Long-Term Care

1. Long-Term Care http://www.youtube.com/watch?v=k7Pe-27LBUY

2. Long term care comes in many types of form. Informal care provided by family. Home Health Services. Home Delivered meals. Personal Assistance provided in a residential setting.

3. The Nature of Long Term Care Long Term Care consists of 7 components. Variety of Services Individualized Services Well-Coordinated Total Care Promotion of Functional Independence Extended Period of Care Holistic Care Quality of Life.

4. Variety of Services A variety of services is necessary because individual needs, as determined by health status, finances, and other factors, vary greatly among people who require LTC (Long Term Care).

5. Individualized Services LTC services are often individualized based on an assessment of an individuals current physical, mental and emotional conditions. Also taken into consideration is past history of medical conditions, leisure activities, and cultural factors.

6. Well Coordinated Total Care • Long Term-Care providers are responsible for managing the total health care needs of an individual. Here, a care taker will help an individual move with ease among other needed services (e.g. - dentist, optometrist, or any other appointments that may be necessary).

7. Promotion of Functional Independence • A major component of Long Term-Care is the degree to which an individual is unable to independently perform certain tasks of daily living. A goal of this function is for the individual to continue to perform certain tasks despite their disability, by using adaptive devices. (E.g. – Walkers, wheelchairs, or portable oxygen devices for breathing).

8. Extended Period of Care • Most Long Term-Care individuals utilize various services extended over a relatively long period because most individuals of care will at least require ongoing monitoring to note any deterioration in their health and to address any emerging needs. Any deterioration of health would require an extended period of care.

9. Holistic Care • Holistic Care would propose any health needs that extend beyond physical and mental needs. In Holistic care, a patients mental, physical, and spiritual needs should be incorporated into medical care delivery.

10. Quality of Life • A sense of satisfaction, fulfillment, and self worth is regarded as a critical patient outcome in any health care delivery setting. An Individuals quality of life must consist of 5 factors. Attempting to maintain a certain lifestyle, living environment, clinical palliation, human factors, which consist of compassion, respect, and human dignity for the patient, and personal choices, in which an individual is given options, without a rigid schedule.

11. Levels of Care for Long Term-Care • Personal Care – Refers to assistance with basic activities of basic living, such as bathing. • Custodial Care – is non-medical care provided to support and generally maintain the patients conditions and the essentials of daily living. These services are provided to help maintain, rather than restore functioning. • Restorative Care – based on caregiving in which patients are viewed as participants who can reach maximum potential in physical and mental functioning. Examples would be range-of-motion exercises, bladder training, and assisted walking. These services are usually provided by Home Health Agencies, rehabilitation hospitals, and outpatient clinics.

12. Skilled Nursing Care – is medically oriented care provided mainly by a licensed nurse under the overall direction of a physician. Delivery of this care includes monitoring of acute and unstable chronic conditions, and a variety of treatments that may include wound care, intravenous therapy, oncology care, HIV/AIDS care, management of neurological conditions and phlebotomy. • Subacute Care – is often required during the post acute phase of an acute period. This at times is a complex service that are beyond traditional skilled nursing care. This type of care is for patients who remain critically ill during the postacute phase of illness or injury, or who have actively complex conditions that require ongoing monitoring and treatment of intense rehabilitation.

13. Levels of intensity A variety of services are now available to address the varied requirements from basic personal to the more specialized sub acute long term care.

14. 5 types of Long Term Care Personal Care • Personal care refers to light assistance with basic ADLs such as bathing. • Paraprofessionals are the ones that provide this kind of service such as HHA, CNA, and TA. • Personal Care can be provided by informal caregivers such as Home Health Agencies, Adult Day Care (ADC), Adult Foster Care (AFC) and residential and assisted living facilities. Custodial Care • Is a non-medical care provided to support and generally maintain the patient’s condition and the essential of daily living. The emphasis of this care is to prevent further deterioration. • This care doesn’t require active nursing treatments only a routine assistance with ADLs services. • This care is generally longer term its is continued after the patient shows no potential improvement and cannot participate in therapy.

