Long-Term Care

Front 1

Long-Term Care definition

Back 1

assistance giver over sustained period of time to people experiencing long term inabilities or difficulties in functioning (b/c of disability)

Front 2

Goals of LTC (PUFH SLAM)

Back 2

-Psychological wellbeing enhanced
-Unmet care assistance needs met
-Functional decline improvement/delay
-Health (improve/maintain)
-Social Wellbeing (enhance)
-Least restrictive setting*
-Autonomy maximized
-Meaningful life



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Front 3

LTC younger vs elderly distribution

Back 3

37% young disabled
63% frail older adults

Front 4

Disability rates in elderly populations young old, old old, oldest old?

Back 4

65-74 = 9%
75-84 = 20%
85+ = 50%
9 million older adults need LTC 2020 = 12 million!

Front 5

Formal LTC definition

Back 5

paid professional/nonprofessional care in a variety of settings
(professional = therapy
nonprofessioanl = certified nurse assistant, homemaker)

Front 6

Formal LTC continuum

Back 6

1) Home and community based services
2) Supportive Housing / Residential Care
3) Nursing Home Services
(Continuing Care Retirement Community exists across continuum)

Front 7

Why is formal LTC a continuum?

Back 7

-Fits needs of individuals
-addresses changing needs

Front 8

As one progress on LTC continuum what increases?

Back 8

Formality
Impairment
Increased Cost

Front 9

In Home aspects of HCBS

Back 9

Homemaker
Home health care
Personal Care
Respite services

Front 10

Community based aspect of HCBS (SMACT)

Back 10

Senior Centers
Meals delivered
Adult Day Care
Case management (coordinate
Transportation


services and activities)

Front 11

Four goals of HCBS* (DDRS)

Back 11

1) Deliver LTC least expensive, restrictive setting
2)Supplement informal caregiving
3)Temporary Respite to caregivers
4) delay/prevent Institutionalization

Front 12

Costs of HCBS

Back 12

$19,000 / year (least expensive LTC)
maintain greater levels of independence and meets preference to stay home

Front 13

Supportive Housing/Residential Care definition

Back 13

variety of group housing options that offer assistance with ADLs and IADLs
(e.g. Board and Care homes, Assisted Living)

Front 14

Board and Care Homes definition*

Back 14

-gives Room/board, meals, ADL assist
-no professional care though
-no regulation/inspection
5 or fewer residents per home!

Front 15

Assisted Living definition*

Back 15

Residential setting that provides personal care, 24 hour supervision, (un)scheduled assistance, nursing care

Front 16

Assisted living service plans and advantages?

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-offers individual plans based on varying needs (from just needing meal to ADL help e.g.)
-home-like enviro maximize dignity, privacy, autonomy

Front 17

Goal of Assisted Living*

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promote aging in place aka *grow older in specific setting til death
(fasted growing LTC option, 68,000 nationwide)

Front 18

Assisted Living Cost

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$1,300 to $4,000+ / month

Front 19

Nursing Home defnition

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-Provide 24 hour skill nursing and (personal) custodial care
-Operates under medical model of care (sterile, double occupancy, stricter rules less autonomy)

Front 20

Types of Care provided in Nursing home

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Acute/rehabilitative (24-hour skilled nursing + therapy, is post hospital)
(less than 3 months)
and
Long-term care (24 hour nursing, custodial, and holistic care)
(extended period of time

Front 21

Who provides Nursing Home care?
(SLANTD)

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-Social worker
-Licensed Nurses
-Attending Physician
-Nursing Assistants
-Therapists
-Dietitian

Front 22

who provides majority of nursing home care?

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-majority provided by nursing assistant (least formally trained)
-physically/emotionally taxing few extrinsic rewards

Front 23

Costs of Nursing home care

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about $70,000 per year
(3 year average til death)

Front 24

Elderly adults and nursing home statistics (how many 65+ residents, what % older adults, how many need it eventually?)

Back 24

87%
only 5% at one time (5% fallacy)
40% will need a one time

Front 25

Nursing Home resident demographic?

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mostly white, women, widowed, with 75% 3+ adls (60% dementia)

Front 26

SEE AT RISK FOR PLACEMENT GRAPH!

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5% increased risk for each IADL assistance needed, dementia incontinece higher risk (54% + 20%)

Front 27

Continuing Care Retirement Communities definition

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Offers a full range of residential service and healthcare in order to serve older residents as needs change over time.
-expensive, but lifelong care guaranteed
-longer living resident = $$$

Front 28

Functional Assessment for LTC includes?

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-multidimensional assessment uses physical, mental, social needs.
-ADLs most important measure

Front 29

How much does LTC cost each year?

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$150 billion

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How is LTC financed (2 big sources)

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$84.7 billion medicaid
$37.2 billion out-of-pocket
($30.7 billion medicare first 100 days)
rest private insurance, other public and private)

Front 31

Medicaid Waivers

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limited waivers for HCBS and AL that "waive" institutional requirement of medicaid payment and makes community-based altnernatives available

Front 32

% of nursing home residents who coulda been eligible for waiver

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10-40%

Front 33

Pros and Cons of Waivers

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+ = less restrictive, expensive setting
- = inappropriate placing with less supervision sometimes,
"woodwork effect" from ppl who relied on family care instead of nursing home

Front 34

Best and worst states for % of medicaid LTC budget waivered

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Tennessee only 1% medicaid to HCBS and AL
-Oregon 55% of medicaid LTC budgetto waiver

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Private pay

Back 35

second largest payer for LTC and required unless financially eligible for medicaid
(spenddown requires 3 months to take effect???)

Front 36

private pay FIX CARD

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not second most expensive!! 2nd largest payer FIX CARD

Front 37

Divestment planning

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Transfer assets or
keep assets in form exempt (estate)
set up trust account
-appear impoverished but is criminal offense

Front 38

Nursing Home care before late 80s (before Institute of Medicine)

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was grossly inadequate, until Improving Quality of Care in Nursing Homes report

Front 39

Omnibus Budget Reconciliation Act of 1987 NH improvements (SCARR)

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-Restraints Discouraged
-Staffing levels increased
-CNA training improved
-Rights for residents implemented
-Assessment process for residents required

(25% homes still have serious concerns!)