, rather than paying providers based on incurred costs.

What was the significance of the Omnibus Budget Reconciliation Act of 1987 (OBRA '87)?

OBRA '87 was a major piece of legislation that increased government oversight of nursing homes, establishing stricter regulatory standards.

What was the central ruling of the Supreme Court's 1999 Olmstead decision?

The Supreme Court ruled that institutionalizing individuals with disabilities violated the Americans with Disabilities Act, requiring states to offer community-based alternatives under Medicaid.

In what year was the Americans with Disabilities Act (ADA) passed?

The Americans with Disabilities Act was passed in 1990.

How did state Medicaid programs react to the Supreme Court's Olmstead decision?

States expanded home and community-based services (HCBS) to help individuals with disabilities receive care in community settings rather than being defaulted into institutions.

What impact did the American Rescue Plan of 2021 have on long term care?

It reauthorized multi-year federal funding for the Older Americans Act.

What major concern did the Department of Justice (DOJ) memo in June 2026 raise among disability advocates?

The DOJ memo questioned long-standing protections under the Olmstead decision and asserted that states are not required to provide home and community-based services.

Who is Maria Town?

Maria Town is the President and CEO of the American Association of People with Disabilities.

How old were the Americans with Disabilities Act and the Olmstead decision at the time of Maria Town's interview?

The Americans with Disabilities Act was turning $36$ years old, and the Olmstead decision turned $27$ years old.

Why is the long term care system described as a continuum?

It is called a continuum because care is not one-size-fits-all; individuals have different needs, and an individual's care needs often change over time.

In which chapter will residential care and assisted living facilities be discussed in depth?

Chapter 5.

What is the formal healthcare term used for a standard nursing home?

A skilled nursing facility.

What type of long term care service does Generations Crossing provide?

Generations Crossing provides adult day care or adult day services, which offer daytime programming for older adults who cannot remain unsupervised.

What overarching structural shift has occurred in long term care over the past several decades?

A shift away from institutional settings (nursing homes) toward noninstitutional, home and community-based services.

In what decade did assisted living facilities first emerge?

Assisted living facilities first emerged in the 1990s.

What are the three primary reasons for the shift toward noninstitutional long term care services?

Individual preference to remain at home, lower costs when services are received in moderation, and legal mandates from the Olmstead decision under Medicaid.

What is the estimated annual cost of care in a nursing home according to the lecture?

Well over $100,000$ a year.

What key factors determine appropriate placement for a patient along the long term care continuum?

Extent of disability (ADLs/IADLs), personal preferences, service availability in the geographic area, and ability to pay or insurance coverage.

What is the average nationwide nursing home occupancy rate since the COVID-19 pandemic?

Approximately 80\text{\null} occupancy.

Who provides the majority of long term care in the United States?

Informal caregivers, primarily family members.

Which demographic group provides the largest portion of informal family caregiving?

Middle-aged women.

What is the estimated annual economic value that family caregivers contribute to the U.S. health care system?

Approximately $470,000,000,000$ (nearly $500,000,000,000$).

According to statistics cited in the lecture's video clip, what percentage of people over age 60 will require long term care?

70\text{\null} of people over the age of 60.

What percentage of individuals requiring long term care rely on private long term care insurance policies?

Only 7\text{\null}.

What is the Village movement, and where was it originally established in 2001?

It is a community grassroots model allowing seniors to stay in their own homes safely while accessing support services; it originated with Beacon Hill Village in Boston.

How many villages were operating or in development nationwide according to the video report?

There were $140$ operational villages across the country and over $100$ more in development.

What major legislative expansion occurred in government programs for older adults and needy groups between 1935 and 1965?

The 30-year period from 1935 to 1965 saw significant expansion in government programs designed to support older adults and other needy groups.

What were the main developments in long term care from 1970 to approximately 2000?

This period saw increased federal oversight and regulation of long term care, alongside significant pressure across the health care system to reduce spiraling costs.

When was the Medicare prospective payment system enacted in long term care, and which providers did it initially target?

It was enacted under the Balanced Budget Act of 1997, starting with nursing homes and home health agencies.

In what year did Medicare implement the prospective payment system (PPS) and Diagnosis-Related Groups (DRGs) in hospitals?

Medicare implemented PPS in hospitals in 1983.

How is prospective payment defined under Medicare?

Prospective payment is a system where Medicare determines reimbursement rates in advance annually for grouped patient conditions, rather than paying providers based on incurred costs.

What was the significance of the Omnibus Budget Reconciliation Act of 1987 (OBRA '87)?