15. Restorative Care • Also known as rehabilitation care which is based on philosophy of caregiving in which the patients is viewed as a participant who can reach their maximum potential in physical and mental functioning. • In RC therapies are included into the daily routine such as physical, occupational and speech therapy. Example; bowel and bladder training and assisted walking. • This service is provided by paraprofessionals as well. Skilled Nursing Care • This service is provided by a licenses nurse under the overall direction of a physician. • This care provide services such as monitoring of acute and unstable chronic conditions, it also includes wound care, tube care management, intravenous therapy, HIV/AIDS care, and phlebotomy. • Skilled Nursing Care is provided by Home Health Agencies and Skilled Nursing Facilities.

16. Subacute Care It is required during the postacute phase of an acute episode. This care is for patients who remain critically ill during the postacute phase of illness or injury. It includes various medical, surgical, oncological, rehabilitation and other intensive services. There are four levels of Subacute Care which are extensive, special, clinically and rehabilitation care.

17. Key Social Aspects of LTC Housing • The national Affordable Housing Act of 1990 is a program that provides federal funds to construct a supportive house designed for low-income elderly. • Housing is an option for seniors and disabled adults who do not want to live alone. This service offer patients a private bedroom and supportive services such as meals, transportations, housekeeping, security and social activities. • End-of-Life Care • Dealing with death and dying is very much a part of LTC. End-of-life care deals with preventing needless pain and distress for terminally ill patients and their families. • End-of-Life clinical pathway video with examples of good practice. http://www.youtube.com/watch?v=weFqpNzflug

18. Clients of Long Term Care Older Adults Children and Adolescents • At the beginning of the 20th century, persons 65+ years of age constituted 4% of the population in the US. Today, roughly 12.5% of the populations falls in that age group. • This been said , elderly in the lowest socioeconomic status are the greatest risk of need for LTC and are also the least able to pay for such services. • The second highest % of clients in the LTC are Children and adolescents that are born with birth disorders such as logical palsy, autism, epilepsy etc. • Children that develop physical disability such as dysfunctions are referred to as developmentally disabled, and children that are bellow-average intellectually lead to the MR. Today the average life expectancy of those whit MR approaches 66 years. • Fact: DS is the most common cause of MR in America.

19. Young Adults PPL with HIV/AIDS • The most common disability in young adults is neurological malfunctions. For example; multiple sclerosis is potentially the most common cause of neurological disability in young adults. PPL requiring Specialized Care • A growing # of nursing facilities have developed specialized services such as ventilator care and specialized care for head trauma victims. • Aids has evolved from an end-stage terminal illness into a chronic condition. Over a period of time people with AIDS are subject to a number of debilitating conditions, creating the need of assistance. • Furthermore, HIV/AIDS patients are likely to be younger than 60 years, male and Black or Hispanic. This patients require special challenges than the rest of the patients in the LTC because they have higher prevalence of depressions, psychiatric disorders, and dementia associated with AIDS.

20. Types of community –based Long-term care service: · To deliver LTC in the most economical and least restrictive setting whenever appropriate for the patient’s health care needs. · To supplement informal care giving when more advance skills are needed · To provide temporary delay to family from caregiving stress · To delay institutionalization by meeting the needs of the most weak elderly community settings.

21. What is Home Health Care? HHC refers to health care provided in the home of the patient by health care professionals. It commonly requires a community or hospital-based home health agency that sends health care professional and paraprofessionals to patient’s homes to deliver services approached by a physician. What is Adult Day Care? ADC referred to as adult day service, is a daytime program of nursing care, rehabilitation therapies supervision, and socialization that enables weak people to remain in the community. The national adult day services association is designed for people who because of physical or mental conditions cannot remain along during the day, but who have family members to take care of them so this allows family caregivers to work during the day .It provides a variety of health, social, and other related support services in a protective setting during any part of a day but less than 24-hour care. It normally operates during normal business hours five days a week

22. Adult Foster Care: Is a service characterized by small, family-run homes providing room, board, and various levels of supervisions, oversight, and personal care to nonrelated adults who are unable to care for themselves. Typically, the care giving family resides in part of the home, however; many people have made a business of AFC by buying several houses and hiring families to live in them to care for functionally impaired elderly people.

