Chapter 10: Long Term Care – Flashcards

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Introduction to Long Term Care
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LTC provided for those with chronic conditions, like illness, disability, and death ~Elderly are primary recipients of LTC, but there are those physically and mentally healthy to live independently ~Associated with care from nursing homes, but more of a community-based setting ~Strong desire of older Americans to stay in their homes ~Examples are informal care from family, home-delivered meals, and foster homes. ~System cannot be isolated and must interfere with rest of system to provide health care
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The Nature of Long-Term Care
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LTC is multidimensional ~Variety of services ~Individualized services ~Extended period of care ~Well-coordinated total care ~Maintenance of residual function ~Holistic care ~Quality of Life ~Use of current technology ~Use of evidence-based practices
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1. Variety of services 2. Individualized services 3. Extended period of care 4. Well-coordinated total care
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1. Fit personal preferences ~Adapt to change over time ~Based on needs and health status of individual 2. Comprehensive assessment of individual's physical, mental, and emotional conditions ~Care plan is individualized ~Customized interventions 3. Services monitor for any deterioration of health or any emerging needs ~Indefinite institutional care ~Short-term rehabilitation until patent is independent 4. Providers responsible for total health care of individual
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1. Total Care 2. Case Management 3. Congregate housing
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1. Any health care need is recognized, evaluated, and addressed by appropriate clinical professional 2. Matching client needs with available services most likely to address individual's needs ~Coordination with LTC system. 3. Multiunit housing with support services for those that do not want to live along yet maintain privacy and companionship
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5. Maintenance of residual function 6. Holistic care 7. Quality of life
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5. Goal is to maintain function and prevent further decline ~Allows person to do as much as possible for himself ~Caregiver when unable to perform daily living tasks 6. Physical, mental, social, and spiritual needs met 7. Important due to loss of self worth for patient in LTC for long durations
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8. Use of current technology 9. Use of evidence-based practices
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8. Promotes safety and quality of care 9. Clinical practice guidelines provide directions and treatment protocols for improved health outcomes ~Best practices are evaluated through clinical research
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Factors for Quality of Life
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~Lifestyle pursuits--meaningul activities ~Living environment--comfortability ~Clinical palliation--relief from unpleasant symptoms ~Human factors--emphasis on compassion and dignity ~Personal choices--ability to choose
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Types of Long-Term Care Services
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~Medical Care, nursing and rehabilitation ~Mental health services and dementia care ~Social Support ~Prevention and Therapeutic LTC ~Informal and formal care ~Respite care ~Community-based home and community-based ~Institutional services ~Housing ~End-of-Life care
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1. Medical care, nursing, and rehabilitation 2. Mental health services and dementia care
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1. Clinical management of chronic illness and comorbidity ~Restoration or maintenance of physical function ~After treatment of acute episode in hospital ~Post-acute continuity of care 2. Mental illness among 25% of elderly ~Usually accompanied with other chronic illnesses ~Diagnosing mental illness among elderly is challenging, not receiving correct diagnosis or care
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Dementia
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~Progressive and irreversible decline in cognition, thinking, and memory ~Alzheimer's disease is most common ~15% of elderly have dementia ~40% need institutional care
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1. Social support 2. Prevention and Therapeutic LTC
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1. Coping and support with changing life events that create emotional imbalances ~Help deal with conflict within social systems ~Adaptation to new environment and people ~Total care is coordinated ~Should keep clients connected with community and outside world. 2. Main goal is to prevent or delay institutionalization ~Access to vaccines and routine medical care ~Restorative services--nursing care, rehabilitation, and therapeutic diets ~Community-based LTC services provide assistance
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1. Informal and Formal care 2. Respite care
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1. Most LTC in US is informal--unpaid care by family and friends ~Insufficient informal care is associated with higher all-cause morality, hospitalization, and institutionalization ~Family helps in transition between care delivery to hospitals and nursing homes ~Formal care: From professionals and anyone connected to a facility. 2. Any type of LTC services that allows caregivers free time from stress ~Family caregivers face physical, emotional, social, and financial issues.