OBRA '87 was a major piece of legislation that increased government oversight of nursing homes, establishing stricter regulatory standards.

What was the central ruling of the Supreme Court's 1999 Olmstead decision?

The Supreme Court ruled that institutionalizing individuals with disabilities violated the Americans with Disabilities Act, requiring states to offer community-based alternatives under Medicaid.

In what year was the Americans with Disabilities Act (ADA) passed?

The Americans with Disabilities Act was passed in 1990.

How did state Medicaid programs react to the Supreme Court's Olmstead decision?

States expanded home and community-based services (HCBS) to help individuals with disabilities receive care in community settings rather than being defaulted into institutions.

What impact did the American Rescue Plan of 2021 have on long term care?

It reauthorized multi-year federal funding for the Older Americans Act.

What major concern did the Department of Justice (DOJ) memo in June 2026 raise among disability advocates?

The DOJ memo questioned long-standing protections under the Olmstead decision and asserted that states are not required to provide home and community-based services.

Who is Maria Town?

Maria Town is the President and CEO of the American Association of People with Disabilities.

How old were the Americans with Disabilities Act and the Olmstead decision at the time of Maria Town's interview?

The Americans with Disabilities Act was turning $36$ years old, and the Olmstead decision turned $27$ years old.

Why is the long term care system described as a continuum?

It is called a continuum because care is not one-size-fits-all; individuals have different needs, and an individual's care needs often change over time.

In which chapter will residential care and assisted living facilities be discussed in depth?

Chapter 5.

What is the formal healthcare term used for a standard nursing home?

A skilled nursing facility.

What type of long term care service does Generations Crossing provide?

Generations Crossing provides adult day care or adult day services, which offer daytime programming for older adults who cannot remain unsupervised.

What overarching structural shift has occurred in long term care over the past several decades?

A shift away from institutional settings (nursing homes) toward noninstitutional, home and community-based services.

In what decade did assisted living facilities first emerge?

Assisted living facilities first emerged in the 1990s.

What are the three primary reasons for the shift toward noninstitutional long term care services?

Individual preference to remain at home, lower costs when services are received in moderation, and legal mandates from the Olmstead decision under Medicaid.

What is the estimated annual cost of care in a nursing home according to the lecture?

Well over $100,000$ a year.

What key factors determine appropriate placement for a patient along the long term care continuum?

Extent of disability (ADLs/IADLs), personal preferences, service availability in the geographic area, and ability to pay or insurance coverage.

What is the average nationwide nursing home occupancy rate since the COVID-19 pandemic?

Approximately 80\text{\null} occupancy.

Who provides the majority of long term care in the United States?

Informal caregivers, primarily family members.

Which demographic group provides the largest portion of informal family caregiving?

Middle-aged women.

What is the estimated annual economic value that family caregivers contribute to the U.S. health care system?

Approximately $470,000,000,000$ (nearly $500,000,000,000$).

According to statistics cited in the lecture's video clip, what percentage of people over age 60 will require long term care?

70\text{\null} of people over the age of 60.

What percentage of individuals requiring long term care rely on private long term care insurance policies?

Only 7\text{\null}.

What is the Village movement, and where was it originally established in 2001?

It is a community grassroots model allowing seniors to stay in their own homes safely while accessing support services; it originated with Beacon Hill Village in Boston.

How many villages were operating or in development nationwide according to the video report?

There were $140$ operational villages across the country and over $100$ more in development.

What Medicare integration framework, expanded under the Affordable Care Act (ACA), allows nursing homes to coordinate care with broader health care systems?

Accountable Care Organizations (ACOs).

What term describes individuals who do not qualify for Medicaid due to income, yet lack sufficient wealth to pay for private long term care?

The middle-income care gap (being trapped 'in the middle').

What specific types of post-acute care are reimbursed by Medicare on a short-term basis?

Skilled nursing facilities and home health agencies.

What health care concept refers to the movement of older adults between different care settings as their health status changes?

Transitions of care.

What is the annual membership dues fee per couple for members of Beacon Hill Village?

Approximately $1,000$ per year.

In which types of facilities is subacute long term care primarily provided?

Skilled nursing facilities and long term care hospitals.

How do nursing homes control the number of Medicaid beneficiaries admitted to their facilities?

By certifying only a specific number of beds for Medicaid reimbursement.

What is the primary objective of independent living and supportive housing options for older adults?

To enable seniors to safely age in place in noninstitutional settings.

What major legislative expansion occurred in government programs for older adults and needy groups between $1935$ and $1965$?

The $30$-year period from $1935$ to $1965$ saw significant expansion in government programs designed to support older adults and other needy groups.