23. SENIOR CENTERS • Community Center • Wellness Center • Lifelong Learning/Arts • Continuum of Care/Transitions

24. Seniors feel a sense of purpose, productive, vital Seniors feel physical and mental health is better Seniors enjoy making new friends, camaraderie of professional work environment Vital community resource is mobilized by using senior’s skills

25. HOME DELIVERED AND CONGREGATE MEALS (Meals for the Elderly)

26. WHO IS ELEGIBLE? A person 60 years of age or older, and the spouse of the person regardless of age. Individuals with disabilities who reside in housing facilities occupied primarily by older individuals at which congregate meals are provided. Adults with disabilities who reside at home.

27. HOMEMAKER SERVICES Personal non-medical care. Meal preparation, shopping. Light housekeeping, laundry, and grooming to frail elderly and persons with disabilities.

28. EMERGENCY RESPONSE AND TELEPHONE REASSURANCE

29. CASE MANAGEMENT • Health assessment. • Planning. • Procurement. • Delivery and coordination of services. • Monitoring to assure that the multiple service needs of the client are met.

30. Case Management

31. Case Management

32. Managed Care

33. HOSPICE CARE

34. INSTITUTIONAL LONG TERM-CARE • Retirement Living. • Assisted Living. • Residential Care.

35. Nursing Home Industry • The nursing home industry is dominated by the for-profit sector. • Nationally, the average nursing home had 107.6 beds with an occupancy rate of 86%. 92 beds. • Most nursing homes operate in chains, the 10 largest chains have at least 90 homes.

36. Nursing Homes Stats • 90% of all residents that live in nursing homes are 65 years of age or older. • 80% of residents are dependent for their mobility, 66% are incontinent, 47% require assistance when eating and 37% are dependent in all three areas.

37. Nursing Home Services • Nursing homes provide a variety of services such as: • Restorative care. • Treatment of skin wounds. • Dementia care. • These are the most commonly available services offered at nursing homes.

38. Patient Conditions • The three most common conditions nursing home patients suffer from are: • Bladder incontinence 54%. • Alzheimer’s disease 46%. • Bowel incontinence 43%. • Also weight variation, pressure sores and skin rashes.

39. Nursing Home Finances • National expenditures for nursing home care have been much lower than those in other sectors of health care delivery. • Most of the expenses are financed through Medicaid, but private sources like private insurance and out of pocket cover a sizeable portion.

40. Medicare • Medicare is known for being the primary payer for elderly medical services. • In 2004, Medicare only covered 13.9% of the costs of nursing homes. • Medicare only covers limited benefits for nursing home care.

41. Medicaid • Of the 52 million Medicaid beneficiaries, only 3.3% received services in nursing home facilities. • These facilities consumed 22% of total Medicaid expenditures, which is far more than what it spent for any other service.

42. Private Pay • Private pay is out of pocket financing for LTC (long-term care insurance). • Many patients are initially admitted to a facility through private funds. • Once the funds are exhausted, then the patient may qualify for Medicaid. • The term step down refers to exhausting ones assets and income to the medically needy levels to qualify for Medicaid.

43. Prospective Payment • In 1998, Medicare implemented the PPS program to replace cost based reimbursement for SNFs. • Prospective payment is based on case mix. • Patients who are more seriously ill incur more costs so depending on the case mix will determine how much the SNF is reimbursed.

44. Prospective Payment • Patient assessment plays a big role in prospective reimbursement because it is used to determine the case mix. • A trained RN oversees the assessment process using a minimum data sheet (MDS) which contains over 100 assessment items that provide extensive information about the patient.

45. Federal Certification • In order for SNFs and NFs to qualify for federal certification which allows them to admit Medicare and Medicaid patients they must meet 17 major categories. • Examples: Residents rights, Quality of Life, Nursing Services, Dietary Services and Physician Services.

46. Conclusion • Nursing facilities play a very key role in our society. They offer families and people who are unable to care for themselves or loved ones, an opportunity of assisted living.