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1. Community-based home and community-based 2. Institutional services
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1. Delay or prevent institutionalization ~Economical and least restrictive setting ~For those without informal support ~Supplement or substitute informal caregiving 2. Short or long duration ~Therapeutic services, ADL help for difficult impairments ~Adequate communication with physicial and staff about patient's condition. ~Paraprofessionals in more institutions--nurses or therapists ~Prevent functional decline, and coordinate total care
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1. Housing 2. End-of-Life Care
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1. May or may not have support services ~Noninstitutional housing other than one's home ~Occasional LTC needs met ~Private of public housing 2. Prevent needless pain and distress for the terminally ill and families ~Quality emphasis on dignity and comfort from institutional staff or hospice services
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1. Private Housing 2. Public Housing
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1. Upscale retirement centers ~Some support services may be included ~Entrance fee and monthly rental 2. Government assisted, subsidized housing ~Provide federal aid to local housing agencies ~Operated by government, and funded by nonprofit sponsors to construct rentals. ~Vouchers used for preferential housing
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Types of Clients of LTC
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1. Older adults 2. Children and adolescents 3. Young adults 4. People with HIV/AIDS
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1. Older adults 2. Children and adolescents
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1. 85+ age group (oldest old) that is fast-growing by 2030--"baby boom generation" ~Elderly in lowest socioeconomic status are at greatest risk for LTC and no way to pay for services. ~Possible strain on taxpayers to cover delivery of LTC services. 2. ~Developmental disability: Incapacity at a young age ~Impairments are functional and birth related ~Mental retardation--intellectual disability, like Down syndrome ~Examples: Birth-related disorders, cerebral palsy, and autism. ~Specialized facilities equipped to care for ID.
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3. Young Adults 4. People with HIV/AIDS
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3. May need ventilator care and total assistance with ADLs ~Adults with MR/DD ~Permanent diability from neurological malfunctions, degenerative conditions, traumatic injury ~Special facilities to a community-based service to show better adaptive behavior and satisfaction. 4. Considered chronic condition due to anti-retroviral therapy ~High cost treatment ~Increase cases among elderly ~Lack of informal support
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1. Olmstead vs. L.C. 2. Home and Community Based Services Waiver Program
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1. Supreme court rules community-based services for MR/DD patients when appropriate 2. State expansion on community-based LTC services under Medicaid ~Provide services for Medicaid that would be institutionalized
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Level of Care Continuum
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~Personal care--basic ADL assistance, light assistance from paraprofessional or informal care ~Custodial care--nonmedical care to mantain function on routine assistance with ADLs and prevent deterioration, no active medical care ~Restorative care--help regain or improve function after onset of disability. Short treatment through therapist to reach maximum potential of function
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Level of Care Continuum (Part 2)
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~Skilled nursing care--clinical care from nurses under physicians through assessing patient needs, monitor conditions, and provide care ~Subacute care--complex service for critically ill for treatment or intense rehabilitation. With extensive care from long-term hospitals or skilled nursing facilities
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HCBS
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~Allows state to expand community-based LTC services under Medicaid ~Provides services to those on Medicaid that would be institutionalized ~Save money on institutional care
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Objective of Community-Based LTC Services
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1. Provide most economical and least restrictive setting appropriate for patient's healthcare needs 2. Informal caregiving with advanced skills 3. Temporary respite to family from caregiving 4. Delay or prevent institutionalization by meet most vulnerable needs in community setting
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Financing of Community-Based LTC Services
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~Private donors ~Long-term care insurance ~Medicare and Medicaid ~Other public sources ~Title III of the Older American Act of 1965 funds states ~Provide for 60 and older with social or economic need
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Types of Community-Based LTC Services
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~Case management ~Homemaker services ~Adult day care ~Home health care ~Continuing care at home ~Adult foster care ~Senior centers ~Home-delivered and congregate meals
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Home Health Care
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~Community or hospital-based agency ~Agencies are private for profit ~Medicare is largest payer, followed by Medicaid ~Mean length of service is higher among nonelderly ~Services approved by physician and provide help for ADLs. ~Skilled nursing care is most common service
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Adult Day Care
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~Clients that stay with family/ friends but cannot be left alone during daytime ~Respite care for families ~Increased across country ~Focused on prevention and health maintenance ~Incorporate nursing care, rehabilitation, and therapy ~Funded by Medicaid, private sources, and Medicare ~Almost half of clients have dementia
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Models of Adult Day Care
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1. Health rehabilitative model: More intense medial staff for recovery from degenerative conditions ~Formal procedures, individualized plan based on evaluation, discontinued once patient is independent 2. Health maintenance model: Focus on maintenance of health and function, preventive and last longer than health rehabilitation 3. Social-psychological model: For dementia and Alzheimer's
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Adult Foster Care
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~Small-community based, family-run homes ~Services are mostly room and board, supervision, and light ADL assistance ~State to state different standards in program ~Source of money from Medicaid, private sources, and Medicare for rehabilitation--cost is one-third of nursing homes.