What were the main developments in long term care from $1970$ to approximately $2000$?

This period saw increased federal oversight and regulation of long term care, alongside significant pressure across the health care system to reduce spiraling costs.

When was the Medicare prospective payment system enacted in long term care, and which providers did it initially target?

It was enacted under the Balanced Budget Act of $1997$, starting with nursing homes and home health agencies.

In what year did Medicare implement the prospective payment system (PPS) and Diagnosis-Related Groups (DRGs) in hospitals?

Medicare implemented PPS in hospitals in $1983$.

How is prospective payment defined under Medicare?

Prospective payment is a system where Medicare determines reimbursement rates in advance annually for grouped patient conditions, rather than paying providers based on incurred costs.

What was the significance of the Omnibus Budget Reconciliation Act of $1987$ (OBRA '87)?

OBRA '87 was a major piece of legislation that increased government oversight of nursing homes, establishing stricter regulatory standards.

What was the central ruling of the Supreme Court's $1999$ Olmstead decision?

The Supreme Court ruled that institutionalizing individuals with disabilities violated the Americans with Disabilities Act, requiring states to offer community-based alternatives under Medicaid.

In what year was the Americans with Disabilities Act (ADA) passed?

The Americans with Disabilities Act was passed in $1990$.

How did state Medicaid programs react to the Supreme Court's Olmstead decision?

States expanded home and community-based services (HCBS) to help individuals with disabilities receive care in community settings rather than being defaulted into institutions.

What impact did the American Rescue Plan of $2021$ have on long term care?

It reauthorized multi-year federal funding for the Older Americans Act.

What major concern did the Department of Justice (DOJ) memo in June $2026$ raise among disability advocates?

The DOJ memo questioned long-standing protections under the Olmstead decision and asserted that states are not required to provide home and community-based services.

Who is Maria Town?

Maria Town is the President and CEO of the American Association of People with Disabilities.

How old were the Americans with Disabilities Act and the Olmstead decision at the time of Maria Town's interview?

The Americans with Disabilities Act was turning $36$ years old, and the Olmstead decision turned $27$ years old.

Why is the long term care system described as a continuum?

It is called a continuum because care is not one-size-fits-all; individuals have different needs, and an individual's care needs often change over time.

In which chapter will residential care and assisted living facilities be discussed in depth?

Chapter $5$.

What is the formal healthcare term used for a standard nursing home?

A skilled nursing facility.

What type of long term care service does Generations Crossing provide?

Generations Crossing provides adult day care or adult day services, which offer daytime programming for older adults who cannot remain unsupervised.

What overarching structural shift has occurred in long term care over the past several decades?

A shift away from institutional settings (nursing homes) toward noninstitutional, home and community-based services.

In what decade did assisted living facilities first emerge?

Assisted living facilities first emerged in the $1990$s.

What are the three primary reasons for the shift toward noninstitutional long term care services?

Individual preference to remain at home, lower costs when services are received in moderation, and legal mandates from the Olmstead decision under Medicaid.

What is the estimated annual cost of care in a nursing home according to the lecture?

Well over $100,000$ dollars a year.

What key factors determine appropriate placement for a patient along the long term care continuum?

Extent of disability (ADLs/IADLs), personal preferences, service availability in the geographic area, and ability to pay or insurance coverage.

What is the average nationwide nursing home occupancy rate since the COVID-19 pandemic?

Approximately 80\text{\null} occupancy.

Who provides the majority of long term care in the United States?

Informal caregivers, primarily family members.

Which demographic group provides the largest portion of informal family caregiving?

Middle-aged women.

What is the estimated annual economic value that family caregivers contribute to the U.S. health care system?

Approximately $470,000,000,000$ dollars (nearly $500,000,000,000$ dollars).

According to statistics cited in the lecture's video clip, what percentage of people over age $60$ will require long term care?

70\text{\null} of people over the age of $60$.

What percentage of individuals requiring long term care rely on private long term care insurance policies?

Only 7\text{\null}.

What is the Village movement, and where was it originally established in $2001$?

It is a community grassroots model allowing seniors to stay in their own homes safely while accessing support services; it originated with Beacon Hill Village in Boston.

How many villages were operating or in development nationwide according to the video report?

There were $140$ operational villages across the country and over $100$ more in development.

What Medicare integration framework, expanded under the Affordable Care Act (ACA), allows nursing homes to coordinate care with broader health care systems?

Accountable Care Organizations (ACOs).

What term describes individuals who do not qualify for Medicaid due to income, yet lack sufficient wealth to pay for private long term care?

The middle-income care gap (being trapped 'in the middle').