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Long Term Care in Older Adults

Long Term Care in Older Adults. Seki Balogun, MD, FACP. Objectives. By the end of this session, students will be able to: Recognize the two main types of long term care Recognize the differences between the nursing homes and assisted living facilities.

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Long Term Care in Older Adults

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  1. Long Term Care in Older Adults Seki Balogun, MD, FACP

  2. Objectives By the end of this session, students will be able to: • Recognize the two main types of long term care • Recognize the differences between the nursing homes and assisted living facilities. • Discuss the different patient characteristics of both institutions. • Relate to older adults who are in long term care.

  3. Long Term Care • Nursing Homes • Assisted living facilities • Focus of care is to achieve and maintain an optimal level of functioning • Interdisciplinary care

  4. LTC: Historical background Twelfth century • “Gerocomeia” in ancient Greece Early 1900 • Europe: special care units for the chronically ill elderly • United States: chronically ill and disabled • Poorhouses

  5. Historical background • 1920s • State licensure programs • Standards and oversight were minimal • Mid – 1900s • Social Security Act • Private nursing homes • Run by nurses • Custodial care • Post- world war II: modeled after hospitals • Minimum standard of care

  6. Historical background • 1980s • Nursing Home Reform Act (OBRA ’87) • State regulations • Quality of care for the cognitively and functionally impaired

  7. Nursing homes • 1.5 million Americans (most aged 65 years and older) reside in 17,000 nursing facilities nationwide • 43% of adults 65 years and older will stay in a nursing home at some time before they die • 55% have a lifetime use of at least 1 year • 21% have a total lifetime use of 5 years or more

  8. Nursing Homes • Skilled nursing care • Long term nursing care • Hospice care

  9. Case 1. • Mr. TB is a 90 year old man with multiple medical problems, who was admitted to the hospital last week with community acquired pneumonia. • He is now ready for discharge • He is deconditioned and is unable to ambulate • He lives with and is the caregiver for his wife, who has advanced dementia

  10. Nursing Homes Skilled nursing care • Typically for those discharged from an inpt setting with functional deficits and often medically complex • Require one or more forms of therapy (PT, OT, speech) • High degree of nursing care: IV, wound care • Length of stay usually less than 6 months (few days to months) • Paid for by Medicare

  11. Case 2. • Ms. TJ is an 85year old woman with paraplegia from a spinal cord injury. She has severe neuropathic pain and is wheelchair dependent. • She lives alone, has no relatives in VA. • She had a paid caregiver, 6hrs/day, who helped her with self care (bathing, toileting) and her instrumental ADLs (cooking, cleaning and shopping). • She can no longer afford to pay her caregiver

  12. Nursing Homes Long term nursing care • For those who can no longer live independently • Require assistance for self care and IADLs • Significant functional, cognitive or psychosocial deficits • Paid for: • Private pay • Long term care insurance • Medicaid

  13. Nursing Homes Hospice care • Terminal conditions with less than 6 months to live • Usually in conjunction with an independent hospice organization • Team provides a network of services: physicians, nurses, social workers, chaplain • Paid for by Medicare

  14. So what should happen to seniors who need some help, but do not require 24 hr nursing care? • They should be admitted to the nursing home: better safe than sorry. • Their family should care for them: it is their responsibility • They could live in an assisted living facility • They should pay for a caregiver

  15. Assisted Living facility • Residents require some supervision or physical assistance due to functional or cognitive deficits • Usually owned by private organizations • Provision of individual care needs vary with facility • Provides 3 meals and medication administration • Costs about $2-4K/month • Paid for: Private pay Long term care insurance

  16. Assisted living facility • Better received by seniors • More home - like • Less institutionalized setting • Rare “Auxiliary Grants” for low income people. • A few beds in our area at Mountainside in Crozet.

  17. HealthCare Financing in LTC • Medicare • Medicaid • Long term care insurance • Private pay

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