health services

(Overview of Long Term Care Continuum)

  • The long term care (LTC) system is extensive and increasingly complex over time.

  • Key objectives of long term care include:

    • Health: Ensuring the overall well-being of individuals receiving care.

    • Custodial Services: Defined as assistance with everyday activities, rather than medical care; predominantly provided by Certified Nursing Assistants (CNAs).

    • Example of Custodial Care: Helping individuals with daily tasks like bathing, dressing, and eating.

    • Social and Housing Needs: Additional factors not extensively dealt with in acute care settings.

Target Population for Long Term Care

  • Long term care is designed for individuals who cannot care for themselves, either due to loss of capacity over time or never having had the capacity.

  • The focus of this discussion is on the elderly demographic.

  • Duration of Care: Long term care is intended for indefinite periods, as indicated by its name.

Goals of Long Term Care

  1. Promoting Health:

    • Maintaining health is crucial as it leads to decreased costs in healthcare systems.

  2. Independence and Functional Abilities:

    • Vital to support autonomy and prevent individuals from feeling despondent, leading to a decline in health (e.g., a person losing autonomy may give up).

    • Personal Anecdote: An example illustrates the frustration of needing help after an injury, reflecting the feelings of individuals in LTC settings.

  3. Quality of Life:

    • Unlike acute care, LTC focuses on developing relationships and understanding individuals to enhance their quality of life.

    • LTC also addresses terminal illnesses through hospice, which focuses on providing a peaceful and dignified dying process.

Differences between Acute Care and Long Term Care

  • Acute Care:

    • Crisis-oriented, with sudden medical issues requiring immediate treatment (e.g., surgery).

    • Goal: Expectation of recovery and return to pre-incident functionality.

    • High-tech, predominantly involving advanced medical technology.

  • Long Term Care:

    • Chronic conditions, often with gradual onset.

    • Focus on maintaining current status and preventing decline; improvement is not the primary goal.

    • Low-tech approach, emphasizing personal relationships and caregiver support.

Long Term Care Continuum

  • The continuum includes:

    • Acute Care: Initial medical intervention generally leads to LTC services.

    • Post-Acute Care: Follow-up care after hospitalization.

    • Nursing Homes and Assisted Living: Different levels of care; not interchangeable.

    • Continuing Care Retirement Communities: A combination of various care options.

    • Adult Day Services (ADS): Outpatient services for individuals requiring daytime support.

    • Home Health or Home Care: Support provided in the home setting.

    • Hospice: Specialized care for terminally ill patients.

Informal Care

  • Definition: Unpaid care provided by family members or friends.

  • Often less recognized, yet critical support in long term care—monetizing this service could surpass formal care costs.

  • Importance of caregivers is acknowledged for both the financial system (Medicare cost savings) and the health of the caregiver, preventing further healthcare system strain.

User Demographics in Long Term Care

  • Primary users include elderly individuals, disabled persons, and those with mental illnesses.

  • Statistics: In 2018, ~15 million individuals utilized long term care in the U.S., projected to double in 20 years due to the aging baby boomer population.

  • Significant increase in the number of older adults, impacting healthcare resource needs.

Population Proportions and Age Classifications

  • Classification of elderly population:

    • 65-74 years: Young old or "Gogos"

    • 75-84 years: Old or "Slogos"

    • 85+ years: Old old or "No Gos"

  • Aging correlates directly with an increased need for healthcare resources and services.

Functional Abilities and Disabilities

  • Long term care needs are primarily based on functional ability vs. disability.

  • Activities of Daily Living (ADLs): Essential for personal survival includes:

    • Bathing

    • Dressing

    • Toileting

    • Transferring (moving from one place to another)

    • Eating

  • Instrumental Activities of Daily Living (IADLs): Necessary for community living includes:

    • Managing finances

    • Using communication devices

    • Shopping

    • Transportation (driving/public transit)

    • House cleaning

    • Medication management

Strengths and Weaknesses of Long Term Care

  • Strengths:

    • Adaptability to the changing needs of the aging population (e.g., dementia care).

    • High dedication and commitment of caregivers in the field.

    • Development of innovative care approaches.

    • Increased focus on customer service.

  • Weaknesses:

    • Heavily influenced by reimbursement models, leading to inequitable service distribution.

    • Public perception issues and reputation overshadowed by acute care systems.

    • Funding disparities, with long term care often underfunded compared to acute care.

Career Considerations in Long Term Care

  • The conversation highlights various preferences among healthcare professionals between working in acute vs. long term care:

    • Many express preference for acute care due to higher compensation and less emotionally challenging work environments.

    • Concerns about the emotional toll and labor intensity of long term care (dirty work, caregiving tasks discomfort).

    • The discussion encourages students to explore long term care as a potential career option and to understand the different environments and rewards they offer.