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Senior Centers
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~Local community centers for older adults. ~Socializing and offer of one or more meals ~Wellness program, education, counseling, recreation ~Financed by public funds and private donations
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Home-Delivered and Congregate Meals
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~Elderly nutrition program ~Hot noon meal, five days per week ~People age 60+ and spouses qualify ~Home delivery and preventive nutrition, senior centers, and other congregate settings ~Program successfully targeted at-risk people ~Financed by Older Americans Act, Title XX block grants, and private donations
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Homemaker Services
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~Financing from Medicaid, Title XX block grants, Older Americans Act, private funds ~Light cleaning ~Assistance from volunteers ~Minor home repairs ~Errands ~Shopping for groceries
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Continuing Care at Home
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~Extension of the CCRC model into home health ~Initial lump-sum fee + monthly fee ~Future LTC care guaranteed ~Services include care coordination, home maintenance, home health care, transportation, meals ~Future institution needs are met
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Case Management Functions
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~Evaluating needs ~Plan to address the needs ~Identifying appropriate services ~Determining eligibility and financing ~Making referrals ~Coordinating delivery of services ~Reevaluating needs
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Types Case Management Models
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1. Brokerage model 2. Managed care model 3. Integrated care model
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1. Brokerage Model 2. Managed Care Model 3. Integrated Care Model
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1. Case managers are freestanding agents who assess client needs and make referrals and service plan ~Minimal coordination and monitoring ~Pre-admission screening to look at need assessment and referral. 2. Services are delivered through a social health maintenance organization that coordinates acute, chronic, LTC, and social services to address a patient's comprehensive needs. ~All services from MCO and capital financing ~Can postpone institutionalization ~Managers are nurses or social workers 3. Focused on frail elderly already certified for nursing home placement under Medicare and/or Medicaid. ~Ongiong prevention of progression of disability. ~Use of capitation.
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Institutional LTC Continuum
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~For needs of people that have needs not met in community-based settings. ~Independent of Retirement Living Centers ~Residential and personal care facilities ~Assisted living facilities ~Skilled nursing facilities ~Subacute care facilities
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Residential and personal care facilities
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~Physically supportive dwelling and monitoring and assistance with medications, oversight, and personal or custodial care ~For those in wheelchairs or cognitive impairments ~Advanced services are arranged with a home health agency ~Private pay; SSI payment and other government assistance ~Services generally include meals, housekeeping, laundry, and recreational activities.
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Retirement Living Centers
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~Meet housing, but NO delivery of clinical services ~Independent lifestyle for residents with amenities for physically disabled--larger bathrooms, railings, assistance cord ~Supportive environment ~Paid by private funds with government asistance
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Assisted Living Facilities
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~Personal care services with 24 hour supervision, social services, recreational activities, and some rehabilitation services ~Can improve dementia care ~For people who cannot function independently but no need for skilled nursing care. ~Private rather than shared accommodations ~All states require AFLs to be licensed ~No federal oversight ~85% of residents pay privately.
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Skilled Nursing Facilities
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All facilities licensed by state ~Federal certification optional ~Certification required for Medicare and Medicaid ~Noncertified would have privately-funded patients
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Skilled Nursing Facilities Properties
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~Level of care is more complex and involved than basic care ~Most common conditions are bladder incontinence, depression, Alzheimer's, bowel incontinence ~Quality of care improved ~"Culture change" to create vibrant living environment.
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Subacute Care Facilities
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~Three type of institutions 1. LTCHs_ Most expensive with SNF certification 2. Transitional care units in hospitals 3. Skilled care nursing homes ~Medicare reimbursement
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Specialized Facilities
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~Intermediate care facilities for individuals with intellectual disabilities ~Separate federal certification ~Financed by Medicaid ~"Active treatment" ~Patients often have disorders, like seizures, behavioral problems, or mental illness
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Alzheimer's Facilities
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~Small-group living arrangements ~Lighting, color, pleasant surrounding ~Objective is to minimize agitation, anxiety, and combative behavior
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Continuing Care Retirement Communities
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~Integrates and coordinates independent living with other institutional services located on one campus ~Independent apartments, personal care and assisted living, medical certification ~People admitted are still healthy ~Types of contracts: Life or extended care, modified contract, fee-for-service contract
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Institutional Trends, Utilization, and Costs
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~Nursing homes and beds have decreased ~There is a wait-list and low reimbursement ~Hospitals have drastically cut back on SNFs ~Nursing home costs inceased but care of personal care expenditures decreased ~Most nursing home care financed by Medicaid ~Disparity between Medicaid and private-pay nursing home costs ~Medicare spending for nursing home has risen sharply
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Private LTC Insurance
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~Wide range of choices on duration of care and services covered ~Coverage of nursing home care and community-based services ~Private LTC insurance has seen slow growth ~Issues are affordability, too many options, thinking that Medicare will pay, few public policy incentives.
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