Chapter 4 part 1 – Flashcards
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> Activities of daily living (ADLs) > Instrumental activities of daily livings(IADL)
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LTC help is given with
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> needs; circumstances; informal caregivers; finance ; public programs risk factors: ages, chronic (quantum nature), living standards, difficulties ADL, cognitive; output admission
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Determinants on long term care
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-Older adults primary users of LTC services (70%) > May need help with IALD or ADLs due to chronic disease or disability - Patients **65+ example end stage renal disease, dementia, parkinsons stroke > with chronic disease 80% > with 2 conditions > experience disability physical limitations 19% maybe a 20 year old with end stage renal failure or with a server head or spinal injury
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Who needs LTC services
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Instrumental activities of daily livings
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IALD
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Activities of daily living
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ADLs
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-when long term services are provided by family and friends - a typical caregiver is a >spouse >adult child >women (48+, 20hours some college education, live within 20-30minutes -men (34+)
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Informal caregiving
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1.5 million 65 and up make up 88.3% 85 and up make up 85.5% females make up 71.2%; white 85.5%
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Nursing home demographics
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Yes, people assume that LTC refers only to nursing hime care, but LTC can occur in BOTH community and institutional settings
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Can long term care occur in a community setting
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age number and types of of chronic conditions - difficulties with ADL's -living alone
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The main factors for institutionalization include
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-cognitive impairment - ethnicity (minorities are generally at a lower risk) - low social support -poverty -difficulties with IADL's -outpatient admission and hospital admission
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Non main factors for institutional include
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Institutional services: nursing homes continuing care retirement communities psychiatric institutions subacute care
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Long term care options for individuals in the United States (institutional)
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Community based services: home health hospice adult day care senior center retirement housing independent community living correctional facility mental health center
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Long term care options for individuals in the United States (community based services)
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The need for long term care increases with age
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Whats the relationship between the need for long term care and age
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70% of adults will require long term care 40% will spend time in a nursing home 4.5 will RESIDE in a nursing home
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Statistics involved with long term care
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Greater risks of disabilities because of rising rates of obesity > another result is the greater utilization of healthcare
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is the baby boomer generation expected to have more or less rates of disability?
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dementia stroke depression hip fractures diabetes alzheimers disease
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Diagnosis commonly associated with LTC services include d
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>Because of cost containment -
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Why are patients frequently released from hospitals earlier and sicker than past years?
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nursing home settings rehabilitation center
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If patients are not ready to return home but need assistance they may be discharged for additional care like
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include individuals whose prognosis is poor and are typically around 6 months to death hospice care is available in an institution and at home
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people with terminal illness
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physical; social, and spiritual aspect of illness or pallitative care at home
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Hospice care includes
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> most medially and therapeutically intensive > comply with CMS reg -medical care '-physical therapy - restorative care
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Skilled nursing facilities
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facilities associated with hospital care or longterm acute care - clinical background
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RPhs role in dispensing or consultive
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25 days
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What are the qualifications for short term stay in LTC
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skilled nursing facilities
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Which long term care facility is the most medically and therapeutically intensive?
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1. Medicare 2. Medicaid 3. Private insurance 4. out of pocket insurance
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Extended care services are financed in four majors ways
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federally operated insurance program primarily intended for individuals older than age 65 **young people with disabilities or with end stage renal disease may have coverage through medicare
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Medicare
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Depends on the length of the persons disability, the type of disability, the type of disability, and the severity of the kidney damage
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What determines the eligibility of a young person to have medicare?
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provides limited benefits for -LTC institutional services -skilled nursing care in residential homes - In home or institutional based hospice services for individuals who are expected to live 6months or fewer
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Medicare part A
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patient must be hospitalized for at least 3 consecutive days and admitted to a skilled nursing facility within 30 days of discharge and a doctor must agree
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What are the requirements for medicare to cover 100 days of long term care?
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Medicare part B
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Home care is reimbursed via
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No, medicare pays for skilled nursing care Medicaid services or private insurances, or out of pocket services usually pay for custodial care
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Does medicare pay for services like custodial care ie) help with bathing, dressing, using the bathroom
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pays for patients prescriptions
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Medicare part D
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Medicare part A
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For hospice patients medications are covered by
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is a federally regulated public welfare program for the poor
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Medicaid
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> it is financed by both the federal and state governments and ADMINISTERED by the state
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who finances Medicaid?
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No, they vary from state by state with different qualifications for eligibility and services
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Are medicaid programs consistent?
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is often the primary payer for nursing home care in many if not all states (used to only pay for insitutional care or nursing home care nut not pays for home and community care)
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because custodial care is not reimbursed by medicare, medicaid...
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A policy that pacys for charges that are not traditional medicare **fill in the gaps in Medicare reimbursement those with this service must pay a monthly insurance premium in addition to copayments
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Medigap
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1. becuase Medicare and Medigap do not cover custodial care and skilled care beyond 100 days 2. to avoid the spend-down of their assets before meeting financial eligibility requirements for medicaid services include: transportation to medical appointments , medical equipment, home maker services
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Many older adilts purchance LTC insurance
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No, and they are expensive
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Are individuals who recive LTC services eligible for LTC insurance?
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extended living facilities
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Which is less money extended living facilities or hospitals?
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LTC facilities are based on interdisciplinary philosophy LTC is not environment specific
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The philosophy of long term care
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made it preferable to refer nursing homes as nursing facilities
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What did the Omnibus Budget reconciliation act of 1987 do?
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> those who remain in the facility for fewer then 3 months > those who enter the nursing facility for short term rehabilitation > those who enter with a short life expectancy
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short stayers
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can be further classified as residents with impairments of physical or cognitive function
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Long-stayers
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>for patients who need clinical and rehabilitative services > need continuous care that may not be available at nursing facilities
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Long term care acute care hospitals
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Patients with clinical conditions like >postcerebrovascular accident >chronic obstructive pulmonary disease >those who require parenteral nutrition >intravenous antibiotics >post surgical wound care mechanical ventilator weaning
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What type of people would use long term acute care?
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Long term acute care hospitals average stay is 25 days
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What was originally started to decease the cost of associated with hospitalization for patients who were not ready to be discharged?
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Pharmacists here provide > treatment recomendations > patient education > medication reviews > patient medication clinics
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Psychiatric facilities and the role of the pharmacists here
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Not to cure the disease, but to maintain the quality of life
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The goal of hospice and palliative care
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Yes hospice care decreases medicare costs in the long run by avoiding expensive hospital stays
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Will medicare reimburse services related to palliative care?
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that older adults have the right to remain in their homes if able abd willing because moving older adults to dacilities before necessary would isolate and limit them from certain interactions >
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Supreme court Olmstead cause
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Nope (this is basically for rich people they can golf, swim, take college course ect)
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is CCRC covered by medicare?
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continuing care retirement community CCRC
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One of the fastest growing gtypes of senior housing is the
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continuing care retirement community has a AGING IN PLACE philosophy and provide continuum of independent living, assisted living, and skilled nursing care on a single campus can move among the different levels of care without relocating
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ccrc philosophy
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Medicare program approach integrates medicare and medicaid and includes transportation, adult day care, meals for frail and older adults who are disabled
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All intensive care for the elderly
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1. 55 years and older 2. live in an area with this program 3. certified/eligible for care 4. can live safely in community program services
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Program of all intensive care for the elderly (PACE) REQUIRMENTS
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used when ineligible for medicare and medicaid or lack private insurance
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Out of pocket
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provides financial assistance with the cost of LTC plans vary greatly may cover the following services > skilled nursing facilities > assisted living facilities > home health services > adult day cares
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Private insurance
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